November 15, 2021 — The state must hire more mental health nurses and other professionals to meet the mounting demands of New Yorkers throughout the state. But the state can’t recruit and retain enough staff to meet the challenge until it greatly improves pay and benefits enough to compete in a marketplace driven by labor shortages and increasing service needs.
Those were the key messages delivered to state legislators when PEF spoke at a November 9 hearing on state workforce issues held in Albany by the state Assembly Committee on Mental Health. PEF Vice President Randi DiAntonio delivered the union’s oral testimony, which expanded upon the written testimony submitted by PEF President Wayne Spence.
The union also voiced the need for the state to provide hazardous duty pay to its mental health employees who were deemed essential and have worked throughout the continuing pandemic to provide direct services.
After DiAntonio spoke, Assemblywoman Aileen Gunther, who chairs the committee, and Assemblymen John McDonald and Angelo Santabarbara, thanked DiAntonio and expressed their strong agreement with many of the concerns she raised in her testimony.
Gunther, who is a registered nurse, said she understands very well how difficult it is for the state’s nurses to work next to traveling nurses whom the state pays a rate of $250/hour, plus full coverage of their hotel and food costs.
DiAntonio said she recently took an anguished phone call from a PEF member in pension Tier 6 who felt she had to leave her state job to become one of those highly paid traveling nurses. While strong pension benefits and secure employment and pay were enough to hold on to state employees in the past, those factors have been eroded to the point that they can no longer compete in the labor market for high demand positions.
“The pay difference is absolutely ludicrous,” Assemblyman McDonald said.
“It’s enough to attract nurses out of state service, leaving our neediest citizens without care,” DiAntonio said.
DiAntonio thanked the committee members for their efforts to slow the state’s divestment from public to private service providers, and for rejecting the plan to close Rockland Children’s Psychiatric Center, as well as the proposed merger of the state Office of Mental Health with the state Office of Addiction Services and Supports.
PEF also drew lawmakers’ attention to a plan that would move children’s services from Hutchings Psychiatric Center to SUNY Upstate University Hospital, where fewer beds would be available for youths who need in-patient mental health services. PEF’s requests for data on the use of existing beds and related information have not been met.
The state has tried to patch over its chronic underfunding and understaffing, with a combination of outsourcing services to private agencies, merging state agencies and services, working state employees massive amounts of overtime, and bringing in highly paid private-sector nurses to plug the staffing gaps, DiAntonio said. It’s not practical, not efficient and not cost-effective and it doesn’t meet the need that has picked up additional momentum from the disruptions and stress of the COVID-19 pandemic.
The combined effect has been to lengthen the waiting lists for services and disproportionally harm low-income, uninsured, underinsured, undocumented and severely handicapped New Yorkers who suffer from acute mental illness.
Prolonged and irresponsibly heavy overtime demands accelerate burnout and drive employees off the job and sometimes out of their professions.
“Healthcare professionals are being put into unsafe situations where they are working alone at times,” DiAntonio said. “This places them at risk as well as the patients.”
Nevertheless, OT has been a favorite go-to strategy at state psychiatric facilities and services.
In 2020, state employees worked more than 19 million hours of overtime at a cost of more than $850 million. Staff at OMH worked an annual average of 220 hours of overtime compared to 148 hours in 2011, a 33 percent increase. Moreover, total overtime costs at OMH totaled $128 million in 2020. This is not simply a product of the COVID-19 pandemic – on average, staff at OMH facilities worked 211 overtime hours in 2019 and 185 hours of overtime in 2018.
DiAntonio said PEF recognizes there is a need and a role for private-sector-based services, but the state has shifted too much of the work onto them and it has underfunded those services as well. The state’s overreliance on the private provider network diverted too many resources away from the public mental health service delivery system and left too many New Yorkers and their families alone to deal with their illnesses.
Numerous other speakers at the hearing, who represent those private agencies and mental health advocacy groups, verified that they, too, are experiencing the underfunding and understaffing that plagues state agencies. Reimbursements from insurance and Medicaid are not keeping pace with rising operating costs and a very tight labor market, they said. As a result, some said they are losing money at an unsustainable rate and the quality of their services is being seriously eroded.
PEF cited studies showing that New York state has been cutting services and reducing its patient bed capacity in spite of the growing need. According to the 2020 Census, New York state grew by more than 800,000 people from 2010 and the state’s population now exceeds 20 million residents. The Treatment Advocacy Center, a national think-thank and advocacy group for eliminating barriers to effective mental health treatment, recommends states maintain 50 in-patient beds for every 100,000 residents. According to this formula, New York state should maintain at least 10,000 in-patient residential beds. However, it currently has just 2,523 funded beds – 2,209 for adults and 314 for youths.
It’s not just about numbers, DiAntonio said, reducing local mental health services, especially for children, has a devastating effect on families and impairs their ability to be supportive and active in treatment efforts. This is most true for families with the least financial and other resources.
PEF remains concerned that the state will continue to seek to further reduce state-supported psychiatric beds and staffing despite the fact that we are in the midst of a mental health crisis. OMH lost 2,916 staff between 2010 and 2020. The agency had planned to decrease its workforce by another 446 staff this year.
“We need more staff and more services, not fewer,” DiAntonio said.
It’s one of the main demands PEF is making in its New York State Fund Our Future campaign, which aims to spotlight the vital work public employees and advocate for improved staffing, funding and other resources. If you’d like to get involved, please visit the Fund Our Future website.
Media Coverage of the hearing: