A five-day work week quickly becomes six at Community Mental Health Centers across the state, as managers consistently pick up extra shifts.

As staffing shortages overlap with an increased demand for services, working extra is the new normal, according to Maggie Pritchard, president of the NH Community Behavioral Health Association.

Low staff retention means wait lists are longer and when critical employees, like therapists, leave, it can take months to fill that position. 

Patients have had their therapy sessions suspended, or there’s a new counselor filling in, who they have to learn to trust. The effects of this instability can be detrimental, said Pritchard. But sadly, it’s a reoccurring issue among the ten Community Mental Health Centers. 

“I’ve got to start all over with somebody else. I’ve got to learn to trust someone else. I’ve got to tell someone else my story again. I’ve got to develop a relationship that leads me on my path to recovery so I can get back to work and do a better job,” Pritchard said, repeating what patients often say when they lose their therapist. “That's devastating.”

To help address staffing shortages, and be able to invest in programs like supportive housing services, the state’s ten Community Mental Health Centers are calling on state leaders to provide more funding for the system of care. 

The House of Representatives passed a budget last week that included $9 million to ensure Medicaid rates are sufficient to cover services, $3.4 million to bring rates up to the level of Medicaid reimbursement and $11.9 million to increase rates or wages for providers of community mental health services.

But the association of mental health centers say they need $26.8 to $28.2 million to address their wage shortages. Although the House upped the funding from the Governor’s initial budget, Roland Lamy, the executive director of the behavioral health association, says providers are looking to the Senate for more funding. 

“We've seen some initial support through the budget process. We're hoping to see additional support through the Senate process,” said Lamy. “We're going to have to adjust that and have this necessary spotlight on mental health care in the future.”

Over the last few years, the behavioral health association has tracked employment numbers, alongside demand for services. In February, the workforce of almost 3,000 people across the ten agencies had 383 vacant positions, of which 334 were clinical. 

In the last two years, the ten centers have had to add 173 new positions, to support services that are seeing an increase in demand – like rapid response and supportive housing. 

Between 2020 and 2022, the centers collectively invested $44.9 million to retain and recruit workers. But now additional support from the state is needed to help continue these efforts, Lamy said. 

The association is also calling on state leaders to allocate money to support their housing programs. Currently, mental health centers run supportive housing programs – like Twitchwell House through Riverbend in Concord, that provides 24-hour care for people with mental illness, in a 15-bed, residential treatment program. 

“We've all heard about the challenges for acquiring property here in New Hampshire, in this particular market,” said Lamy. “The sustainability of existing resources investment, to expand and to expand resources for supportive housing is critical in order to preserve existing capacity and expand future capacity.”

And if centers can continue to expand their supportive housing offerings, it will also help relieve the current backlog on inpatient beds – which has been an ongoing concern in the state. 

“This service is also very critical in order to decant the pressure on inpatient acute psychiatric care where access is very limited,” he said. 

To fund supportive housing, the association is suggesting investing $1.5 million to acquire land for these services, which equates to the cost of providing 60 additional beds. 

To recruit a new workforce, Pritchard knows the association needs to start proposing careers in social work to students throughout the state at a young age. Think of the kid who would look out for someone else if they got hurt, she said, or the child who always was eager to visit a grandparent in a nursing home. 

“People who do this work really care about what they do. They really want to make a difference in people's lives, and they don't take that responsibility lightly,” she said. 

The workforce shortage is not just felt in the mental health industry as well. This week, caregiving providers Ascentria In-Home Care, Waypoint, The Alliance for Healthy Aging Advocacy Group and Granite State Home Health and Hospice Association, announced a new initiative, The Care Paradox. Together, they hope to call on legislators to increase funding for the state’s Choices for Independence program, to better recruit and retain staff. 

And it’s a problem felt across the country as the pandemic led to mass migration out of the workforce that has slowly trickled back. But what sets New Hampshire apart from other state’s mental health emergencies, is the successful response the state has taken so far – like the state’s mental health first aid system – and should continue to support. 

“Community mental health centers across the country have struggled to address the need for our workforce amidst the rise in demand for services, so we're not alone,” he said. “Investment in our system of care ensures proper access to quality care, and it's a more efficient and affordable way to respond to the mental health care needs of each of our communities here in New Hampshire.”

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