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Staff shortages force Missouri psychiatric hospitals to seek outside help

Outside medical help has been called in to care for patients at the Fulton State Hospital as it grapples with steep staffing shortages upwards of 80% for some positions.

With staffing shortages compounded by an increase in employees isolating due to COVID-19, two members of the state’s Disaster Medical Assistance Team assisted last weekend at the maximum-security psychiatric hospital. Another two are scheduled to help through Friday and will be providing direct care, said Debra Walker, a spokeswoman for the Department of Mental Health (DMH).

The Fulton State Hospital has a 51% vacancy rate for registered nurses, an 82% vacancy rate for licensed practical nurses and a 33.6% vacancy rate for security support care assistants, Walker said.

As of Monday, there were 297 active COVID cases among DMH staff and 83 among residents, according to DMH data.

For months, DMH facilities have struggled with staffing issues, leading to dozens of beds being taken offline because of an inability to staff them, state officials said in November.

In November, a 25-bed ward was closed at the Fulton State Hospital, DMH Director Valerie Huhn told lawmakers on the House Budget Committee last week.

The department is “truly struggling with a workforce crisis,” Huhn said. DMH is spending more on contracted staff through private companies than “we’ve ever spent before” and medical assistance through the Disaster Medical Assistance Team is “still not enough.”

DMAT staff have been used at psychiatric hospitals throughout the state, but it’s the first time DMAT staff have been used to assist with care at Fulton State Hospital, Walker said.

Temporary contracted staff cost the department about two-thirds more, Huhn said, and staff across facilities have been mandated to work overtime to combat low staffing and high turnover.

The staffing shortages have contributed to people having to stay in jails as they await treatment at the state’s psychiatric hospitals, which serve patients with a variety of mental health diagnoses, including those who have been committed by the courts.

Nearly 160 people are waiting on admission after receiving judges’ orders for “competency restoration.”

“Right now, we don’t have a place for them,” Huhn told lawmakers.

The coronavirus has exacerbated staffing shortages that already existed, in part, due to low pay.

“We are seeing quite a bit of turnover in all areas and we are getting to the point where if we see any more turnover we are not going to be able to operate our state facilities,” state Budget Director Dan Haug told a House budget committee earlier this month.

Haug told lawmakers that the state had the space but not the staff to open a new ward at the Fulton State Hospital. 

“We are hoping the pay increases we are proposing would do that,” Haug said.

Gov. Mike Parson proposed a 5.5% pay raise for all state workers that aims to bring state employees’ base pay to $15 an hour. The raise has not yet been approved.

This article by Tessa Weinberg is published by permission of The Missouri Independent.

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