Across Missouri mental health facilities, staffing shortages limit access to patient care

Asked how patients are being taken care of without the necessary staff, a Department of Mental Health division director said, “in many respects, they’re not”

By: - November 4, 2021 2:14 pm

The Southeast Missouri Mental Health Center in Farmington, Mo. This Google Maps Street View image shows the facility. (Screenshot via Google Maps)

A staffing crisis across state-run mental health facilities has decreased access to care for patients, with some waiting months for services, state officials told the Mental Health Commission on Thursday.

Within the Department of Mental Health’s division of behavioral health, about 35% of registered nurse positions are vacant, 57% of licensed practical nurses are vacant, 32% of entry-level psychiatric tech positions are vacant and 28% of entry level security aide positions are vacant as well.

The department has slowed admissions to its adult psychiatric hospitals, and 41 beds have been taken offline across facilities “due to our inability to safely staff those locations,” Nora Bock, the director of the department’s division of behavioral health, said.

Asked by Commissioner Lynne Unnerstall how patients are being taken care of without the necessary staff, Bock said, “in many respects, they’re not.”

Staffing shortages mean less available capacity and fewer patients being served, Bock said.

State-operated facilities for adults can serve individuals who have been committed by the courts, and without sufficient capacity, some have to remain in jails instead, “and it’s a question of whether they’re getting any type of appropriate service,” Bock said.

“Within our facilities as well, if you’re just trying to make it day by day, less treatment is occurring because people are just trying to cover minimums and make sure that people get their medications and get fed,” Bock said. “So it’s a negative consequence all the way around, and it’s a reality that happens in our inpatient settings as well as in our community settings.”

Department officials told the commission low pay was a factor contributing to the staffing shortage. The department has already spent hundreds of thousands of dollars with temporary staffing agencies to try to fill shortages.

“We’ve become dependent on high-cost agency staffing contracts to meet the needs,” Bock said. “We’re a little bit concerned because those contracts may become less available in the near future.”

“Within our facilities as well, if you’re just trying to make it day by day, less treatment is occurring because people are just trying to cover minimums and make sure that people get their medications and get fed.

– Nora Bock, the director of the department’s division of behavioral health

Last year, department-run facilities also saw COVID cases surge, causing staff to have to stay home and quarantine. But unions representing facility workers said at the time that enforcement policies were patchwork, and due to staff shortages were being required to work after testing positive for the virus if they weren’t showing symptoms.

As of Monday, there have been 2,281 cases among department staff, with 24 of those active, and 528 cases among residents and patients, with one active. In total, six staff and ​​13 patients have died due to the virus, according to department figures.

The department has worked with Learfield Communications, a Plano, Texas marketing consultant who has an office in Jefferson City, on a social media campaign in an effort to recruit workers. The firm has been paid over $405,000 by the Department of Mental Health for advertising services in fiscal year 2022, according to the Missouri Accountability Portal.

While ads have had high engagement on social media, at a recent job fair only five candidates showed up, Sara Murphy, the department’s human resources director, told the commission. 

Potential job candidates have expressed disappointment in the rate of pay the department offers, Murphy said.

“It is not making the dent that we need it to,” Murphy said.

Jessica Bax, the director of DMH’s division of developmental disabilities, said during Thursday’s meeting that October marked the first month in “a very long time” that more new employees started versus those leaving.

According to a slide shared during the meeting, 35 direct support professionals started in October, versus 32 whose employment ended. In both August and September there were higher numbers of staff whose employment was ending than new employees starting.

“I would hope that’s some start of some big shifts, but I think we all know that’s probably not the truth,” Bax said. “Plus, now there’s a vaccine mandate coming out.”

On Thursday, President Joe Biden’s administration announced new federal rules regarding vaccinations, including one that will require health care workers whose facilities participate in Medicare and Medicaid health insurance programs be vaccinated against COVID-19 by Jan. 4. Critics of the mandate have raised concerns that it will drive health care workers who are already in short supply out of the industry.


While a wait list has declined since previous highs, there are currently 465 people waiting for residential services, Bax said. Over half have been waiting between three months to more than a year for services.

“Having slots available and funded does not equal access to care, “ Bax said.

Angeline Stanislaus, the chief medical director for the department, also said Thursday a case of Legionnaires’ disease was confirmed at a facility in Farmington Wednesday afternoon. 

Debra Walker, a spokeswoman for the department, confirmed after Thursday’s commission meeting that the Southeast Missouri Mental Health Center was informed Wednesday that Legionnaires’ disease was found in a patient who had been transported to the hospital.

The patient remains at the hospital, and Department of Health and Senior Services staff are at the Southeast Missouri Mental Health Center “conducting extensive testing of the facility’s water,” Walker said.

Breathing in water droplets containing Legionella bacteria can cause Legionnaires’ disease, a severe form of pneumonia. Generally, people do not spread the disease to one another, according to the Centers for Disease Control and Prevention.


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Tessa Weinberg
Tessa Weinberg

Tessa Weinberg covered education, health care and the legislature with the Missouri Independent. She previously covered the Missouri statehouse for The Kansas City Star and The Columbia Missourian, where her reporting into social media use by the governor prompted an investigation by the Attorney General’s office. She also covered state government in Texas for The Fort Worth Star-Telegram.