Waite: Gov. Hochul’s mental health spending plan could be undermined by understaffing

FILE - Fulton County Family Counseling Center Executive Director Michael Countryman speaks at the grand opening of Genoa Pharmacy Healthcare in June 2022.

FILE - Fulton County Family Counseling Center Executive Director Michael Countryman speaks at the grand opening of Genoa Pharmacy Healthcare in June 2022.

If someone in a mental health crisis comes to Ellis Hospital, that patient may have to wait days to be admitted for inpatient care, according to Fred Durocher, a registered nurse.

In the meantime, the patient, often brought to the hospital in an ambulance or a police car, will be treated in Ellis’ crisis unit. The 12-bed emergency facility is really supposed to be a place where patients are made medically stable ahead of being sent upstairs for more intensive mental health care, said Durocher, who works in the crisis unit.

That stabilization usually only takes a few hours. Yet patients sometimes wait nearly a week for the next step in their care, according to Durocher.

The delay is due to the fact that the hospital’s inpatient unit is understaffed. Prior to 2020, the adult inpatient unit had 36 beds. It now has 18. While the cut was to initially allow for renovation, it’s now primarily a result of not having enough staff.

Fewer beds mean fewer patients admitted, which can create backlogs of people in need of care.

“[Patients] end up in the crisis unit and spilling over into the main emergency room, and we end up holding them for much longer than we ever used to,” said Durocher, who has been a nurse since 1996. “I would say 100 hours is not uncommon.”

The staffing issues at Ellis represent an underlying crisis of mental health care in our region, state and across the country. Unfortunately, that staffing shortage threatens to seriously undermine the impact of the potentially transformative investment in mental health care New York Gov. Kathy Hochul unveiled this past week.

During the governor’s budget proposal presentation, Hochul touted an unprecedented $1 billion, multi-year spending plan to expand mental health care services as part of her overall $227 billion state spending plan. Among other initiatives, the mental health plan calls for $890 million in capital and $120 million in operating funding to build and run 3,500 new residential units for New Yorkers with mental illness. It also includes $60 million in capital and $121.6 million operating funding to expand outpatient services, including establishing 12 new comprehensive psychiatric emergency programs providing hospital-level crisis care, and tripling the number of New York’s Certified Community Behavioral Health Clinics, from 13 to 39, that offer walk-in, immediate integrated mental health and substance use disorder services.

The plan represents incredible recognition of the value of mental health services, a sector of our health care system historically cast aside. The proposal has a chance to make mental health services more mainstream. This normalization comes, in part, by bolstering support to school-based mental health services – which familiarizes our children with mental health care earlier in life – and by pushing to close gaps in insurance coverage for mental health care, including prohibiting insurers from denying high-need services.

As William Gettman Jr, CEO of Northern Rivers, which provides a range of services, including behavioral health and crisis response in the region, said: “It’s probably the first time in over a decade that a governor has actually talked about mental health at this level. So we can all nitpick at some of the details, but credit to her.”

The problem is – and Gettman points this out himself – without the staff to support the governor’s mental health initiatives, many of those initiatives won’t actually translate to improved care for more New Yorkers.

Michael Countryman, executive director of The Family Counseling Center based in Gloversville, said of Hochul’s mental health spending plan: “She hit the nail right on the head and identified what was needed as far as programs and services. As we see an increase in demand for services, she has her hands right on the pulse. But she fell short in the area of people and salaries to pay for those people.”

Hochul’s proposal missed an opportunity to meaningfully address providers’ staffing concerns. While providers have been calling for an 8.5% cost-of-living increase, which would largely be passed onto them through increased state-funded insurance plan reimbursement rates, the governor’s plan only includes a 2.5% increase.

Providers argue the 8.5% increase would more closely align with the consumer price index and improve their ability to recruit and maintain staff for jobs that are already undervalued.

