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Critical Staff Vacancies at Central State Hospital

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sherlockj
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By James C. Sherlock

This space has offered the opinion previously that it is unwise to build a new Central State Hospital (CSH) on the site of the old one.

A follow-up FOIA request to the Virginia Department of Behavioral Health and Developmental Services has yielded current “jobs filled” data to compare to “jobs vacant” data reported earlier to enable us to examine significant personnel shortfalls by percentages.

They make a discouraging point about the current status and the future prospects of CHS in Dinwiddie County.

The reasons for the job vacancies include, in no particular order:

  1. The overall shortage of mental health professionals in Virginia and nationwide;
  2. The area of the hospital is very poor and dangerous, as are the public schools, meaning many candidates will not wish to live and raise a family close to CHS;
  3. There is no nearby research hospital available to staff:
    1. to seek an in-person second opinion on a case; or
    2. in which to maintain a teaching position; or
    3. to help research cures;
  4. And, insufficiently attractive pay and working conditions to overcome the first three.

Those combine to remind us that in a competitive market for skilled labor in short supply, labor can and does optimize the conditions under which it will work.

Not nearly enough of the required skilled labor wants to work at a maximum security mental hospital in Dinwiddie County. It is hard to imagine a realistic pathway to fill the vacant jobs at Central State while it remains there.

Spending $400 million (or more) to build a new hospital on that same site seems to represent in the General Assembly some combination of:

  • ignorance of the staffing challenges;
  • treating Central State as a regional entitlement with a touch of NIMBY from other regions;
  • systemic inertia; or
  • all three rather than a realistic consideration of care quality and patient and staff needs.

Governors McAuliffe and Northam tried to build it for eight years. When last reported, construction is to start in the fall of this year.

Maybe.

That new facility seems as destined to fail in attracting critical staff as the current one.

That in turn seems a scandalous disregard of the needs of the patients reflected in the quality and quantity of staff.

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10 responses to “Critical Staff Vacancies at Central State Hospital”

  1. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Before blaming the staff shortages at Central State on its location, it would be instructive to compare those shortages with staff shortages at Eastern State Hospital in Williamsburg, Western State Hospital in Staunton, Piedmont Geriatric Hospital in Burkeville, the Virginia Center for Behavioral Rehabilitation in Burkeville, the Commonwealth Center for Children and Adolescents in Staunton,
    the Southwestern Virginia Mental Health Institute in Marion, and the Marion Correctional Center (a high security mental health hospital run by the Department of Corrections).

    1. James C. Sherlock Avatar
      James C. Sherlock

      Sounds like a good project for someone.

      Perhaps someone is already working on getting the information for some of those places.

      But I thought more of what you asked, professor, and my work here is not a thesis, just a well researched article.

      It matters only for the purposes of CHS that not enough mental health professionals wish to work there, which I have demonstrated.

      Then we come to you.

      Do you now or did you ever want to work or live in Dinwiddie County or Petersburg?

      Didn’t think so.

      1. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        The jobs that attracted me to the Richmond area were in Richmond, not in Petersburg or Dinwiddie. Therefore, it never occurred to me to live in either of those places.

        Many might think Dinwiddie or Petersburg, close to Richmond, would be more preferable that Burkeville in the heart of Southside or Marion, a little town on I-81, far from any metropolitan area. (Don’t get me wrong; under the right circumstances, I would not mind Marion.)

    2. Nancy Naive Avatar
      Nancy Naive

      Then compare to similar institution’s pay scales.

      Money solves all (most) staffing problems.

      “Even before the pandemic, DBHDS had more than a thousand vacancies at state-run mental hospitals — roughly one-fifth of the roughly 5,500 staff the facilities normally require. In fiscal 2020, some facilities saw more than 30 percent of their direct care positions remain unfilled.”

      You are not alone…

      “There will be an estimated shortfall of 10 million healthcare workers worldwide by 2030, primarily in low- and middle-income countries. Urgent and extreme action is needed now to improve recruitment and retention of the global healthcare workforce.”

    3. Nancy Naive Avatar
      Nancy Naive

      Then compare to similar institution’s pay scales.

      Money solves all (most) staffing problems.

      “Even before the pandemic, DBHDS had more than a thousand vacancies at state-run mental hospitals — roughly one-fifth of the roughly 5,500 staff the facilities normally require. In fiscal 2020, some facilities saw more than 30 percent of their direct care positions remain unfilled.”

      You are not alone…

      “There will be an estimated shortfall of 10 million healthcare workers worldwide by 2030, primarily in low- and middle-income countries. Urgent and extreme action is needed now to improve recruitment and retention of the global healthcare workforce.”

    4. Nancy Naive Avatar
      Nancy Naive

      Then compare to similar institution’s pay scales.

      Money solves all (most) staffing problems — if there is staff to be had.

      “Even before the pandemic, DBHDS had more than a thousand vacancies at state-run mental hospitals — roughly one-fifth of the roughly 5,500 staff the facilities normally require. In fiscal 2020, some facilities saw more than 30 percent of their direct care positions remain unfilled.”

      You are not alone…

      “There will be an estimated shortfall of 10 million healthcare workers worldwide by 2030, primarily in low- and middle-income countries. Urgent and extreme action is needed now to improve recruitment and retention of the global healthcare workforce.”

      and it won’t get better…
      https://www.aamc.org/news-insights/growing-psychiatrist-shortage-enormous-demand-mental-health-services
      “Yet the United States does not have nearly enough mental health professionals to treat everyone who is suffering. Already, more than 150 million people live in federally designated mental health professional shortage areas. Within a few years, the country will be short between 14,280 and 31,109 psychiatrists, and psychologists, social workers, and others will be overextended as well, experts say.”

  2. Lefty665 Avatar
    Lefty665

    The VCU health campus is 23 miles from Central State and is located right at the I95 interchange. It does not take much longer to get to Central State than it does to the VCU academic campus in Richmond during heavier traffic.

    Virginia State University is physically close to Central State. A program there to prepare staff would resolve many of the staffing issues as well as provide a training site for students. VCU could participate via a shuttle from Richmond. In the longer run that would let Virginia become a resource to help alleviate a nationwide shortage of psychiatric workers instead of exacerbating it.

    There are alternatives to your quest to increase costs by scattering psychiatric forensic units across the state to densely populated university communities where they will not be welcomed.

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      Those are good suggestions.

      Jim’s quest is like that of Don Quixote. The decision to build a new facility at the Central State location was made several years ago by the General Assembly after several years of agonizing and putting it off. The issuance of bonds for the construction has been authorized and planning and design are underway.

      To do what Jim is suggesting, regardless of its merits, would entail stopping the work on the new Central State and then commencing a multi-year process of planning for, and constructing, smaller high security facilities scattered around the state. Because there is a broad consensus that Central State is in poor condition and needed replacing years ago, a proposal to stop work and let the current Central State continue to operate for many more years would meet strong opposition.

    2. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      Those are good suggestions.

      Jim’s quest is like that of Don Quixote. The decision to build a new facility at the Central State location was made several years ago by the General Assembly after several years of agonizing and putting it off. The issuance of bonds for the construction has been authorized and planning and design are underway.

      To do what Jim is suggesting, regardless of its merits, would entail stopping the work on the new Central State and then commencing a multi-year process of planning for, and constructing, smaller high security facilities scattered around the state. Because there is a broad consensus that Central State is in poor condition and needed replacing years ago, a proposal to stop work and let the current Central State continue to operate for many more years would meet strong opposition.

      1. Lefty665 Avatar
        Lefty665

        Makes sense. The cost and delay from stopping work in process and starting planning for a radically different service delivery paradigm that requires major changes in service delivery institutions in addition to establishing new facilities is hard to over state. What could go wrong?

        On a practical level, I know how hard we had to work to gain community acceptance for something as simple as group homes for small numbers of benign folks with intellectual disabilities.

        Don’t know how I’d go about marketing forensic units for violent people with severe criminal psychiatric illness in already high density communities adjacent to universities. Maybe “Compared to the college kids I’m not sure you will notice the homicidal maniacs who may occasionally get loose in your neighborhood.” It would be a hard sell with unpredictable outcomes confronting NIMBY on steroids in areas with lots of activists and lawyers.

        Where would it leave the project if Richmond, Charlottesville or Fairfax said “No thank you”, eminent domain? Central State has been where it is for coming up on 150 years. Everyone in the area knows what the institution is. It has been peoples back yards far longer than any of them have lived there.

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