JEFFERSON CITY, Mo. — There are more than 1,700 vacancies within the Missouri Department of Mental Health, which are leaving hundreds on waiting lists to receive the right resources. 

The department said in a House Subcommittee on Appropriations for Health, Mental Health and Social Services Wednesday, that there are more than 600 people with development and intellectual disabilities waiting for resident care providers to have an open spot. It means some of those patients are occupying hospital rooms. 

“The average hospital stay while waiting for a provider is 116 days,” said Jessica Bax, division director for the Division of Developmental Disabilities. “The longest that we currently have is over 450 days.”

In the state of Missouri, more than 100 individuals have been waiting over a year to be placed in residential care settings. Director for the Department of Mental Health (DMH) Valerie Huhn said until July, Missouri was under an emergency situation for contracted workers. One of the state’s largest facilities has an open ward due to a lack of staffing. 

“We are understaffed in the state’s psychiatric hospitals right now,” Huhn said. “We do have, at Fulton, one 25-bed ward that is not currently staff, so it’s sitting vacant.”

A major roadblock for the department is a shortage of workers. Huhn along with other providers testified in front of the committee Wednesday, explaining to members what the department needs. 

“Solutions where there are appropriate living situations, creative solutions to help these individuals thrive in our community and be in the appropriate setting which is not the hospital,” said Shannon Griggs Failes, chief operating officer for Research Psychiatric Hospital in Kansas City.

Failes said there are roughly 100 patients in the Kansas City area who are in emergency rooms or hospitals waiting to be cared for because resources are tied up with one patient who needs a nurse and a mental health technician to one individual alone. 

Patty Morrow, vice president of Behavioral Health Services at Mercy Health, told the committee a similar story. 

“We’ve had to close a 10-bed unit to accommodate this young man for the last 290 days,” Morrow said. “We’ve calculated not only his costs, but revenue for those beds not being used, and keeping people backed up in our emergency department, we’re looking north of a million dollars.”

Morrow called the state’s situation within the mental health department a “crisis.”

“Between the children’s division and the developmental disability clients, our health system in general, we are housing, boarding, roughly between 12 and 20 individuals each day in our hospital settings,” Morrow said. “We are seeing a growing crisis of vulnerable youth and adults being left really at the doorstep of our hospitals without the necessary resources.”

Earlier this year, state workers received a 5.5% cost of living adjustment raise. While there has been improvement, Huhn said, providers are still calling it a crisis. 

“We have always relied on contracted staff in those positions, but the labor market doesn’t even have that available for us at this point,” Huhn said. “If you look at July of 2021, just for that support care assistant category, we were at 104% turnover. This July, we were at 53% turnover, so we are seeing some improvement.”

Huhn told members there are currently 210 incarcerated people who are waiting for placement at a psychiatric hospital. Rep. Peter Merideth, D-St. Louis, asked Huhn and Bax if raising worker’s pay to $30 or $40 would help fill the open positions. 

“It cost us four times as much for contracted people and if we paid more, we might not need the contracted people,” Merideth said.

“I don’t think you can really operate in a world right now where you are going to ever be fully staffed the way you used to be, so let’s start being smart about what we are doing,” Huhn said. “If I could get somebody to stay more than a year, I would be really excited at this point.”

Huhn said it cost $78 an hour to hire a contracted certified nursing assistant and $195 an hour to hire a contracted practical nurse. Depending on the recent raise, certified nursing assistants, who are employed by the state, make around $15 to $25 an hour. 

“We have vacant full-time employees in the Division of Behavioral Health, of roughly 1,000 individuals and in the Division of Developmental Disabilities of 742 individuals,” Huhn said. “We are seeing some improvements in direct care staffing, unfortunately we are not seeing improvements in clinical staffing.”

Director of Advocacy with SSM Health Justin Alferman said the health provider has 25 patients waiting placement that have been waiting for a combined 1,866 days. Last year, SSM had 106 adults that waited 7,242 days for placement. 

“It’s demonstrably more expensive to keep them in an acute care situation that they are not necessarily in need of,” Alferman said. 


During Wednesday’s hearing, Acting Director for the Department of Social Services (DSS) Robert Knodell told the committee the state finally no longer has a backlog for Medicaid applications. At one point, people were waiting 100 days for their application to be processed, when federal guidelines say patients must be approved within 45 days. 

“We sort of had an unprecedented triple whammy at the department,” Knodell said. “We were the only state in the country that attempted to expand Medicaid at the height of the pandemic, on top of unprecedented staffing shortages and vacancy rates that have never been seen before.”

Last month, the Center for Medicare and Medicaid Services (CMS) had to step in to help the state process the excess of applications. Knodell DSS is now processing applications within the federal requirement of 45 days.