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WASHINGTON -- What will it take to keep mental health professionals from leaving the field? About $13 per hour more in pay, said Emily Blomme, CEO of Foundation 2 Crisis Services, a crisis prevention and intervention service in Cedar Rapids, Iowa, during a mental health summit sponsored by the Alliance for Health Policy Wednesday.

For example, with the new 988 nationwide suicide prevention hotline, "one of the difficulties is that the federal government left it up to states to fund," Blomme said. Out of the 25 people Blomme needs to staff her crisis hotline, she has hired 10.

"Pay starts at $17.50 an hour; I'm competing with places like Target," she noted. "I lost an employee to AirFX, which is a trampoline park ... Being a cashier is much easier than answering crisis calls. My teams work 8, 10, 12-hour shifts and they never know what's on the other end of the line when they pick it up. The dilemma is, what do I pay someone that saves lives for a living? What is that worth per hour? The answer is that I don't have enough money to pay people what they're worth."

In response to a question from an audience member, Blomme said that being able to pay $25-30 per hour "would allow me to recruit people who'd be willing to do the work ... But if I do that to our crisis counselors, they're making more than my supervisors, so there's a 'trickle-up' effect; it has to be a chunk of money we can figure out how to put across the workforce." She noted that five states had successfully implemented a 988 tax or fee statewide to help pay for the new service.

Peer support counselors are another type of mental health professional that have difficulty getting needed financial support, according to Keris Jän Myrick, MBA, MS, board member and policy liaison at the National Association of Peer Supporters. "I think why we're struggling with advancing peer support is that the wages are very low -- peers are making $15 an hour and up," she said. The few studies on this issue have also shown that women make less money in the field than men, Myrick added.

Overall, the mental health workforce is hurting, said Russ Petrella, PhD, a senior advisor at consulting firm McKinsey & Company. "The demand now for mental health professionals ... is greater than ever," he said. "There are more people seeking mental health services." In addition, "people are more willing to talk about services, reach out for services, and get services, particularly younger folk, which I think is a good thing."

More than a third of the country doesn't meet the generally agreed-on minimum standard for the supply of mental health professionals, Petrella said, adding that adequacy varies greatly according to geography. For example, "the population of psychiatrists in New York state is 612 per 100,000 people, but in Idaho, it's one psychiatrist per 100,000."

And the up-and-down nature of psychiatric crises combined with lack of access makes things even worse, he continued. "The individual who reaches out for help, maybe made the decision for themselves or sometimes are urged to the decision by family and friends. There's really kind of a moment when people are willing to make that call, and that moment is sometimes fleeting."

If the patient then calls and can't get an appointment for weeks, that's a problem, said Petrella. "There's a lot of no-shows for these first appointments, because whatever was bothering them, and they were ready to talk about it, it goes away ... The problem is mental health problems tend to get worse over time."

Marley Doyle, MD, director of the Behavioral Health Education Center of Nebraska in Omaha, described some of the efforts her state has made in trying to increase its behavioral health workforce. "We have a huge shortage," she said. "Currently, 88 of [Nebraska's] 93 counties are designated as Behavioral Health Professional Shortage Areas."

In 2009, the state legislature agreed to fund a Behavioral Health Workforce Development Center. "Since its inception, we've seen a 38% increase in the behavioral health workforce," Doyle said, adding that although the increase can't be definitively attributed to the center, the organization's efforts can't be ignored either. "It's pretty profound, since most states in the surrounding area have seen a decrease" in their supply of behavioral health professionals, she said.

Nebraska is also doing more to expose students to behavioral health as a career option. "We got into high schools; there's a program called the High School Alliance where students are exposed to health careers, and behavioral health is one of those," said Doyle, adding that another program allows high schoolers to stay at a state college for a week, get college credit, and learn about mental health career options.

The state also supports training opportunities for behavioral health statewide, because "if people train in the areas they're from, they're more likely to stay there," she added.

Telehealth has been another way to help expand the behavioral health workforce, said Andrew Bertagnolli, PhD, national director of virtual behavioral health services at One Medical, a chain of healthcare facilities. "Telehealth has really allowed to broaden the applicant pool when we're looking for licensed clinical staff," he said. And with telehealth, more people show up for their appointments, "so we're able to keep our people busy," he added, noting that the loosening of restrictions by Medicare and other payers for telehealth coverage during the COVID-19 public health emergency has been very helpful.

Of course, matching patients with the mental health providers that have appropriate licensure in the patient's home state can be a complicated process, Bertagnolli said, adding that, unfortunately, "there's no one-stop-shop to explain variation in telehealth laws ... There may be four given sets of rules in one jurisdiction."

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