When Systems of Care, High Quality Training, & Evidence-Based Supports are not Enough ...

Consider what makes up an effective community mental health system. We often talk about the importance of systems of care, high quality training, and evidence based treatment. However, these elements assume the presence of one very critical element - qualified and experienced community mental health center (CMHC) staff.

Unfortunately, the assumption that we have these staff in sufficient capacity is incorrect.

The recently released study on challenges in the mental health workforce (see Improving Child and Community Health: Addressing Workforce Challenges in Our Community Mental Health Centers) indicates that New Hampshire falls short in this area. Until workforce capacity is effectively addressed, our ability to improve systems of care, to implement best practices, and, ultimately, to help children and their families thrive will be consistently undermined.  

Specific takeaways from the study include:

 CMHC Director feedback that there is not enough staffing available to effectively meet mental health treatment needs. This includes a lack of clinicians, case managers, prescribers, and especially drug / alcohol trained counselors across the State.

  • For staff that are available, they don't always remain for long. This results in multiple negative impacts for all involved, including

    • a loss of critical professional experience among staff,

    • declines in staff productivity, competency, and experience,

    • excessive financial burdens for the agency,

    • negative impacts on workplace culture,

    • lost opportunities to integrate and improve services,

    • and in some cases, failure to improve outcomes for children, youth, and their families.

  • Turnover rates that are sometimes so high such that staff experience across certain professions either slows down to a crawl or declines over a five-year time period

The research highlights two primary factors driving staff turnover: documentation burden and staff pay. Concerning documentation, CMHC directors noted that current standards result in staff spending 20% to 40% of their work week on documentation rather than direct care. On the topic of staff pay, we found that

  • pay increases for nine of twelve professions did not keep pace with inflation over five years, and
  • wages for many CMHC staff are substantively lower than that of peers working in other settings.

The above factors, combined with a host of other challenges defined in the report, result in a working environment that frequently pushes mental health staff to seek employment in other areas.

With that in mind, there are solutions to pursue. In fact, the report outlines feedback from staff on 48 potential strategies that could be pursued in order to reduce New Hampshire's high staff turnover rate. Addressing basics such as cost of living increases, pay equity, and a livable wage are part of the solution. Other solutions might focus on providing improved supports for staff, addressing documentation  burdens, service restrictions based on licensure, and improving decision making capacity for staff.

Creating systems of care and improving training are activities worthy of our time and resources. So are the staff who help to ensure these systems can work and serve a vital role for children and their families. It is time for New Hampshire to invest in its CMHC staff to ensure that all of its reform efforts will cme to fruition.

By Peter Antal, Ph.D., Antal Consulting, LLC

Peter Antal has a Ph.D. and an MPA from the University of Delaware in the fields of urban affairs and public administration.  Past work in the mental health field has focused on the statewide public mental health survey, analysis of hospital discharges for mental illness and substance use, reviews of claims data on mental illness and substance use, and supporting multiple initiatives in the state aimed at improving mental health services and access. He currently provides research and evaluation support to a range of NH based initiatives through Antal Consulting, LLC as well as through ongoing collaborations with the Institute on Disability at UNH.