By Wes Venteicher
The Sacramento Bee
SACRAMENTO, Calif. - The pay at California’s state mental hospitals is good, but increasingly, it’s not enough to convince employees to endure the violence and forced overtime that come with the work.
That’s the takeaway from a recent analysis published by the Legislative Analyst’s Office, which recommended lawmakers dig deeper into hiring and retention struggles at the Department of State Hospitals.
The technicians are licensed providers of mental and behavioral health care who perform many of the same tasks as nurses. Most who work for the state earn around $68,000 per year — about 31% more than their peers in the private sector and local government in California, according to state salary surveys.
But they treat the most difficult patients. Ninety percent of people in the hospitals were charged with or convicted of crimes related to mental illness, according to the Department of State Hospitals. The population includes sexually violent predators and those found not guilty by reason of insanity.
The department employs nearly 13,000 people, with about 7,000 psychiatric technicians providing the bulk of front-line care.
From the beginning of 2020 through June of this year, patients attacked employees an average of six times per day, according to the Legislative Analyst’s Office.
“It’s not a matter of if you get assaulted, it’s when, and just how severe it’s going to be,” said Eric Soto, president of the California Association of Psychiatric Technicians, the union representing rank-and-file state psychiatric technicians.
As recently as June, a female employee at the state hospital in Coalinga was stabbed in the face with a plastic knife by a patient who said he wanted to remove her eye, and vowed he would try again, said Jaime Garcia, a senior psychiatric technician and union chapter president.
“That’s the danger with psychosis,” Garcia said. “When a patient has completely determined this is something they have to accomplish, it’s very hard to stop them.”
No employees have been killed since 2010, when a patient strangled Napa State Hospital employee Donna Gross.
Soto said employees still experience too many attacks on employees, but acknowledged reductions in violence due to changes at the hospitals over the last 10 years, including providing workers with GPS-equipped personal alarm devices.
“DSH continues to see declines in violence and reminds us of the critical importance of continuing our efforts,” Stephanie Clendenin, the department’s director, said in a recent report on rates of violence from 2010 to 2020.
Violence, overtime
The Legislative Analyst’s Office spotlighted violence against employees in its analysis of a recent contract agreement between the union and Gov. Gavin Newsom’s administration. The Legislature must approve the agreement for it to take effect.
As of 2020, 22% of psychiatric technician jobs at state hospitals and prisons were vacant, according to the analysis.
The office said more study is needed to find definitive reasons for the high rate of unfilled jobs, but cited dangerous working conditions and forced overtime as possibilities.
“When we saw that report, we were all kind of like, ‘Yeah, that’s what we’ve been saying for years,” Soto said.
The state hospitals are required to maintain daytime staff-to-patient ratios of at least one to eight under a longstanding court order, said Garcia, the union’s Coalinga chapter president. At hospitals with high vacancy rates, employees are more likely to be tapped for a second shift.
With fewer vacancies, there’s less need for overtime, and the hospitals have opportunities to increase staffing ratios for groups of patients with the most acute needs, Garcia said.
The union’s recent contract agreement includes a number of incentives aimed at reducing the vacancies, such as longevity pay starting at 17 years, semi-annual bonuses of $600, 4% raises for workers at the top of their pay scales and stipends for employees at state hospitals with the most unfilled jobs. The agreement will increase state spending by about $96 million per year by the end of its three-year term.
Competition for California mental health workers
But the analyst’s office questioned whether the incentives would convince employees to stay.
While the state offers far more psychiatric technician jobs in California than private and local government employers, demand in those sectors is projected to grow in the years ahead as dementia and other illnesses become more prevalent, according to the analysis.
“The Legislature may wish to better understand the issues that contribute to the recruitment and retention challenges of psychiatric technicians and to understand what factors it should consider when determining if the proposed agreement provides a reasonable level of compensation to address those challenges, especially in the context of rising inflation, the pandemic, and dangerous working conditions,” states the report.
In addition to the new GPS alarms, the Department of State Hospitals has adopted measures such as creating separate units for the most violent patients, department spokesman Ralph Montano said in an email.
The department also is expanding training programs to bring in more new recruits — an effort that was delayed during the pandemic but is being resumed this year, according to Montano’s email.