$20,000 bonuses among latest moves to improve California's mental health system in California

$20,000 bonuses among latest moves to improve California's mental health system in California

After decades of failed efforts to improve California's prison conditions, opting for unconstitutional and responsible suicides, lawyers and federal judges are betting that bonuses and better work deals will finally be enough to attract and retain the mental health providers needed to treat prisoners.

The funds come from nearly $200 million in federal penalties imposed due to California's lack of progress in hiring sufficient mental health workforce. They will be used for hiring and retention bonuses, including an additional $20,000 for psychologists and psychiatric social workers — roles with the highest vacancy rates — and $5,000 for psychiatrists and recreational therapists.

“I think it's important to point out that this is money that the state by not hiring people for these positions has saved,” said Michael Bien, an attorney who represented the roughly one-third of California prisoners with serious mental illnesses in a class action lawsuit. “And we know that no attitude has caused suffering, harm and even death.”

The money aims to address a shortage of mental health workers in California and across the country. State officials blame that shortage of workers for their chronic inability to meet the hiring levels required by the long-running lawsuit - a failure that prompted a federal judge to order top officials in court last year. The funds will be distributed after an appeals court upheld the contempt in March, saying staffing shortages affect whether prisoners can access “essential, even life-saving care.” The spending plan was developed jointly by lawyers representing prisoners and state officials.

Janet Coffman, a professor at the University of California-San Francisco Institute for Health Policy Studies, said planned improvements to working conditions should help with hiring but was skeptical about the impact of bonuses.

"What I don't see is the continued increase, the increase in salaries over the long term, which I think is probably more effective for retention than one-time bonuses," Coffman said.

The state has not taken this view. His expert witness, Labor economist Erica Greulich, showed during the 2023 trial that led to the fines that higher salaries were unlikely to increase hiring.

Facing a $12 billion deficit, Gov. Gavin Newsom in May proposed $767 million in pay cuts across state government that would "make it extremely difficult to fill chronically vacant mental health positions," said Abdul Johnson, chief negotiator for the bargaining unit that represents health and human services jobs in prisons and other authorities. He said he believes California should add longevity wages to retain veteran employees and pay more in areas with higher costs of living.

At first glance, salaries for mental health positions in California prisons are competitive with the private sector. For example, the range for a prison psychologist is $133,932 to $162,372, while the annual median for psychologists in California was $117,630 to $137,540 last year. The state's most recent contract with prison psychiatrists already includes 15% bonuses, in addition to other sweeteners, with a state salary range of $360,000, nearly $34,000 above the California average salary.

However, California prisons are competing for behavioral health workers amid a roughly 40% shortage of psychologists and psychiatrists in the state, and the shortfall is expected to worsen. More than a year before the court's contempt of court, the vacancy rate for psychologists never fell below 35% - the state is currently recruiting for nearly 300 such positions - while vacancies among social workers ranged from 17% to 29%. The court ruled that the state oversaw "appropriate" staffing for psychiatrists and recreational therapists but only periodically succeeded in reducing the vacancy rate below the 10% maximum. Officials are in the process of adding several new positions eligible for the bonuses.

Further complicating the hiring push, other organizations that hire these professionals may offer more competitive packages that may include bonuses and other benefits, according to statements made during the 2023 trial.

The state is also adopting a new hybrid work policy that allows mental health workers to spend some of their time remotely. The policy will see the state better compete with the private sector, particularly in the remote areas where many prisons are located, Coffman said.

The money from the fines will also improve a work environment in which the appeal decision "was often taken in the form of windowless converted cells in old and unheated prisons." One-time payments of between $50,000 and $300,000 will go to various prison mental health programs for new furniture and improvements to treatment and office space.

“Working in a prison is difficult and dangerous work,” Johnson said. “Our members face constant threats, physical attacks and extremely high cases.”

Angela Reinhold, a supervising psychiatric social worker at the California Correctional Institution in Tehachapi, said during the 2023 hearings that her office is in a closet and contained "post-1970s to 1970s" furniture.

She compared her situation to that of a colleague who had recently left for a safer, higher-paying job in the private sector.

“She is very excited that she is getting a bathroom with two-ply toilet paper, not to mention the other office equipment that is state of the art and the treatment room and an office with the type of technology in mind,” Reinhold said. “She doesn’t risk her safety with her patients and she telecommutes three times a week.”

Alexandra David, chief of mental health at the California Medical Center in Vacaville, described working in buildings without adequate heating or cooling, with leaky ceilings and flooded clinical offices.

"You know, it's an old prison. There are smells and sometimes rodents," David said at the same hearings.

The California Department of Corrections and Rehabilitation did not respond to requests for comment on the spending plan.

In what Bien described as a bid to avoid ill will, all mental health workers will benefit from the new spending, with current employees and new hires receiving one-time $10,000 bonuses. All Corrections Department employees, not just mental health employees, are also eligible to receive $5,000 for referrals that lead to new hires in understaffed areas. The state estimates the bonuses will cost about $44 million, although the projection does not include referral bonuses or bonuses paid to new employees hired during the year.

Future bonuses and other incentives are likely to depend on recommendations from a court-appointed receiver who develops a long-term plan to bring the prison's mental health system up to constitutional standards.

“We believe they have to do better with money, but money alone is not the answer here,” Bien said. “And that’s why we’re trying to do these work conditions as well as bonuses.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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