According to county health rankings and roadmaps from the University of Wisconsin Population Health Institute, Washtenaw County has one mental health care provider for every 160 residents. With an estimated population of nearly 370,000 as of July 2021, which represents approximately 2,300 mental health care providers available to county residents and places the county in the 90th percentile nationally for providers per capita. But as awareness of the importance of behavioral health has grown in recent years, those who suffer from mental health issues and those who want to treat them have one thing in common: a need for more providers.
“Recruitment is one thing. Retention is another, and the level of compensation is a big part of that,” says Nancy Baum, director of health policy at Health and Research Transformation Center in Ann Arbor. “If you lined up all the different types of doctors by salary, you would see at the bottom [that] the lowest paid doctors are paediatricians, general practitioners and psychiatrists. When you have a medical degree and you can do what you want with it, psychiatry is not always what you are looking for.
In Michigan, according to salary.com, the average salary of psychiatrists is around $241,000, while the average salary of cardiothoracic surgeons – those who specialize in the heart, lungs and esophagus – is around $500,000. The average clinical mental health counselor in Michigan earns considerably less than a psychiatrist: $52,420.
But the financial question goes even beyond the salary. Although Medicaid is the largest payer for behavioral health services in the nation, Baum notes that Medicaid pay rates are low enough that some providers don’t see patients covered by it.
“That’s just not the case for any other specialty,” Baum says. “There’s a real disconnect between what Medicaid pays and what behavioral health care providers charge.” 
Nancy Baum, director of health policy at the Center for Health Transformation and Research.
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 need, because of this 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’ve been pretty competitive in terms of recruiting,” Cortes says. “But there are certain disciplines that are more difficult to recruit for, and one of them is specifically nursing, especially when you have all these health systems around us. It’s difficult to be competitive.”
That difficulty led CMH to contract a talent recruiting firm to fill positions, something Cortes says the agency has never had to do before.
“What we’re seeing more and more is people, all of a sudden, are going to rescind their offer because they’ve found a different job that pays better,” she says.
Trish Cortes, executive director of community mental health for Washtenaw County.
CMH is a Certified Community Behavioral Health Clinic, which means there is no waiting period to be seen by a doctor at CMH, and a patient can be seen at any level of health care. mind he needs. Cortes describes CMH as a “gateway,” where patients can either stay and be treated or be referred to another provider in the area who might better meet their needs. Cortes says Washtenaw County is fortunate to have a “strong prescribing group” compared to most other areas.
“We are also a training ground for prescribing disciplines, such as psychiatry or nurse practitioner,” she says. “We find people who are genuinely looking to work with our people as a mission.”
Being driven by a mission to help those in need seems like one of the best remedies for this particular job shortage, which is exactly what Doug Campbell, CEO of the Ypsilanti-based nonprofit provider Clinic of Hopefocused on its team of over 1,000 volunteers.
“We doubled down on mission and culture,” Campbell said. “We attract a specific person who is interested in the mission and the culture we live in.”
Hope’s mission centers around a Zulu greeting, “Sawubona”, which translates to “I see you”, and greets the whole person wherever they are at the time. Campbell explains that Hope is the first free clinic to offer “whole person behavioral health care”, offering not only traditional free physical and mental health care services, but also dental care and dietary needs like delivery. groceries and pantries. 
Doug Campbell, CEO of Hope Clinic.
Hope raises about $3 million each year to keep its doors open and is currently running a $5.5 million campaign to expand its services. Campbell says $2 million of those funds will go toward a program to integrate behavioral health care into all of Hope’s services.
“If you come for food service, there will be someone there to provide instant behavioral care,” Campbell said. “We provide a space both to give help and to get help. If you need help, you come here to take care of the whole person, and if you want to serve, fill out a form volunteering on the website.”
Other incentives outside of mission-driven motivation can help attract more mental health practitioners to the field. These include loan relief programs for doctors at the state level, through the Michigan State Loan Repayment Programand at Federal level. These programs may reward mental health care providers who work in low-income or rural areas, or in specific programs such as addiction and recovery services or pediatrics.
Behavioral health can be an emotionally challenging area to pursue in a career. However, it is just as important as physical health, which makes this emotional difficulty more fulfilling for those who choose to pursue it.
“Most people want to help out,” Campbell says. “Even when they have the motive of well-paying work, they want to help, but they don’t know how. At Hope, we will give you the opportunity to serve.”
“I say [CMH] staff all the time [that] they do little miracles every day,” Cortes says. “It’s incredibly important and incredibly fulfilling work. It’s not for everyone, but it’s quite inspiring work.”
Rylee Barnsdale is a Michigan native and longtime resident of Washtenaw County. She wants to use her journalism background 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 pictures of Doug Combe.
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