By Carly Snyder
Rockbridge Area Community Services (RACS) and local hospitals, hit by staff shortages and increased demand from patients, are scaling back or cutting mental health services.
Ten to 15 positions have been open at RACS since the outbreak of COVID-19, said Executive Director Kimberly Shaw.
Open positions range from entry-level to specialized jobs in mental health care.
RACS is one of 40 community service boards or behavioral health authorities in Virginia, and one of nine within the region. “We’re all competing for the same staff because we all provide similar services,” Shaw said. “Even though they might not be provided in the exact same way.”
One factor that impacts hiring is the pay at such public facilities compared to private medical practices, or other industries.
“Unlike private providers, we can’t just raise our salaries and then raise rates,” said Shaw. “You can probably go to a Walmart or McDonald’s and make more money.”
Shaw did not give the starting wage for open entry-level positions at RACS, but a cashier at Lexington’s Walmart has a starting salary of $14 per hour.
A majority of RACS’ clients rely on Medicaid, a joint federal and state program that provides medical coverage to qualifying low-income individuals, among others. That means RACS’ budget is limited to what the federal government reimburses for services.
Still, RACS has to figure out how to maintain state-mandated programs, which is especially difficult when it is receiving more calls for crisis intervention services.
“We have been running a 24/7, 365 emergency services department locally with two full-time people,” Shaw said.
RACS recently stopped offering a skill-building program to adults with various physical or mental impairments.
A shortage of mental health professionals has also impacted local schools.
“It’s hard to find counselors right now at any level because there’s such a demand,” Rockbridge County High School Principal Mike Craft said. “Our school is sending kids to the hospital to make sure that they are in a safe place.”
Carilion Clinic’s Chair of Psychiatry and Behavioral Medicine Dr. Robert Trestman said treatments have changed at hospitals, too.
Pandemic-related staffing shortages cut the number of inpatient beds in half, even at private hospitals like Carilion, Trestman said.
“We, as doctors or nurses, are trained to deal with trauma that lasts for a day, two days, or even a week,” Trestman said. “But no one is trained to keep going at that level of intensity for years, which has led to people burning out.”
Carilion has also seen an increase in demand for mental health resources especially suicide prevention services.
“We are seeing an increased rate of a sense of hopelessness and frustration among teens, leading to an increase in substance use, suicidality and death by suicide,” Trestman said.
Previously, if a school referred a student to Carilion for mental health concerns, the hospital would coordinate with the patient’s family to discuss if the student needed to be placed in a psychiatric hospital.
“Now, we don’t have the resources to provide the care and the treatment that we know is needed,” Trestman said.
As a result, patients are spending more time in emergency rooms rather than being immediately evaluated.
But Trestman remains hopeful.
“For the first time we are more openly talking about mental illness, substance use, and addiction, reducing the stigma,” Trestman said. “That makes it easier for more people to become engaged in the treatment process—not only those who are highly trained.”