Staff shortages at state hospitals causing 'a workforce crisis'

by Teghan Simonton

Missouri News Network

 

Hundreds of inmates in county jails throughout Missouri are awaiting inpatient psychiatric care but can't receive it due to severe staff shortages at state hospitals.

"We are truly struggling with a workforce crisis," Valerie Huhn, director of the Department of Mental Health, told state representatives at a hearing last week.

In county jails, 160 inmates are on a waiting list for state-run psychiatric hospitals, having been mandated to be treated for "competency restoration" in order to stand trial. Another 65 inmates have been evaluated by the mental health agency and were determined incompetent for trial; the department is waiting for court orders and will add them to the waiting list, as well.

But there aren't enough staff at the hospitals to care for the patients.

Fulton State Hospital, for example, is so understaffed that services in a 25-bed ward have been frozen and the hospital is unable to take new admissions, Huhn said. There are only 761 staff working at the hospital – compared to the 1,176 the department has budgeted for.

At present, the average wait time to be admitted is about six months, a department spokeswoman said. In Boone County, a spokesman for the Sheriff's Office confirmed the jail has recently experienced delays in transferring detainees to state hospitals for mental health care. He did not specify how many transfers had been delayed.

The jail does provide mental health services through a contracted health care organization. If the court or medical staff determines that an inmate needs inpatient care, the jail helps coordinate a transfer.

The situation has consequences for patient care. Housing these patients in jails rather than at state facilities means delaying their evaluation and treatment, in some cases prolonging their ability to stand trial, Huhn said. Many can't be treated in jail settings and their condition will worsen.

"We're trying to bring in mobile crisis so we can at least manage meds," she said. "But in terms of treatment, group, anything like that to restore them to competency, it's really just very limited."

Staff shortages at mental health facilities have been critical for months. In a hearing with members of the state House, Huhn said the department is over-relying on contracted staff to make up for the statewide shortage, further diminishing the quality of care. Every facility in the state is also requiring employees to work overtime, contributing to burnout and turnover. Officials point to low pay for state workers as a key factor in the shortage.

Gov. Mike Parson has proposed a pay increase of 5.5% for state workers, or a minimum wage of $15 an hour. It would include those working at mental health facilities. Parson had hoped the proposal would pass by Feb. 1, but the spending bill that includes the wages has yet to be approved by the House Budget Committee.

"We need to get people back into facilities so we can stop requiring overtime," Huhn said.

The shortages are not just affecting hospitals. Other mental health treatment centers, including programs that provide substance abuse treatment or work with teens and children, are also struggling with inadequate and overworked staff.

"We literally have people who go on their break and we don't see them again," Nora Bock, director of the Division of Behavioral Health, said at the hearing.

But even a pay increase won't solve everything, officials have noted. Additional inpatient beds are also needed. The governor's budget recommendations for fiscal year 2023 include allocations for 25 beds and staff at St. Louis Forensic Treatment Center-North, but that's still not enough to allay the current waiting list.