LEBANON — West Central Behavioral Health sent out a letter to its adult clients in Lebanon earlier this summer informing them that due to a workforce shortage, people receiving individual therapy were now being asked to join groups instead.
“We recognize that this is not ideal and may cause you some anxiety and uncertainty,” Regina Mix, West Central’s director of adult services, said in the letter. “Please be assured that our current priority is to recruit and retain skilled staff to meet the needs of our clients. Our goal is to offer Individual Therapy services as soon as we have staff to provide those services.”
How soon individual services may resume is unclear as the organization, which was short-staffed before the COVID-19 pandemic, has seen its workforce shrink even as demand for services has not.
Roger Osmun, West Central’s CEO, said that when he first took the job three years ago he was told workforce was an issue. In the early days of the pandemic in 2020, Osmun said employees hunkered down and made few moves, but since September of last year attrition has returned to normal levels. Meanwhile, the organization isn’t seeing new employees it needs to replace people who leave.
“We’re just not getting applicants like we did previously,” Osmun said.
Statewide, Osmun said the 10 community mental health centers have more than 400 vacant positions. That’s a fourfold increase from the average vacancies before the pandemic, he said.
While it was previously difficult to attract master’s-level clinicians, it also is now difficult to attract people with bachelor’s degrees, Osmun said. He pointed to the state’s 2% unemployment rate and broader workforce shortage as one driver of the current situation. Osmun also noted that West Central’s Lebanon office has a worse worker shortage than its Claremont office, perhaps due to competition from the nearby White River Junction VA Medical Center and Dartmouth Hitchcock Medical Center, as well as private practices in the area. West Central also is finding it more difficult to find clinicians to serve adults than to serve children.
“We’re trying to help our community understand we can’t manufacture the people to perform these services,” he said.
Some patients are unhappy with the move to group therapy, which doesn’t work for everyone.
Erin Maher, a 45-year-old Lebanon resident with complex post-traumatic stress disorder and other mental health issues who had been receiving individual therapy from West Central until this summer, said, “Groups don’t exactly work out for me as of yet. In terms of timing and what they were offering, I didn’t really feel like it was something that would benefit me in a positive way.”
Maher said she landed in Lebanon in 2020 amid the pandemic after struggling with homelessness. She stayed at a shelter run by WISE, which “was pretty much the only women’s shelter that had extra space,” she said.
She has since found stable housing but said losing the individual therapy has been stressful.
“I’ve worked really hard,” she said.
“I’m also a person who does best with a routine. I think most people do.”
Due to her borderline personality disorder, Maher said, she doesn’t “handle quick, abrupt changes very well.”
Maher is still working with a case manager at West Central, whom she described as “sort of my go-to person right now.” But she said she feels like she is on her own to find one-on-one therapy. She said she tried a local private practice, which told her it would be a five-month wait for an appointment. She has considered going to the acute psychiatric unit at Dartmouth Hitchcock Medical Center in Lebanon because she said a referral from there for therapy might put her at the head of the line.
Kate Lamphere, chief clinical services officer and director of the adult services division for Health Care and Rehabilitation Services, which serves people in Windsor and Windham counties in Vermont, said that HCRS doesn’t currently have a waiting list for adults seeking individual psychotherapy, but it does have a waiting list for children.
She also said that there’s been a broad shift away from individual psychotherapy.
“Being in treatment for years and years is not something that is available really outside of the private practitioner world,” she said.
Instead, a therapist might work with a client to achieve certain goals to help them become more independent. Once those goals are met, clients might move into another form of treatment such as groups.
HCRS also is struggling with staffing, but it’s in better shape than it was a few months ago, Lamphere said. She said the workforce has been shored up somewhat by increasing some salaries and offering bonuses and loan repayment.
Still, it’s challenging to meet people’s needs. Lamphere said she is concerned that clinicians’ caseloads are beginning to creep up to unsustainable levels.
“There will come a point when we have to say these caseloads cant go any higher,” she said.
West Central hasn’t put a pause on accepting new clients, but it does have to evaluate each person who comes seeking services to determine whether staffing levels allow the organization to take them on. Osmun said he’s mindful of trying to avoid “compassion fatigue” that might burn out West Central’s current employees.
“There’s so many people that need our services,” Osmun said.
West Central also is monitoring existing clients’ engagement with services and discontinuing services for those who repeatedly miss appointments.
In an effort to attract new employees, West Central has recently begun offering signing bonuses using federal pandemic relief money provided through the New Hampshire Department of Health and Human Services. But the bonuses have had little effect.
“We’re still not getting any appreciable increase in applicants,” Osmun said.
This week, West Central began offering a new student loan assistance program for employees who have been there for at least a year, Dave Celone, West Central’s director of development and community relations, said. The donor-funded program is available to any employee working at least 16 hours a week, and it can pay as much as $10,000 per employee over the course of three years, Celone said.
Eventually, Osmun said he hopes the organization will eventually see staffing levels rise by trying different advertising approaches and by offering part-time work and flexible schedules, in addition to the signing bonuses and loan repayment.
“There’s not one single silver bullet,” he said.
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.