When the COVID-19 pandemic hit, telehealth allowed mental health agencies and clients to meet without risking infection. But now, local agencies are losing their counselors to telehealth, without enough replacements to fill the void.
Duane Piccirilli, president of the Hermitage Board of Commissioners and executive director of the Mahoning County Mental Health Recovery Board, described the pandemic as a “double-edged sword” due to the advances made in telehealth and counseling through Zoom: Now those virtual services are attracting counselors away from other agencies.
In the case of Mahoning County, Piccirilli said the agencies funded by Mental Health Recovery Board are losing workers to national and statewide for-profit companies at a time when mental health services are seeing an increased need from clients.
“Agencies have openings at all levels, from BA degree caseworker to master level counselor. It’s a big problem,” Piccirilli said.
Renee Klaric, executive director of Valley Counseling and director of behavioral health programs of Family and Community Services in Warren, Ohio, agreed that telehealth services had contributed to the counselor shortage.
Klaric added that part of the issue for community mental health services is that their clients often have additional issues, such as housing and food insecurity, while telehealth and for-profit agencies can focus specifically on the mental health issue.
At the Community Counseling Center of Mercer County in Hermitage, Clinical Director Dr. Scott Baker said the agency had only about one-third the number of counselors it used to have.
At one point, the center had about 23 counselors, but now has only nine to serve about 500 clients in outpatient services. The center assists about 1,500 people overall through the center’s other programs such as employment and housing services.
The center even had to stop taking in new clients for about a month, but that has since opened up as the center filled vacant positions.
“It’s been all hands on deck, with all of the supervisors and myself as director taking care of clients,” Baker said.
Center officials have tried hiring new counselors, but some potential hires end up receiving raises from their current jobs and back out. Other applicants schedule interviews but never show up, Baker said.
A major factor in the center’s attrition among counselors: The combined everyday stress that comes with the job and the stress of the COVID-19 pandemic, which led many people to focus on self-care and either retire or seek new jobs.
Telehealth seemed a viable option for many counselors, since telehealth agencies traditionally do not take patients with severe issues such as suicidal tendencies or histories of violence that seek help with community-oriented agencies.
Telehealth companies can also expect an uptick in clients seeking mental health services, which allows those companies to increase their rates and thus offer higher wages. This is not an option for the counseling center, since its rates are set by insurance or Medicaid, Baker said.
Telehealth also can’t completely replace in-person counseling sessions, even though Baker said the counseling center does offer some limited telehealth options.
“If a child is in a house where it’s not safe to talk openly, then telehealth won’t work,” Baker said. “If a partner is in an abusive relationship or someone is reliving trauma during trauma treatment, then they shouldn’t be at home alone without support.”
The counseling center is looking for people who are licensed professional counselors or licensed clinical social workers, and will provide supervision to people who are license-eligible, Baker said.
Challenging but satisfying
And despite the job’s challenges, Baker said it can be very satisfying working with clients.
“Community counseling is my mission, it’s why we’re here,” he said.
Those interested in working in counseling or other jobs at the Community Counseling Center of Mercer County can visit cccmer.org/careers for more information.
At the Mercer County Behavioral Health Commission, Director Paulette Benegasi said the commission usually employs case workers who help assess clients, then direct the clients to providers specific to their need.
Since the commission works with so many agencies, such as contracting with the Community Counseling Center of Mercer County for counseling services, she has also noticed the counselors shortage, along with numerous fields from attorneys to human resources specialists in need of applicants.
“I’m sure COVID influenced that, where people spent a little more time at home and gave a second thought toward, ‘maybe now is a good time to retire,’” Benegasi said.
Even hiring case workers is sometimes difficult, and she said commission officials have tried reaching a broader range of individuals, from running newspaper advertisements to hiring online and reaching out to local universities.
Like telehealth and for-profit agencies, Benegasi said it was difficult to compete since the commission’s funds are allocated through the county by the state, with many clients having only Medicaid or no insurance at all.
However, that also makes the commission for accessible for clients who can’t afford or access other agencies.
“They can call us at our intake number so we can help figure out what they need, and if they need a fuller assessment, we don’t charge for that,” Benegasi said.
Potential case workers need a degree in a human services field, such as psychology, criminal justice or social work, and a minimum of 12 credits in psychology social work. Interns also come through the commission as well.
“We’re working people toward being independent, and doing the most they can with their lives,” she said.
Anyone interested in the commission’s services or in need of assistance can call (724) 662-2230.
One possible solution to alleviate the counselor shortage could be a compact among states, which would allow counselors and social workers to practice in different states without having to undergo the licensing process over and over for each state.
According to the American Counseling Association, a counseling compact in the works would focus on licensed professional counselors and licensed professional clinical counselors.
North Carolina was the latest state to join the Counseling Compact, which brings the compact’s membership to 16 states. Although some nearby states, including Ohio and West Virginia, have joined the compact, Pennsylvania has not.
A separate compact specifically for social workers, the Social Work Licensure Compact, is under development by the Council of State Governments, the Department of Defense and the Association of Social Work Boards, along with other supporting agencies, according to the National Center for Interstate Compacts.
The project’s team has a draft of the compact, with editing expected to be completed this fall and the compact presented to states for their 2023 legislative sessions.
State Rep. Mark Longietti, Democratic chair on the state House Education Committee, said he would strongly advocate toward Pennsylvania joining such compacts.
A similar approach has been applied to education, with amendments were made to the state’s school code that would make it easier for Ohio teachers to get certified in Pennsylvania — showing that such a program could work for mental health.
“In border communities like ours, I think we could really benefit from that reciprocity,” Longietti said.
Another approach could be to create pathways for young people to enter the mental health field, such as how school districts can introduce students to vocational training that can be built upon in post-secondary education.
Such shortages of counselors and social workers were not unique to Mercer County, however. Longietti said officials from across the state reported a decrease in counselors, as well as school superintendents who can’t find social workers and mental health counselors to serve in school districts.
“It was an issue before the pandemic, and it was exacerbated by the pandemic,” he said.
State Sen. Michele Brooks’ office said she was looking into counseling compact participation for Pennsylvania, and funding is also being allocated toward mental health needs.
The state General Assembly recently included funding in the 2022-23 state budget to provide $100 million in block grants for school-based mental health services to train and fund counselors and mental health professionals in school districts, according to a statement from Brooks’ office.
“These counselors are pivotal to helping our schools and communities continue responding to the effects of the pandemic,” the statement said.