Report: As admissions surge, some state mental hospitals are understaffed, lack overtime policies

At a time when involuntary admissions to state mental hospitals are spiking, a review by state inspectors found that nearly half of the state’s 13 facilities do not have an approved policy that limits hours or consecutive days of overtime for increasingly overworked nurses and other staff. The report also says more than half of the hospitals were not properly staffed, among other findings.

“With the increase in certain patient populations and patient turnover at the facilities, more medical personnel are being asked to provide patient services for which they have not received direct training,” said state Inspector General Michael Westfall in a news release. “Not having staff members cross-trained puts the employee and patients at risk for not effectively providing and receiving the patient-specific care needed.”

The 32-page report by the Virginia Office of the State Inspector General recommends the Department of Behavioral Health and Development Services implement a policy that limits overtime hours per week and consecutive shifts that direct care nursing staff are allowed to work.

“By not placing a limit on the number of overtime hours per week and consecutive shifts or consecutive hours of overtime worked by direct care nursing staff at facilities, DBHDS runs the risk of staff working excessive amounts of time and becoming too fatigued to carry out their duties,” the report says. “This could lead to lapses in adherence to safety policies or health care standards, which in turn will lead to substandard conditions and care for patients at DBHDS facilities.”

A response from the agency’s management, included in the report, blamed the overtime on 2014 legislation that required state hospitals to serve as the “facility of last resort” for people under temporary detention orders, issued when patients are deemed to pose a risk to themselves or others. The law also mandated that they “admit incompetent individuals within 10 days of receipt of a court order.”

And though the department got a boost from the General Assembly in this year’s budget, including additional money for hospitals operating at 90% capacity or greater, “the state hospitals continue to consistently operate well above their funded and staffed levels and these census trends are projected to continue at a 2% growth rate annually.”

The department also says it’s working to improve recruitment and retention.

“The conditions observed and recommendations as stated infer that overtime and safety issues will be ameliorated with an umbrella OT policy for all state facilities; however, each facility’s unique staffing needs must be recognized and managed accordingly,” DBHDS said.

The agency said it would convene a workgroup that would recommend guidelines and that it would “ensure that each facility has a policy, tailored to its unique needs and funded staffing levels that provides guidance on the number of overtime hours worked within a week, the number of consecutive hours worked and the amount of time between shifts.”