Tackling the mental healthcare crisis

Founded in 1961, Martha’s Vineyard Community Services (MVCS) was one of America’s first rural Community Mental Health Centers (CMHC). The community mental health movement of the 1950s and 1960s had the dream that communities could come together to support mental health needs regardless of ability to pay. The CMHC model is based on the notion that mental health is way more than providing a pill, and encompasses psychotherapy, group therapy, early childhood services, support for families, the elderly, the disabled, victims of domestic violence, people with substance use disorders, and individuals in crisis. For more than six decades, this full range of services has been the fabric of our work and mission at MVCS, and specifically, as part of our Island Counseling Center (ICC). In recent years however, a crisis in mental health care has stricken America.

Seventy-seven percent of counties across the U.S. suffer from severe shortages in mental health professionals. Dukes County is no exception. Martha’s Vineyard and similar Island communities, like Nantucket, have long struggled to sustain a stable, enduring workforce of mental health practitioners. A February 2022 report by the Massachusetts Association for Behavioral Health highlighted the behavioral health workforce crisis in community mental health centers such as MVCS’ Island Counseling Center.

Here are some other staggering report findings:


  • For every 10 clinicians entering the profession, 13 leave.
  • It takes an average of nine months to fill a psychotherapy position, and about the same for a psychiatrist or nurse practitioner. 
  • The average number of open positions in Massachusetts mental health clinics is 17.
  • Noncompetitive compensation and benefits were the top reasons for leaving, when compared with other factors, such as stress, work hours, and the complicated and urgent nature of many of the problems we see. 


Clearly we are not alone in our struggle at ICC. In the past 12 months, 14 clinical staff have left our clinic or reduced their hours. During this period, six clinicians joined our center, producing a net workforce reduction of eight clinicians. For a small, rural clinic like ICC, this means that at least 300 Islanders who reach out to us for services in a given year must wait on a waitlist or seek services elsewhere, mostly off-Island. While we have been hard at work to keep this waitlist as small as possible, it presently includes approximately 75 Islanders in need of counseling and psychiatric care. 

Many staff have left because they can make more money in hospitality professions, or in private practice. Inflation and associated costs can make salary increases and bonuses nearly imperceptible. Clinicians are also susceptible to compassion fatigue and burnout, particularly with increased demand caused by pandemic-induced loneliness, fear, and anger. For staff working in community mental health everywhere, it can be demoralizing to see colleagues move on. 

Furthermore, the seasonal duality of life on the Vineyard can make this a stressful place to live under normal circumstances. Many of our clients have suffered due to the pandemic, in addition to fears related to the political divisions on the Vineyard (and beyond) and climate change. That’s not to mention the stress caused by increases in the cost of living (which here already seems almost absurdly high). The cumulative effect of these challenges can be stressful not only for our clients but also for our staff. 

In a community mental health center, the entire staff gets to know clients and their families. Even the receptionist and office manager are crucial members of the team. Work in community mental health is highly relational: What our clients need most is to know that they are seen, heard, known, valued, cared about, and that they can trust and entrust themselves, their bodies, their lives, and their care to the CMHC. This is what makes CMHCs effective. A clinic cannot accomplish this without people who possess the local knowledge, presence, and reputations critical to building and maintaining relational trust. We continue to strengthen our team so that we can provide the care that the Vineyard has come to rely on. 


To address these challenges, we are:


  • Increasing pay for qualified practitioners to be more competitive with other healthcare and social service organizations. We aim to increase clinician compensation by at least $10,000 per full-time clinician no later than December 2022.
  • Building a career path to strengthen our staff’s long-term commitment to our mission and organization. Two wonderful therapists and Island residents, Molly Purves and Gabrielle Chudnow, have recently been licensed as mental health counselors. Our hope is that therapists like Molly and Gabby will continue to find ICC an enticing place to work, learn, and grow. 
  • Launching a clinician housing program in West Tisbury, with five affordable, single-room-occupancy openings for master’s-prepared clinical graduates who wish to pursue their clinical licensure. Island Counseling Center is an exciting place in which to learn, and we hope that recent graduates from around the country will come to the Vineyard to start their careers.
  • Working to make MVCS a Center of Excellence, a way of operating we continue to hone, which involves a structured, team-oriented approach to camaraderie, exposure to diverse clinical work, robust supervision, and ongoing professional development. 
  • Creating part-time opportunities for seasoned Island clinicians (many of whom have worked with us in the past). It can get lonely and feel isolating to work independently in private practice. Historically, staff who work in CMHCs earn less than they would in the private sector or in hospitals, and find their principal sense of value and reward in the joy of helping people who are in need, the pleasure of feeling part of a team, and the satisfaction in leveraging one’s training and ideas to produce creative solutions to complex problems. What’s more, there is the excitement of building programs together and a feeling of being respected, appreciated, and heard. Human beings are, after all, tribal animals, and being part of a community of clinicians and clients feels good and is good for our own mental health.
  • Expanding our clinical and support staff. Dr. Jennifer Hawken, who has been running the consultation service for medical inpatients at Mass General, joined our staff this month. Psychiatric Nurse Practitioner Beth Muller has spent decades working with children and adolescents at Yale, and will join our clinical team in mid-September. Scott Turton, LICSW, a seasoned clinician and administrator with three decades of experience, has taken the helm as the ICC program director. Community mental health is a team effort, and no one knows all of the people whom we serve more than our quality management coordinator, Geany Rolanti. While still new to her role, Geany has hit the ground running, and in addition to overseeing daily quality operations at ICC, assumes an important role offering translation services for Portuguese-speaking clients. Other clinical and operational resources are in process or on the way. 
  • Strengthening our collaborations with Martha’s Vineyard Hospital and Island Health Care. No one organization can address all of the behavioral health needs of our community, but working together, we aim for the goal that no mental health needs go unmet. 


Community mental health — the crux of our work — is all about creating healthy communities for our clients, staff, and neighbors. Our goal is to nurture the most kind, skilled, knowledgeable, respectful, and collaborative environment possible. 

As we celebrate our 61st year, and in an effort to become a stronger clinic and organization, we look to our community for help. We have to stretch our collective thinking to find solutions, join more closely with neighbors to restore connections disrupted by the challenges of the past two years, and lead with care and passion for our community. We hope Islanders will visit our website, examine our employment opportunities, and work side by side in partnership with us to bring the best mental health services to all Islanders in need. 


Dr. Folcarelli is the CEO of Martha’s Vineyard Community Services. Dr. Silberstein is the medical director of Island Counseling Center at MVCS. For more information about MVCS, and to support our work, please visit mvcommunityservices.org