This article is part of a series about mental health in Washtenaw County. It is made possible with funding from Washtenaw County's Public Safety and Mental Health Preservation Millage.
According to the University of Wisconsin Population Health Institute's County Health Rankings and Roadmaps, Washtenaw County has one mental health care provider per 160 residents
. With an estimated population of
almost 370,000 as of July 2021, that makes for roughly 2,300 mental health care providers available to county residents and puts the county in the 90th percentile nationwide for providers per capita. But as awareness of the importance of behavioral health has grown in recent years, those suffering from mental health issues and those who want to treat them have one thing in common: a need for more providers.
"Recruiting is one thing. Retaining is another, and level of pay is a big part of that," says Nancy Baum, health policy director at the Center for Health and Research Transformation
in Ann Arbor. "If you lined up all the different types of doctors by pay, you would see at the bottom [that] the physicians that are paid the least are pediatricians, primary care physicians, and psychiatrists. When you have a medical degree and you can do whatever you want with it, psychiatry is not always the one you go for."
In Michigan, according to salary.com, the average salary for psychiatrists
is around $241,000, while the average salary for cardiothoracic surgeons
– those who specialize in the heart, lungs, and esophagus – is around $500,000. The average clinical mental health counselor
in Michigan makes drastically less than even a psychiatrist: $52,420.
But the financial issue goes even beyond salary. Despite Medicaid being the largest payor to behavioral health services in the country, Baum notes that Medicaid pay rates are low enough that some providers will not see patients covered by it.
"That just isn’t the case for any other specialty," Baum says. "There’s a real disconnect between what Medicaid is paying and what behavioral health providers are charging."
Center for Health and Research Transformation Health Policy Director Nancy Baum.
Baum also says some providers will only see patients covered by private insurance, or only allow patients to pay out of pocket for the services they require, due to that disconnect.
Trish Cortes, executive director of Washtenaw County Community Mental Health
(CMH), echoes Baum's sentiment that recruitment and retention are two very different challenges.
"Here at CMH, historically, we’re pretty competitive in terms of recruiting," Cortes says. "But there are some disciplines that are more difficult to recruit for, and one of them specifically is nursing, especially when you’ve got all these health systems around us. It’s difficult to compete."
That difficulty has led CMH to contract a talent recruiting firm in order to fill positions, something Cortes says the agency has never had to do before.
"What we’re seeing more and more of is people, all of a sudden, will rescind accepting their offer because they’ve found a different position that pays better," she says.
Washtenaw County Community Mental Health Executive Director Trish Cortes.
CMH is a Certified Community Behavioral Health Clinic, meaning that there is no waiting period to be seen by a physician at CMH, and a patient can be seen no matter what level of mental health care they require. Cortes describes CMH as a "front door," where patients can either stay and be treated, or be referred to another provider in the area that may better suit their needs. Cortes says Washtenaw County is lucky to have a "strong prescriber group" compared to most other areas.
"We are also a training ground for those prescribing disciplines, like psychiatry or nurse practitioner," she says. "We find people that really seek working with our populations as mission-driven."
Being driven by a mission to help those in need seems to be one of the stronger remedies for this particular employment shortage, which is exactly what Doug Campbell, CEO of the Ypsilanti-based nonprofit provider Hope Clinic
, has been emphasizing for his staff of over 1,000 volunteers.
"We’ve doubled down on mission and culture," Campbell said. "We attract a particular person that is keen on the mission and culture that we live out."
Hope’s mission is centered around a Zulu greeting, "Sawubona," which translates to "I see you," and greets the whole person where they are in that moment. Campbell explains that Hope is the first free clinic to offer "whole person behavioral health care," offering not only traditional physical and mental health care services for free, but also dentistry and food needs like grocery delivery and food pantries.
Hope Clinic CEO Doug Campbell.
Hope raises around $3 million each year to keep its doors open, and is currently running a $5.5 million campaign to further expand services. Campbell says $2 million of those funds will go to a program to integrate behavioral health care into all of Hope's services.
"If you come in for food services, there will be someone to provide instant behavioral care," Campbell said. "We provide a space both to give help and get help. If you need help, you come here for that whole person care, and if you want to serve, then fill out a volunteer form on the website
Other incentives outside of mission-driven motivation may help bring more mental health care practitioners into the field. Those include loan forgiveness programs for physicians both at the state level, through the Michigan State Loan Repayment Program
, and at the federal level
. These programs may reward mental health providers who work in low-income or rural regions, or in specific programs like addiction and recovery services or pediatrics.
Behavioral health can be an emotionally difficult field to make a career in. However, it's just as important as physical health, which makes that emotional difficulty more fulfilling for those who choose to pursue it.
"Most people want to help," Campbell says. "Even when they have the motive of the job paying well, they want to help, but they don’t know how. At Hope, we will give you the opportunity to serve."
"I tell [CMH] staff all the time [that] they work small miracles every day," Cortes says. "It’s just incredibly important work, and incredibly fulfilling. It’s not for everyone, but it’s pretty inspirational work."
Rylee Barnsdale is a Michigan native and longtime Washtenaw County resident. She wants to use her journalistic experience from her time at Eastern Michigan University writing for the Eastern Echo to tell the stories of Washtenaw County residents that need to be heard.
All photos by Doug Coombe.