Quick Take
Santa Cruz County’s planned expansion of after-hours mental health services is well-intentioned, but not tenable, writes county mental health liaison Keli Benko. The shift will increase the already heavy workload of crisis responders like her and will cause the quality of care to suffer, she writes. Rather than hiring licensed clinicians to meet an 140% increase in need, the county has contracted an outside agency to staff the program with non-licensed care providers. This leaves a handful of county staff to provide 24/7 overnight and weekend on-call coverage to supervise these workers.
Santa Cruz County’s mental health crisis workers are in crisis.
We have weathered the skyrocketing demand for behavioral health services since the COVID-19 pandemic and done so in a community which has more unhoused people in need of mental health care per capita than anywhere else in California. The crisis at hand, though, is the working conditions and burnout faced by our community’s front-line mental health clinicians at the hands of county leadership.
As a mental health liaison (MHL) embedded with law enforcement, I am no stranger to crisis. I respond to behavioral health emergencies alongside patrol teams to de-escalate crises and conduct mental health evaluations. I assess situations for risk and safety and work with people and their loved ones to determine care needs.
When creating safety at home isn’t possible, I initiate involuntary psychiatric holds and accompany individuals to the crisis stabilization unit for a higher level of care. I sit and listen to people on the worst days of their lives, I provide guidance to parents desperately advocating for their children, I support families with the abysmal grief that comes when a loved one has died by suicide and I navigate between advocacy for a person’s right to self-determination and my duty to create safety for those struggling to do it on their own.
While no two cases are ever the same, the common thread is crisis.
When I meet people and explain what I do for a living, the most common response comes with a genuine look of concern and some iteration of, “Wow, that must be very hard!”
My invariable reply is to smile and concede that, yes, some days are very hard, but I truly love my job. As a fifth-generation Santa Cruzan raising a child in this city, it is a privilege to care for my community in this way.
Most people I encounter in my work are wrestling with problems and systems much bigger than anything I alone can fix.
I am meeting them in moments of life that are often traumatic and under circumstances that are beyond my control. To not be crushed by the weight of my neighbors’ struggles, I have come to gauge my effectiveness in this role not by how many problems I fix, but by my ability to make connections, to reduce harm, to make ethical decisions and to lower barriers to accessing care.
On the hardest days, when tragedy occurs and there are no words to ease someone’s pain, I find meaning in having been there at all.
Sometimes just being with someone is the most important thing; I want to be here.
When I accepted this role, I assumed that I would stay until I burned out from the work and the constant exposure to trauma it entails.
I never imagined I would be where I am now, considering leaving a job I love because I am burned out by the conditions within the agency I work for.
As I write, there is a 50% vacancy rate for MHLs, and we are currently operating as a team of three serving a population of 270,000. We are understaffed and overstretched.
We are paid significantly less than our counterparts in surrounding counties. We are also paid less than the other government-employed first responders we work alongside every day.
Salaries for my Santa Cruz job range from $6,607- $8,351 a month. The same job ranges from $9,277 – $11,223 in Santa Clara County.
Our wages do not adequately reflect our training and experience or our value as front-line workers, nor do they address the escalating cost of living and the reality that Santa Cruz is the least affordable place to live in the country.
The job is a challenge to be sure, but the lack of tangible support and the added struggle of trying to live and raise a family in this community are what make it unsustainable.
The county’s leadership team is currently in the process of rolling out the “Crisis Now” program in alignment with new state mandates requiring counties to provide 24/7 mobile crisis response for behavioral health emergencies. The program aims to reduce police presence during mental health crises and expand non-law enforcement response, which the county is doing via unlicensed mental health workers employed through a contract agency.
The issue of licensure is relevant because comprehensive crisis response requires the presence of a licensed mental health professional. Rather than hiring additional licensed staff to meet this 140% increase in service provision, the county is requiring a handful of licensed clinicians, including MHLs like me, to provide 24/7 overnight and weekend on-call coverage to support and supervise these contracted workers.
This is in addition to our regular job duties.
Such an extraordinary expansion of our duties and work hours will only further burden our severely understaffed and overworked skeleton crew of dedicated clinicians. This arrangement will also cause the quality of care to suffer for our community members in crisis.
County leadership has so far refused proposals to address these concerns and failed to generate staff buy-in for the rollout of this well-intentioned program. They have also not shared information about how other counties are managing this. What we on the front line do know is that our county’s plan is untenable.
All of this is happening concurrently with the expiration of the SEIU 521 labor contract on Sept. 18 and the unwillingness of county leadership to meaningfully address these and other agencywide concerns about the burdens being placed on already taxed care providers.
Expanding mental health crisis services at the expense of the workers who provide the mental health care is antithetical to the goal of improving health and well-being communitywide.
The mental health crisis in our county is multi-faceted and progress never occurs in a straight line. However, my hope is that county leadership will tend to the reality that a program is only as strong as its workers, and its workers are in crisis.
We have already lost multiple valuable team members because of these conditions and their impacts on our families and our own well-being. I know I am not the only provider who wants to be here, but is increasingly hard-pressed to justify the burdens placed on us.
At work, I often find myself in conversation with individuals in crisis who are hesitant to seek mental health care because they are a caregiver to a child, parent, pet or other loved one.
In my own firm but gentle way, I offer practical solutions and remind them of the simple truth that you cannot take care of anyone else if you do not also take care of yourself.
I believe that our community understands the value and importance of accessible mental health care, especially in moments of crisis. It is my hope that in sharing our struggle, our community and board of supervisors may speak in support of us, so that we can continue to support you.
Keli Benko works for the County of Santa Cruz Health Services Agency as a mental health liaison embedded with law enforcement responding to behavioral health crises.