Sacramento County needs therapists for 911 strike teams. It won’t be easy to find them

Sacramento County wants more mental health and medical professionals in its jails and on the streets. Here’s the problem: So do schools, hospitals, nonprofits and other municipalities.

As a result, county officials are girding for intense competition in the next year as they look to hire enough experienced therapists to staff a new program that will respond to 911 calls involving homeless and mental health crises.

Therapists will respond to emergencies without police officers under the $12 million venture funded by the Board of Supervisors this month, replicating a well-known program in Eugene, Ore., and other cities. The team of therapists will operate a call center and respond to emergency mental health calls in unincorporated parts of the county and all cities except Sacramento. County officials expect it to launch by July 2022.

The effort is aimed at relieving law enforcement of the type of calls that advocates have long said are better suited for a counselor or therapist and sometimes end in deadly confrontations. In 2015, Sacramento County received funding to begin pairing mental health counselors with law enforcement agencies and until recently could only staff six of the 11 teams funded.

One of their big hurdles for the mobile crisis support teams, although not the only one, was finding the right people.

County officials said there is intense competition for therapists, and the lingering pandemic is keeping some candidates away. Critically, the jobs they’re trying to fill are difficult and could involve intense encounters with people in crisis.

“This is specialized work. If you’re a clinician used to doing family therapy in an office, this might not be the right role for you,” said Ryan Quist, who oversees the county’s behavioral health services division. “We’re looking for somebody with specialized experience, the right skill, expertise, experience and comfort level to be able to do this type of work.”

Quist and other administrators also said there is a shortage in California and beyond of licensed mental health professionals to fill an increasing number of jobs as stigma around therapy declines. The race for talent means the county often competes with school districts for workers and larger organizations like Kaiser Permanente.

The anticipated needs in the community are likely significant: The Sacramento County Sheriff’s Office once estimated that it received nearly 2,800 calls related to mental health in 2019 and more than 18,700 calls related to homeless issues.

The idea for the new program, which is being called the mobile field response team, was first suggested by activists and supported by the Board of Supervisors.

Public programs like those created by Sacramento County usually have the hardest time finding therapists, said Jane Adcock, executive director of the California Behavioral Health Planning Council.

“There are so many other systems that want and need licensed and experienced mental health professionals and the public system is just right in there vying at the same time,” Adcock said.

‘Mixed evidence’ on shortage

A study by the Healthforce Center at UCSF projected that there would be a shortage by 2028, leaving the state with between 12% and 40% fewer mental health workers than needed.

There are a handful of paths into the mental health profession, but California’s workforce is largely made up of marriage and family therapists, social workers, and psychologists. In the UCSF report which relied on data from 2016, the Sacramento region had fewer psychologists and marriage and family therapists per capita than the state average.

In the years since, however, the region has added more than 1,000 licensed mental health professionals, according to data tracked by the Department of Consumer Affairs. More than 400 additional therapists were licensed in 2019 compared to 2016; about 340 more social workers; 150 more clinical counselors and 100 additional psychologists, the data shows.

A report later published by the Legislative Analyst’s Office concluded that there was only “mixed evidence” of a shortage, citing an uptick in the number of recent graduates. The nonpartisan agency cast doubt on the assumption because salaries for mental health professions were not growing at a rapid pace — a possible sign of intense competition.

While the shortage might be in dispute, health care organizations said the challenge is real.

“It’s incredibly competitive. I don’t know of any agency that isn’t struggling to find either qualified clinicians or even paraprofessional staff with the skills to do the kind of work we do in the community,” said Diana White, chief operations officer at the Turning Point Community Programs. “I’ve never seen a time as hard to bring those people on as now.”

White said the nonprofit often recruit early-career therapists who are still working to gain enough hours for licensure. She said it’s not unrealistic for them to later double their salary after leaving to work for a hospital, adding that the pay is so high they “can’t really touch” it as a non-profit.

Salaries for senior mental health counselors in Sacramento County government, for example, range between $78,000 and 86,000, according to state data. According to the website Glassdoor, which crowdsources salary information, the average marriage and family therapist at Kaiser Permanente earns about $50 an hour, or $104,000 a year.

“We get a lot of people in our organization who are really passionate to do the work,” White said. “Even with that passion though, the kind of pay we can provide our employees in a place like Sacramento where rents have gone up so high — even if they want to stay working with us it becomes harder and harder.”

Before the new alternatives to 911 program was approved during the county’s recent budget meeting, top health officials made sure to point out the challenges ahead. Chevon Kothari, the county’s new director of health services, said they will need to do “full-scale” recruitment and outreach for the positions.

“It will take us some time,” Kothari said. “We don’t anticipate we will be able to hire and fully staff up until mid-year.”

This story was originally published June 24, 2021 at 5:00 AM.