Public Advocate: State Psychiatric Hospitals should hire staff with more education and experience

No educational requirement for most entry level hospital jobs

TRENTON – The state should recruit the most qualified staff possible – with the highest level of relevant education and experience – to fill direct care staff positions in the state’s four psychiatric hospitals, New Jersey Public Advocate Ronald K. Chen said today.

Read Public Advocate State Psychiatric Hospital Staffing Report

“As the state works to improve the quality of care at our state psychiatric hospitals, it is clear that more qualified and better trained staff will best serve the needs of patients and help them obtain the treatment they need to get well,” said Chen.  “Historically, most patients spent the bulk of their time with staff who are not required to have any significant training in the mental health field, and may not even have a high school diploma.  While progress has been made, we still need to do better.”

Individuals in custodial direct care positions are responsible for assisting patients in meeting basic adult living needs and for implementing patient care plans designed by the patient’s treatment team. 

There are a number of different civil service titles used to fill these direct care positions, which range in salary from $26,000 to $47,000 annually, these include: 

• Human Services Assistant [HSA]:
• Human Services Technician [HST],
• Senior Human Services Technician [SHST]:
• Therapy Program Assistant [TPA]:
• Senior Therapy Program Assistant [STPA]: and
• Residential Living Specialist [RLS]. 

None of these direct care positions includes an education requirement, although post-high school education may be substituted for experience in some cases

“Of particular concern is the fact that there are virtually no standards for the lowest entry level position of Human Services Assistant – which is basically the gateway into the system” said Chen, noting that the Department of Human Services has indicated it may change the hiring process for HSAs by establishing a competitive Civil Service exam and hiring only full-time, rather than part-time, HSAs.

Custodial Care Civil Service Titles Used in State Psychiatric Hospitals

In the state’s four psychiatric hospitals, there are 714 Human Services Assistant (HSA) positions– which do not require any education or experience – and there are 486 Human Services Technician positions (HST) – which do not require any education but require one year of experience.

Note:  Ann Klein Forensic Hospital is not included here because medical security titles are used there, unlike the direct care titles used at the four other state psychiatric facilities.

The over-reliance on entry level direct care staff is particularly prevalent at the state’s largest psychiatric facility, Ancora Psychiatric Hospital in Winslow Township, Camden County.

According to the report:  “Despite the variety of titles available, the vast majority of the custodial direct care employees at Ancora Psychiatric Hospital are either in HSA or HST titles.  Data provided by the Department of Personnel shows that 67 percent of these employees are in the HSA title and another 23 percent are in HST titles.  In total, employees holding the HST or HSA title comprise 90 percent of all custodial direct care employees. 

“In contrast, Greystone Psychiatric Hospital utilizes a significant number of higher-level custodial direct care employees.  There, only 34 percent of custodial direct care employees are in the HSA title and 32 percent are in the HST title.  Twenty-four percent of Greystone’s custodial direct care staff consists of employees in the RLS title.”

Ancora also has the highest percentage of HSA staff who do not possess a high school diploma -- about 10 percent.

Chen noted that the Department of Human Services, which operates the state’s four psychiatric hospitals, recently bolstered training of existing staff at Ancora and that this additional training and other measures appear to have improved treatment at the 600-plus bed facility.

In addition, legislators in the Assembly and Senate have introduced a series of bills intended to improve conditions and strengthen training at the psychiatric hospitals.

Still, very little, if any, education and experience is currently required to obtain a direct care position in any of the state’s four psychiatric hospitals.      

The report also recommends that staff be provided with additional training to give them a greater understanding of serious and persistent mental illness.and highlights the salary disparity between the state psychiatric hospitals and state-funded community providers, where bachelor’s level professionals often earn less than hospital direct care staff.

“Patients at state psychiatric facilities are among the sickest and need the highest level of care.  They deserve to be treated by staff members who have the level of education and experience necessary to assist mental health consumers in achieving their treatment goals.  Given that community mental health providers offer professional staff salaries that are barely competitive with entry level state positions, state hospitals should be able to recruit more qualified individuals for their direct care staff,” the report states.

Finally, the report recommends that the Department of Human Services begin to require a Certified Psychiatric Rehabilitation Practitioner [CPRP] credential for all direct care positions. A CPRP is similar to a Certified Nursing Assistant title used in other state. Those who hold the CPRP credential will have received the training needed to work in a psychiatric setting. 

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