Relations Board. Dorn-Medeiros says the push toward unionization shows it’s not always the work itself causing burnout but a lack of structure and compensation in the workplace. “I want to say it was 2018 or so, some agencies were thinking about unionizing,” says Dorn-Medeiros. “There was no pay scale, or regular raises and people weren’t even getting cost-of-living [raises] year to year. Workloads were getting higher and higher, and some agencies were moving more toward productivity standards, saying, ‘You need to work X number of billable hours per workday. I think after a while, it just came to a head for people. I think it speaks to the fact that it wasn’t people saying, ‘I don’t like working with clients or even in really hard populations,’ it was the pay and the hours and the workload. There really wasn’t a structure for that. I think unions can provide that.” Andy Mendenhall, president and CEO of Portland’s Central City Concern, a nonprofit supporting the city’s unhoused population, says the state’s investment is a good start — but that it will take more to address the crisis. “The way we like to think about this is, you’ve got to attract people to the field, you then need to grow them over time, and you need to make sure their career tracks are sustainable — that these are living and family-wage jobs — and that the conditions upon which folks are working allows you the ability to do your job effectively,” Mendenhall says. “Those are all moving in the right direction. So that’s one arm. The other thing is you need to bring people in who are already trained.” He says addressing the worker shortage will require Oregon licensing boards to make it easier for professionals from other states to get licensed in Oregon. “Where the system needs to evolve is the individual licensing boards for each type of behavioral-health professional have to get out of their own way,” Mendenhall says. “They have to be committed to eliminating barriers for people to come into the state of Oregon and be licensed, and the ways in which those barriers can be eliminated are things like what are referred to as interstate compacts for licensure, and licensure reciprocity. We need licensure reciprocity to be something that each of the licensing boards commits to so that we don’t just rely on a multiyear pipeline to train new people.” “MHRA is committed to removing barriers to entry into the professions we regulate,” wrote Charles Hill, executive director of the Oregon Mental Health Regulatory Agency, in an email to Oregon Business. “I’d point you to our respective websites, where you can read about a diversity study our agency completed and the changes we have implemented. Over the past two years, our boards have made significant changes to our OARs [Oregon Administrative Rules], which has had a positive impact on reducing barriers to entry. These changes also include license-fee reductions for both boards effective 1/1/24 to help reduce barriers. Also, the website contains several good newsletters that highlight many of the positive changes we have made.” Hill went on to say that the idea of an interstate compact like that proposed by Mendenhall is a complex issue, to which his agency is taking a cautious approach. “In a nutshell, there are Oregon constitutional and statutory issues that have to be addressed by the Oregon Legislature and the Governor before our two boards can enter into any interstate compacts,” he wrote. The state is also working to increase pay parity between behavioral-health care workers and workers in other medical professions. In April 2023, Oregon raised the Medicaid reimbursement rate to 100% for psychiatrists, becoming one of eight states with a Medicaid reimbursement rate equal to or greater than Medicare for mental-health services. After years of delay, the OHA is also opening four peer-respite centers across the state this summer, where people experiencing mental distress can stay for up to two weeks and receive support from peer mentors who have also struggled with mental-health challenges. For Jones, who also works on the OHA’s behavioral-health housing-investment team, the work is still just beginning. In order to address continuing issues of burnout, workplace trauma and pay parity, the OHA convened a 21-member work group as part of House Bill 2235 to deliver further policy recommendations to the Legislature by January 15, 2025. Part of the process involves surveying students as they pass through the program, as they tackle the state’s mental- health workforce crisis head-on. “Every time someone reaches out for help and has to call multiple places, every time they show up to an appointment but have to miss it because someone called out, that’s a missed opportunity for that person’s recovery,” Jones says. “Other states have not had this kind of unprecedented investment, so I have a lot of pride in the fact that we’ve been able to push this out and make a difference.” Andy Mendenhall, president and CEO of Portland’s Central City Concern PHOTOS BY JASON E. KAPLAN 31
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