Staffing of Psychologists at the Mississippi State Hospital in a Changing Mental Health Service Delivery Environment
Executive Summary
Introduction
PEER conducted this review in response to an anonymous complaint alleging that the Mississippi State Hospital’s Doctoral Internship in Professional Psychology program could lose its accreditation due to vacancies and frequent turnover in the hospital’s staff of licensed psychologists, who serve as supervisors for interns in the program. The complainant was also concerned that the number of licensed psychologist positions at the Mississippi State Hospital (MSH) was not sufficient to provide newly licensed psychologists with an opportunity for permanent employment at the hospital.
What is the status of MSH’s Doctoral Internship in Professional Psychology program?
MSH offers an accredited internship program for doctoral students in clinical and counseling psychology programs. The program provides interns with the opportunity to increase their clinical skills in an inpatient setting under the supervision of licensed psychologists. The state benefits from the internship program by having highly educated persons performing advanced-level mental health service delivery functions at a fraction of the cost compared to their fully licensed counterparts. Also, the program offers the state an opportunity to recruit these interns into the Department of Mental Health (DMH) system upon graduation. For the mental health care profession, the internship program offers young professionals just entering the field an opportunity to translate classroom theory into practical application, gaining experience as they do so, while simultaneously fulfilling a requirement of licensure.
MSH experienced a high degree of turnover of psychologists from FY 2011 to FY 2014, which MSH attributed to non-competitive salaries offered by MSH. This turnover affected MSH’s Doctoral Internship in Professional Psychology program, with numerous changes in internship training directors and a reduction in the number of interns from four to three for FY 2013.
After MSH requested and received from the State Personnel Board salary realignment and recruitment flexibility for its licensed psychologist positions, MSH was able to increase its total number of licensed psychologists on staff. The internship program resumed offering four intern positions in 2013-2014 and the American Psychological Association’s Commission on Accreditation recently awarded accreditation to MSH’s internship program until the next site visit in 2021.
How is Mississippi’s mental health service delivery environment changing?
The mental health service delivery environment in the United States has changed in recent years from an institution-based system to a community-based system. Mississippi will be forced to move toward providing more community-based mental health care due to factors and events at both the national and state levels:
On August 29, 2014, Mississippi and the DOJ entered into a nonbinding agreement wherein the state agreed to address problem areas identified by the DOJ in its findings letter. DMH’s current strategic plan goals and the Attorney General’s letter of agreement both support the need to provide more community-based mental health services.
How can MSH align its staffing of psychologists with its current and future needs?
The Mississippi State Hospital must ensure that it has the appropriate number and type of staff needed to implement evidence-based programs and monitor outcomes. Psychologists are essential to accomplishing these tasks. As of March 27, 2015, MSH had a patient-to-psychologist ratio of sixty-three patients to one licensed psychologist (63:1).
Successful transition to providing more community-based mental health services would reduce MSH’s patient load, which in turn would reduce the number of staff that would be needed to fulfill the needs of acute care mental health patients at the hospital. However, while the role and scope of the hospital might diminish as community-based programs are implemented, there would be a continued need for the hospital and its staff. DMH and MSH should gather the appropriate data sets regarding the mental health needs of the hospital, the communities, and the state in order for the department to articulate its community-based services strategy, design its implementation process, and reallocate its resources.