In Missouri Mental Health Facilities, COVID Surged. Staff Say Policies Are Patchwork

By Tessa Weinberg, the Missouri Independent

December 18, 2020

More than 1,500 coronavirus cases have been reported across Missouri’s Department of Mental Health offices and facilities since the start of September — a figure that’s nearly five times larger than the previous six months combined.

Those cases represent staff and patients in state-run mental health hospitals and department offices in roughly 20 communities throughout Missouri.

The outbreaks have affected care, causing group therapy sessions to be temporarily suspended at some locations. And at least 11 patients have died, including seven deaths since mid-November.

Four staff have also died.

Three of those patient deaths have been at the Southeast Missouri Mental Health Center in Farmington — one of the state’s largest facilities and the one with the highest number of cases. Since March, 330 staff and 97 residents have contracted the virus — with over 250 of those cases reported in November alone.

Angeline Stanislaus, chief medical director for the department of mental health, said there’s only so much the department can do when the virus is spreading unchecked in the communities where facilities are located.

The department operates seven mental health hospitals and four residential centers for people with developmental disabilities. It also has community programs for mental health, substance abuse and people with developmental disabilities.

While no visitors are allowed and inpatients are kept within facility grounds, staff come and go.

“There’s nothing I can do when the community transmission is so high or a county does not have a mask mandate,” Stanislaus said. “That’s beyond our control what happens in the community — and yet our staff come from communities.”

But representatives of staff who work inside state facilities and are unionized with the American Federation of State, County and Municipal Employees, or AFSCME, said enforcement of policies is patchwork.

Due to a lack of available staff, some employees have been required to work after testing positive if they aren’t showing symptoms. Others don’t get tested for COVID when they walk in the door like the department stipulates, AFSCME representatives said.

At some facilities, requests for time off have been canceled and staff are being deployed to locations where the numbers of staff are especially down, union representatives told the Independent.

“It’s kind of like a revolving door sometimes,” said Jennifer Schmidt, an AFSCME union representative for Council 61, which includes facilities in the western and central parts of the state. “So then they’re out for longer than they need to be, and that puts a strain on the workforce as well.”

AFSCME represents most workers within state facilities in non-supervisory roles, from the housekeeping staff to licensed practical nurses. It’s the union’s policy to not name individual workers for fear of retaliation.

See the chart here.

Debra Walker, a spokeswoman for the department, wrote in an email Thursday that there have been “only a few instances within (department of mental health) of asymptomatic staff who tested positive and chose to return to work prior to the end of their isolation period.”

While guidance early in the pandemic had suggested approved annual leave and future vacation requests would be temporarily suspended, Walker said that is no longer the case.

However, Walker added, “staffing is a challenge.”

Staff are drained and at times have worked double shifts. Dozens of employees have left their jobs, while others are planning to retire as soon as possible, union representatives said. Danny Homan, the president of AFSCME Council 61, said that while workers may be contracting COVID from the community — facilities need to have better protocols to screen and protect staff to ensure the virus doesn’t continue to spread.

“It’s so frustrating because everybody wants to blame everybody else,” Homan said. “I’m sorry, we’re not the boss.”

‘It’s not consistent’

Since March, staff within state facilities have been required to wear masks, Stanislaus said.

But Schmidt said at some facilities, employees are only given N95 masks when working directly with patients they know have tested positive for COVID.

Walker said the department is providing available protective equipment “as supplies and circumstances warrant.”

“The State of Missouri has placed orders for millions of dollars in PPE,” Walker said, “and while most supplies are received, some remain unavailable in the quantities needed due to the statewide demand.”

Patients themselves are encouraged — but not required — to wear face coverings.

There are about 1,200 beds in mental health hospitals and space for more than 400 people with developmental disabilities in residential habilitation centers, according to department information online.

Stanislaus estimates more than 80 percent of patients wear a face mask. Teresa Glover, a union representative for the eastern portion of the state, said it’s a difficult challenge to wrestle with.

“This is their home, too. Do they wear it 24/7?” Glover said of patients. “So there’s questions, but it should be encouraged and enforced if you want to stop the spread.”

Across the country, state-run facilities have faced outbreaks. In Iowa, COVID cases quadrupled in one month at a state facility that cares for people with disabilities. In Michigan, the number of cases in psychiatric hospitals are not being regularly disclosed.

