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Recommendations for Implementation
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a.
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Plan to
increase the supply of skilled and experienced mental health providers.
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Using data from research, policymakers and state
legislators should consider steps that will ensure availability of sufficient
resources to attract qualified workers to the mental health field and to make
work in the mental health field an attractive career choice for those with an aptitude
for provision of supportive services. At the same time, state mental health
officials should undertake efforts designed to raise the professional standing
of mental health field workers and others involved in providing mental health
services. Working in concert with universities and other entities outside the
public mental health system, officials should develop degree or certificate
programs that recognize and reward life experience that can be converted to
credentials acceptable to regulatory, licensing, and reimbursement bodies.
Efforts should also be made to provide financial or other incentives that will
attract workers to the mental health field. For example, tuition loan
forgiveness or support programs should be implemented. Innovative opportunities
for professional development and advancement should be increased.
Example:
Ohio Residency/Traineeship Program, Ohio Department of Mental Health
Since 1947, the Ohio Department of Mental Health
(ODMH) has funded the training of psychiatric residents, psychology students,
graduate-level nurses, and social workers to provide services to persons in
Ohio's public mental health system. This program is seen as critical in the
development of high-quality and high- performance mental health clinicians.
Recruitment and retention is closely linked to experience gained and expertise
fostered in this program. ODMH works in partnership with local mental health
systems and institutions of higher education to implement this initiative.
Example:
Mental Health Worker Certificate Program, Walnut (CA)
A new project at Mt. San Antonio College/Regional
Health Occupations Center in Walnut, California, will create a competency-based
certificate program for entry- level mental health workers. The program expects
to contribute to a more prepared mental health workforce. The curriculum
includes 64 hours classroom study and 6 months' clinical practice experience.
It expects to train between 20 and 50 workers over a six-month period.
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b.
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Promote
the employment of current and former clients in the provision of mental health
services.
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The mental health system's own clients may represent a
ready reservoir of talent that can supply workers for many positions in the
field. An expanding body of research shows that consumers of mental health services
bring skills and compassion to such frontline positions. Training programs
should be developed to maintain high standards of care and full integration of
consumers into the workforce. Programs that ensure appropriate support for
consumers working in mental health services should be developed at local
agencies. Agencies should also come to consensus on the ethical issues raised
by the inclusion of consumers in the mental health workforce; seeing a possible
compromise to patient confidentiality, some agencies prohibit their clients
from taking on provider positions, while others have founds ways to minimize
the issue. Finally, state systems and provider agencies must find ways to
substitute experience for education in qualifications for case management and
other frontline positions. This may require negotiations with a state Medicaid
authority so that providers can bill for experienced peer counselor activities,
thus eliminating a major obstacle to consumer employment.
Example:
New Jersey Division of Mental Health Services, Department of Human Services
The New Jersey Division of Mental Health
Services, Department of Human Services, wanted to open the way for employment
of consumers as peer counselors in Assertive Community Treatment programs
operated in many of the state's counties. While the benefits of this initiative
seemed obvious to the division, Medicaid reimbursement regulations were a
barrier. The state Medicaid agency's willingness to defer to state mental
health agency guidelines made it possible for this plan to move forward.
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c.
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Provide
training that specifically addresses the consumer and family experience of
mental illness.
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While ongoing training of all mental health workers is
necessary to ensure familiarity with developments in the field and to address
deficits in training received prior to employment, specific training by
consumers and family members can help mental health workers better understand
the needs of those they serve. Exposure to the experiences of primary consumers
of mental health services and their families can provide insights that do not
come from much of the training received in classroom or credentialing
situations.
Example:
NAMI Training Courses
State NAMI affiliates in fourteen states have
presented a comprehensive course for providers that is taught by mixed teams of
consumers and family members. Classes are presented throughout the year and
with significant state mental health agency support in Vermont, Connecticut,
Missouri, and Utah. The purpose of the course is to acquaint providers with the
firsthand experience of mental illness. Evaluations of early classes indicate
that staff have changed clinical practice as a result of what they have learned
in the course.
The need for training and cross-training of professionals is
addressed elsewhere in this report but must be mentioned here again for
emphasis (see Chapter VI: Training Practitioners and Policymakers and Educating the Community). With workforce issues, including job frustration and burnout, looming
as large problems in the mental health field, staff training is a tremendously
important function. A workforce in which individuals have a firm grasp of their
role and of the options open to them in the performance of their duties will
provide a more professional response to the challenges faced in the field.
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d.
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Plan to
increase the supply of skilled and experienced mental health providers in rural
areas.
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A separate but very much related issue is the acute
shortage of mental health workers in many rural areas. Particularly in the
rural West, where population density is low, recruitment of psychiatrists and
other skilled professionals presents an enormous challenge. Many counties
report vacancies in key positions lasting several years. Community mental
health therefore takes on a different look in rural areas, especially in the
West. Care may be delivered by whatever professionals are available. Primary
care physicians often take on the role of psychiatrist in rural communities,
and telemedicine and other techniques that allow few professionals to cover
vast areas are widely employed. Wide distances distort the meaning of
"community" mental health, and institutional care at state hospitals
many hours' drive from home can be more common. Practices that have proven
effective in more densely populated districts are often simply impractical in
rural areas.
The unique needs of people with mental illness in rural
states have been explored in detail by the Mental Health Program of the Western
Interstate Commission for Higher Education (WICHE), in Boulder, Colorado. By
collecting and analyzing data on mental health services in frontier counties
(fewer than seven persons per square mile), WICHE has identified the greater
challenges in service provision. At the same time, policymakers and providers
in states with large rural areas have worked to identify services that are
effective in such settings.
Another organization that focuses on the issues in rural
mental health is the National Association for Rural Mental Health (NARMH).
Founded in 1977 in order to develop and enhance rural mental health and
substance abuse services and to support mental health providers in rural areas,
NARMH has added the goal of developing and supporting initiatives that will
strengthen the voices of rural consumers and their families.
Both WICHE and NARMH address recruitment and retention
issues in the rural mental health workforce.
NARMH maintains a job bank on its Web site and provides information on
recruitment through its annual conference.
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