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Inside the critical need for mental health, addiction workers in WNY: 'We've had high caseloads nonstop'

Buffalo News - 11/13/2022

Nov. 13—Debbie LaBounty gets in her SUV every workday and makes the 45-minute trip from her Depew home to Warsaw, where she's been a clinician for a little over six years at Spectrum Health & Human Services'Wyoming County Counseling Center.

Sure, she could work closer to home, but the 66-year-old always gravitates to a community in need.

Dawn Stone, a 55-year-old lifelong Wyoming County resident, has a shorter commute but is no less committed. A recovering alcoholic with bipolar disorder, Stone has been a certified recovery peer advocate at the Warsaw center for five years, taking pride in supporting clients on their journey because she, too, once walked the same difficult path.

Meanwhile, at Spectrum Health'sOrchard Park headquarters, Senior Vice President of Human Resources Mark Hendrickson wonders where he can find more employees like LaBounty and Stone.

It's a daunting, but pressing, task, since the demand for mental health and substance use counseling skyrocketed during the Covid-19 pandemic across the country and in Western New York.

While employers like Spectrum search and recruit, more work — and stress — is being put on the employees who remain such as LaBounty and Stone, with providers running the risk of burning out existing staff in what is already a field prone to high turnover.

The situation is even worse in rural areas, such as Warsaw, that traditionally struggle to compete for health professionals.

As of early November, Spectrum Health had 44 open jobs across all of its locations — and 14 of them, or nearly one-third, were in Wyoming County. In addition to the counseling center, Spectrum also is hiring for its proposed HELP Center in Warsaw, a crisis care center for non-life-threatening behavioral health support.

Hendrickson said he's never seen so many openings concentrated in one place during his decade with Spectrum.

"A lot of these openings have been open nine months to a year," he said of the Warsaw job listings. "We're not going to be shutting anything down because of it but, you know, it's a struggle."

The situation is similar at other Western New York behavioral health providers.

Horizon Health Services President and CEO Anne Constantino called it a "workforce crisis," with too much work and not enough employees. Not only are providers all competing with one another for a limited pool of well-trained and well-educated professionals, they also are battling with digital startups that offer higher pay and the flexibility to work from home with the rise of telehealth services during the pandemic.

Lauri Cole, executive director of the New York State Council for Community Behavioral Healthcare, said conversations with each of her group's 120 members begin and end with workforce concerns.

"Nobody can get their hands on enough staff to fill vacancies, especially for client-facing care," she said. "What I see is waiting lists for care across the state. It's very intense in rural areas, but it's not just rural areas."

It's something LaBounty and Stone see every day.

'If not me, who?'

LaBounty and Stone were drawn to the field later in life.

LaBounty had worked at a Western New York homeless shelter, seeing the need for mental health services but a lack of trained clinicians.

"I just said, 'Well, if not me, who?'" she recalled.

So she went back to school, got her degree in clinical mental health counseling and joined Spectrum Health in Warsaw more than six years ago. While she was unsure about the long commute at first, she doubled-down by buying a Toyota Rav4 for the steep roads, mounting deer whistles on it and embracing the quiet, beautiful ride through the country as a debriefing session for herself.

LaBounty's primary role is counseling and assessments, and she also specializes in trauma therapy. She runs groups focused on anger management and the journey through aging. And she also helps link clients with services at Spectrum and has worked with everyone from 5-year-olds to 90-year-olds.

"This is my second career," she said. "For me, it's more like a calling than a career."

Hendrickson noted how rare it is to find someone like LaBounty willing to commute that far, pointing out that Spectrum usually aims to recruit within 30 miles of a clinic. Candidates typically don't want to drive much farther than that, he noted, unless the price is right — and these are not six-figure jobs. He called Spectrum's benefits "very competitive" and its wages "market competitive," with annual salaries for peer support positions ranging from $35,000 to $41,000 and clinicians making anywhere from $42,000 to $54,000.

In Stone, Spectrum found a relatable personality passionately committed to her home of Wyoming County — also a difficult person to find.

Stone, who lives a few miles down the road in Silver Springs, had worked for 19 years as a family development specialist at another nonprofit when she found out her program was ending.

Her counselor at Spectrum's Warsaw center, where Stone had been a client for 10 years, had a suggestion.

