In early 2022, the Administration and Virginia legislators wrestled with a worsening workforce crisis impacting the healthcare industry with a particular focus on behavioral health. Various budget amendments to support the 40 locally-funded community services board (CSB) direct care workforce were proposed and discussed. The result of those discussions was instruction to the Department of Behavioral Health and Developmental Services (DBHDS) to examine the CSB workforce and report those findings back to the General Assembly.

After collecting and reviewing all available data pertaining to CSB compensation, turnover, and vacancy, as well as conducting an exhaustive interview process to gain perspective on the realities in the field, DBHDS reports the following:

• A workforce crisis does indeed exist within Virginia’s publicly-funded behavioral health system. Vacancy rates for direct care staff at multiple levels are alarming. These vacancies are impacting service delivery across the mental health, substance use, and developmental disability system.

• Using available compensation data, CSB compensation for specialized positions like Licensed Mental Health Professionals is well below market average in most areas.

• While the data collected demonstrates Virginia has a workforce crisis within the public behavioral health system, it is has limited utility in informing curative action due to the difficultly in conducting comparative analysis on the highly-variable CSB workforce.

• While compensation is a fundamental driver of the issue, factors other than compensation contribute to the workforce crisis. These include tremendous administrative burden and certification-related regulatory barriers impacting Virginia’s CSBs.

Of particular concern is the code-mandated Emergency Services function that is unique to CSBs and the closely-related crisis continuum of care. These community-based functions are critical to the health and wellbeing of Virginians and to the Commonwealth’s goals of transforming the behavioral health landscape to a more community-based system of care.

Addressing these workforce issues is of paramount importance and DBHDS has provided the following recommendations for consideration:

Recommendations

1. Budgetary relief of compensation issues within the CSB system should be addressed despite the available data not being sufficient to clearly define a curative action. It is also important to recognize that certain critical segments of CSB staff have a tremendous effect on other system partners. For example, the solvency of CSB emergency services staff is hinged to the success of the ECO/TDO process and has a significant impact on state and private hospitals and law enforcement.

2. This report lists two issues impacting the CSB workforce that are unrelated to compensation: administrative burden and certification malalignment. Additional impetus behind these efforts can positively impact the workforce.

3. DBHDS recommends support for various health workforce initiatives that are underway across the Commonwealth to ensure the pipeline of available workers supports long-term needs. Specifically, DBHDS highlights the recent report from the Claude Moore Charitable Foundation: Virginia’s Human Services Workforce: Strategic Investment Initiatives Report as a key and current document outlining the workforce issues across human services as well as proposed path forward with specific considerations for behavioral health.