Social Justice for Social Workers? 

Mental health budgets don't keep up with cost of living

Last week, social worker Sherrie Davis took a low-income woman to look for affordable housing. Then she took another of her charges to visit his parole officer. Some days she roams grocery stores with people suffering from mental disabilities. Grocery trips usually involve lessons in home economics and quests to find the biggest bang for the buck. Sometimes Davis just makes sure clients don't have suicide on their mind.

For her work to keep some of the area's most vulnerable out of mental institutions, hospitals or prisons, Davis regularly drives herself. Mental health professionals credit psychosocial rehabilitators like Davis with helping people maintain their mental health. They say that without workers like Davis, many would be unable to tend to demands of daily living.

"These workers are keeping costs down by keeping individuals out of the hospitals," said Melissa Paller, co-owner of Ada Family Services, a psychosocial rehabilitation (PSR) agency.

But the money that they save the state by reducing mental health spending doesn't always translate into a liveable wage for social workers or sometimes, any wage at all.

A survey of local PSR provider agencies found that PSR workers earn anywhere between $12 to $21 per hour. A recent report by the Northwest Federation of Community Organizations put Idaho's living wage at $13.24 for a family of four.

Some of Idaho's social workers get paid for the time they drive from client to client. Others may not. And the agencies that pay the least are the least likely to compensate their employees for gas or time spent in the car. That has left some PSR workers looking for a new job as soon as they start.

"We go out to homes and we're in the community. You probably see us," said Davis, one of the area's better-paid psychosocial rehabilitators. Her type of social worker does a little bit of everything, from playing basketball with socially withdrawn kids, to assisting people who suffer from bipolar disorder to manage their medications.

"There are a million things that we do," Davis said.

Davis loves her job. But it's not a career everyone can hack. Psychosocial rehabilitators are required to hold a bachelors degree in social or behavioral science or have completed at least 21 college credit hours in those fields. They must also pass a background check and have reliable, personal transportation.

Social workers don't go into the field to make money, said Bill Whitaker, a Boise State social work professor. But the local pay for PSR workers doesn't always keep pace with the rate of inflation and cost of living increases.

"I can't make it on $12 an hour," Davis said of the wage many of her colleagues at other agencies earn. Some PSR agencies see an economic injustice in paying social workers a $12 per-hour wage.

"I couldn't see paying someone with a college degree that rate," Paller said. But many of the 19 psychosocial rehabilitation provider agencies in Idaho that contract with Medicaid pay their employees just around $12 per hour and do not offer many common benefits, like health insurance, according to PSR employees and managers.

Davis earns a liveable wage along with health insurance and is compensated for the time she spends behind the wheel. But that isn't the case for all PSR workers. Medicaid does not reimburse PSR workers for the time that they do not spend with clients, and that includes driving time between client's homes. Psychosocial rehabilitators who have clients scattered all over the Treasure Valley find that much of their time is spent driving from home to home. If the private agencies that contract with Medicaid for PSR services don't compensate for that time, then employees are essentially performing work-related duties for free.

"Some of them are everywhere--driving all over the place . . . and I really feel sorry for them," Davis said.

Agencies can choose to compensate for time and gas expenses associated with driving that is part of the job. Paller said that how well social workers are paid and whether they are compensated or not for driving has a lot to do with the bottom line of the contracting agency.

"Some of us are making a killing and some of us are just employed," Paller said.

Medicaid reimburses agencies $45.40 per hour for PSR services. How much of that sum the worker sees varies from agency to agency. Psychosocial rehabilitators for agencies such as Community Support receive no compensation for the time or expenses they incur while driving between clients' homes. Managers at the agency said they pay their PSR workers between $12 and $16 per hour and that's expected to cover the time they spend in a car. Other agencies, such as Ada Family Services, pay PSR workers a flat monthly rate that's expected to cover time and expenses associated with job-related driving. Agencies such as Cornerstone pay their workers about 37 cents for every mile that they drive.

State officials and social work advocates are well aware of the pinch that entry-level social workers often find themselves in. The state psychosocial rehabilitation budget, which is administered through Medicaid, has not had a substantial increase since 1999. Yet the volume of patients who need PSR services has increased, said Tom Shanahan of Idaho Health and Welfare.

Lawmakers passed legislation this year that mandated an investigation of the state cost of providing mental health care. And a committee charged with the investigation is expected to make budget increase recommendations by the end of the year. The recommendations could give mental health spending a boost and better cover the increasing costs in gasoline and other expenses.

It would be a first in a long while. Some cost-of-living standards have not been addressed in seven years, said Gregory Dickerson, president of the Mental Health Providers Association of Idaho.

"There's a lot of costs associated with delivering service that are not taken into account," he said.

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