Shortage of mental health workers causes problems

With experts agreeing that the need for rural mental health care is as great as it's ever been, Havre's two mental health facilities teeter-totter in opposite directions as a depleted workforce shifts between the two.

Bullhook Community Health Center has been expanding. CEO Cindy Smith said the clinic went from 43 employees in 2014 to 64 now. Seven of the 63 have been added this week and, she said, there are "more to come." Most of the recent increases are in the mental health area.

But that is not the case with the Center for Mental Health.

Center CEO Sydney Blair said in a phone interview Tuesday that she recently received four resignations in 48 hours.

During a Bullhook health center strategic planning session meeting Monday in a packed Jon Tester Conference Room at

the clinic, four new Bullhook employees who had worked at the Center were introduced. They said Monday was their first day at Bullhook.

Blair said that, although she cannot confirm what Bullhook is paying

employees, some people did say in their resignation notices that pay was a reason for their decision to leave.

Blair touched on the center's struggle to generate revenue, adding that it's reflective of a problem common to rural clinics in general.

"The rural office areas are the ones most at risk now because they are not cost-neutral" - they are not covering their cost and expenses - "What you find is that the bigger towns end up covering for their loss," Blair said.

She said that about five years ago, the Cascade County Center for Mental Health office made enough money to cover the costs of the Havre office when it didn't cover its expenses. But the Cascade County office is projected to make far less than

what it did years ago, she said.

When asked if the decline in revenue may have created an atmosphere at the Center that made generating revenue the priority over the client's needs and the employee's autonomy, Blair said the Center uses the same standard that the rest of the providers in the state use when it comes to community mental health, the same standard used nationally.

Blair said there are no plans to close Havre's Center - "We are moving forward in hiring staff" - but also added a caveat that getting the workforce is a "risk factor." She said she was concerned the Center may lose so many clients that the Center for Mental Health's clinic will not be able to make enough money to sustain itself.

Blair said a workforce shifting has begun in rural areas and that begs the question: "As the federally qualified health center (Bullhook) gets these expansion grants ... if they become more of a strong competitor, is there room for two?" Blair said.

The main concern, however, should be for the clients, she said. Will clients in the area get the care they need?

Smith said client needs is precisely the reason for Bullhook's expansion.

She said federal grants have helped Bullhook's ability to expand. Those grants include the 330 Grant from Bureau of Primary Health Care, the Expanded Services Behavioral Health Expansion Grant, the Substance Abuse Expansion Grant and an Expanded Services II Grant. All the grants come from HRSA, the federal Health Resources and Services Administration.

Smith said there are no concerns about the grants drying up and possibly causing the clinic to cut staff in the future. The clinic has had bipartisan support, and she expects money to continue flowing in as long as the clinic meets grant requirements, Smith said.

But, she said, only a small percentage of the clinic's revenue comes from grants. The bulk is collected from patients.

Smith said Bullhook is simply providing services HRSA has given them resources to provide. As far as where the employees are coming from, she said, Bullhook's intention was to simply hire "good, qualified staff."

"The staff that we hired came and applied for positions that we had open - we didn't go to them. They came to us and applied," Smith said.

Smith and Blair both said the mental health workforce shortage is a statewide problem. Smith echoed Blair's sentiment that the workforce shortage contributes to a shifting workforce.

"There's not enough trained workers for what we need to fill the positions in Montana," Smith said. "We just keep borrowing from each other around the state."

Smith said clinics around the state need an influx of new people, and the way people are being trained needs to be reviewed because training is difficult to achieve due to "a lot of rules and regulations."

Smith said there simply aren't enough behavioral health professionals in the state, even in the country. She said Bullhook has to entice recruits with higher salaries and a "slower pace of life" and even the Bear Paw Mountains.

Smith said she doesn't know what the workers were previously paid and couldn't compare their pay at Bullhook - the pay was advertised with its corresponding positions.

"It gets tougher and tougher to recruit," Smith said. "Workforce is on the agenda and a priority for the governor."

As for client care continuity, Smith said clients have the freedom to go wherever they can get in. She said she can't guarantee that the services a client was getting at the Center will be with the same counselor at Bullhook, but there are counselors who can see them for the same services.

Although Blair said she wasn't sure what the future holds for Havre's Center, Smith said there's more than enough needs in town. She said every counselor in town is booked with clients.

"I do not think there is a shortage of patients," Smith said. "There's a shortage of workers, and it's a statewide issue."