In Los Angeles County, the need for mental health services is great. The funding is available. The infrastructure has been created in the form of mobile response teams designed to aide the homeless, foster youth and K-12 students.
But the problem is, workers are scarce. Vacancies have hampered response teams from rolling out to help people in distress on 911 calls, and from addressing the mental health of the homeless. Of the 69,000 unhoused in L.A. County, 25% to 50% have a mental illness, according to various survey data.
For more than a year, the Los Angeles County Department of Mental Health has been on a recruiting binge. They’ve dangled carrots such as signing bonuses, student loan forgiveness and streamlined applications for those who join the mental health teams — with very limited success.
As of April 4, gaping holes in mental health teams remained, which prompted the Board of Supervisors to adopt more job incentives.
“We’ve implemented signing bonuses, student loan forgiveness,” said Fourth District Supervisor and Board Chair Janice Hahn at the Tuesday board meeting. “But none of this has been enough. We have too many vacancies across our mental health response teams.”
The board passed a motion to begin a pilot program that will offer 14 incentives.
The motion stated, “For too long, people experiencing a mental health crisis and their loved ones have only been able to call 911 and get a response from law enforcement or paramedics. These responses can not only be ineffective, but can also exacerbate the situation and lead to negative outcomes.”
The vacancies in mental health response teams take many forms and carry consequences.
The lack of personnel on mobile crisis teams delays their response times for several hours and can prevent the rollout of street teams that pair with law enforcement when someone is suffering full-on mental distress.
Mental Evaluation Teams (MET) respond to 911 calls involving people with mental illness, but the teams have been hampered by worker shortages. The county’s April 4 report said there were six mental health clinician vacancies in MET.
The county contracts with private providers to staff its Mobile Crisis Outreach Teams (MCOTs). At the meeting Tuesday, the news was not good from Sycamores, a mental health nonprofit and county contractor.
“Since October 24, 2022, we have embarked on our most aggressive recruiting but only attracted a handful of LCSW (licensed clinical social workers). This continues to delay our ability to fully staff up,” said Wendy Wang, chief public policy, advocacy and strategy advisor with Sycamores.
Sycamores operates just two Mobile Crisis Outreach Teams “because they are facing the same challenges as the Department of Mental Health in hiring and retention. As a result, the mobile crisis services are still not running 24/7 in the county,” read the April 4 report.
The nonprofit PATH, which contracts with the county to provide mental health workers, is trying to keep up by offering more pay and incentives to recruit and retain employees.
“While we applaud the County of Los Angeles for increasing incentives to hire their own mental health staff, it can put nonprofit service providers at a disadvantage,” wrote CEO Jennifer Hark Dietz in an emailed response. “Nonprofit providers like PATH contract with the county, but their contracts limit our capacity to pay a competitive salary and offer comparable benefits.”
The county recently allocated $152 million from state and federal grants to expand its Psychiatric Mobile Response Teams (PMRTs) and call centers for people dialing 998 for mental health help. Last year, the county Department of Mental Health decided to fund 50 response teams with the goal of operating nights and weekends. But as of April 4, only 33 teams were operating due to high vacancies, according to the county report.
Second District Supervisor Holly Mitchell said teams operating in South Los Angeles remained understaffed. And First District Supervisor Hilda Solis said a partnership with the county’s mental health department and LA Metro to help homeless people on trains and buses has yet to attract a single worker.
The 14 incentives approved by the board in its new pilot program to draw in workers will offer bigger signing bonuses; add differential pay and incentives for field-based workers; provide sabbaticals; give field workers a flexible schedule that includes telehealth services; enhance the student loan forgiveness program; and reach into colleges and universities to offer stipends for qualified recruits.
But incentives may not address fundamental issues in the labor force, surfacing three years after the start of the COVID-19 pandemic.
Solis said the market is wide open for mental health workers, with some county employees stolen away by private sector facilities.
Hahn noted a post-pandemic shift in labor practices in which many workers — especially women — want flexible schedules to spend time with their children. Some prefer telehealth jobs because that usually means working from home instead of venturing out to deal with homeless individuals with schizophrenia, bipolar disorder or other mental disorders or substance abuse issues.
She said many employees want to work at home, giving them time to help their children with homework, attend sports games and parent-teacher conferences. “Employers need to be aware that means a lot to people. Things have changed,” she said.
Mike Molina, a member of county’s Mental Health Commission, said the county’s hiring process is fraught with red tape.
Fifth District Supervisor Kathryn Barger, who said the Department of Mental Health has been making small strides, noted that keeping social workers and clinical psychologists is also essential. But, she said, that is harder because many are overworked and fatigued.
Mitchell said the younger generation has lost faith in government.
“We’ve lost a generation of people who value government work,” Mitchell said during the board meeting. “We need to say, ‘Hey! Look. You, too can be a part of the solution.”