More raises ordered at state hospitals

The federal judge overseeing reforms in mental healthcare for California prisoners has ordered the Department of Mental Health to significantly raise salaries of all clinicians at state mental hospitals who treat the sick prisoners.

U.S. District Judge Lawrence Karlton had indicated at a Sacramento hearing Monday that he might require pay raises only for psychiatrists. But his written order, released late Wednesday, is far more sweeping -- applying also to psychologists, licensed clinical social workers and the psychiatric technicians on the front lines of day-to-day care.

Still, it remained far from clear Thursday when or how the raises would be implemented and whether the majority of hospital workers would even receive them.

The move came after Karlton’s December order to sharply raise pay for prison clinicians inadvertently helped trigger an exodus of staff from the state hospitals -- which treat some of the same prisoners whom Karlton’s court aims to protect. Although all five state hospitals have been affected, Atascadero State Hospital on the Central Coast has seen the largest staff exodus and treats the greatest proportion of sick prisoners.

The shortages at Atascadero are so acute and detrimental to patient and staff safety that the facility effectively has been closed to new admissions since January, contributing to a growing waiting list of severely mentally ill patients in prisons and elsewhere.

“It is apparent to this court that steps must be taken immediately to remedy the staffing shortage,” Karlton wrote in his six-page order, which instructs the department to file a plan within three weeks laying out raises equal to those that prison clinicians received.

Karlton is overseeing the reforms in response to a class-action lawsuit on behalf of mentally ill prisoners, whose care he deemed unconstitutionally poor. He has no jurisdiction over Department of Mental Health treatment of non-prisoners, who include sex offenders who have already served their prison time, parolees too violent to be released, jail inmates too ill to stand trial or not guilty by reason of insanity, and a dwindling number of patients committed to the facilities through the civil courts.

Although Atascadero, Coalinga, Patton, Napa and Metropolitan state hospitals all house mentally ill prisoners, Napa and Metropolitan have only five beds apiece for such patients.

The state could avoid some of the mandated raises by moving mentally ill patients out of some hospitals and grouping them at fewer facilities. It could also raise salaries only for those clinicians who treat the patients under the court’s jurisdiction. But that would create a two-tiered system and might prompt state hospital workers to flood toward the jobs with better pay.

“It requires some analysis,” Department of Mental Health Director Stephen Mayberg said Thursday. “Who’s included? Who’s not included?

Karlton’s order already raised the alarm for mental health clinicians at developmental centers across the state, which have lost staff to the prisons and could lose more if additional employees left for higher-paying hospital jobs.

Mayberg and Gov. Arnold Schwarzenegger have pushed for a plan that would centralize mental health recruiting for numerous agencies, including the departments of Developmental Services and Veterans Affairs. But their proposal for a million-dollar-a-year headhunter has been criticized as inadequate to solve the immediate crisis. They are also seeking enhanced funding from the Legislature to hire 750 more people in the coming year at enhanced salaries that would nevertheless fall significantly short of the pay parity Karlton is ordering.

Mayberg said he would forge ahead with that strategy while analyzing Karlton’s order. “We are committed to addressing all of the concerns that the judge has raised,” he said.

At Atascadero, psychiatric technicians reacted jubilantly to the order. Paul Hannula, the facility’s California Assn. of Psychiatric Technicians representative, said he had fielded dozens of calls since Wednesday night, some from staffers who had left for prison jobs and wanted to return to the hospital and others from those who had planned to leave but now wished to stay.

“This decision is the only way to save California’s forensic mental health system,” Hannula said. “This will be the turning point of us being able to maintain staff and recruit staff, and at the same time it increases safety.”

The mood was less ebullient at Metropolitan State Hospital in Norwalk, which has lost psychologists, social workers and other staffers in a steady stream in recent months.

Social worker Osbaldo Gutierrez, 27, said both psychologists had recently left his unit -- which treats 57 patients routed through the criminal justice system -- and he too is laying the groundwork to abandon the hospital for a correctional facility where he can make more money in a safer environment with a lighter caseload.

The strains on remaining staff have left patients increasingly antsy and aggressive, he said, because scheduled therapy and educational sessions are often canceled.

“As the clinicians leave, the patients don’t have anyone to talk to,” he said. “They’re agitated. It impacts the progress they’ve made,” and their condition worsens. As that happens, “It becomes a safety issue. There are more assaults.”

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