‘We’re exhausted’: Bay Area mental health shortage deepens as need explodes

Mental health providers say there's a deepening shortage of workers as the need has exploded in the wake of COVID-19.

For Nataly Velasquez, a counselor at a teen crisis center in Concord, just getting through the day can feel like a small miracle.

Velasquez is tasked with leading therapy groups and one-on-one patient sessions, but too often she’s also scrambling to respond to emergencies on the floor of the inpatient mental health hospital. One patient might be trying to harm themself, while another might need help calming a manic episode.

“We witness things that you might see in a movie, things that someone might say are extreme or just unbearable to even witness,” the 34-year-old Velasquez said.

Across the Bay Area, overwhelmed mental health workers are reaching a breaking point. In addition to serving on the front lines of a national crisis, many are also struggling to manage the costs of living in one of the country’s most unforgiving housing markets. After propping up an already strained system of care during the pandemic, some are leaving the field altogether.

“Counselors definitely feel a huge burnout,” Velasquez said. “We’re exhausted.”

Mental health care providers say the exodus is deepening a longstanding shortage of psychiatrists, social workers, drug counselors and other mental health and addiction professionals as the need has exploded in the wake of the COVID-19 pandemic.

“This is already a pretty fragile, brittle existing workforce,” said David Mineta, chief executive of the Silicon Valley mental health nonprofit Momentum for Health. “And when you have vacancies, and you don’t have enough coworkers, then it makes it really, really hard.”

How the region responds to the shortage could be crucial to confronting many of its most dire post-pandemic challenges, as many residents continue grappling with the lasting effects of social isolation, financial insecurity and grief.

Studies show children and young adults have experienced heightened rates of anxiety and depression. Overdose deaths have spiked. And thousands of people with serious psychiatric disorders continue languishing on the streets across California.

“With the pandemic, it was followed by a behavioral health tsunami or crisis, where there was just a lot more need,” said Elisa Koff-Ginsborg, executive director of the Association of Mental Health Contract Agencies of Santa Clara County.

Even so, the Bay Area still has more mental health workers per capita for most positions than the state as a whole. And some state officials and local health care employee unions question whether there’s actually a significant shortage, though experts note the available data is incomplete and doesn’t reflect the full impact of post-pandemic needs.

There’s broad agreement, however, that county health agencies and community nonprofits like Momentum — the groups most often treating the region’s most vulnerable patients — face the greatest struggle in hiring and retaining workers.

“I hear lots of anecdotes about people burning out, particularly in what we might call safety net behavioral health,” said Janet Coffman, a health policy researcher with UC San Francisco.

A UCSF survey by Coffman last year found more than 70% of California’s county behavioral health agencies were struggling to hire psychiatrists, clinical social workers, registered nurses and many other types of mental health workers.

Darren Tan, deputy director of Santa Clara County’s Behavioral Health Services Department, said in an email that his agency’s “assessment of the market shows a small pool of potential workers — and high burnout among current ones.”

A separate report by Coffman from 2018 — before the pandemic sent need soaring — predicted that if all types of providers are unable to hire more workers in the next few years, the demand for psychiatrists could be 50% higher than the supply, while the shortfall of psychologists and other therapists could reach 28%.

For the nonprofit Abode, which provides housing, mental health and addiction services to homeless people across the Bay Area, the region’s staggering cost of living makes maintaining its workforce a constant challenge.

“The affordability of housing, affordability of food, affordability to live, and the nation’s standard of pay for this work,” said Brittney Kirkland, a senior director of health and wellness at Abode, “with high rates of burnout, it takes people away from the field faster than ever before.”

In the Bay Area, the highest-paid mental health positions, typically psychiatrists, can earn salaries above $300,000. But community health workers — who work directly with low-income families on treatment plans and make up a significant portion of the mental health workforce — may earn only around $55,000 to $65,000 a year, according to a new report by the Silicon Valley Institute for Regional Studies, a nonprofit research group.

The report, which includes a survey of students earning degrees for mental health and addiction care in Santa Clara County, found 50% plan to leave the Bay Area, primarily due to cost-of-living concerns.

To keep more mental health workers in the region, providers want to continue the expansion of state and local workforce development programs, particularly student scholarships and loan repayment plans.

Proposition 1, Gov. Gavin Newsom’s narrowly passed $6.4 billion mental health bond measure, includes money to boost the pool of mental health workers. That’s on top of the $1.5 billion the state approved last year for various health care workforce programs.

Rachel Massaro, director of research with Silicon Valley Institute for Regional Studies, said more focus needs to be placed on recruiting and training workers from diverse backgrounds that reflect the communities they serve. That wouldn’t just encourage more people to enter the workforce, Massaro said, but could also help break down language and cultural barriers that make it difficult to reach many who need care.

“There’s so much benefit,” she said, “to feeling a greater sense of belonging.”