As New Hampshire tries to address an epidemic of opiate abuse, leaders in the state often focus on increasing the number of treatment beds and programs. But many in the state say staffing those programs may be much harder than building them.
Addiction treatment programs have been facing staffing shortages across the country for many years. In New Hampshire, things are particularly bad.
Call almost any clinic in the state – and you’ll find they’ve been trying to hire a counselor or two for six months to a year.
At Phoenix House in Keene, Director Amelie Gooding has spent the last year and a half trying to find an addiction treatment counselor.
“It’s frustrating,” Gooding says, “I’m training good people and they’re working here, and I can’t reward them sufficiently either financially or otherwise that they want to stay.”
Even more frustrating, Gooding says, is the absence of applicants.
Because she’s short one counselor, Gooding has to leave three of her 18 beds empty, and keep her outpatient program enrolled at fifty percent.
“Everybody thinks ‘oh there’s not enough beds!’” Gooding exclaims. “There’s not enough treatment staff to open more beds.”
Why are all these folks leaving?
For Melissa Chickering , “it just got too heavy.”
Chickering used to work for Gooding at Phoenix House. She has a master’s level addiction counseling license, a mental health counseling license, and a decade of experience. Clinical directors around New Hampshire would give their right arm to hire someone like her.
But Chickering spends her days teaching psychology and health science students at Antioch and Keene State.
“I think there’s a lot of guilt involved,” Chickering says. “I do feel like I should be doing more or helping more like I’ve abandoned the field or something.”
Over the years, Chickering says, witnessing so much suffering and early deaths takes a toll. But what really drove her out, she says, is the anemic funding and poor coordination from the state.
“The lack of funding for adolescents is honestly criminal,” Gooding says of her time at Dublin Academy, an adolescent addiction treatment center not far from Keene.
The state required Chickering to reserve some beds for court-ordered clients, others for state subsidized clients, and a third set of beds for the private insured.
“There was one point I was working there that had open beds, physically. A girl came in and was on the waiting list, she just didn’t have the right funding, so she died while she was sitting on the waiting list. I went home that night and was like, ‘I had an open bed. She could have been getting treatment. And instead, she died.’ How do you sit with that and be okay the next day?”
Chickering is not the only one to leave clinical work. In 2015, 39 people joined the ranks of licensed addiction treatment counselors. That same year, 35 counselors let their licenses expire. The state netted a total of only 4 new licensees.
And for those who can withstand the exposure to trauma, other things can drive them out.
Master’s level addiction treatment counselors in New Hampshire make $40,000 to $55,000 a year. These numbers already reflect increased reimbursements under Medicaid Expansion and the Affordable Care Act.
Jen Whitehead is another former addiction counselor at Phoenix House. A year ago, she left direct care to work in addiction prevention at Keene High School.
“The pay is better,” she says, “and the schedule is better.”
Whitehead is a single mom.
She was also one of James Newman’s counselors at Phoenix House.
Today, Newman has a 15 month old baby, a house, and is getting married. But two years ago, he arrived at Phoenix House addicted to both alcohol and heroin.
First, he had a counselor named Alice.
“She’s a friggin’ saint,” he says. “she is the reason why I’m sober today. She’s an angel.”
After that, he had Jen Whitehead. After Whitehead, Newman went through three different counselors.
“You get into like a comfort zone with these counselors and when they leave, it’s a slap in the face, you know.”
More money is coming into the system. New Hampshire recently received a $150 million grant over five years from the federal Medicaid office.
There is also a small school loan-repayment program for counselors in New Hampshire’s underserved regions. But compared to statewide efforts to recruit a STEM workforce, for example, social work and counseling programs get relatively little attention.
Harding does hope to convince some of the state’s 2,000 generalist mental health counselors and social workers to join the substance abuse ranks.
“You know this is also within their scope of practice,” says Joe Harding, Director of New Hampshire Bureau of Drug and Alcohol Services, “but some of them may not feel like they’ve had adequate resources or training available to them.”
Harding’s department subsidizes training programs that help generalists make the transition.
The question is: will there be enough funding and support to convince them to come help - and get them to stay?