To address homelessness crisis, L.A. County needs mental health workers, fast
An $18,500 stipend to help pay for graduate school. Student loan forgiveness. Free on-the-job training. All license fees paid. And the chance to serve the under-served — “with dignity.”
“Do Worthwhile Work,” the new marketing campaign of the Los Angeles County Department of Mental Health, highlights these perks on its website in the hope that job candidates will see the benefits of public sector mental health work, and apply.
“Your work can change lives,” the campaign reads. “Leave today better than you found it, LA County DMH has a place for you.”
Many places, in fact: As of mid-September, the agency had a vacancy rate of 28%, with 1,890 vacant positions and just over 4,800 employees, according to county data.
For decades, the department didn’t need marketing campaigns or too many perks to get people to apply for jobs. But in recent years, the largest county mental health department in America has seen a decline in applicants.
Before the COVID-19 pandemic, demand for mental health practitioners was already exceeding the supply. Many in California were retiring, and master’s programs and medical schools were not turning out enough therapists, psychologists or psychiatrists to replace retirees, or meet the growing demand, according to recent research on the state’s behavioral health workforce.
If workforce trends continue, California is projected to experience a shortage of 5,000 mental health practitioners by 2026, according to research by consulting firm Mercer.
Demand has only grown as more Americans than ever, struck by the uncertainty and misery brought by the COVID-19 pandemic, sign up for therapy. New therapists who would have traditionally started out in the public sector are being recruited by private companies that offer bonuses, flexible schedules and remote work — and patients who, while still struggling, aren’t unhoused or suffering from acute psychosis made worse by years of life outside.
Internally, the Department of Mental Health still hasn’t recovered from the 18-month countywide hiring freeze, implemented by the Board of Supervisors at the start of the pandemic to save money amid disaster. That left many important administrative positions unfilled. And it can still take months to get hired at the county because of civil service rules that dictate how hiring must be carried out.
Of the 103 people the department hired in August , it took an average of 227 days from the time the candidate submitted an application to when they started their job.
The county’s Department of Mental Health says people declined or left positions for various reasons during the pandemic, including the opportunity to work full time in telehealth. But the county says it’s beginning to see a rebound in interest.
The department’s vacancies have stymied progress in addressing L.A. County’s homelessness crisis as pressure mounts from an impatient public. A lack of workers has meant longer response times from teams who respond to mental health crises called in on the 988 hotline. It has delayed care — in 2021, it took an average of 27 days to see a county psychiatrist in clinic. It has also led to burnout among existing staff, who work longer hours to make up for the lack of new talent, a point supervisors discussed at a recent meeting.
And it’s made implementing changes coming down from Sacramento challenging. On Dec. 1, L.A. County will launch Gov. Gavin Newsom’s Community Assistance, Recovery and Empowerment Court. If they don’t have enough staff hired, they’ll pull people from existing programs until hiring is complete, according to department documents.
“There is no doubt we have two crises — the immense mental health crisis in our communities and the challenge in our own Department of Mental Health to hire enough people to respond to it,” Board of Supervisors Chair Janice Hahn said in a statement. “My vision is that we will have enough mental health professionals to not only be in encampments working with people suffering from mental illness on our streets, but also enough to respond immediately to emergency mental health calls, and hiring has held us back.”
CARE courts open in several California counties Oct. 2. Some families and others question the voluntary-compliance aspect of the mental illness law.
These challenges have forced the Department of Mental Health to get creative.
It has started holding hiring fairs where applicants get offers on the same day they interview. These events have especially targeted hard-to-fill positions — and are showing results.
In the last five months, Hahn said, the mental health department hired 272 people at fairs, including 37 to join its homeless outreach teams and 30 who will respond to emergency mental health calls, which have seen a recent improvement in response times.
These hiring events are like a speed-dating session between employers and applicants. On a recent Thursday at the department’s headquarters in Koreatown, dozens of recent master’s of social work graduates filed into a meeting room to hear elevator pitches from almost 20 mental health clinics.
Each hiring manager briefly explained the benefits of working at their location.
