COLUMBIA — In 2009, more than 40 employees with the Missouri Department of Mental Health worked enough overtime to double their salaries.
One worker at the Marshall Habilitation Center clocked an average of eight hours of overtime every day between 2008 and 2009, according to a state audit.
His overtime pay for the two years added up to almost $99,000.
At the same hospital, during the same period, another employee clocked 4,000 hours of overtime. He earned more than $60,000 in extra pay.
Both were classified as a developmental assistant 1, an entry-level job devoted to the direct care of patients with developmental disabilities.
Based on the December audit, 527 employees with the Department of Mental Health earned overtime pay between Jan. 1, 2008, and June 20, 2010, that equaled at least 50 percent of their regular pay.
The report by then-State Auditor Susan Montee noted that the department paid about $48 million in overtime over a period of three years. Much of that went to employees at facilities that provide care to clients 24 hours a day, such as habilitation centers for the developmentally disabled or the state mental health hospital.
The department oversees two different kinds of facilities — developmental disability and psychiatric services. Overtime at these facilities impacts more than the department budget. It can be detrimental to employee health, which can, in turn, affect patient care.
"It just makes it that much harder for people to deal with their mental illness when they have workers who are under a lot of stress," said Tim Harlan, president of National Alliance on Mental Illness Missouri.
"This is a high-risk population that we know needs special care, and they need the best care," Harlan said. "It's taking chances with patient safety, staff safety and public safety to understaff."
After the audit was released in January, the department addressed the overtime problem by sharply restricting the amount each employee can work.
Under the new rules, an employee in the division of developmental disabilities in Missouri cannot work more than 24 hours of overtime in a two-week pay period.
On April 1, the division of comprehensive psychiatric services limited the amount of overtime for its employees to no more than 40 hours in a pay period, or more than 32 hours in a consecutive seven-day period.
A facility must make a reasonable effort to see that no employee works more than 12 hours in a 24-hour period. Employees also cannot be asked to work overtime more than once during a work week, or before a day off.
But the restrictions on all employees can lead to more overtime for those who object to working longer hours. They can also mean less overtime for employees who welcome it.
Before the audit, up to 90 percent of overtime was voluntary, according to department records. Under the new regulations, mandatory overtime is likely to affect a wider number of workers.
More employees will be asked to clock extra hours because the department doesn't have enough staff to cover every shift 24/7.
"You could look at it like (overtime) will be more evenly spread among all the employees," said Bob Bax, a spokesman for the department.
Harland Ross, a health care coordinator who retired from Marshall Habilitation Center on Dec. 1, said the previous system was a better option for employees.
"Some people don't have families and want to work overtime," Ross said. "They worked a lot of overtime, and they made a lot of money, but the auditors didn't like that."
Bax said overtime is required for direct care staff, and refusing to work overtime is handled as a disciplinary action. The department simply needs to ensure all shifts are covered adequately, he said.
"These people have no choice," said Jeanette Parker, a licensed counseling professional and retired employee from Fulton State Hospital. "If they are told to work overtime, and they leave, it's called abandonment. They are fired for that."
Significant overtime can cause stress, illness, even depression. It can also put additional burdens on the staff and impact patient care, she said.
"If you have been on duty for eight hours, and then you're mandated to work another eight or another six, and you're angry, it's gonna come out in your work," Parker said. "It's harder to get along with coworkers. It's harder to get along with patients."
Ross said he often sees people complaining on Facebook about mandatory overtime.
"People that are being forced to work ... they didn't plan on having to work 16 hours that day," Ross said. "I'm guessing that they're probably not doing their best because they're upset."
"You see it all the time: 'I hate my job. I can't stand it. I have a life outside of the hab center,'" he said. "Six months, eight months ago, you didn't see that on there."
Parker also said family disruptions can arise from working long hours.
"We're talking about anger. We're talking about depression. We're talking about anxiety. We're talking about family problems," she said. "For some people, there's marital stress. Some people are deprived of time with their children."
Harlan said overworked employees pose a risk for patients. It's important to remember that even if there are no obvious consequences, an overworked staff is still a problem, he said.
"My concern would be that it's not a risk we want to take in the first place," he said.
It comes down to having enough people, Parker said.
To keep Medicare and Medicaid funding and safety certification, she said, a facility is required to have a certain number of security and nursing staffers.
"I have worked those wards when they didn't have enough staff," Parker said. "I've seen people cry because they had to work overtime and they were exhausted. I've seen young women who have children told at the last second they have to work overtime and they're like, 'What am I supposed to do with my kids?'"
The overtime issue persists, in part, because it is often difficult to recruit and retain qualified employees, according to the department's response to the audit. To secure a job at a mental health facility, applicants need references, relevant experience and a clean record.
Forty percent of direct care staff leave in their first year of service, according to the department.
This can be attributed, in part, to the nature of the job, uncertainty about days off and a "public stigma" that may be associated with a job in a mental health facility.
"I know that they have tried very hard to fill these positions," Parker said. "What happens is you get people who aren't qualified, or people who go through two to three weeks of training, and decide, 'This isn't for me.'"
There's always a chance that an employee may be physically assaulted, she said. Among the direct care staff at Marshall Habilitation Center, 79 were injured on the job during the last fiscal year, Bax said.
As a supervisor, Ross said he was never aware of decreased job performance from employees who worked a great deal of overtime. But, he said, working a lot of overtime could affect their health.
"There's no way I could work all night and then work all day," Ross said. "I don't see how those people do it."
Controlling overtime seems to be a problem for mental health departments around the country.
According to the report from the Missouri Department of Mental Health, the average percentage of personnel expenditures paid for overtime among nine Midwestern states in 2010 is 6 percent.
Indiana paid the largest percentage at 13.43, and Michigan paid the smallest at 3 percent. Missouri paid 5 percent, or $14.1 million. Of that $14.1 million, more than $8 million went to direct-care employees at the six developmental-disability facilities.
Marshall Habilitation Center spent more than 16 percent of its personnel costs on overtime pay — the highest of any facility, according to an expenditures report provided by the department.
The audit suggested the department conduct a cost-benefit analysis to determine if hiring more employees would be cheaper than paying for overtime. Bax said the department's internal audit unit completed its analysis in March.
It concluded that it would cost more to hire additional staff than eliminate overtime, largely due to the cost of benefits, and using overtime effectively saves taxpayers $2 million each year.
The department would not provide the Missourian with individual overtime numbers, despite the fact that the Sunshine Law requires public institutions to disclose salaries for public employees.
The department provides gross pay — regular pay and overtime combined — on the Missouri Accountability Portal website.
Rikki Wright, general counsel at the department, said it was not required to provide a separate breakout of overtime and regular pay because that information is part of the employee's individually identifiable personnel record.
The Missourian has asked state Rep. Chris Kelly, D-Columbia, to ask the attorney general for an official opinion on the matter.
Bax said the department also does not keep a report of individual overtime paid to employees.
He said the situation ultimately has been improved with the new policies.
"I do think that the policies that are in place now to limit the amount of overtime are implemented to ensure that no one is working more than they're capable of in any one period of time," he said.
State Auditor Tom Schweich said in a news release last month the department had "taken substantial steps to implement the recommendations made by my office and improvements have been made."
The department needs to be able to recruit and retain more employees, Bax said.
"We'd like to get in a situation where the facilities don't have as much difficulty in the staffing and not to have to have any mandatory overtime," he said.