A shortage of workers is hindering efforts to improve mental health care in Virginia

Virginia’s already strained mental health workforce is expected to shrink more over the next several years, threatening the state’s efforts to improve access to care.

The data, collected by the Virginia Health Care Foundation, comes as the state continues to grapple with a crisis in behavioral health services. Earlier this summer, staffing shortages forced more than half of Virginia’s state-run psychiatric hospitals to close to new admissions. While the facilities have since reopened, a lack of workers continues to limit the number of patients they can safely accept, according to Alison Land, commissioner of the Department of Behavioral Health and Developmental Services.

Private hospitals have also reported growing demand for mental health services throughout the pandemic. At the same time, licensed community providers are being inundated with new treatment requests, according to Debbie Oswalt, the executive director of the foundation.

“We specifically asked them about the impact of the pandemic and they all said they were overwhelmed,” she said. “One psychologist told us he doesn’t even keep a wait list anymore because what’s the point?”

Amid ongoing initiatives to shore up services, the dearth of providers presents a more fundamental problem for the state. According to the foundation’s report, there are already wide disparities in access to behavioral health care. Fairfax County, for example, has five times as many providers as anywhere else in the state, while two localities — Craig and Surry — don’t have a single licensed mental health professional.

But there’s also concern that the workforce will continue to dwindle over the next several years. The foundation examined five types of licensed providers, including psychiatrists, psychologists and psychiatric nurse practitioners. In each field, a significant portion are nearing retirement age. 

Among licensed psychiatrists in Virginia, 61 percent — a total of 677 providers — are at least 55 years old. For clinical psychologists, it’s 36 percent, or 1,030 workers. Thirty-nine percent of psychiatric nurse practitioners (212 in all) are nearing retirement age. 

And in all three fields, there’s only a small number of graduates to replace outgoing professionals. The foundation estimated that roughly 40 people a year become licensed psychiatrists in Virginia, based on historical graduation and licensing rates, and 39 become psychiatric nurse practitioners. Only 63 graduates a year go on to become licensed clinical psychologists.

“That, to me, is the most frightening thing,” Oswalt said. “Because when you look at the pipeline, it’s just not there.”

The foundation began assessing Virginia’s mental health workforce as part of a growing focus on basic access to care. “It seemed like there was a lot of attention on emergency cases and not a lot on improving essential services,” Oswalt added. But the shortfall has a ripple effect across the state’s behavioral health system, from community providers to state mental hospitals.

In Virginia, many patients are connected to treatment through local community service boards, which can provide assistance like medication management and outpatient therapy to patients with serious mental illness. Even before the pandemic, many local offices were struggling to hire providers, according to Jennifer Faison, executive director of the Virginia Association of Community Service Boards.

State hospitals have also struggled with staffing shortages, including among direct care staff (registered nurses, for example) and licensed providers such as psychiatrists. Recently, DBHDS directed emergency funding toward bonuses for staff bonuses to improve retention. As a result, though, Faison said some community service boards located near state hospitals were losing workers to the state-run facilities.

“One of our biggest concerns is that those funding incentives will cause many of our staff to move over to that higher-paying environment,” she said at a recent board meeting for the agency. 

Private hospitals, too, sometimes struggle to hire enough staff as demand surges and competition becomes more fierce. Back in June, Children’s Hospital of The King’s Daughters in Norfolk had more than 1,600 children on the waitlist for its mental health program, even after adding nine new child psychiatrists over the previous two and a half years. Since 2018, the hospital’s behavioral health team has expanded from 30 professionals to more than 100, including 11 total psychiatrists.

“But we could get to 20 psychiatrists tomorrow and we’d still have a waitlist,” said Dr. Mary Margaret Gleason, the vice chief of the hospital’s mental health services. Other providers worry that the ongoing shortfall could delay other efforts to expand care, including a statewide initiative to reform mental health crisis calls.

Oswalt said the state still has opportunities to expand its mental health workforce. In Virginia, clinical social workers and professional counselors often pay $10,000 or more for supervision by a licensed professional as they work to obtain their own license — fees that might push some aspiring workers out of the profession, she suggested. The Virginia Health Care Foundation has proposed a pilot program to pay those fees for targeted graduates, including people of color and providers hoping to work in underserved areas.

Other initiatives, she said, could include more psychiatric residencies or incentives to keep graduates in Virginia.

“All of this is solvable,” Oswalt said. “You can come at it from so many different directions, but it’s just something we need to apply ourselves to.”