"I'm sorry your program's closing, but we're having this job fair, and I think you'd be really good at this job," her counselor said, handing Stone a flyer for a certified recovery peer advocate position.

It's a person-centered job. And Stone's learned experiences help her build trust with clients.

With some clients, Stone stays in the Warsaw center and just talks. But she also gets out of the office: She takes some clients out to get groceries occasionally if they get food stamps or if they lack transportation. With others, she might bring them to Tim Hortons or Taco Bell. Stone also does art and wellness groups, with some clients finding the process of putting brush to paper calming.

"I also enjoy people," she said. "I'm very curious about getting to meet people and sharing whatever may help them on their road or just listening, because sometimes people just need to be seen and heard."

The job can be a daily struggle, Stone mentions, but it also can be rewarding.

"And it's hard right now because we do need more staff," Stone said.

'When Covid hit, there was no relief'

Back in November 2018, the state Council for Community Behavioral Healthcare surveyed its members and found workforce turnover ranged from 35% to 40% annually among community-based mental health and substance use disorder agencies.

And that was before Covid.

"You can imagine what Covid and other public health crises like the opioid crisis and to some degree suicide ideation and attempts have meant to already very persistent and pervasive shortages," said Cole, the council's executive director.

Stone and LaBounty have seen it up close in Warsaw.

At full strength, the Warsaw counseling center has about 26 employees — post-Covid, it has just over half of that.

At the same time, demand for services has increased. For instance, according to CDC figures, the percentage of U.S. adults who had received mental health treatment increased from 19.2% in 2019 to 21.6% last year.

While she's only supposed to carry a caseload of 20 to 25 clients, Stone said she has 37 right now. A fellow peer advocate has more than 50 clients, she said. Stone mentioned the counseling center once had four peers but now only has two, though it's trying to hire more.

Stone said she sees many people trying to get sober and struggling with it, noting the isolation from the pandemic bred depression and substance use. Further, she also sees a lot of elderly clients, grappling with the lost connection to their loved ones during the pandemic.

LaBounty said the center lost some children's clinicians during the pandemic to private practices — at a time when the U.S. surgeon general issued an advisory last December to highlight the need to address what was called a "youth mental health crisis."

In particular, she's seeing a lot more high-risk teens, something she thinks about often on her 45-minute ride to work.

"The teens have really been on my mind a lot because I just feel that they're really struggling," LaBounty said.

Covid had a big effect on their jobs, and LaBounty can feel it in the pace of the workday.

"When Covid hit, there was no relief," she said. "Sometimes in the past, there would be relief, there would be pockets of time when you would just kind of be able to chill a little bit and kind of catch up and kind of, you know, get a grip. But when Covid hit, I don't think there's been any relief since then. We've had high caseloads nonstop."

'Try to keep each other going'

Even with the job's challenges, LaBounty and Stone are committed to the work.

LaBounty had actually left the Warsaw clinic for a time, taking another job at a congregate foster care agency. But when that job wasn't what she thought, she signed back up for the long ride to Warsaw and rejoined Spectrum Health.

Still, she is constantly getting pitches from recruiters for out-of-state companies capitalizing on the rise of telehealth.

"It's hard to not be tempted because they're going, 'We'll pay you all this money, and you'll get to work from home,'" she said. "And I'm like, 'Stop, I've got to concentrate on what I'm doing.'"

And for Stone, she feels she finally found her perfect job. She gets to know clients. Born and raised in Wyoming County, she also gets involved in the community to educate residents about mental health and addiction.

And the chronic staffing issues are starting to get more attention on a state and national basis. The most recent state budget includes a cost-of-living adjustment in payments to human services agencies, giving providers flexibility to handle increased costs and boost wages for workers.

But all too often, advocates say, reimbursements for many services that mental health and addiction programs provide don't cover the actual cost of care, putting providers in a financial hole right away.

On top of soaring need, many providers have an aging workforce and lost staff during the pandemic who haven't returned, noted Joshua Lynch, a clinical associate professor of emergency medicine at University at Buffalo.

"It's on its way to creating a perfect storm, or at least a really bad one," he said.

But here LaBounty and Stone are, weathering the storm and waiting for reinforcements.

"I really feel like we reach out to each other and try to keep each other going along, you know, so that we don't fall apart," Stone said.


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