California Psychiatric Association
Policy Statement on State Hospitals*
10/06/06
CPA Policy Statement on State Hospitals*
California Psychiatric Association State Hospital advocacy priorities are: Safety, Salaries, Structure and Support for Medical Leadership.
Psychiatrists and other disciplines practice in state hospitals under persistent threat to their physical safety as well as their psychological well-being. In the two State hospitals visited, and in reports from the remaining two, the incidence of patient-to-patient violence has increased despite the oversight of the Federal Department of Justice Consultant, and Federal Court Monitor who enforces the recent settlement agreement with the state.
State Hospital staff position vacancy rates of significant proportions persist in the face of salaries that in some instances are lower than that for county mental health departments in the same locales and suffer significantly in comparison to salary increases proposed by the Federal Court Receiver for state prison health services – in some cases doubling present salaries for prison employed health professionals possibly also for prison psychiatrists. Under present conditions state hospital employees who personally deliver patient care should qualify for “hazardous duty pay” that recognizes the hazardous conditions of employment under which they labor, or at a minimum should have salary levels competitive with other public sectors. Recruitment and retention bonuses should also reflect state priority to attract qualified psychiatrists to the state hospitals.
State Hospital administrative lines of authority are fragmented and inefficient and clearly violate state law that requires that oversight of all clinical treatment shall be overseen by a medical director. Currently the only disciplines that are overseen by the medical director are physicians, with all other disciplines answering to a clinical administrator who may be a psych tech, nurse or social worker Current statute also does not require that the qualifications for the medical director position should be an individual who is either board eligible or board certified in psychiatry.
Psychiatric leadership and authority is undermined by many overlapping program and organizational components and policies which at times have contradictory purposes, missions and/or functions. The end result is that traditionally clear patient management responsibilities in an interdisciplinary team model are now diffuse and not clearly defined, with the result that coordination and continuity of quality of patient care is severely lacking.
There are also numerous instances in which medical staff autonomy and authority are undermined and weakened.
The CPA, will work in coordination with the Union of American Physicians and Dentists and other organizations and associations having a stake in these conditions, to explore legislative, budget and/or regulatory options to effectively ameliorate these conditions, including advocacy to the Department of Justice consultant for state hospitals, the monitor established by the Federal Court in it’s consent decree for state hospitals, as well as directly to the Federal Court.
*Adopted by CPA Council October 6, 2006
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