Staffing shortages in Solano County’s mental health programs have led to major delays in treatment for those in need, according to county employees who are members of the SEIU. The union held the last of three days of strike voting on Thursday, as workers are also trying to negotiate a fair contract with Solano County management to no avail thus far, despite months of negotiations.
SEIU Local 1021 released an advertisement earlier this week outlining the situation, featuring Solano County employee and Licensed Mental Health Clinician Sarah Soroken.
“We all know that Solano County is facing a severe staffing crisis, but what does that mean in practice? “Soroken said in the ad. “That means it’s almost impossible for new patients to get connected to individual therapy through our county’s mental health programs.
The wait can be months from intake to first appointment, she said.
“I know firsthand,” Soroken said. “During these extended waits, I’ve seen patients self-harm and require emergency psychiatric care. We need more staffing.”
Soroken said she worked in Behavioral Health Services for the first two and a half years she spent with the county. She has since transferred to Family Health Services and has seen the impacts of staffing shortages in both, particularly in behavioral health.
“Ever since I started, there have been waitlists, especially for adults, for any kind of care other than medication,” she said.
Medicating patients without any other mental health treatment is not evidence-based care at the onset of treatment, Soroken said, and patients often struggle as they wait to speak to a professional.
“People are getting worse and suffering, and they are slipping through the cracks while they are waiting months and longer for therapy and other support,” she said.
Patients on waitlists often require crisis visits and emergency evaluations while still waiting, she said, which Solano County staff see reflected later in the patients’ charts. Emergency care is more intensive and costs more than scheduled care, Sorokin said, not to mention the inhumanity of forcing vulnerable patients into dangerous situations and mental health crises.
“I switched over to family health because of that moral injury,” she said.
Staffing issues in the department reflect the countywide staffing shortages due to a lack of recruitment and retention by the county, Soroken said.
“The fact is, the pay and the working conditions don’t keep people or attract people to that job,” she said of behavioral health roles.
Private practice roles deal with less acute patients and are able to accept out-of-pocket pay rather than insurance, Soroken said. The mental healthcare system is stacked heavily against the less privileged, she said, who disproportionately experience severe mental illness. Soroken said a significant minority of people she has treated for the county are homeless with unmanaged mental issues.
“It impacts actual people’s lives, and what you see,” she said.
“The likelihood of them being able to obtain and maintain stable housing is less, and so it also impacts what you see on the streets, the suffering that you see,” she continued.
Contrary to messaging from policymakers, Soroken said California does not face sweeping shortages of public mental health professionals. In core urban areas, she said, municipalities exhibit sufficient funding and willingness to fund these programs at much higher rates than in Solano County.
“It’s important to note that the county has not exhausted its options to have an adequately staffed workforce,” she said.
Quality of life improvements for employees would go a long way, she said, and something as simple as an option for alternate scheduling could help bolster retention.
“Our job, even in the best of situations is very stressful and takes a lot out of you,” Soroken said.
Soroken said it is generally cheaper to meet legal requirements by staffing enough to meet demand rather than paying fines and making legally mandated corrections later. She said the Family Health Services is under a corrective action plan with Partnership Health Plan of California due to lack of access to pediatrician appointments.
“At what point do sanctions or fines or things like that factor into budget?” she said. My thought is it would be better to have a stable, well-staffed workforce and to serve people before they need higher-level, more expensive care.”
Adult patients on initial assessment often seek mental healthcare after discharge from incarceration, when facing homelessness or substance use concerns, she said. Severe trauma and emotional pain can be compounded by the wait.
“It really broke my heart because these are people who have suffered their whole lives and really are reaching out for health,” Soroken said.
Soroken said Solano County has a moral and legal obligation to provide better care to its patients and thus better compensation and treatment to its mental health professionals. She said Solano County’s Board of Supervisors must take social services seriously rather than ignoring them and not doing their job to keep the community safe and healthy,” she said.
Soroken asked policymakers to prioritize the county’s purpose as a service provider to those most in need in the community. She said a hired bargaining team runs negotiations for the county, and that employees have not negotiated directly with supervisors on the issue.
“It feels like at this point there needs to be more of an effort to come together and figure this out,” she said.
In the event of a strike, Soroken said, Solano County and labor groups come together to make decisions on which essential staff must stay on for safety reasons. Not all county employees represented by striking groups would strike. Also, she said every health insurer in the state is required to pay for out-of-network care when in-network options are not available. However, she noted that is not always taken seriously or enforced.
“What planning at the leadership level at the county has happened to ensure that everybody gets the care that they need if there are many healthcare workers that are out on strike?” she asked.
Jaron West, another mental healthcare provider for Solano County, echoed Soroken’s concerns.
“There is an extreme shortage of both therapists and psychiatric providers; we just lost a couple more,” he said.
West said new patients regularly wait six to 12 months to receive care, including those suffering from suicidal ideation.
“It’s unacceptable that we do not have the staff to get them in sooner,” he said.
Despite not being set up for success by their employer, West said county workers are doing everything they can for their patients.
“We are a small group of very dedicated individuals who are trying to serve this county,” he said.
West said he is frustrated that policymakers have not stepped up with a fair contract.
“What they are currently offering in terms of wages is frankly an insult to the hardworking employees here,” he said.