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The New York state Capitol in Albany

ALBANY — Recruiting staff to provide mental health services has been a struggle for years. But that challenge has grown far more daunting during the pandemic.

That was among the messages delivered Tuesday by mental health administrators and care association leaders as they urged state lawmakers to back their push for greater state support to help stop the attrition that has accelerated over the past two years.

"The burden on the front-line clinical staff is unrelenting," said Anne Constantino, the president of Horizon Health Services, a nonprofit agency that has programs throughout Western New York, with several sites in Niagara Count. Horizon serves more than 14,000 people annually, with about 750 staffers and 41 current vacancies.

She said the programs recently averaged one critical incident per day: a fatal overdose, a suicide, an attempted suicide or an overdose that was reversed through intervention.

Because of Horizon's inability to match the pay some other employers offer, Constantino said recruitment is a constant struggle, even though her company has received a New York State "Best Companies to Work" designation for 13 consecutive years.

"It is virtually impossible to do this work and make ends meet," Constantino said, lamenting that government reimbursements are insufficient to keep the operation sustainable.

When a therapist moves on to another job, it is not merely inconvenient for Horizon, she pointed out; it can be devastating for the patient who had grown to rely on the assistance offered by that counselor.

The current staff turnover rate is 28%, up from 22% last year, she said.

Across New York, mental health service providers are dealing with three crises at once, said Harvey Rosenthal, director of the New York State Association of Psychiatric Rehabilitation Services.

Those crises are the impacts of COVID-19; the surge in demand for services responding to trauma, anxiety, depression, youth suicide and overdoses; and the state's "inability" to address the demand after years of inadequate funding, Rosenthal said.

The state, he said, has "reneged" on previous commitments to provide annual cost-of-living adjustments to mental health workers.

"As a result, we have seen a steady stream of workers leaving or not even applying for community-based behavioral health positions," Rosenthal said.

Meanwhile, the state psychiatric treatment programs have been wrestling with their own workforce challenges. Randi DiAntonio, vice president of the Public Employees Federation, said the state Office of Mental Health has been "bleeding nurses" because of stress from working during the pandemic and mandatory overtime, coupled with opportunities to increase their pay by taking more lucrative job offers.

"We're losing services as fast as possible when we have waiting lists of families in crisis," DiAntonio said. "We have people sitting on gurneys in emergency rooms, calling 911, because they don't know where else to go."

The state has attempted to patch some of the labor shortages by retaining contract nurses, outside the civil service system, she said, adding: "But, frankly, they can't keep them, either."

DiAntonio urged lawmakers to supporting a review of salary grades for mental health professionals employed by the state, along with performance incentives.

"We have people who are dedicating their lives to taking care of those with mental illness, and they have been treated pretty badly by their employer," she said.

The state government announced last month it is channeling $21 million in federal stimulus funding to increase access to mental health care and support the behavioral health workforce. But DiAntonio noted that money will go to providers outside the state's own psychiatric programs.

The advocates for the service providers are urging lawmakers to back a $500 million state funding commitment in the next state budget for the wide array of programs providing mental health services. They also said a 5.4% cost-of-living adjustment is crucial to address the staffing and retention challenges.

"I should tell you that staff who are seeing a lot of death and a lot of misery are traumatized," said Lauri Cole, director of the New York State Council for Community Behavioral Healthcare. "There is collective trauma across our workforce, and that as well as the lack of adequate salaries drive people out the door — and they are leaving in droves."

After working in the mental health field for more than 40 years, Rosenthal said he has never observed the system under such stress as it is now.

"We're on life support — and we need to be resuscitated," Rosenthal said.

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