In today?s news, despite the pandemic’s decline, state health officials report that the shortages it brought about have gotten worse with lengthier wait times for mental health services. The Navy on Tuesday unveiled a “Mental Health Playbook” with the goal of promoting discussions about mental health among commanders and sailors and removing the frequently perceived stigma attached to asking for assistance. A state senator is defending herself after receiving criticism for speaking out about her own battle with mental illness.
Hospitals can’t admit mental health patients due to staff shortages
Mental health patients seeking admission to state-run psychiatric institutions in North Carolina may wait hours, days, or weeks in an emergency department for a spot in a better-staffed and equipped facility.
Over the past year, the state Department of Health and Human Services built a monitoring system that quickly reports open mental health beds across the state.
The content is unsettling.
With its new bed tracker, DHHS found that 489 persons were waiting to be admitted to a state psychiatric facility on Feb. 20, 253 of them were waiting for a hospital.
There were always beds. Behavioral health facilities often have a severe staffing deficit.
?We actually had empty beds, but we lacked the staff, the personnel to staff them, which means that we aren’t able to admit individuals off of that waiting list at the rate that you and we would expect,? DHHS Deputy Secretary Mark Benton told lawmakers last week during an appropriations committee meeting.
Benton and others described the dire staffing situation at North Carolina’s three psychiatric hospitals and 11 other state-operated facilities, including alcohol and drug treatment centers and facilities for people with severe intellectual and developmental disabilities or children with mental health issues.
Vacancies, turnover high
More than 11,000 people?nearly two-thirds of the state health department’s 17,400 positions?operate such institutions at capacity.
Luke McDonald from the legislature’s independent fiscal research office informed legislators that 3,700 posts are empty, nearly treble the 1,230 reported in 2020.
McDonald said the number of persons serviced had decreased since two years ago. ?Across all sites [that] comes out to approximately 2,400 fewer persons served, thus a 31% decrease.?
The state’s three psychiatric facilities have 894 beds but averaged 667 patients. The state’s three Alcohol and Drug Addiction Treatment Centers could treat 146 patients per day if fully staffed, but they averaged 80 in 2022.
Benton informed legislators that two-thirds of the vacant posts have been unfilled for nearly six months.
Last year, Benton and DHHS Sec. Kody Kinsley briefed lawmakers on a 26.2% employee vacancy rate in state-operated facilities. Benton reported 30.1 percent.
?Our larger mental health system depends upon the availability of beds, services, and staff all throughout the continuum of behavioral health care, whether that is in the community or within our facilities,? Benton said.
Benton and Kinsley are drawing a stark picture of what’s needed to fix the state’s mental health system as lawmakers prepare a biennial budget beginning July 1. They credit higher compensation for doctors, cooks, and cleaners.
North Carolina has a better fiscal outlook. In mid-February, General Assembly budget analysts and the governor’s budget staff forecast $3.25 billion more income than a year earlier.
Republicans with majorities in both General Assembly houses may push for tax cuts and state workforce expenditures.
Stocking a bed requires more than employing nurses.
DHHS estimates that 10 to 20 registered nurses and 20 to 25 nurse aides or health care techs would be needed to staff 20 beds for three shifts per day.
?Then as you move into multiples of those 20 beds, into 40 and 60, then you start thinking about the need to recruit an extra psychiatrist and more psychologists and social workers who will begin working on the release plans for those new patients,? Benton said.
The bed stays empty or the state hires temporary staff if there aren’t enough workers.
Workers are expensive
?We spent $65 million last year to hire temporary nurses, nurse aides, and other staff,? Benton added. ?We are on schedule to spend that amount this year, $32 million is what we have spent around midway through this year, so I believe that we will spend a similar amount by the end of this state fiscal year.?
McDonald remarked that money is allocated and spent even if no one is working.
He stated they’re usually utilized for overtime or shift premiums for current employees or temporary or contract labor.
Benton said worker turnover rates vary.
One in four Wright School employees left in 2022. Two-thirds of Black Mountain Neuro-Medical Treatment Center employees quit that year. Black Mountain is a 24-hour nursing home for complicated medical and behavioral patients.
The burnout many health care employees suffered during the coronavirus pandemic increased the vacancies. Workers can negotiate greater wages elsewhere.
Benton cited a Greenville facility example.
Benton told lawmakers that the director was close to hiring a nurse, but they got a competing offer that was $50,000 more than he could afford. ?I don’t think he wanted me to match that dollar for dollar. I need to be at the ballpark to compete.?
Benton said the agency cannot afford to hire when others are prepared to pay tens of thousands more.
New hiring flexibility insufficient
During the pandemic, the legislature allowed the department to hire faster and award bonuses and shift differential pay to doctors, nurses, and psychologists. That affected certain jobs, Benton said.
Unlicensed professionals in food service, maintenance, HR, and IT make up three-quarters of the workforce. Benton said the department uses expired salaries to pay unlicensed staff overtime and hire temporary workers.
?I think about the thousands of unlicensed nurse aides, health care techs, youth program assistants, who are the backbone of the work that we perform in our institutions, and we’re losing them to businesses like Starbucks and the dollar store, who can pay a better hourly rate,? Benton said. ?They don’t have to work second or third shift, and they don’t have to care for our patients with really complicated needs.?