For Hochul’s part, her office said in a statement: “Governor Hochul fully understands the myriad challenges being faced by service providers, which is why she has dedicated a tremendous level of state resources to support these organizations over the past two years. This funding is aimed at helping them stabilize their workforce, prevent program reduction and address widespread financial concerns voiced by advocacy groups,” the statement reads. “This year’s budget continues the governor’s strong record of investment in mental health services, which also includes funding for residential programs, workforce bonuses, loan forgiveness for mental health professionals, and a multitude of other initiatives aimed supporting service providers.”

To that end, it’s worth noting the 2.5% COLA increase in Hochul’s proposal follows a 5.4% increase in the current budget. In addition, the governor’s office points to additional supports given to the workforce, including $1.3 billion allocated in the current budget for the payment of recruitment and retention bonuses to frontline health care and mental hygiene workers. Plus, lobbying for an increase somewhere in a budget means supporting a cut elsewhere.

Still, it’s hard to ignore the providers, who are already hurting for staff, saying the governor’s spending proposal is unlikely to address their needs.

As some indication of the staff shortage, data from the New York State Nurses Association shows that upstate hospitals with inpatient mental health beds are out of nurse-to-patient compliance ratios between 3.4% to 100% of the time, with severe understaffing meaning that some days a single nurse may have 17 patients on his or her caseload.

The bottom line is that current staff shortages in mental health care – from nurses to technicians to social workers – mean people aren’t getting the care they need.

At The Family Counseling Center, the waitlist for services is about 100 after spiking to approximately 500 last summer, according to Countryman.

Northern Rivers, which has more than 100 job openings out of a workforce of approximately 1,400 people, has waitlists in nearly all of its programs, including a waitlist in the 100s in its community-based mental health programming and a waitlist of about 500 for its outpatient mental health clinics.

“If I had more staff, I could serve more clients,” Gettman said.

Therein lies the problem. Despite significant recruitment efforts, care providers have struggled to fill jobs. While the pandemic accelerated the arrival of the staffing crisis as more people sought mental health services and many care providers quit, the looming staffing shortage has been feared for quite some time.

It may be possible to increase the future pools of candidates entering mental health professions by changing some degree requirements or offering additional financial support to pay for people to pursue these often-pricey degrees.

But a lot of it simply comes down to wages.

“We say to a lot of the young people it’s a great career, you can move up. And they say, ‘Yeah — but I’ve got to pay my bills,’” Gettman said. “The fundamental problem we have is our workforce is under-respected and underpaid.”

Hochul’s $1 billion proposal goes a long way toward addressing the respect issue. But the proposal fails to seriously address the issue of pay.

Because we’ve all been impacted by rising costs, we may be tempted to say “what about me?” So what if food costs for Northern Rivers’ residential program have gone up 19% in a year? My grocery bills have skyrocketed, too.

But not all of us were working the front lines during the pandemic. Not all of us have sacrificed time and money to provide critical care for others – care that is more in demand than ever.

In a telling point, Gettman said he’s concerned about the impact that another of Hochul’s proposals could have on his ability to staff positions. Hochul has called for indexing minimum wage to inflation. It’s an admirable move. The problem for facilities like Northern Rivers is that some of their jobs have starting salaries that don’t pay all that much more than the current minimum wage. That means, as the minimum wage goes up, social service providers could very well be competing for workers with stores at the mall offering much less stressful jobs.

The fact that mental health providers have to worry at all about competing for minimum wage jobs should tell us everything we need to know about how out of whack salaries are in this country.

It strikes me that during the pandemic, we held up health care workers – mental health care providers included – as heroes. This was while athletes, actors and other highly paid professionals we often consider “heroes” were at home like the rest of us.

The governor’s spending plan is a step toward truly starting to value our real heroes and acknowledging the critical care they provide. But if we don’t do more to help mental health providers with initiatives that can actually address staffing deficits, we’ll be left with more New Yorkers with unmet mental health needs.

We’ll be left with empty hospital beds and empty promises.

Columnist Andrew Waite can be reached at [email protected] and at 518-417-9338. Follow him on Twitter @UpstateWaite.





Categories: Andrew Waite, Fulton Montgomery Schoharie, News, Opinion, Schenectady, Schenectady County

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