Jeff Thomas discusses Washington’s behavioral health crisis system, workforce shortages and improving the behavioral health system

Jeff Thomas is the CEO of Frontier Behavioral Health. Frontier Behavioral Health is a nonprofit organization that provides behavioral health and related services to individuals of all ages in collaboration with community partners. They are also one of regional operators for Washington’s behavioral health crisis system.

In this Q&A, Thomas discusses the behavioral health crisis system in Washington, workforce shortages in the behavioral health industry and what’s being done to address these shortages.


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Matt Beuschlein: Can you tell me about Washington’s behavioral health crisis system and how it looks across the state?

Jeff Thomas: “First of all, we don’t have one state behavioral health crisis system, we have nine regions that each have different crisis systems.

That’s an important thing to be aware of…There are certain commonalities because there’s certain statutes that dictate what services look like, most notably, the statutes around ITA [Involuntary Treatment ACT] evaluations, and then there’s contractual requirements to have a regional behavioral health crisis line. So those two things are in place in each region, although how those exist in each region look very, very different.

For instance, in Spokane, we operate the regional crisis line for all six counties in that region. But we only do the ITA evaluations for Spokane County. How ITA evaluations look in Spokane County by us, is very different than in Pend Oreille County or Stevens County, where you basically have a clinician who has to bring the phone home at night and go out on a call in the middle of the night. They don’t have a whole department doing it. So even though statutes and contracts can look the same, how it looks on the ground level can be really different. 

I think it’d be very challenging to say every system in every region and every county is going to be identical. Because there’s just such vast differences from very, very rural to very, very urban.”


MB: What do the behavioral health workforce shortages look like and what are the impacts we’re seeing on account of those shortages?

JT: “The workforce shortage is a challenge everywhere in the state and across the nation. One that is more acutely felt in rural areas. Many behavioral health agencies are experiencing up to 30% vacancy rates for their clinical staff. I know of one rural provider that is experiencing a 55% vacancy rate. 

Sadly, many agencies are having to curtail and limit the number of new clients they are accepting. Which means people aren’t getting into care as quickly as we would want them to. But caseloads can only swell to a certain point before we’re not doing anybody any favors to bring them into care because we can’t provide them with the level of care they need.”


MB: Speaking on the workforce shortage, how is Frontier Behavioral Health working to address the shortage? What’s being done outside of your organization to address these shortages?

JT: “Frontier Behavioral Health and others are looking at hiring more bachelors level staff. The biggest shortages right now are for masters level clinicians. So there are ways in which we can be hiring bachelor’s level staff to provide additional support. It’s not going to be the only solution, but that’s one of the things we’re looking at. 

We’re certainly doing everything we can to be creative, in terms of recruitment and retention. But if somebody can go somewhere else and make 30% more, you’re gonna have a hard time retaining them. 

But the bottom line is there’s been significantly more individuals getting care under their insurance, which is great. But the pipeline of people who are entering the field and the current workforce is just not coming close to keeping up with the increased caseload. So we keep losing ground on that front. We’re always having staff heading out the doors to these higher paying jobs.”


MB: What are some of the top priorities for improving the behavioral health system? Are there any critical issues that need to be addressed?

JT: “It’s challenging to not be too ambitious about what could be when we’ve got such workforce shortages. That is the most foundational issue, to recruit and retain, to have a workforce to do the work that’s there. 

There’s definitely ways in which there can be improved coordination with integrated and managed care. 

I’ll give you an example, Frontier Behavioral Health has nearly a dozen care navigators, all of them grant funded or research funded, connecting individuals with the care they need. 

If you’ve ever had to seek specialized medical care for yourself or a family member, that’s a whole labyrinth unto itself. And if you’re somebody who’s already impoverished or struggling with mental health issues, trying to get from A to B, and then from B to C, and then go get a lab draw, and then go back over to the specialists… It’s tough. 

So we’ve got care navigators assisting with everything from opioid addiction to oral health care, to working with our physical health partners, but all of that is grant funded presently, or research funded. We need to have mechanisms where these inexpensive, non-credentialed staff can have their services recognized and reported. So these services are counted when people are looking at what the costs are. So that’s an example of an avenue that I think would be important as life goes forward.”


MB: How has COVID impacted both the demand for behavioral health services, and also the capacity for the system to respond? 

JT: “Since last March, for a period of time in our organization, and I think in many, there was a slight reduction in people accessing services. It was different, all done remotely, and that was a new thing for everybody. But people figured it out, and as we crested through the late part of last year, the number of people trying to access services increased. And it’s continued at a high level ever since.

There’s higher levels of prevalence of anxiety and depression, and social isolation doesn’t help with those things. Youngsters who can’t do the normal things, they would [normally] get to go out and play or be on a sports team or in school. So we’re absolutely seeing an increase in need at the same time as we see increasingly high vacancy rates with the workforce shortage. So it’s certainly not helpful that those two things are coinciding with one another.”