Why Should Delaware Care?
Delaware spends tens of millions of dollars each year on its mental health programming statewide, not to mention the more than $1.2 billion it spends on Medicaid. When programs aren’t effective, it not only burdens patients, but the state which has to pay for more treatment.
This article was produced as a project for the USC Annenberg Center for Health Journalism’s 2026 National Fellowship Fund for Reporting on Child Well-being.
Mental healthcare in Delaware looked a lot different 15 years ago.
Delawareans had been chronically hospitalized within a state-run psychiatric facility, where they would often cycle in and out of treatment more than a dozen times with little effect.
That facility, the Delaware Psychiatric Center near New Castle, had also faced its own problems. Multiple employees were convicted of abusing patients, and the hospital faced years of scandals ranging from employee retaliation to a revolving door of leadership.
All the while, patients languished with no path back to normalcy.
The situation deteriorated so much that the federal government sued Delaware in 2011, claiming it had simply warehoused residents with mental illness, providing them no meaningful on-ramp back into society.
At the time, the complaint warned that more than 17,000 Delawareans managing severe mental health issues, or nearly 2% of the state’s population, were at risk of “unnecessary institutionalization.”
Delaware and the federal government quickly settled that lawsuit, and Delaware was forced to reimagine its mental health ecosystem. The state developed robust services meant to keep people out of a never-ending cycle of hospitalization.
More housing for those with severe mental illness, stabilization centers meant to keep people out of emergency rooms and psychiatric hospitals, group homes for those with long-term care needs, and mobile crisis units fanned out across the state to reduce unnecessary inpatient admissions.
And by the end of 2016, those services had demonstrated a positive impact on residents. Robert Bernstein, an outside court monitor responsible for holding Delaware accountable to the terms of the settlement agreement, said that while the state’s new systems weren’t perfect, they made “substantial progress” in supporting those with mental illness.
Bernstein, who ran the Bazelon Center for Mental Health Law, a national advocacy organization, also wrote that people who took advantage of Delaware’s new programs had been able to find stability they otherwise may have never been able to grasp.
“They reflect individuals who have struggled against incredible challenges — clinically and otherwise — and who are pursuing recovery that might have been unthinkable not so long ago,” he wrote.
A decade later, these programs still support Delawareans, but a Spotlight Delaware investigation found that some are beginning to falter.
Mobile crisis units are responding to a fraction of the calls they used to and staffing vacancies have plagued the state agency responsible for managing mental health services.
According to experts, when people have poor experiences with mental health programs, they are unlikely to seek out care again.
A spokesperson for the Delaware Division of Substance Abuse and Mental Health (DSAMH) acknowledged many of these findings, chiefly that staffing shortages have challenged its services.
But the state also says it is making investments to close those staffing gaps, and that it is one of many states across the country battling with turnover and vacancies.
Services nearing capacity, staffing woes
Delaware’s release from its federal settlement in 2016 represented a major milestone in what had been a five-year journey to improve outcomes for residents with mental illness. The state dramatically increased spending on programs like group homes, mental health housing vouchers, as well as case management teams meant to act as supports to keep people stable.
It had also built out a robust system of mobile crisis units and recovery response centers that serve as diversion tracks, meant to keep those in crisis out of unnecessary inpatient admissions.
But some of DSAMH’s services within its community mental health program have neared or reached capacity in recent years, said Tim Mastro, a spokesperson for the division.
The state’s housing vouchers for people with mental illness have been nearly used up over the past two fiscal years, and its 205 group home beds also are full, Mastro said. But he added that DSAMH has worked over the last decade to expand bed capacity by nearly 70 beds.
Still, since 2019, the annual group home budget has remained flat at a little more than $11 million. But Mastro said funding is not the primary pinch point for Delaware’s group home services.
Instead, one of its largest shortfalls is in staffing its programs.
For years, DSAMH officials have cited issues with vacancies and staff turnover within the department during annual budget presentations to state lawmakers.
Vacancies have plagued DSAMH since at least the onset of the COVID pandemic in 2020. The following year, the division turned over nearly a third of its employees, a trend officials said carried into 2022.
And despite efforts over the past year to attract and retain staff, the department’s overall vacancy rate is currently higher than it was in 2022.
Excluding the Delaware Psychiatric Center, the state’s government-run psychiatric hospital, DSAMH had 42 vacancies in March 2022, which represented about 18% of the division.
As of October of this year, the department had 118 empty positions – or 21% of the division.
Delaware is not unique in its struggle to staff mental health programs. NRI, a national mental health research firm, reported earlier this summer that workforce has been a challenge in most states.
The study, which surveyed nearly 40 states, said more than half of them had reported “moderate” or “catastrophic” employee shortages.
Many of the states reported shortages within a host of their community mental health programs, like their mobile crisis units, as well as stabilization centers.
“In short: despite major progress in expanding crisis services, workforce shortages now constrain states’ ability to sustain and fully implement these systems,” the report said.
Mobile crisis units falter
Along with overall department staffing issues, one of DSAMH’s primary mental health diversion programs, its two mobile crisis units, has also slowed in recent years.
As part of the settlement agreement between Delaware and the federal government, the state created the mobile crisis units, meant to divert people to the least restrictive treatment setting possible.
