Precarious staffing levels at the state’s Riverview Psychiatric Center are contributing to a crisis environment that can only be remedied by immediate salary increases. So says Republican state Sen. Roger Katz, who has put forth a bill that would increase salaries for mental health workers at Riverview and at the Dorothea Dix Psychiatric Center in Bangor.
Mental health advocates and hospital staffers support the measure, but the superintendent at Riverview says wage increases alone will not solve all of the problems.
Katz’s bill carries a $700,000 price tag. But Rep. Peggy Rotundo, the Democratic House chair of the Legislature’s Appropriations Committee, says it may be just what’s needed to begin a new proactive approach to confronting issues at the embattled Augusta hospital.
“I really hope that we as a Legislature can give thought to how we can work with the governor and the administration to create a situation in our future where we are not lurching from one crisis to another,” she says.
And there are costs for failing to act. The state risks losing more than $20 million in federal Medicaid reimbursement due to noncompliance issues dating back to 2013, when an audit revealed numerous issues involving the housing of forensic and nonforensic patients, improper use of stun guns and restraints and record-keeping.
Staffers have been assaulted by patients on several occasions over the last three years, prompting resignations, which in turn have contributed to understaffing problems.
The hospital’s administration has responded by imposing work requirements that include mandated shifts, or forced overtime. Katz says the word “crisis” accurately describes the current situation at Riverview.
“That word was chosen carefully and I do not think it is inaccurate,” he says. “It is significant shortages in staffing for mental health workers, for acuity specialists, for nurses at all levels and for social workers. When the facility is not properly staffed, bad things are going to happen.”
“I have stood with my co-workers as they have cried after being mandated because they are exhausted and being forced to stay another eight hours,” says Blair Fenning, an acuity specialist and former mental health care worker at Riverview.
Fenning says chronic understaffing at the hospital is at the core of most of its problems. Inadequate pay, he says, makes it difficult for the hospital attract and retain staff, which in turn contributes to an environment that places patients and workers at risk.
“The reality is, due to the low staffing levels, we are only creating a dangerous environment that need not happen if the facility were adequately staffed,” Fenning says. “Due to our historically high turnover, even when the facility on paper has met its core staffing requirements, we are unable to retain staff — or that core levels are maintained by pulling from others areas to meet our staffing requirements.”
Katz’s measure would dedicate a $1.9 million boost to salaries for workers at the two facilities, and supporters say it would bring Maine in line with other states that offer more generous compensation packages.
Jenna Mehnert, executive director of the Maine chapter of the National Alliance on Mental Illness, says without Katz’s bill, the state can expect the cycle of hirings and resignations at Riverview to continue.
“If we don’t adequately compensate people, it means that we’re serving as a training ground at Dorothea Dix and Riverview and then they are going to go somewhere else where they can make more money, whether that’s in the state of Maine or outside the state of Maine,” she says. “So we need to make these professional living wages.”
But Jay Harper, the superintendent at Riverview, says there are other problems within the system that need to be addressed.
Harper, who took no position on Katz’s bill, says lawmakers should also consider the governor’s plan to relocate the hospital’s potentially violent forensic patients to the Intensive Mental Health Unit at the Maine State Prison in Warren. That would improve conditions at Riverview, Harper says, and make it easier to retain staff there.
“I’m not saying that people should not have a livable wage and that we should not look at dollar amounts, but to think that that is biggest part of the solution or the only part is not from my perspective the correct way to do this,” Harper says.
Harper also told the committee that if they do approve wage increases for mental health staff, the measure should be expanded to include several other employees that also provide direct patient care.