CORONAVIRUS (COVID-19) RESOURCE CENTER Read More
Add To Favorites

Severe shortage of mental health clinicians prompts Stanislaus County to try bold approach

Modesto Bee - 5/15/2023

May 15—Facing a scarcity of licensed clinicians and the challenges of the mental health crisis, Stanislaus County officials think layperson counselors could serve a purpose.

County Behavioral Health and Recovery Services is sending 50 case managers and outreach workers to a home-grown academy to be trained as lay mental health counselors.

Modesto psychologist Elizabeth Morrison created the integrated behavioral health services for Golden Valley Health Centers in the 2000s and now is running The Lay Counselor Academy with a colleague from Oakland.

Morrison said she created the academy eight months ago to train people without degrees or licenses to do mental health counseling. It already has trained more than 80 people referred by health agencies in New York, Alameda County and other parts of California, she said.

Morrison said training people without degrees or licenses to do mental health counseling may seem like a radical idea, but some people have the interpersonal skills and compassion to make a difference for these folks.

"We are not saying anyone can do it, but there are many people who have the skills, aptitude and personality," she said.

The San Joaquin Valley has the second most severe scarcity of mental health professionals in California, which means a person might wait four to eight months to see a clinician. Many counties and other agencies across the county are in desperate need of licensed mental health clinicians and usually are not successful in recruiting them from a limited pool.

County BHRS has entered a contract with the Lay Counseling Academy to train 50 case managers, outreach workers and other support staff. The county will pay the academy up to $171,000 for the training services. The first group of 25 staff members will start the 65 hours of training this summer.

The training is designed to better equip them in assisting people struggling with anxiety, depression, suicidal thoughts, substance use disorder and other conditions.

Morrison added that the county's front-line mental health workers more resemble the county's diverse population than do clinicians with advanced degrees.

Morrison and a co-author wrote in a California Health Care Foundation blog that behavioral health needs exploded during the COVID-19 crisis, with triple the number of people reporting problems with depression and anxiety, along with increases in domestic violence and drug use. But only small percentages of people receive treatment for their mental conditions and substance use disorder.

The concept of layperson counselors also could have applications for initiatives such as the Homeboy Industries-like program planned for Stanislaus County, which could use formerly incarcerated people to provide peer mental health support for inmates reentering the community.

County supervisors have not approved any recommendations for a local program similar to Father Gregory Boyle's in Los Angeles but are expected to consider proposals next month.

Morrison said layperson counselors are used effectively in poorer countries where the scarcity of licensed clinicians is much worse. She said she's naturally open to alternative approaches as a native of Alaska, where unlicensed midwives regularly deliver babies in remote villages and communities.

Award for innovation

Morrison and the academy's co-creator, Alli Moreno, were recognized as Steinberg Institute champions for 2023 for bringing innovative solutions to the behavioral health workforce shortage.

BHRS Director Tony Vartan said Friday that he saw an opportunity to provide additional tools to help case managers and other staff with interventions.

As an example, the trainees will learn motivational interviewing, an evidence-based approach for engaging people who need help and getting them into treatment.

"Often, what happens is that case managers don't have the skill sets," Vartan said. "Motivational interviewing is a great talking skill to have. ... The training will teach them skill sets to help intervene and defuse situations while staying within their scope of duties."

Vartan said the academy graduates won't manage psychiatric medications for clients or handle crisis intervention. Medication treatment is within the scope of practice of physicians and registered nurses, he said.

The county's mental health system of care, for people on Medi-Cal or with no insurance, served 9,422 adults and children in the 2021-22 budget year. The number does not include all outreach and engagement efforts.

Another opinion

Darlene Thomas, president of the National Alliance on Mental Illness Stanislaus chapter, said the county should be careful using lay counselors.

"You can't be a therapist with 65 hours of training," Thomas said. "We need more help, but I would feel more comfortable (if unlicensed staff) stay within their scope of work."

Usually, people calling the NAMI office are in a crisis, she said. They have a family member suffering from mental illness who does not think anything is wrong. "The frustration with our system is that you can't make people get help if they don't want it," Thomas said.

Gov. Gavin Newsom committed billions of dollars last year to expand the state's mental health workforce and reimagine mental health and substance use services.

Morrison, the chief executive of EM Consulting, said the state initiative is a long-term plan for expanding the workforce. It's not a short-term solution.

She said the academy has trained staff from other counties, faith organizations and nonprofit agencies. Community health centers have sent outreach workers, medical assistants and substance use counselors for the academy training because of the demand for mental health services.

The training begins with one in-person meeting but most of the learning and counseling practice is done online or on Zoom.

"Counties are deeply understaffed," Morrison said. "But they are also deeply committed to their responsibility of providing this care for their community."

___

(c)2023 The Modesto Bee (Modesto, Calif.)

Visit The Modesto Bee (Modesto, Calif.) at www.modbee.com

Distributed by Tribune Content Agency, LLC.