A Supply Versus Demand Problem with Potentially Devastating Outcomes
When the Covid-19 lockdown started in March of 2020, and we slowly began to realize that getting the virus under control was going to take much longer than initially predicted, I, like many others, grappled with the debilitating fear of the unknown. I worried about what this meant for my life going forward. I was afraid for my health, the health of my loved ones, and my finances. What bothered me the most, however, and what kept me up at night (literally) was what I did know; this foreboding sense of understanding that Covid 19 was going to take a drastic toll on the mental health of all of humanity and that this pandemic was a traumatic event that would have a ripple effect for decades to come. As a mental health practitioner with 10 + years of experience, both in direct practice and in behavioral health leadership, this thought terrified me. I felt fear and anxiety for what was to come because I knew our workforce was already strapped and that we were not at all not prepared for what was to come.
A silver lining of Covid 19 was that it was the catalyst that burst the bubble that held back conversations about mental health. Suddenly, we were actually talking about how we were not ok, we were depressed, anxious; we were unable to sleep, and we were letting others know. As mental health advocate, I had been waiting for this moment; constantly fighting back the pervasive mental health stigma I saw in the populations I was working with. Covid 19 changed the game and while this I ultimately see as a positive effect of the pandemic, we still have to grapple with the severe shortage in the mental health workforce.
Prior to the pandemic, studies had already begun to show that we were facing a shortage of mental health therapists. In 2018 the University of California, San Francisco released a report predicting that by 2028 the need for behavioral health providers was going to be 40% more than what was available in the job market (Cal Matters, 2018). In the middle of the pandemic in September of 2021, The National Council for Mental Wellbeing conducted a survey of behavioral health providers and found that 78% of organizations surveyed reported a demand in the need of behavioral health services. Furthermore, 97% of agencies reported having difficulty hiring and retaining behavioral health employees (HMA, 2021). In August of 2022, a report by the San Diego Workforce Partnership stated San Diego county currently has 17,000 behavioral health workers and already need an additional 8,100 to meet current demand. They further state that in the next five years, they anticipate needing another 10,000 workers because many will be retiring (Workforce, 2022). Retirement is not the only factor contributing to the shortage. Cal Matters recently reported on a union survey with over 200 mental health clinicians who worked for Kaiser in Northern California. The survey found that 85 percent of clinicians said they were leaving because their workload was unsustainable. Additionally, 76 percent said they were unable to “treat patients in line with standards of care and medical necessity.” In other words, mental health providers are burned out.
These trends created a classic supply versus demand problem, and spoiler alert, things are much worse now than they were in 2021 and things will only continue to worsen as we forge into 2023 and beyond.
Trauma and Recovery and How It Relates to Covid 19
Research on trauma and recovery has shown consistently that when a human experiences a traumatic and life-threatening event they experience a severe loss of control and the initial reaction, typically called the “acute phase,” is one of self-preservation, safety, and survival. This survival “mode” is built into the hard-wiring of our brains. For most people during the pandemic, this phase involved a focus on basic needs and safety, such as health, finances, living arrangements, food, and of course, isolation and social distancing. After the “acute phase” of trauma passes and danger is no longer present, individuals enter a phase that trauma researcher Judith Herman refers to as the “remembrance and mourning” phase (Herman, 2015). In this phase, individuals are left incredibly vulnerable to developing symptoms that we have come to recognize as trauma, including flashbacks, intrusive thoughts, nightmares, grief, and disruption to one’s ability to function in daily life. As we shift to a stage of the pandemic where vaccines have been distributed and utilized, children are back in schools, and we are starting to return to some semblance of normalcy, we are starting to see the more severe effects of the pandemic in terms of mental health. As a result, more and more people are seeking care and finding that there are either no providers for mental health or medication management or there are incredibly long wait times. Mental Health First Aid teaches us that the key to preventing mental health problems from getting worse is early intervention (MHFA, 2021). The shortage in the workforce creates a contributing factor that will continue to exacerbate mental health symptoms and challenges in the general population.
Given the estimated shortages by organizations such as Cal Matters, the current mental health workforce shortage is a crisis that requires creative solutions that operate outside of the typical ways in which our health system operates. One possible solution is to expand the use of peer counselors. Peer counselors are people with lived experience who can offer support to others who are struggling. Most commonly, peer counselors are used in substance abuse recovery. Another creative solution is to embrace what Elizabeth Morrison, a behavioral health consultant based out of Northern California, describes as a “lay counseling workforce” (Morrison, 2022). With this model, people without prior mental health education or degrees50-hour complete a 50 hour course that covers mental health conditions, mental health interventions, mindfulness strategies, anti-bias training, and much more. Morrison argues that in the workforce, there are already unlicensed helpers, including health educators, coaches, crisis support workers, case managers, and care coordinators, who could be equipped with training in order to help them meet the current mental health needs of our communities. At a time when we are recovering from the Covid 19 pandemic with a limited workforce, we must consider whether we are going to continue with business as usual or if we will rise to the occasion and take action to prevent further human suffering.
To find out more about Elizabeth Morrison’s lay counselor academy click here.