Even in the best of times the Utah State Hospital has a challenging task, treating patients with some of the most serious mental illnesses in the state.
But now the hospital is in the grips of a critical staffing shortage and employee burnout that has state leaders considering contingency plans that would limit how many patients the hospital accepts, potentially shifting the burden of caring for people with mental illnesses to local providers and even hospital emergency rooms.
“I have never seen a staffing crisis like this before. This is very unique. This is very challenging,” Utah State Hospital Superintendent Dallas Earnshaw told me last week.
Earnshaw has worked at the hospital for 37 years, and during that time there have been areas where adequate staffing has been difficult, he said. “But I’ve never seen it as global as this in just about every department in the hospital. … We’re really struggling to find people.”
The state hospital consists of three sections: the adult facility which houses 152 patients, a pediatric facility with 72 beds and the forensic unit consisting of 124 hospital beds and 22 jail beds, where judges can send people who have been accused of crimes but have been found to be not competent to stand trial.
It is hard to imagine more difficult work. It can, at times, be dangerous. Early in the pandemic, though, Earnshaw said there was an influx of applicants. But within a few months the trend flipped and employees began leaving in droves.
The most acute shortage is among psychiatric technicians where there are currently nearly 100 vacancies.
“We need about 223 psych techs every 24 hours,” Earnshaw said, “and we’re running about 140 to 160 every 24 hours. So it’s a significant shortage.”
Part of the reason is the abysmal pay. Psychiatric technicians start at $13 an hour, less than most fast food jobs. The annual salary is the lowest in the West.
With techs being asked — begged, in some cases — to work overtime, there is a high burnout factor. Earlier this year, Earnshaw reported to the Legislature that there was a 71% turnover rate in the position.
The nursing ranks had been 27 positions short, but recently five nurses were hired, alleviating the strain somewhat.
There are unfilled openings on the custodial crew and 13 openings among the 50 staffers who prepare and serve food to patients. Both of those positions start at a little over $10 an hour.
For nearly two years, the Legislature has been warned of this looming staffing crisis. In the 2020 session, lawmakers provided nearly $900,000 to address the growing retention and recruitment issues, but when COVID hit lawmakers pulled back money from nearly every state department, including the hospital.
Add in the cost of paying overtime and then trying to control the pandemic, 56 patients have contracted COVID-19 in the course of the pandemic — none have died — and the hospital is facing a deficit this year.
The lack of staffing coupled with patients who can be prone to violence creates a potentially dangerous situation.
Earnshaw said staff is trained on what to expect and how to react when confronted with an aggressive patient. Injuries can happen when the hospital is fully staffed. But, he acknowledges, “staffing can have an impact on that. When staffing is short, we have seen a correlation of increase in injuries. There’s no doubt that we can say that.”
In October, Jennette Pearson, a nurse at the hospital who was covering an extra shift, was punched in the face and sustained a concussion while administering medication to a patient, Pearson told KSL-TV. She said she had been concerned about the risk posed by staffing shortages for some time.
All of this has Earnshaw and state leaders considering contingency options, with a decision expected in the next few weeks. But none of the options are good.
Putting patients on the street before they are ready is obviously not a viable option.
There is little wiggle room when it comes to the forensic patients. That’s because, in 2015, the Disability Law Center sued the hospital alleging long delays in admitting patients left people languishing in jail with insufficient care for months at a time. The state settled that lawsuit in 2017, but remains bound by the settlement.
That means the likeliest option, it seems, is that it will begin accepting fewer patients from local mental health providers — like Odyssey House or Valley Behavioral Health — shifting the strain to those organizations.
That’s a major concern, according to Adam Cohen, CEO of Odyssey House of Utah. Organizations like his are also struggling to find and retain staff. And in some instances providers are not equipped to treat the most acutely ill patients.
“The problem is already bad. People are waiting in emergency departments for a week at a time and that’s only going to get longer,” he said. “I have some fears that people who should be in the state hospital will be forced into lower levels of care that aren’t appropriate for the person or the community. And we’re bracing for that.”
The situation has reached a crisis stage and has the potential to get worse.
The Legislature has been warned of this looming cliff for nearly two years and has failed to react. It is unrealistic, as Cohen noted, to think that employees are going to take a job in a potentially dangerous environment when they can make 50% more working at Amazon.
They could have addressed it in the general session earlier this year or in either of the special sessions when they were sitting on hundreds of millions in surplus money.
Now it is urgent that they act. They owe that to the patients who need help and the workers who are sacrificing to care for them.
Correction • Dec. 1, 11:55 a.m.: The story has been updated to reflect the starting salaries for psychiatric technicians and food service workers after wages increased this fall.