This story is part of a collaborative reporting series with Radio Catskill and the River Reporter examining the state of healthcare in the Upper Delaware River Valley region and beyond.

New York’s mental and behavioral health practices are feeling the pinch from healthcare’s workforce gaps.

In Sullivan County, the mental health practitioner shortage is far worse than New York state’s average, according to a report from New York state Comptroller Thomas DiNapoli. The mental health practitioner ratio is 8.1 practitioners per 10,000 people, compared to 16.1 practitioners in New York state.

For Medicaid eligible residents, the shortage in Sullivan County is among the worst in the state.

Radio Catskill‘s Kimberly Izar spoke with Kevin Larragy, Associate Executive Director at The Arc Greater Hudson Valley, a nonprofit serving more than 2,000 people with intellectual and development disabilities in Sullivan, Orange, and Dutchess counties, about how workforce gaps, the COVID pandemic, and big federal policy changes are reshaping the state’s health systems.

The Arc Greater Hudson Valley also runs Sullivan County’s mobile mental health hotline for children under 18 when a child is experiencing a crisis.

These responses have been edited for clarity and length.

How have your programs changed in recent years? 

Larragy: “Over the past couple of years, we’ve seen a huge increase in need for mental health services, not just among the population we serve, but that reflects a broader trend in increased awareness of and need for mental and behavioral health services – from mental health diagnoses to substance use disorders to combinations of chronic health conditions, mental health conditions, and other disorders.” 

What’s behind that increase?

Larragy: “The pandemic placed a much greater focus on mental health. The entire planet went through something very traumatic.

Through that, I think awareness increased greatly that these were not just wishy-washy services, but vital services that provide essential care and support to people to participate fully in society.”

How has increased service demand affected your workforce?

Larragy: “It’s definitely a challenge. Like every service provider, we’re struggling to fill a variety of roles. Professional roles are becoming more challenging to fill, especially in more rural areas. As we see professionals congregate in more urban areas, areas like ours tend to be overlooked, despite the fact that plenty of opportunities exist.

We’ve been very lucky to have providers on staff for upwards of 20 years, a blessing and a curse because we’ll need to replace those with a declining number of physicians. 

But staffing for direct service professionals is a challenge. It’s a very demanding job. I started as one myself more years ago than I’d care to admit. 

It’s immensely rewarding but challenging. You are placing other people’s needs before your own on a regular basis.”

What state or federal policies have affected your workforce? 

Larragy: “Recent federal changes from H.R.1 capping student loan limits to $200,000, particularly for graduate medical education, are concerning. It immediately limits the number of people who are able to participate in those programs.

A graduate medical degree costs more than $200,000. 

Not everybody has access to those resources, and that, in turn, will stratify the graduates who leave these educational establishments as perhaps less familiar with the daily challenges their patients will face, and so you end up with a health care system that could potentially be less responsive or understanding to the needs of the people it’s supposed to support.”

How have you tried to mitigate these workforce challenges? 

Larragy: “It’s complicated because, as a provider of services in a physical sense, a location determines a lot. Can people access your location? Is it open at the times that they’re available? 

It’s a double-edged sword: your location may be where people need services, but your location may be in a place that providers do not look and think, ‘Oh, I’d love to work in that region’ or ‘I’d love to do this.’

What we find is that finding that balance between being able to pay our staff enough that they’re able to live the life they want, while also having a job that provides them with spiritual or psychological value is key.

We’ve done a very good job of getting there. It’s an ongoing process, and it’s not one I don’t think we’ll ever be at a finish point and say, ‘Yeah, we’ve cracked it.’

We’re trying to make sure we’re being very clear about the opportunities that do exist. Sullivan County and the Sullivan County Department of Mental Health and Community Services have just been a fantastic partner. They’re very collaborative in strategizing on what we can do to make people aware of the fact that this is a great place.”