The crisis units respond to a variety of calls, some where individuals may be dealing with a psychiatric emergency, as well as some hotline calls that don’t warrant sending a full crisis team to respond.
According to Bernstein’s court monitor report published shortly before Delaware was released from the federal settlement, mobile crisis teams diverted 80% to 90% of calls away from hospitalized settings between 2014 and 2016.
A decade later, however, it appears that number has dropped. And staffing the program remains a challenge for DSAMH.
Delaware runs two mobile crisis teams. One handles calls in New Castle County, and the other in Kent and Sussex counties. Each team has two vans and is expected to respond to calls in-person within an hour.
DSAMH currently budgets for 31 employees in its crisis intervention positions, but close to half of those positions are currently vacant, Mastro said.
Data obtained by Spotlight Delaware through a Freedom of Information Act request shows that prior to 2023, the Kent and Sussex mobile crisis unit would respond to hundreds of calls each year, which at times represented more than 20% of all calls for help in those counties.
In 2025, the southern Delaware mobile crisis unit only responded to 64 calls, or about 2% of the calls the regional team received that year.
Mastro said staffing has played a large part in the decline of responses in the lower half of the state, and the unit has at times been unable to respond at night or over the weekend, punting some calls to the New Castle County team.
The New Castle County mobile crisis unit also saw a dip in its responses between 2020 and the end of 2025, albeit, not as stark. In 2020, the New Castle County team responded to nearly 600 calls.
At the end of 2025, it responded to close to 400.
Overall, the state is responding to fewer of its crisis calls than just five years ago. And when the mobile crisis units do respond, they are now more likely to send patients to emergency and inpatient facilities than in years past.
In 2025, the percentage of people sent to inpatient facilities and emergency rooms by mobile crisis teams was nearly double what it was in 2022.
Staffing challenges within the mobile crisis units have required the teams to “prioritize” the most acute calls, Mastro said, which has contributed to a greater percentage of hospitalizations.
“Because these individuals may be more likely to require hospitalization, this can contribute to a higher percentage of in-person responses resulting in hospital referrals or admissions,” Mastro said.
For some hospitals, expanding their emergency room space for those with behavioral health needs has been a priority. At a press conference in October, Bayhealth announced it would be bringing more behavioral health beds to its emergency room by 2027.
Separately, TidalHealth Nanticoke in Seaford expanded its emergency department’s behavioral health capabilities earlier this year.
Bayhealth operations and nursing leaders said in an interview the hospital system is working to proactively improve mental healthcare in Delaware, but that it will “take a village.”
Rosi Wurster, Bayhealth’s chief nursing officer, said the hospital’s emergency room expansion would include a new step-down unit for patients who show up with behavioral health needs. The goal of this unit would be to quickly assess and stabilize patients in the emergency room and transfer them to the newer unit with more behavioral health resources.
Wurster also said the hospital is looking to expand its outpatient capabilities to “capture patients when they have their need at the lowest level.”
Kyle Benoit, Bayhealth’s chief operating officer, also stressed the importance of a preventative approach to mental healthcare, and said the hospital wants to work with providers to catch people before they are in crisis by embedding more social workers into primary care locations.
He said oftentimes when first responders encounter someone in crisis, they find themselves in a challenging position where they may not be equipped to provide the immediate treatment that person may need.
And when no outside support or treatment network is available for that person, sending them to the emergency room is a more appropriate response than jail.
“More often than not, I think the go-to is like, OK, we’re going to send them to the emergency department,” Benoit said. “When in doubt, that’s what we’ll do.”
A national issue
As Delaware was in the midst of reinventing its mental health system, it dramatically ramped up spending on its programs. In just five years, spending on mental health supports nearly doubled, jumping to $58 million a year.
But following the state’s release from the settlement in 2016, Delaware’s community mental health budget, which funds many of these programs, has remained largely flat for the better part of a decade.
While staffing has remained a battle for DSAMH. It says it is working to reimagine how and how much its crisis employees are paid. Through a process that is called reclassification, positions within the state can receive higher pay and different responsibilities.
Based on 2024 job postings for some Delaware crisis positions, salaries ranged anywhere from $48,116 to $86,963 for non-managerial roles. According to Mastro, that salary range is what is currently offered for those positions.
Delaware is not alone in its struggle to staff its programs. Across the country, states have reported shortages within many of their mental health programs.
Amy Watson, a professor at Wayne State University in Michigan, said it is very common in state health departments to struggle to find and retain staff.
Watson also said pay often does not match the difficulty of the crisis work and that training often lacks for those in the most intense of situations.
Additionally, she said many of the roles require extra education, like a master’s degree, and for those with the additional education, they may not always want to work the difficult hours that come with working in crisis services.
“The hardest jobs are done by the least-educated, lowest-paid people,” Watson said.
In the NRI report examining nationwide staffing shortages, it pointed to some common initiatives between states to grow their mental health workforces. Among them were tuition reimbursement, hiring bonuses, as well as licensure support.
But the report said not every state had those initiatives, and Delaware only offers a few programs like tuition reimbursement and some apprenticeships.
Additionally, Watson pointed to changes coming to how states pay for mental health services, chiefly Medicaid. If states aren’t able to meaningfully afford paying providers, then workforce shortages will continue to deepen.
“A lot of more people are going to be hitting just the emergency room because they’re not able to access ongoing care,” she said.
