OBHC faces staffing, funding challenges
When someone is in crisis, the person often need a mental health specialist, not a police officer. But most of the time, it’s a law enforcement officer who responds to these crisis calls in Okanogan County.
With crisis calls on the rise locally and across the country over the past couple of years, the need for a designated crisis responder (DCR) has been growing, according to Okanogan County Sheriff Tony Hawley and Okanogan Behavioral HealthCare (OBHC), the county’s largest behavioral health care provider.
Okanogan County is looking into ways to hire or contract for a DCR who could provide appropriate care and intervention for people experiencing a mental health or drug- or alcohol-related crisis. At an Okanogan County commissioners’ meeting early this month, Hawley and Human Resources Director Tanya Everett described the growing need and possible solutions to the commissioners.
One possibility is to allocate a special sales and use tax to fund a DCR, Everett said. The tax is used for chemical-dependency and mental health treatment and for the therapeutic court system. Some of the tax is already allocated to OBHC, she said.
Meanwhile, OBHC is facing its own staffing challenges. While OBHC has four DCRs and several other clinicians who can respond in a crisis, the agency is still looking to fill six positions for master’s-level therapists, OBHC Director of Communications Carolbelle Branch said.
OBHC lost 30% of its staff during the COVID pandemic. Most left because of the state COVID vaccine mandate, but some moved or were hired by agencies that offer more money and career advancement. Others left because they had no child-care options while school was remote, Branch said.
The lean work staff affects OBHC’s capacity to serve, CEO David McClay said. Cross-training has helped, but people seeking care for a non-crisis situation still face a longer wait, Branch said. In addition to licensed therapists, OBHC employs peer counselors, who bring knowledge from personal, lived experience with chemical dependency or other issues.
Ideally, a DCR could provide intervention and mental health care before a situation escalated to a level where someone could get hurt and law enforcement becomes necessary, Hawley said. “We’re trying to keep the criminal justice system out of someone’s life, and to treat a situation before there’s a crime,” he said.
“These people haven’t broken the law. They are in crisis mode and need a mental health professional,” Everett said.
Avoiding escalation
The goal is for the county to have a DCR who could respond immediately and —– unless there was a threat of violence — without law enforcement, Hawley said. Because people are often apprehensive when a police officer shows up, the presence of law enforcement risks escalating a situation. Sometimes an individual is afraid of being sent to jail or gets upset with the family member who called for help, adding to the crisis, he said.
Sheriff’s deputies try to involve a mental health professional as soon as possible, but that’s usually not until the individual in crisis has been transported to an emergency room, whether voluntarily or involuntarily, Hawley said.
At present, OBHC usually isn’t aware of a situation until they hear from law enforcement, since dispatchers usually don’t call them directly, McClay said.
Quick response by a mental health specialist could allow them to address many situations without having to go to an emergency room. Seeing the environment can also help a crisis responder understand the nature of a problem, Hawley said.
It’s difficult to plan and staff for crises, since you can’t predict when they’ll occur, McClay said. By partnering with the county and other agencies and connecting people with the right service as soon as possible, OBHC believes they can improve coverage for the entire county. A DCR could also assist the county when inmates request mental health care or if there’s a crisis situation in the jail, Hawley said.
OBHC recently entered into a contract for a mobile crisis unit, which will help with response, although the practitioners staffing it will be below the DCR level, McClay said.
Not having DCRs also puts a strain on emergency-medical services and can take them away from responding to other emergencies, Hawley said.
Discussions about a DCR at the county are still in the preliminary stages. The commissioners would have to approve the position and funding source, Hawley said.
In the meantime, they’re meeting with stakeholders and first responders and gathering data about dispatch calls that would have benefited from a DCR, Everett said. “It’s definitely a need,” she said.
OBHC: Funding for mental health lags
Okanogan Behavioral HealthCare (OBHC) is busy. The agency provided more than 2,000 services per month from January 2020 to July 2021, including almost 27,000 mental health outpatient services to 2,210 individuals. Through their substance-use-disorder program, they assisted 631 individuals with more than 10,000 services, according to OBHC Director of Communications Carolbelle Branch.
For 60% to 70% of their clients, mental health and chemical dependency issues are co-occurring, OBHC CEO David McClay said.
OBHC lost almost one-third of its staff during the pandemic and, like many health care providers in the county, has been struggling to fill positions.
One of the biggest problems is that the mental health system is not fully funded —– and it hasn’t been throughout his long career at community behavioral-health centers, McClay said.
Community providers like OBHC get 85% to 90% of their funding from Medicaid reimbursements. That reimbursement has remained flat since 2019, even though the cost of providing services has gone up. The Washington Council for Behavioral Health has been lobbying for an increase in Medicaid reimbursement rates, Branch said.
Because of the low reimbursement rates, starting salaries for master’s-level providers at OBHC are typically about $20,000 lower than at psychiatric hospitals and state agencies, Branch said. OBHC competes with agencies across the state and country for therapists and simply can’t pay enough to be competitive, McClay said.
Although money has recently been appropriated for new programs, the effect has been to fracture the work force and increase vacancy rates in existing programs, McClay said.
OBHC often hires recent graduates as counselors, and then provides the supervision and training required for someone to become licensed. But more often than not, those people leave for another agency once they obtain their license, McClay said. Many people carry significant student-loan debt and look for a situation with a higher salary, he said.
Online therapy, which picked up during the pandemic, has also siphoned off providers, since some agencies have been recruiting counselors to provide remote services. OBHC has two providers who work remotely now, Branch said.
Recruiting therapists has been difficult for many mental health providers. As of October 2021, the turnover rate among Washington Council for Behavioral Health members was 29%, Branch said.
OBHC is looking at a variety of possible solutions, including talking with school districts and colleges about developing programs and building interest in mental health careers, Branch said.
“We need people in the work force,” McClay said. “There just aren’t enough people in the field right now, across the country.”
