Solnit Youth Psychiatric Center Struggles with Staffing Shortages, Downsizing

Albert J. Solnit Psychiatric Center - North Campus (Credit Google Map Data, 2022)

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MIDDLETOWN — When Akashdeep Aujla, a psychiatrist at the Albert J. Solnit Children’s Center in Middletown, began working at the center 20 years ago, he said that the center had 100 hospital beds. Now, he said the facility has a maximum inpatient capacity of 44, and it is struggling to bring in workers. 

“The last psychiatrist we recruited at Solnit was 17 years ago,” Aujla said during a virtual panel discussion on the availability of mental health services to children in Connecticut. 

Solnit, the only state-run long-term psychiatric facility in Connecticut, houses children between 12 and 18 years old with mental illness, eating disorders and emotional and behavioral disorders. These children, Aujla explained, often come to the center for longer-term treatment after having been admitted to hospitals. 

“The last psychiatrist we recruited at Solnit was 17 years ago,” Aujla said during a virtual panel discussion on the availability of mental health services to children in Connecticut. 

In addition to the lack of hiring, Aujla said, Solnit has struggled to retain the doctors who were already working there. He said that, at Solnit, they were relying heavily on per-diem and temporary workers. 

“We just don’t compete,” said Aujla. “In fact, for 20 years we haven’t competed in terms of salary.”

Ken Mysogland, bureau chief for external communications at the Department of Children and Families, which runs the center, said in an email that Solnit was employing 20 temporary children’s service workers through this May to fill in for vacancies from staff being out on medical leave or workers compensation. 

Michael Williams, deputy commissioner for the Department of Children and Families, told CT Examiner that Solnit was also experiencing a nursing shortage. 

“We are competing for nursing staff with state salaries that don’t necessarily stand up against the private sector, who can offer bonuses and increases at will and all that. We don’t have that ability to do that,” said Williams. 

Williams said the center was employing per-diem nurses to fill in for staff who were out after contracting COVID. Ken Mysogland, spokesperson for the department, said that on Thursday alone, 35 staff were absent from the facility. 

Williams said that recent retirements had also left vacancies for psychiatrists. 

“Folks who are coming out of med school and residencies like me … we’re talking about loans in the hundreds of thousands,” said Aujla. He said that the center takes in fellows from Yale who, after spending two years training in the hospital, leave in favor of a job that pays more. 

“Whenever there’s turnover, it clearly hurts. Child psychiatry is a premium in the state of Connecticut because there’s been a shortage of that for decades,” he said.

Aujla told CT Examiner that private companies like Hartford Healthcare can offer much higher salaries than state-run facilities, and that the benefits that public sector work offers are no longer enough to compensate. 

“Folks who are coming out of med school and residencies like me … we’re talking about loans in the hundreds of thousands,” said Aujla. He said that the center takes in fellows from Yale who, after spending two years training in the hospital, leave in favor of a job that pays more. 

Williams agreed that the benefits that the state offers for specialized positions like psychiatry and nursing don’t keep up with what they can make in private hospitals. Mysogland also said that the state doesn’t have the ability to offer perks like sign-on bonuses and flexible schedules.  

Aujla said he was particularly worried about a wave of state employee retirements predicted in 2022 as a result of a change to the state pension system. 

“I know my colleagues left and right are planning to retire in 2022,” Aujla said at the conference on Tuesday.  

Williams said he was not yet sure how the increased retirements would affect Solnit. 

Aujla told CT Examiner that he hoped to see increased incentives for people to work at state-run facilities. 

“Connecticut really has a rich legacy of mental health care provision. And I know over the years, maybe because of budgetary issues, they’ve tried to kind of shrink what the state provides or the public sector provides,” he told CT Examiner. “But this is not the time. There never is a good time, but this is certainly not the time.” 

“A ripple effect” 

The lack of staff isn’t unique to Solnit. A pandemic-driven increase in the need for mental health services is abetted by significant staffing shortages in the field, leading veteran mental health workers to call the current crisis worse than anything they have ever seen. 

Darnell Ford, a Democratic Councilman in Middletown, member of the SEIU 1199 union and a lead children’s services worker at Solnit, who was one of the organizers of the conference on Monday, said that the pandemic has taken a system that was already overstretched and underfunded and made it worse. 

Ford, who has worked at Solnit for 35 years, said that the center normally had seven open units – four for hospital care and three residential. 

During the pandemic, the center closed two units to use for COVID-19 quarantine space. One of the units has since reopened, but the other, a residential unit, remains closed because of staffing shortages. 

According to data from DCF, there are currently five children waiting for admission to the hospital side of Solnit, which can house 44 young people. Mysogland said all five children have been given a specific date by which they will enter. On the residential side, 13 of the 14 beds have been filled, with the 14th in the process of being admitted. Mysogland said there are currently an additional 23 young women who are waiting to be admitted either to Solnit or to the Children’s Center of Hamden. 

