The behavioral health specialists who work for Deschutes County overwhelmingly say their motivation for working in community mental health is to help people — but that’s difficult to do sometimes with ongoing staffing shortages.

While hospitals and healthcare institutions across the country have experienced staffing shortages since the pandemic, public behavioral health departments have been hit particularly hard. In Deschutes County, over one-third of all county job postings are for behavioral health specialists, and many of those positions have been open for months.

“The pandemic caused a lot of people to reevaluate their values or their work-life balance, and I think a number of people shifted careers,” said Holly McCown Harris, Deschutes County behavioral health director. “It’s certainly improved a little bit in the last year, but there are positions where it’s not improving, and I think those are our positions that deal with the most acute people, (for example) our crisis positions and our forensic positions.”

Harris said the department has not needed to cut back on services because of the staffing shortage, but the exodus of therapists from the public sector has had a cascading effect on both clinicians and how they treat their patients.

A broader crisis

In order to understand why the Deschutes County Behavioral Health Department has struggled to fill positions, it’s important to understand that some of the key issues the department faces have less to do with the number of people applying in Deschutes County and more with changes happening in the industry.

“We’ve had lots more demand for mental health services and at the same time we have workforce leaving the system,” said Cherryl Ramirez, executive director of the Association of Oregon Community Mental Health Programs.

Needs on state level

State report says Oregon needs nearly 3,000 more beds for behavioral health treatment

One of the main challenges Harris must face in Deschutes County is retaining county staff in spite of the the lure of private practice. The pay is better, the hours are flexible and there isn’t as much paperwork — the exact reasons staffers have given Harris for leaving.

“Community mental health programs are held to a different standard statewide in terms of the requirements put on them … and private practice does not have those same expectations,” Harris said. “There’s really a systemic structural issue at play here that we are working hard at the state level to undo.”

Creative solutions before cutting back

So far, Harris said the Deschutes County Behavioral Health Department has not had to scale back operations at any of its clinics, but that has meant coming up with creative staffing solutions. Taylor McGowan, a crisis therapist at the Deschutes County Stabilization Center, attested to some of these strategies.

“I’m the clinical team lead here, so I sit in on leadership meetings as well as (with) the frontline staff. I am in a meeting weekly where we’re talking about strategies to get shifts covered. Sometimes it means covering myself (or) that can mean myself and other supervisors are on call for a week about once every five weeks,” she said.

Children’s mental health

Central Oregon lacks bed capacity for children in mental health crisis

But on the other side of that coin, it’s very stressful for staff to constantly be filling in shifts and working overtime to make sure clients get the therapy and help they need. It also can be frustrating, Harris said, for clinicians to see clients receiving more infrequent care due to additional work responsibilities.

“I definitely think we see burnout and compassion fatigue because a lot of people help out — and they pick up extra shifts — but there’s a lot already. Even just doing your 40 hours of it in a week sometimes can be draining and when you add on to that, it’s hard,” McGowan said.

Application incentives

While the department could hire traveling clinicians — and have on occasion to help with burnout — Harris said she sees the solution as reducing the administrative burden on public employees and offering additional incentives for hiring new workers.

One issue that has deterred several applicants is the housing economy in Bend. Harris said more than one applicant has accepted a position only to withdraw because housing is difficult to find and expensive. One way she hopes to combat that is by awarding applicants a moving stipend.

Ramirez said her organization also lobbies for additional funding and state-wide programs that would allow counties to implement more hiring and retention incentives. Those might include sign-on bonuses, tuition reimbursements and continuing education incentives. Some larger behavioral health providers have even considered creating in-house childcare services, she said.

“I see Deschutes as being very creative and innovative and doing everything they possibly can to retain and recruit workforce. I think they’re doing a phenomenal job,” Ramirez said. “I certainly believe Deschutes County has taken advantage of every incentive that they can and they are doing the best they absolutely can.”

Reasons to keep working

Despite the difficulties, Harris said the staff is some of the most dedicated workers she’s ever seen. Katherine Chancellor, an alcohol and drug counselor with the county, said one of the main reasons she stays with the county rather than switching to private practice is because of the network of support the county can provide to her clients.

Chancellor said that during her time working outside of Deschutes County, she struggled with the fact that the only thing she could provide to clients was therapy. She couldn’t, for example, refer someone experiencing unemployment to a county-led career program or refer someone who is homeless to a social worker to find subsidized housing.

“Working at Deschutes County allows us to connect people to those basic supports and for me that’s a huge benefit to working here,” Chancellor said.

McGowan said she stays at the county because there is so much appreciation for the services they provide, and sometimes, it makes the entire difference in a person’s life.

“We collect a lot of data on the people we serve and one of the questions we ask is ‘if we hadn’t been here, where would you have gone or what would you have done?’ There’s an overwhelming number of people who say they don’t know. Some people have even said they might have ended their life … I think we all feel like we are making a difference in the community and that’s important to us,” McGowan said.