How can the Bay Area address the mental health worker shortage?

For Natalie Velasquez, a counselor at a teen crisis center in Concord, just getting through the day can feel like a small miracle.

Velasquez is assigned to lead therapy groups and individual sessions with patients, but too often she also struggles to respond to emergencies on the inpatient mental health hospital floor. One patient may be trying to self-harm, while another may need help calming down a manic episode.

“We witnessed things that you might see in a movie, things that someone might say are extreme or just unbearable to even witness,” Velazquez, 34, said.

In the Bay Area, overworked mental health workers are reaching breaking point. In addition to serving on the front lines of a national crisis, many are also struggling to manage the cost of living in one of the nation’s most ruthless housing markets. After supporting an already strained care system during the pandemic, some are leaving the field altogether.

“Counselors are definitely experiencing tremendous burnout,” Velazquez said. “We’re exhausted.”

Mental health providers say the exodus exacerbates a long-standing shortage of psychiatrists, social workers, drug counselors and other mental health and addiction professionals as the need has increased since the COVID-19 pandemic.

“It’s already a pretty fragile, fragile existing workforce,” said David Mineta, CEO of the Silicon Valley mental health nonprofit Momentum for Health. “And when you have vacancies and you don’t have enough colleagues, it makes it really, really difficult.”

How the region responds to shortages could be critical to addressing many of the worst post-pandemic challenges, as many residents continue to struggle with the lasting effects of social isolation, financial insecurity and grief.

Studies show that children and young adults have experienced increased levels of anxiety and depression. Overdose deaths increased. And thousands of people with serious psychiatric disorders continue to languish on the streets of California.

“With the pandemic, it was followed by a behavioral health tsunami or crisis where there was just a lot more need,” said Eliza Koff-Ginsborg, executive director of the Santa Clara County Association of Mental Health Contract Agencies.

Even so, the Bay Area still has more mental health workers per capita for most positions than the state as a whole. And some state officials and local health-care workers’ unions question whether there really is a significant shortage, although experts note that available data is incomplete and does not reflect the full impact of post-pandemic needs.

There is broad agreement, however, that county health agencies and community-based nonprofits like Momentum — the groups that most often treat the region’s most vulnerable patients — face the greatest difficulty recruiting and retaining workers.

“I hear a lot of anecdotes about people burning out, especially in what we might call safety net behavioral health,” said Janet Coffman, a health policy researcher at the University of California, San Francisco.

A UCSF study by Coffman last year found that more than 70 percent of California’s county behavioral health agencies struggle to hire psychiatrists, clinical social workers, registered nurses and many other types of mental health workers.

Darren Tan, deputy director of Santa Clara County’s Department of Behavioral Health Services, said in an email that his agency’s “market assessment shows a small pool of potential workers — and severe burnout among current ones.”

A separate 2018 Coffman report — before the pandemic led to a spike in demand — predicted that if all types of providers were unable to hire more workers in the next few years, demand for psychiatrists could be 50% lower. high of the supply, while the shortage of psychologists and other therapists can reach 28%.

For the nonprofit Abode, which provides housing, mental health and addiction services to homeless people in the Bay Area, the region’s staggering cost of living makes maintaining a workforce a constant challenge.

“Housing affordability, food affordability, livability affordability and the nation’s standard of pay for this work,” said Brittney Kirkland, senior director of health and wellness at Abode, “with high burnout rates, it takes people out of the field more faster than ever.”

In the Bay Area, the highest-paying mental health positions, typically psychiatrists, can earn salaries in excess of $300,000. But community health workers — who work directly with low-income families on treatment plans and make up a significant portion of the mental health workforce — may earn only about $55,000 to $65,000 a year, according to a new report from the Institute for region of Silicon Valley Studies, a non-profit research group.