Idaho’s two state mental hospitals have seen an increase in the acuity of their patients’ conditions, “increased dangerousness,” Ross Edmunds, state Division of Behavioral Health administrator, told legislative budget writers this morning. That’s requiring more use of seclusion, restraint and one-to-one monitoring. As a result, Gov. Butch Otter is recommending a dozen new staffers at the two hospitals, nearly all psychiatric techs, for “life safety issues.”

Edmunds said state mental hospitals are the No. 1 most dangerous place to work as measured by worker’s compensation claims, “More than firefighting, more than law enforcement, because of the assaults on the staff from our patients.” He said he doesn't blame the patients. “Patients are often not thinking clearly, psychotic. … It becomes a dangerous place.” Because of that, he said, he “enthusiastically” supports the governor’s recommended 3 percent merit raises next year for state employees. “I think this is a very deserving group of individuals to be recognized,” Edmunds said.

The new psych tech positions are certified nursing assistants who would be paid around $15 an hour.

State Hospital North in Orofino, which has been operating since 1905, has 60 adult psychiatric beds. There, patients have shown both an increase in acuity and dangerous behavior and, Edmunds said, “prison thinking,” defined as an increase in “criminogenic and antisocial traits.” The hospital has seen “a lot of conflict between patients, a lot of joining against staff. … These are hospitals, these aren’t correctional institutes, so who operates the hospitals is largely nursing staff, not trained guards,” he said. For State Hospital North, the governor’s budget recommends adding six full-time psychiatric tech positions for life safety issues. Seclusions of patients at the hospital due to dangerous behavior have risen from 35 in 2012 to 78 in 2015. That budget request totals $300,000, all from state general funds.

State Hospital South in Blackfoot, which has been operating since 1886, has seen adolescent admissions – teens with serious mental health problems – double since 2008. There were 70 in 2008; there were 149 in 2015. The state hospital has 90 adult psychiatric beds, 16 in its teen unit, and a 29-bed psychiatric skilled nursing unit. The governor is recommending six new staffers there for life safety issues, five psychiatric techs and a program specialist. The budget request totals $321,900, including $71,600 in state general funds.

Overall, the proposed budget for psychiatric hospitalization next year reflects a 9.7 percent increase in state general funds, and 9.9 percent in total funds. That comes to $38 million total, including $25.7 million for State Hospital South, $9.2 million for State Hospital North, and $3.1 million for community hospitalization, which operates through contracts around the state.

Average daily cost per patient for psychiatric hospitalization is now $883 for community hospitalization, $509 for State Hospital North, and $600 for State Hospital South. Patients at state hospitals are either civilly committed through the courts, or sent by the criminal court system because they’ve been deemed mentally incompetent to stand trial. For those patients, “They need to be restored to competency so they can proceed to trial,” Edmunds said.

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