A mental health care worker’s colleagues kept quitting, and patients were becoming disillusioned.

More people need mental health care, as the pandemic has increased rates of anxiety and depression. But some simply can’t access it from state-funded providers because of a shortage of therapists.

“People leave this organization because they cannot support a family on what we can offer,” said the unidentified worker, who sent a letter that made its way to Gov. Bill Lee last week. “People can make more at McDonalds than they can being a transporter, a receptionist or an office coordinator. People can work in a factory without a degree and make more than a therapist or a case manager.”

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The comment was typical of what Lee heard during a week of budget hearings that had Lee’s department heads requesting millions in additional funds for the next fiscal year.

The health care worker said that when therapists take lower-stress jobs, they often have to cut short the relationships they have with clients.

“I am tired, our staff is tired, but most importantly our clients are tired,” the worker said, according to state Mental Health Commissioner Marie Williams. “Some don’t want services anymore and feel ‘why bother’ because they will just get to working with someone good and then that person will leave. . . We need staff right now.”

In a plea for higher pay for mental health care workers, Williams read the worker’s letter to Lee at one of the budget hearings last week.

“Governor, I wish I could say stories like this are uncommon or isolated to one section of the state,” Williams said. “But I frequently get letters like this.”

Williams and other state officials told Lee the workers who do the real business of state government — health care providers, dentists, corrections officers, teachers and more — aren’t paid enough.

They told Lee they’re facing high turnover and vacancy rates — and, consequently, having a harder time delivering quality service — because they can’t compete with higher-paid, lower-stress private sector jobs.

Many workers are quitting for easier jobs, while others, particularly women, are leaving the workforce altogether.

Among the requests from top government officials:

Health Commissioner Lisa Piercey requested about $66 million for dental schools and incentives for dentists to work in rural areas.

Corrections Commissioner Tony Parker requested $16 million for corrections officers and $3 million to increase the pay of teachers in correctional facilities.

Education Commissioner Penny Schwinn asked for a $70 million boost to the Basic Education Program.

Commissioner Brad Turner of the Department of Intellectual & Developmental Disabilities requested almost $46 million for workforce development and a long-overdue cost-of-living adjustment for home health aides.

Top officials from each department made presentations and requests during back-to-back, all-day meetings Nov. 1-4. They represented an early part of the fiscal year 2023 budget process. Lee will propose a budget to lawmakers in January, and they will approve a budget by the end of their spring legislative session.

Hot labor market or worker shortage

The requests for more money for workers come amid a nationwide, red-hot labor market — or a worker shortage, depending on one’s view.

Some of the causes are purely demographic, according to state Labor and Workforce Development Commissioner Jeff McCord — namely, that birth rates are declining.

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The working age population is decreasing, and on top of that, McCord said, many people are leaving the workforce. Experts say many people, particularly women, are leaving because child care often costs as much as a working person’s wages. Some have decided it’s not worth it to work for low pay at places with high risk of COVID transmission; many workers have died of COVID, too.

“It doesn’t look to get any better in terms of trends and population trends,” McCord said. “We’ve got to be honest with the problem.”

College enrollment is declining, and he warned of a looming “enrollment cliff.”

“Those numbers will not grow without some action,” he said.

With the labor shortage, workers have had more leverage in the labor market. In order to compete for workers, many companies are offering higher pay, signing bonuses and better benefits.

Dental care and corrections officers

Piercey’s biggest request was $94 million for dental care for seniors.

Most of that would go to workforce development and higher pay for dentists. She wants to pay dentists an incentive to work in rural areas, arguing the incentive is necessary because dental school often leaves dentists with more debt than they can pay off in rural markets.

A big chunk of that funding, more than two-thirds, would go to the state’s two dental schools, at Meharry Medical College and the University of Tennessee.

“The shortage of dentists is something we’ve been dealing with for a while and it’s actually growing,” she said.

Corrections Commissioner Tony Parker asked for almost $20 million so he could pay corrections officers and teachers more. He said officers have to work extra shifts amid a higher-than-ever vacancy rate.

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“These people are missing ball games, kids’ ball games,” he said. “They can’t go home at the end of their shift, they’re working on their days off because we have mandatory posts that we’re struggling to fill.”

He said he’s not even sure the request he made would be enough to compete with law enforcement, private security and other jobs.

“Governor, I’ll be honest. . . I’m not sure that this will be enough,” he said. “I don’t know that this will make us competitive in the job market that we have today.”

“Creative solutions” and “engaging” with workers

Lee appeared reluctant to make big increases to state spending, although he expressed empathy and gratitude for the workers — particularly health care workers.

“We are very grateful for our partnerships and our providers and the work that’s done, especially through the last year and a half,” he said at the TennCare hearing. “Providing health care in the middle of this pandemic has been a very challenging job for all of our providers. A lot of pressure, a lot of new requirements, a lot of scrutiny, and so your team and your partners are very much appreciated.”

“We don’t know how hard it’s been,” he said, “but we know it’s been hard for all obvious reasons.”

While Parker said higher pay is the most important solution, Brandon Gibson, Lee’s chief operating officer, asked for more “creative solutions” to the worker shortage.

“Can I challenge you to do a couple of things?” she said. She asked Parker to “remodel” some of his salary projections, based on different incentives. “Bring us some more options,” she said.

Lee said it’s important to “engage” with workers.

“I think we can think through one-year turnover, and what are the things that we can do to engage with our employees?” he said. “We’re obviously going to be paying them at a higher level now, so how can we engage with them in a way that addresses and gets feedback on why the turnover, what circumstances, what environment we can create for our workers that would help mitigate that?”