“Once we have a COVID test positive in one of our patients, it’s very hard to contain the spread,” Stanislaus said. “The exposure happens very rapidly.”

Staff are tested for COVID daily with rapid antigen tests that can return results in 15 minutes, Stanislaus said. To combat potential false positives, PCR tests are also used.

If they test positive, “they go home. They don’t come in,” she said.

While some facilities are following that protocol, Schmidt said others test staff after they’ve already entered the facility and have begun their workday — potentially putting other workers and patients at risk.

“It’s not consistent across the board testing,” Schmidt said.

At some facilities experiencing staff shortages, workers have been pulled from isolation wards housing patients who tested positive to work in other areas, union representatives said.

“So now you have cross contamination,” Glover said, later adding, “You’re bouncing around and that’s dangerous.”

Stanislaus said that facilities try not to move staff between units, but at times, if a large portion of staff have tested positive, then workers from another unit will need to be brought in to help.

Areas of facilities, like an annex at the Farmington facility that can house up to eight patients, are being used to quarantine those who test positive. Sometimes it isn’t enough.

“The first time we had close to 15 patients test positive all at one time, then what we do is we take all the patients who are not COVID positive to the annex, and then we make the housing unit the isolation unit,” Stanislaus said.

At the Farmington facility, therapy sessions have been downsized to facilitate social distancing and administrative staff who typically don’t work in clinical roles are now stepping in to help provide direct care when it’s needed, Stanislaus said.

In the coming weeks, monoclonal antibodies will also be used to treat high-risk patients who test positive as the department continues to assess where it can do more.

“I don’t believe we are compromising on the clinical needs of our patients,” Stanislaus said.

Farmington facility

In St. Francois County, home to the 348-bed Southeast Missouri Mental Health Center, the local health department has had to rely on the state’s tally to keep track of cases in the facility.

“We have started using the state numbers instead of trying to keep up with our own numbers, as the process is very time consuming,” Tonya Pitts, the interim director for the county’s health center, wrote in an email earlier this month. “At this time I have no comparison for the state numbers.”

Pitts said the St. Francois County Health Department is working with the state to handle the situation.

The state department of mental health’s goal is to keep patients safe, and the state is working to reduce mortality, ensure mask use and consult with epidemiologists and outside experts to find where it can do more.

“Anything we can do more to decrease our mortality, I’m more than willing to,” Stanislaus said. “But at this point, from what I understand, we have done everything we could.”

In early August, the center in Farmington had reported just seven cases among staff.

That total ballooned in late October, with 80 staff and 16 residents having been infected.

After another month, the number had more than tripled. By Nov. 10, there were 291 residents and staff who tested positive for the virus at some point. By Dec. 10, that number had rocketed to 414 — a 42 percent increase.

When asked what is driving the increase in cases across facilities, Stanislaus said, “That’s our question too.”

As the Farmington facility struggles with an explosion of cases, the surrounding community isn’t having any more luck containing the virus’ spread.

St. Francois County implemented a mask mandate on Sept. 21. A month later, it was allowed to expire after a survey by the health department found mask use had slightly declined.

When the mask mandate expired, COVID cases began to rise, reaching a recent high of 143 new cases on Nov. 16. The county continues to have a seven-day average of nearly 50 new cases a day.

For the week ending Dec.13, St. Francois County had the fifth highest per capita rate of new cases in the entire state, according to the state’s dashboard.

“Farmington and all these different areas have no mask order,” Schmidt said. “…and so therefore, it’s spreading like wildfire now.

When talking with facility workers, Glover, the union representative, spends most of her time simply working through how they are feeling. Most are mentally drained.

Staff can’t wait for the virus’ spread to decline in the surrounding communities. Ultimately, their number one request is for sufficient PPE for all workers so everyone from the custodians to residential aids are better protected.

“These people need recognition,” Homan said. “And the state of Missouri is not giving it to them.”

The Missouri Independent is a nonpartisan, nonprofit news organization covering state government, politics and policy. It is staffed by veteran Missouri reporters and is dedicated to its mission of relentless investigative journalism that sheds light on how decisions in Jefferson City are made and their impact on individuals across the Show-Me State.