“We’re one of the busiest clinics” in our service area in Willowbrook, one manager said. “What helps in our work is to have purpose and meaning, and you can find it there,” a manager from a Compton clinic said.
A supervisor from a San Pedro clinic said it has “one of the strongest housing programs” in its area. “We like to celebrate,” a manager from a Long Beach clinic said, describing its many potlucks and nacho dinners. “We try to support one another.”
The energy among participants was jovial, a mix of nerves and polite laughter — until a social worker in the audience asked about caseloads.
The supervisor from a Skid Row clinic shot straight. If hired there, she said, they’ll have about 150 clients, which will include patients who come in twice a year for check-ups of their medicine regimen as well as clients in crisis who come in frequently.
“Many of these other clinics have that many [on their caseloads] too,” she added, to polite laughter around the room.
Nicole Pyles sat nearby, reminding herself to start breathing again. Pyles, a recent graduate of the USC School of Social Work, had ranked that Skid Row clinic as her No. 1 choice before the event started.
“I thought, ‘Pssh, I got this, I’m not worried about it, I’ve had caseloads as high as 30 people,’ ” said Pyles, 47. “When she said 150 people, I think my heart jumped out of my mouth and was somewhere on the floor.”
Pyles previously worked as a substance abuse counselor, which doesn’t require a master’s degree to get certified and see clients.
But Pyles knew that for many of her clients, their addiction was much more complicated than brain chemicals making them crave a substance. She wanted to get to the root of the problem, namely the trauma fueling their addiction. Such work requires a master’s degree.
Pyles was happy enough, though, working in her last job with pregnant and postpartum clients struggling with substance use disorders.
That was until a client who’d diligently worked with the program for a few months asked for help. The client’s court date to keep custody over her newborn baby had been moved from Monterey Park to the Antelope Valley, and she needed a ride.
Pyles thought she could help with that. Her supervisor, though, told Pyles she was “enabling” this woman and declined the request.
In that moment, Pyles realized she wanted the power to help in a bigger and more meaningful way.
“A friend of mine told me, ‘If you want to make those calls, and you want to be able to make the decisions, you’ve got to get your education,’ ” Pyles said. “And that’s exactly what I did.”
After finishing her master’s at USC, she agreed to work at the downtown Skid Row clinic — committing to the county for a year after accepting an $18,500 stipend. “My goal is to remain at DMH, and move up to leadership,” she said.
These are the kinds of practitioners that Lisa H. Wong, director of the Department of Mental Health, said her department has started to attract.
The department and its contract agencies did take a hit early in the pandemic, when workers across the country reassessed the type of work they wanted.
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Wong said when she worked as a clinical supervisor at a facility in Skid Row 15 years ago, she held recruitment events that brought in dozens of candidates who wanted to work there, even though “admittedly [it] is not for everyone.”
Comparatively, about a year and a half ago, when she held a recruitment effort for adult mental health positions across the county, she got just 13 applicants.
But in recent months, Wong said the department has noticed another shift.
“I know I’ve been accused of being an optimist at times, I do think the tide is turning,” Wong said, noting that hiring and promotions have increased 200% this year. “What we’re seeing now is sort of the blessing in disguise of the nationwide staffing shortage — who we’re getting now are those people who are the true believers, the urban missionaries.”
Beyond the hiring fairs, the department is also renewing academic affiliations with graduate programs, which will lead to more internships there, and for the first time, will start recruiting at conferences and campuses out of state.
The department went to recruit at the American Psychological Assn. conference in Washington, D.C., where LGBTQ+ clinicians told county staff they really wanted to move to California because they didn’t feel safe in their home states.
“But alongside that, we had a lot of people say, ‘I would love to move to California, I would love to live in L.A., but I don’t think I can afford it,’ ” Wong said.
Wong said they will focus much of their attention on recruiting at historically Black colleges and universities, bringing current county staff who are alumni to talk about working at the department.
“We need more clinicians who look like our community,” Wong said. “I would love for an African American little boy to be able to meet with a Black psychologist, and know that not only can they open up and have some cultural understanding but also this is somebody he can aspire to be as well.”
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