“We’ve had a shortage in inpatient beds historically in Connecticut, but not at the level that we’re seeing now. There’s a lot more acuity. Children are really struggling throughout this which has driven the need significantly for more in-patient services than we’ve seen before. So it has exacerbated the shortage that already existed,” said Williams. 

Aujla and Ford, who both work on the hospital side of the facility, said that a lack of in-home services has also made it difficult to discharge patients. 

Aujla said that the length of time that children are remaining in his unit has nearly doubled, from three months to more than five, in the last two years, because of the lack of in-home services. 

“We’ve had a shortage in inpatient beds historically in Connecticut, but not at the level that we’re seeing now. There’s a lot more acuity. Children are really struggling throughout this which has driven the need significantly for more in-patient services than we’ve seen before. So it has exacerbated the shortage that already existed,” said Williams. 

Mysogland said that the average hospital stay in 2021 at Solnit was 99 days, or just over three months, and the average residential stay was about the same. 

Ford said that at one point just before the pandemic, his unit discharged a group of three to five children who were at the level where they could succeed with in-home services or in another facility. He said that in the middle of the pandemic, these children all returned to Solnit, which he attributes to the fact that they weren’t able to get the services and support they needed. 

Williams said that the non-profit organizations who provide in-home services are also suffering from the staff shortages affecting the social services industry. 

“They too are having difficulty recruiting and maintaining the level of workforce they need in order to do the work that they are contracted to do. And so it’s a ripple effect across the entire human services,” he said. 

Ellie Lambert, communications director at the Child and Family Agency of Southeast, one of the non-profits that provides outpatient services for children and youth, said that they were having “significant mental health workforce challenges.” 

“Currently we do not have a waiting list in our outpatient clinics but they are significantly busier than before the pandemic,” Lambert wrote in an email. 

Lambert said that the clinical workforce in the New London area, where the agency is based, had shrunk from 1397 to 699 as of October 2021. She said that the agency had mailed postcards out to licensed social workers in Connecticut encouraging them to apply for work, and that the agency was offering a $5,000 and a $6,000 “bilingual differential.” 

According to Aujla, the combination of children not being discharged and the closure of some of the units has created a backlog that has left families frustrated. 

“The frustration level and the helplessness of the families … is worse now, because needless to say, anybody who shows up here has had, prior to the admission, multiple trips to the emergency room, multiple other lower level interventions, perhaps even admissions to other community psychiatric hospitals, like IOL or Yale,” he said. “And by the time they come to us, they’re exhausted.”

“All we need is personnel” 

According to Ford and to Williams, the children taken in by Solnit are also experiencing higher levels of need since the start of the pandemic. Williams said that children not being able to go to school and be with their peers has led to more children experiencing deep depression, suicidal thoughts and eating disorders. 

Ford said the higher needs of the children has put even more pressure on the already limited staff. 

“Where you would only need one staff, you now need two, and you just don’t have enough people to go around. So you have to do more with less,” he said. 

Adding to the challenge is the limitations that the pandemic has made on in-person contact. Ford said that the limits on families being able to visit Solnit because of the pandemic restrictions has been hard on the children there. 

“Kids are starved for interactions,” he said. 

Williams said that while the children get their services in-person, the facility has had to temporarily return to doing family therapy sessions remotely because of the rise in COVID cases. He said they hope to return to in-person within a few weeks when the cases die down. He said he believes that some of the non-profit providers of in-person services have also reverted to telehealth temporarily because of the omicron variant. 

Aujla pointed out the difficulty of trying to provide care remotely to children suffering acute mental and psychological disorders.  

“We know that children’s behavioral health is going to be an absolute priority in this upcoming legislative session,” said Mysogland. 

“Our children are not the ones where virtual care or a session with a therapist over Zoom is going to help,” he said. “These are kids with developmental traumas. These are kids with developmental disabilities. Their attention span just doesn’t afford them the ability to make that engagement and that therapeutic alliance over the phone or the Zoom.”

Williams said that the department was working on improving some of its current services, such as making sure its Emergency Mobile Services can get to harder-to-reach areas, getting better data and being able to maintain its workforce with competitive pay. 

Mysogland added that he expected many proposals to come up in the state legislature this year surrounding mental health services. 

“We know that children’s behavioral health is going to be an absolute priority in this upcoming legislative session,” said Mysogland. 

And both Ford and Aujla said it was critical for the state to invest more resources in mental health services, particularly in a time when so many people are in need. 

“We need to overinvest in the process that is mental health and addiction services,” said Ford. “We should have a surplus.” 

“For mental health, we don’t need MRIs. We don’t need fancy equipment. All we need is personnel,” added Aujla.