In Pennsylvania, the department of corrections is the largest provider of behavioral health services in the state, something that Department of Corrections Secretary John Wetzel, the keynote presenter at the BHECON forum on March 6th, is working to change. Inadequate behavioral health infrastructure, including workforce shortages, is a significant factor contributing to high levels of incarceration. Changing the status quo by partnering with community-based behavioral health providers would help to ensure that individuals living with a mental illness receive care in their communities and contribute to a lower incarceration rate. Acknowledging that systematic change requires time, the department of corrections has begun to implement behavioral health evidence-based practices, such as Mental Health First Aid training, in its facilities. Secretary Wetzel has required all department of corrections staff to take this valuable training, saying “…It humanized the population that we work with.”
The first thing I did to improve our criminal justice system was to make mental health first aid mandatory for staff. – Secretary of the Department of Corrections, John Wetzel
Strengthening the behavioral health workforce
Prior to Secretary Wetzel’s presentation, providers discussed ways to recruit and retain the behavioral health workforce in Pennsylvania. Community behavioral health clinics are consistently recruiting all levels of the workforce, from caseworkers to psychiatrists; there is always a demand for more of these professionals. Providers shared that psychiatrists were the most challenging to recruit and retain, due to out-dated state regulations that limit psychiatrists’ time to treat patients. Several psychiatrists in the room echoed their frustration with the regulations, stating that in order to both meet the mandated paperwork requirements and treat patients, they would often take the paperwork home to complete.
Psychiatrists jobs aren’t as engaging as they used to be because they spend more time on paperwork. Psychiatrists want to treat patients. – Psychiatrist in attendance.
Additionally, providers discussed their desire to pay caseworkers and junior level staff competitive wages, but due to low reimbursement rates that do not cover the cost of providing services, they were often competing with low-wage service industries for the same workforce.
Initiatives to improve the behavioral health workforce in 2017
Loan forgiveness, revising outdated regulations on treatment plans, and better collaboration between the Pennsylvania Certification Board and community behavioral health clinics were some of the solutions to the workforce shortage in Pennsylvania proposed by a panel of experts.
People who have been certified in counseling and/or addiction services by the Pennsylvania Certification Board call me daily looking for jobs. – Mary Jo Mather, Executive Director of the Pennsylvania Certification Board.
A common theme expressed by providers was that in their experience, there are enough qualified and certified individuals to fill vacancies, but often salaries are too low to recruit and retain these individuals. Certified Community Behavioral Health Clinics (CCBHC’s) are one solution to this problem, since they will receive reimbursement rates that are calculated to cover the actual cost of providing services. Pennsylvania is one of eight states selected to participate in the CCBHC demonstration program.
Additionally, participants agreed that advocating for policies that would provide loan forgiveness for behavioral health providers similar to programs that do so for primary care professionals could help alleviate workforce shortages in the future.
In the end, participants agreed to continue to support efforts to overhaul the outdated paperwork regulation for psychiatrists and pursue other legislative and regulatory relief to the behavioral health workforce shortage. They were also inspired by Secretary Wetzel’s willingness to work with the behavioral health community to provide adequate care and reduce incarceration among individuals living with mental illness, and looking forward to working on this issue with the department of corrections.