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San Diego needs to double behavioral health workforce by 2027, report finds

Rates of substance abuse and psychological distress are in increasing in San Diego County. At the same time, the region is facing a shortage of behavioral health workers.

A new report from the San Diego Workforce Partnership revealed the region needs to more than double the behavioral health workforce by 2027.

"Over the next five years we need to recruit more people ... currently work in this field —that’s a very, very tall order," said Daniel Enemark, chief economist at the San Diego Workforce Partnership.

In addition to reviewing publicly-available data, 1,600 behavioral health workers and students were surveyed for the report. Results found the majority of jobs in the field are underpaying.

Enemark presented the report's findings to local providers during a recent behavioral health symposium.

"This is a problem," he said. "We can’t recruit and retain people if we’re not paying them."

Officials estimate between the private, public and nonprofit sector there are currently 17,000 behavioral health workers to serve a county of more than 3 million people.

"The current behavioral health workforce is meeting a lot of the need but not all of it," Enemark said.

According to the Workforce Partnership, to meet the growing need and replace people leaving the field, about 18,000 more workers need to be hired in the San Diego region over the next five years. That includes peer support specialists, counselors, social workers, psychiatrists and other medical staff.

"I would say nowhere in America has built out the system of behavioral health care to provide the right care to the right person at the right time, and I want San Diego to be the first," said San Diego County Supervisor Nathan Fletcher during the recent symposium.

Fletcher commissioned the study. He said no one entity can fix the gap overnight, but many must chip in.

"We’re hoping to not only leverage our friends in philanthropy, to have the county join, to have the state join and we’ll be going to Washington D.C. to advocate for funding there because we’ve got to develop a system that gets the right person the right care at the right time," Fletcher said. "And investing in the workforce is a vital component."

For Fletcher, this issue is personal. He said he had a turbulent and traumatic childhood. Then as a U.S. Marine had multiple combat deployments.

"I've watched the impact of combat weigh not just on me but on my friends and I know how serious that is, but the reality of trauma is it's not just Marine and Navy SEALS in war who go through this, trauma is trauma," Fletcher said. "Anyone who survived a sexual assault, anyone who has been in a difficult situation could be experiencing it and it pains me deeply that we don't treat issues of mental health the same way we do physical health."

The county has been investing more year over year. The last four budget cycles have resulted in a $230 million increase in behavioral health services, with the overall budget approaching $900 million.

Local nonprofits also get county contracts to provide behavioral health services in the region, but some argue that system is outdated and does not keep pace with rising costs of living.

"Right now the county is allowing us to do hire-on bonuses, but we also need to do retention bonuses," said Cathryn Nacario, CEO of the San Diego chapter of the National Alliance on Mental Illness, or NAMI. "We need to be able to reward the staff who stuck with us, especially during the pandemic."

NAMI San Diego works with up to 40,000 San Diegans a year. Nacario said some of her staff are leaving the field due to burnout.

"Individuals are also leaving for higher paying jobs within the same industry because there’s such a workforce shortage," she said. "What we’re seeing happening is folks are leaving for $1 or $2 more per hour and literally giving no notice. Saying, 'Hey I'm going to work for so and so and I’m leaving tomorrow.'"

The Workforce Partnership estimates the price tag for hiring and training 18,000 additional workers would be around $424 million. They recommend a "down payment" strategy, which calls for investing $128 million to bring on 4,250 workers over the next five to 10 years. Nacario is part of the steering committee that aims to put these goals into action.

"This is truly where the work begins," she said. "We don’t want this to go up on a shelf and gather dust. So we have to get a group of core individuals together to make sure over the next two, three, five, seven years this continues to move forward."

The Workforce Partnership also recommends developing a regional training hub to create a steady pipeline of behavioral health workers.

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