The critical shortage of mental health physicians is prompting Stanislaus County to take a bold approach

Facing a shortage of licensed physicians and the challenges of the mental health crisis, Stanislaus County officials think lay counselors could serve a purpose.

The county’s Behavioral Health and Recovery Services is sending 50 case managers and outreach workers to a local academy to be trained as lay mental health counselors.

Modesto psychologist Elizabeth Morrison created Integrated Behavioral Health Services for Golden Valley Health Centers in the 2000s and now runs The Lay Counselor Academy with a colleague from Oakland.

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Morrison said he created the academy eight months ago to train people without qualifications or licenses to do mental health counseling. He has already trained more than 80 people referred by health agencies in New York, Alameda County and other parts of California, he said.

Morrison said that training people without college degrees or licenses to do mental health counseling may seem like a radical idea, but some people have the interpersonal skills and compassion to make a difference for these people.

We’re not saying anyone can do it, but there are plenty of people who have the skills, the aptitude and the personality, he said.

The San Joaquin Valley has the second worst shortage of mental health professionals in California, meaning a person could wait four to eight months to see a doctor. Many counties and other agencies throughout the county are in dire need of licensed mental health physicians and are usually unable to recruit them from a limited pool.

BHRS County has contracted with the Lay Counseling Academy to train 50 case managers, outreach workers and other support staff. The county will pay the academy up to $171,000 for education services. The first batch of 25 staff members will begin their 65-hour training this summer.

The training is designed to better equip them to assist people struggling with anxiety, depression, suicidal thoughts, substance use disorder, and other conditions.

Morrison added that the county’s frontline mental health workers look more like the county’s diverse population than physicians with advanced degrees.

Morrison and a co-author wrote in a California Health Care Foundation blog that behavioral health needs have exploded during the COVID-19 crisis, with triple the number of people reporting depression and anxiety issues, along with the increase domestic violence and drug use. But only small percentages of people receive treatment for their mental conditions and substance use disorder.

The concept of lay counselors could also have applications for initiatives like the Homeboy Industries-like program planned for Stanislaus County, which could use previously incarcerated individuals to provide peer mental health support to inmates returning to the community.

County supervisors have not approved any recommendations for a local program similar to Father Gregory Boyles’ in Los Angeles, but are expected to consider the proposals next month.

Morrison said lay counselors are used effectively in poorer countries where the shortage of licensed doctors is much worse. She said she is naturally open to alternative approaches as she is an Alaskan native, where unlicensed midwives routinely deliver babies in remote villages and communities.

Innovation Award

Morrison and academy co-creator, Alli Moreno, were recognized as 2023 Steinberg Institute Champions for bringing innovative solutions to the behavioral health workforce shortage.

BHRS director Tony Vartan said on Friday he saw an opportunity to provide additional tools to help case managers and other staff with interventions.

For example, trainees will learn about motivational interviewing, an evidence-based approach to engaging people who need help and getting them into care.

Often, what happens is that case managers lack the skills, Vartan said. Motivational interviewing is a great speaking skill to have. The training will teach them skills to help intervene and defuse situations while remaining within their duties.

Vartan said graduates of the academy will not manage psychiatric medications for clients or manage crisis interventions. Drug treatment falls within the scope of the practice of registered doctors and nurses, he said she.

The county’s mental health care system, for people with Medi-Cal or the uninsured, served 9,422 adults and children in the 2021-22 financial year. The number does not include all awareness and engagement efforts.

Another opinion

Darlene Thomas, president of the Stanislaus chapter of the National Alliance on Mental Illness, said the county should be careful about using lay counsellors.

You can’t be a therapist with 65 hours of training, Thomas said. We need more help, but I’d feel more comfortable (if unlicensed personnel) stayed within their scope of work.

Usually, people who call the NAMI office are in a meltdown, she said. They have a family member with a mental illness who doesn’t think anything is wrong. The frustration with our system is that you can’t make people get help if they don’t want it, Thomas said.

Governor Gavin Newsom pledged billions of dollars last year to expand the state’s mental health workforce and reinvent mental health and substance use services.

Morrison, the chief executive officer of EM Consulting, said the state initiative is a long-term plan to expand the workforce. It’s not a short-term solution.

He said the academy has trained staff from other counties, religious organizations and non-profit agencies. Community health centers have sent outreach workers, physician assistants, and substance use counselors for academic training due to the demand for mental health services.

Training begins with an in-person meeting, but most of the learning and counseling practice is done online or on Zoom.

Counties are deeply understaffed, Morrison said. But they are also deeply committed to their responsibility to provide this assistance to their community.