“Our community’s health is not someone else’s problem but rather a shared responsibility that requires an investment by all of us.”
After considerable reflection and impatience, I write as a long time Colchester resident and retired clinical leader at Howard Center about the urgent issue of unmet mental health and substance use needs in our community. I have witnessed the myriad of ways Howard Center supports and treats young and old facing mental health challenges or substance misuse.
At the same time, I am often asked by friends and community members what can be done about the unmet mental health and substance use challenges in our state.
Good work has already happened to validate that mental health is a prime concern for most in our community. The 2022 Community Health Needs Assessment (CHNA) led by University of Vermont Medical Center (UVMMC) in collaboration with 25 community partners identified three community health priorities: cultural humility and inclusive health care, housing, and mental health and wellness. Three years earlier, the 2019 CHNA also identified mental health as a top health priority. The CHNA findings inform the Community Health Improvement Plan (CHIP) developed by UVMMC with community partners including Howard Center.
The strategic investments via UVMMC’s CHIP are helpful but there is urgency to dig deeper to address a community need that is only growing whether measured by wait lists for mental health treatment, opioid overdoses, or emergency rooms overwhelmed by mental health needs. Recently, Howard Center in partnership with several community agencies; UVM Medical Center, Community Health Centers, Pathways Vermont, and the VT Department of Mental Health opened an Urgent Care Center, a therapeutic alternative to emergency department visits. This new collaborative initiative is a hopeful strategy of addressing unmet mental health needs but took several years to stand up in part related to workforce challenges. Howard Center is well positioned to respond to community mental health and substance use challenges through an array of specialized programming but limited in capacity to expand programming due to a funding model that does not cover the full cost of services AND workforce challenges.
I am convinced after more than three decades working at Howard Center in a variety of clinical roles and retiring two years ago as Chief Client Services Officer, that an effective strategy to address unmet mental health and substance use challenges is to increase the investment in the workforce who provides the critical supports, outreach, and interventions to those in need.
Howard Center cannot meet its mission to help people and communities thrive by providing supports and services to address mental health, substance use, and developmental needs without a talented and committed workforce.
Workforce shortages in the behavioral health world is an issue across the United States in part related to the pandemic aftermath. Nationwide workforce investment strategies are challenged by the historical underinvestment in mental health and substance use treatment services.
Here in Vermont, the funding model for agencies like Howard Center does not cover the actual cost of delivering services, which means that Howard Center is insufficiently funded to provide loan forgiveness, tuition remission, or to increase salaries for clinical positions to compensation benchmarks. Addressing staff compensation has been a strategic goal led by the Howard Center Board with substantive progress by the time I left the agency, but clinical positions requiring an advanced degree still fell behind regional compensation benchmarks.
Grappling with equity within an agency like Howard Center forces the examination of how staff without financial resources can advance themselves professionally. Higher education is costly, creating a barrier for staff with economic challenges to pay for their additional education. During my long tenure at Howard Center, I worked with many colleagues who worked full time while they completed their graduate degree part-time, often committing most of their weekends to course work and internships. A grueling but attainable route to advancement, however this path is not equitable for those who have family responsibilities or other financial restrictions that do not allow for the associated tuition payments.
A model of providing support through flexible work schedules and tuition remission can both attract and retain valued staff. The size and breadth of programming at Howard Center provides a platform for staff to pursue a pathway from entry level positions to programs that require more experience, training, and/or education. Creating AND funding a pathway for professional advancement will increase retention and thereby expand the workforce in our community dedicated to helping those struggling with mental health or substance use challenges. This workforce strategy utilized currently in many health care and education institutions takes resources but produces results.
Our community’s health is not someone else’s problem but rather a shared responsibility that requires an investment by all of us. Every day, Howard Center staff are working with individuals and families directly impacted by mental health and substance misuse. Community support makes the difference for Howard Center’s current and future workforce.