Schenectady

Ellis closes adolescent psychiatric unit; solutions sought for workforce shortage

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SCHENECTADY — The adolescent inpatient mental health unit at Ellis Hospital closed Monday, the latest symptom of a healthcare workforce shortage that is particularly acute in adolescent psychiatric care.

But advocates are hopeful that a regulatory change at the state level will open the field to a greater number of potential caregivers, as the alternative — training more psychiatrists — is a years-long proposition. 

Such a revision was excluded from the package of legislation passed with the state budget in April but more than 30 advocates joined in a conference call Wednesday in an attempt to build support for such a move before the current legislative season ends. 

Ellis continues to offer outpatient mental healthcare care for teens and said it hopes to reopen the inpatient unit when it can. It’s one of the few inpatient hospital settings for acute care for children in crisis, and had served an average of six to seven patients a day. 

Ellis said in a prepared statement that it became impossible to staff the unit at a sufficient level.

It’s indicative of a situation across the state and beyond, in which thousands of healthcare workers have retired, burned out amid the pandemic, or quit rather than be vaccinated.

Ellis in March had to curtail the hours of service at its Clifton Park Medical Center for the same reason.

As of Wednesday, the Ellis Medicine website showed 370 job vacancies across its various facilities, 272 of them at Ellis Hospital.

“We arrived at the difficult, but necessary, decision following persistent staffing limitations stemming from the local and national healthcare employee shortage, which will limit our abilities in the months ahead to safely staff this unit on a 24/7 basis,” Ellis said about the adolescent mental health unit.

Ellis said it does plan to reopen the unit and is mounting an aggressive recruiting campaign to make that possible.

The industry group Healthcare Association of New York State said Ellis is not alone.

“Hospitals across New York are experiencing unprecedented, high vacancy rates among all healthcare titles,” President Bea Grause said Wednesday. “We’re hearing consistently from members that vacancies are four to five times what they typically were pre-pandemic.”

She said a September survey by HANYS drew responses from more than 60 hospitals, nursing homes and other healthcare facilities across upstate New York. They said their average vacancy rate was 19% for all positions and 25% for registered nurses. 

Grause said anecdotally, the organization continues to hear similar statistics eight months later.

LONG-RUNNING SHORTAGE

Years and even decades before COVID arrived, advocates were warning of a shortage of child and adolescent psychiatrists and psychologists. The wait for an initial appointment could stretch months.

They concurrently warned of an increasing need for psychological services. The Centers for Disease Control noted a 44% increase in suicides by New Yorkers age 10 to 24 between 2008 and 2018, just short of the national increase of 47%.

The pandemic response, with its disruptions and isolation, has only exacerbated anxiety and other problems for troubled adolescents, advocates say. 

“Ellis is symptomatic of a problem that’s very big,” Andrea Smyth, president and CEO of the New York State Coalition for Children’s Behavioral Health, said Wednesday.

“We aren’t going to recruit our way out of this child psychiatry shortage.”

Smyth said she would like to have seen Gov. Kathy Hochul and the state Legislature declare the shortage an emergency. The advocacy and lobbying organization had hoped a measure would be passed with the budget last month to expand the scope of practice allowed to licensed mental health counselors, psychoanalysts and family therapists, whom Smyth said number more than 10,000 statewide.

They each have earned a graduate degree and have amassed 3,000 hours of supervised work experience before being licensed, she said, and could take on more diagnosis and treatment duties, short of prescribing drugs.

“We do have legislators who are committed to expanding the scope of practice before the end of session,” Smyth said.

Wednesday’s conference call joined some of these legislators or their aides with professionals and advocates in the field, she added. 

Smyth is still hopeful for change before the Legislature adjourns.

The 2022-2023 budget did recognize the labor shortage confronting New York’s healthcare industry but focused more on incentivizing current employees to stay on the job and non-employees to embark on an education and career path that will lead to healthcare professions.

For the short term, Smyth said, there are few alternatives for the adolescents who would have been admitted to Ellis.

“The other inpatient operations are quite far away,” she said.

Outpatient treatment and longer-term residential treatment options are available but they aren’t the same as acute inpatient care, she said.

“It is the moment of crisis that is so dangerous not just for the child but for the family, the critical point where nothing else will defuse the situation,” Smyth said.

“The inpatient unit is that moment in time when the only thing is a safe, out-of-home period of observation.”

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