Why Are Our Most Vulnerable in the Hands of the Least Qualified?

PsychOdyssey OpEd, December 12, 2010

In the course of sleuthing details of the proposed closing of Hagedorn Psychiatric Hospital in New Jersey, we discovered a disquieting circumstance that should distress all family members of loved ones in New Jersey’s state psychiatric hospitals. It seems that the our most vulnerable psychiatric patients are in the care of direct service staff members who are apparently the least educated in the New Jersey Civil Service. (See more details about this in PsychOdyssey’s recent testimony about Hagedorn’s proposed closing by clicking here.)

For its 278 mostly geriatric patients, Hagedorn employs 197 direct service workers who are classified into four title categories. At the top are Residential Living Specialists (RLS), followed by Therapy Program Assistants (TPA). Below these are Human Service Technicians (HST). At the entry level are Human Service Assistants (HSA). For the entry level HSA positions, the Department of Mental Health and Addiction Services has no–repeat no–qualification criteria for either education or experience. Not even a high school degree is required! For the HST level, there in only one requirement: only one year’s service in the mental health sector. As it happens, most HSTs achieve their one year of experience serving as HSAs in the hospitals which hire them.

What is the percentage of direct care staff members at the HSA and HST positions for which the State requires neither no education or nearly no experience? Family members would rightfully expect that the percentage would be nearly zero. Their loved ones deserve a reasonable minimum standard of care service credential. Yet at Hagedorn, the percentage is a shocking 86%! More than 4 out of 5 of their loved ones’ direct care workers are not required to have any educational attainment. The percentages at New Jersey’s other hospitals are not much better. Greystone tops the list with 66%, while Trenton’s percentage is 71%. Ancora Hospital, a particularly difficult management challenge, sits at the bottom with 90% of its direct care staff without any particular credentials.

This inexplicable circumstance stands in stark contradiction to the requirements imposed by New Jersey’s Division of Mental Health and Addiction Services (DMHAS), the very same managing agency of the non-profit agencies the State funds in the community sector. DMHAS requires many entry level positions in community agencies to have at least a bachelor’s college degree. But it does not require the same of its own institutions. Why?

What is to be done? An immediate measure for staff already in place would be to require all direct contact staff to become Certified Psychiatric Rehabilitation Practitioners, as offered by the U.S. Psychiatric Rehabilitation Association. It is a straightforward process that many service providers at all levels of the industry, from PhD to high school dropout, have achieved. The State should train all its direct service staff workers to attain at least this minimum uniform standard. This is the bare minimum that it owes to its patients and their family members. All Human Service Assistants and Human Service Technicians should have sufficient education and training to understand and implement the latest best evidence-based, person-centered practices consistent with psychiatric rehabilitation principles. Better yet, the State should harmonize its internal recruitment policies with those it requires of agencies it funds in the communities.

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