How a ‘mental health workforce crisis’ has these nonprofits retooling office culture

At First Step House’s Central City neighborhood intake office, Paulette Anderson, with short, curly hair, round glasses, and a warm, steady demeanor, is often the first person visitors see.

“Everybody that walks in is family,” she said. “I’m here when you reach that bottom and just need someone to talk to,. If you just need to cry, you can do that.”

First Step House is a nonprofit organization offering recovery from substance use disorders and supportive housing services to some of Salt Lake City’s most vulnerable residents, a safety net for people who wouldn’t otherwise have one.

The services offered at the facility are vitally important in a city where people experiencing homelessness rose by 14% from 2020 to 2021 and demand for mental health treatment has increased across the country.

But while the need for mental health, substance use treatment and supportive housing services may be growing, organizations across the U.S. that serve those populations are struggling to hire enough people to fill jobs. One analysis found that Utah and Wyoming “have the largest proportion of their populations living in mental health shortage areas.”

The country is going through a “mental health workforce crisis,” said Shawn McMillen, First Step House executive director.

Last August, Odyssey House, another behavioral health services nonprofit, had a 20% vacancy rate. That’s down to about 10% now.

“We’re making progress,” said Emily Tillett, chief people and infrastructure officer for Odyssey House, “but it’s still not the same as it was even five years ago, when we had people lining up and down the street to work for us.”

First Step House also hired more workers and is now at a vacancy rate just below 3%, according to Jazz Hamilton, First Step House’s human resources director.

First Step House and Odyssey House have been named Top Workplaces for several years, including 2022, and seen some success in retaining and attracting new workers during a time when many behavioral health services are struggling to do so. The Salt Lake Tribune interviewed workers and managers at the two nonprofits about what they’re doing differently.

Shorter workweek, higher pay

Raye Silvers, admissions manager, has worked at First Step House for 16 years.

During the pandemic, she found herself working longer hours. “The need has always been great,” Silvers said, but during the pandemic she started seeing people with “higher levels of acuity.”

In evaluating the mental and physical drain on the staff, First Step House moved to a four-day workweek and Silvers cut back a little on her hours. That change allowed her to join a gym, go to yoga classes and take long walks with her dog while still getting about the same amount of work done.

Moving to a four-day workweek was just one recent change designed to improve employee morale, retention rates and burnout, Hamilton explained.

“What we’re trying to do is rearrange the ‘to-do lists,’” Hamilton said. “What are the most impactful things you can do? What can get kicked around till tomorrow or next week?”

Hamilton noted that while bosses shortened the workweek, they also raised pay. He said their lowest paid employee now makes nearly $19 an hour.

Odyssey House has also boosted pay over the past few years, Tillet said. This was due, in part, to an increase in Medicaid reimbursement rate changes pushed through the state Legislature.

“Over the past two years most of our positions have increased by at least 25% in wages,” she said. “That’s been a huge deal for us. Medicaid has been static since the dawn of time. Now we’ve finally been able to break through, and that is having a trickle-down effect for our staff and clients as well.”

Educational and training opportunities

The nonprofits are also retaining employees through education and training opportunities.

At Odyssey House, Tillett said, those who stay with the nonprofit for a year are eligible for a $9,000 per year tuition reimbursement program when pursuing degrees in behavioral health-related subjects.

Certain employees are also eligible for loan forgiveness through the National Health Service Corps.

Evelyn Anderson, a licensed clinical social worker at Odyssey House, is taking advantage of that program. She started interning at Odyssey House after completing her master’s degree online at a university based out of Texas. During her internship, human resources sent out emails about the program, and she made a note to apply once eligible.

Now, she’s had the majority of her student loans forgiven and is about halfway through the program.

“I would have been in this field no matter what,” Evelyn Anderson said. “I’d be here, whether that was the case or not, but it is really helpful.”

She loves her job, in part, because “watching people’s lives actually get back on track, and then work through all their mental health issues that led to their substance use, really is very rewarding.”

She said that working at a nonprofit and with folks who are sometimes in court-ordered treatment makes her job more difficult and less lucrative than others in her field.

But seeing people go through treatment on their “own terms” makes it worth it. “It can be more rewarding in the end,” she said, “even though it’s more difficult at the beginning.”

Supportive and authentic

Both nonprofits offer employee assistance programs for staffers in need of mental health support.

They also try to create supportive environments not only for clients but for staff as well. “It’s a very supportive and authentic environment for workers,” said Hamilton at First Step House.

Even small things, like what people wear to work, can be a recruitment tactic. At Odyssey House “we want you to come to work as a whole person so we advertise that we have a casual dress atmosphere,” Tillett said.

“Everyone’s open to ideas of how we can do things better,” Evelyn Anderson said, “both for staff and clients.”

Raye Silvers and Paulette Anderson at First Step House say they have informal check-ins with each other after disruptive events — like someone walking in screaming, yelling and intoxicated. Team members take time to acknowledge the sense of bystander trauma associated with those experiences, and to talk through them.

For Anderson, who started working at First Step House roughly a year ago, those efforts have been working.

“This,” she said, “is the most fulfilling job I’ve ever had.”