A 24 percent pay bump offered three years ago failed to convince enough psychiatrists to go to work in California’s prisons, where inmate suicides reached record highs last year, according to prison and union officials.
Lawmakers and unions agree the record 38 suicides recorded last year reflect fundamental problems in the state’s correctional system, and that a lack of psychiatrists contributes to the problems.
“We’ve got a serious issue,” Assemblywoman Shirley Weber, D-San Diego, said during a Monday budget hearing. “Whatever we’re doing is supposed to make life better for folks, not worse. These are folks who walking the street wouldn’t commit suicide, but they go into our place and they do.”
About 40 percent of the state’s psychiatry jobs, including those at prisons and mental institutions, were empty in 2018, the last year for which vacancy rate data was available from CalHR. That’s despite average wages of about $296,000 per year, according to the CalHR survey.
Elizabeth Gransee, a spokeswoman for California Correctional Health Care Services, said the vacancy rate stands at 28 percent today when contract psychiatrists, including some who use telepsychiatry, are counted.
“We are continuously improving recruitment of health care staff including mental health care providers,” Gransee said in an email. “(The California Department of Corrections and Rehabilitation) continues to make substantial improvements in the delivery of health care and we will continue to ensure our population has access to the care they need.”
California’s prisons have struggled to provide adequate mental health care for inmates for decades. In 1990, a class action lawsuit was filed on behalf of those with serious mental illness. The state has been working under a judge’s orders to make improvements since a 1995 trial.
In 2018, whistleblower Michael Golding, the chief psychiatrist at the California Department of Corrections and Rehabilitation headquarters, alleged prison leaders falsified data to cover up shortcomings in its psychiatric care.
Twenty-seven of the 38 people who killed themselves had serious mental illness and are part of the lawsuit’s class of plaintiffs, Michael Bien, an attorney representing the plaintiffs, said during Monday’s hearing.
Bien said the “vast majority” of the suicides were foreseeable or preventable, blaming many on lapses in mental health care.
He cited the psychiatrist vacancies, burnout and high turnover as contributing to the lapses. He said the situation is only getting worse as the remaining psychiatrists face added stress.
“The system is in a dangerous spiral careening towards catastrophe,” he said.
A recruitment and retention bonus the state gave psychiatrists at a dozen state prisons in 2017 nudged hiring up slightly but barely made a difference, said Dr. Stuart Bussey, president of the Union of American Physicians and Dentists.
The prisons where the state offered the bonuses recorded some of the highest suicide rates last year. California State Prison – Sacramento, in Folsom, recorded nine suicides in 2019, Bien said at the hearing.
The state has attempted to fill some of the gaps with contractors. Bussey said the contractors, which cost the state far more than staff psychiatrists, can’t offer the same quality or continuity of care that staff psychiatrists can.
CalHR found that the state psychiatrists are better-paid than their private sector peers, but Bussey said the survey doesn’t reflect many of the incentives available in the private sector and at some local government agencies, including loan forgiveness programs and zero-interest home loans.
According to an analysis from the doctors’ union, contract psychiatrists cost the state about $36 million for a seven-month period that ended in January 2019.
Bussey, Bien, and representatives from the California Correctional Peace Officers Association said the state needs to boost pay and find other incentives and changes to boost hiring. Suicides are also increasing among correctional officers.
“The environment that we’re putting folks in is really really toxic for everyone,” Weber said at the hearing.
The union is pursuing some of its preferred fixes through contract negotiations with Gov. Gavin Newsom’s administration and seeking solutions through the Legislature, Bussey said.
In addition to pay increases, the state needs to improve working conditions, Bussey said. Right now, psychiatrists’ treatment decisions may be overruled by prison workers with far less medical training and they face other frustrations and disruptions in inmate treatment.