Nurses, clinical social workers, health technologists, and psychologists?the backbone of a good mental health facility?have the greatest vacancy rates.
Benton said that gap causes the “gloomy news” that a third of state-funded facilities’ beds are unoccupied.
?If we had sufficient resources and were able to keep on to the employees that we now have in our facilities and hire extra staff, we could fill every one, take everyone off that waiting list and put them into our facilities,? Benton said.
Navy releases new “playbook” to address concerns of sailors with mental health
The Navy issued a “Mental Health Playbook” Tuesday to help commanders and sailors discuss mental health and remove the stigma of getting treatment.
?This playbook is designed to aid Navy leaders in preventing, reducing, or treating mental health concerns within your commands,? it says. ?This work begins long before a mental health issue. That starts with our leaders’ climate and how you lead your charges.?
It specifies three leadership responsibilities, from the deckplate to the command triad.
- “Create an atmosphere of trust and respect with open, two-way communication; challenge inappropriate behaviour or bad leadership; and eliminate stigma for seeking help,” leaders must do.
- It urges people to utilize empathy, have talks beyond professional performance, actively listen during difficult conversations, watch for behavior changes, and consult with chaplains and therapists.
- It expects leaders to help sailors obtain care and stay on the team. It also helps seafarers find mental health resources.
Following last year’s George Washington tragedy, sailors’ mental health issues are being addressed. Given the overall mental health practitioner shortfall, employing more is not feasible. The Navy says all leaders must step up.
?We’re aware of the obstacles that many have had in bringing sailors to the mental health options available to them,? Navy Culture and Force Resilience Office director Rear Adm. Brett Mietus told reporters Monday. The playbook “solves some of these difficulties, putting tools in the hands of every Navy leader, no matter the rank.”
?Our goal is that everyone in our great Navy learns a shared understanding about how to do mental health preventative maintenance for our folks, and then where to go for more resources,? he said.
As military mental health talks grow more accepted, the playbook advises commanders to ?use appropriate language that does not stigmatize? and not judge.
Colorado lawmaker stands tall after being criticized for disclosing mental illness
State lawmaker who was criticized for discussing her mental condition is fighting back.
Adams County Democratic State Rep. Dafna Michaelson Jenet thinks it’s time to end behavioral health misconceptions.
“I have terrible depression. It’s hard to discuss, “Jenet Michaelson. Yet we must talk about it to remove the stigma.
Over the past six years, she has introduced over a dozen measures to end mental illness stigma and improve care. Her current idea would prohibit insurers from pushing people with significant mental illnesses to try several cheaper medications before covering their doctor’s recommendation.
Last week, Michaelson Jenet highlighted why the law was so important: “I noted that when I was prescribed a prescription, I had to take fail-first medication and ended up in an outpatient partial hospitalization program to be stable while we tried to find the appropriate one. It was the worst two weeks of my life.”
“We appreciate that you bring your lived experience to the capitol,” a tweet read.
Next came a tweet ordering her to resign as chair of the Behavioral Health and Human Service Committee since she couldn’t manage a fast-food restaurant due to her mental disorder.
“When the initial tweet came in, I shrunk inside,” Michaelson Jenet recalled. “I’m talking to you about it today because we need to stop stigmatizing people.”
Michaelson Jenet, who ran for office because she couldn’t receive care for her 9-year-old son’s suicide attempt, may have done more to destigmatize mental illness in the capitol.
She claims crisis affects more than children: “We have an adult mental health crisis, and if we can’t talk about it and be open about it, we can’t help each other survive.”
Cancer struck Michaelson Jenet five years ago. That was well-received on social media. She hopes to evoke the same reaction when she posts about her depression, which she says she is thriving with owing to medicine.
Around 20% of U.S. individuals have mental illness, but many don’t seek care due to stigma.
“There’s work to be done and we can do it and we’ll do it,” says Michaelson Jenet.
Summary of today?s mental health news
Overall, North Carolina mental health patients waiting for admittance to state-run psychiatric facilities may spend hours, days, or weeks in an emergency department. According to DHHS, a facility with 20 beds would need 10 to 20 registered nurses and 20 to 25 nurse aides or health care techs to work three shifts per day. If there aren’t enough staff, the bed stays unoccupied or the state hires temporary personnel. The largest vacancy rates are for nurses, clinical social workers, health technologists, and psychologists, the core of a good mental health center.
Meanwhile, the Navy on Tuesday unveiled a “Mental Health Playbook” with the goal of encouraging commanders and sailors to have mental health discussions and removing the frequently perceived stigma associated with asking for help. In the playbook, leaders are urged to “employ appropriate language that does not stigmatize” and to avoid being judgmental as these talks grow more commonplace. The playbook also addresses the stigma that might be associated with getting care for mental health concerns in the military.
Finally, a state lawmaker is fighting back after being criticized for discussing her mental condition. Democratic State Rep. Dafna Michaelson Jenet, whose district covers Adams County, thinks it’s time to dispel behavioral health stigmas. She says, “We have an adult mental health problem as well, and if we can’t talk about it and if we can’t be open about it, then we can’t help each other survive.” The National Institutes of Health reports that roughly one in five U.S. adults have a mental illness, yet many don’t seek care. Michaelson Jenet says, “There’s work to be done and we can do it and we’re going to do it.”