Filed Over Ill Mental Patients Jean Dietz, Boston
Globe February 27, 1985
class action suit, alleging that more than 200 patients
in state mental health facilities with serious medical problems
are receiving inadequate care, will be filed against state
officials in US District Court in Boston today.
eight plaintiffs, whose illnesses range from epilepsy to
congestive heart failure, as victims of grave medical and
nursing care problems in various facilities, the suit seeks
money damages for all such patients and court judgment that
the facilities violate state and federal constitutional
rights. The suit is brought on behalf of the patients by
Palmer and Dodge, a Boston law firm, and the Lawyers' Committee
for Civil Rights under Law of the Boston Bar Assn. The action
was taken following a year of effort to negotiate with human
services officials to correct conditions surrounding the
care of patients, Barbara Arnwine, executive director of
the legal group, said yesterday. Patients cited in the case
are confined at Lindemann Mental Health Center, Solomon
Carter Fuller Mental Health Center, Metropolitan State Hospital
and Danvers State Hospital. They include a 55-year-old Spanish-speaking
woman who has diabetes, arthritis and chronic schizophrenia,
a 33-year-old woman who has chronic bleeding from a peptic
ulcer, asthma, chronic renal failure, hypertension and a
borderline personality disorder, a 52-year-old man with
hepatitis, nephritis and organic brain damage and a 56-year-old
man with temporal lobe epilepsy and a chronic urinary tract
infection who fell while being bathed and fractured his
hip. "Our information shows that physically ill mental
patients are constantly neglected due to the lack of minimally
adequate medical care on state hospital and mental health
center units," said Darcy DuMont, an attorney at the
Mental Health Legal Advisors Committee, one of the groups
that investigated medical care for mental patients.
group found that "with so few staff, limited staff
training, totally inconsistent medical record-keeping and
faulty or nonexistent medical equipment, there is no way
anything approaching adequate medical care can be provided,"
Dumont said. A suit by the US Justice Department against
Worcester State Hospital, charging the state with depriving
435 patients at the hospital of their constitutional rights
to proper and safe care and medical treatment, was filed
in the same court last week. The suit also follows disclosure
of three deaths at Solomon Carter Fuller Mental Health Center
of patients whose medical complications allegedly went undetected.
In a related development, legislation has been filed by
Sen. Jack Backman (D-Brookline) to provide needed medical
services or appropriate placements for physically ill state
mental patients. Backman said yesterday that his investigators
at the Solomon Carter Fuller Center found that "there
were no doctors or nurses on the ward for the eight- hour
period in which each of the three Fuller patients died."
Named as defendants in the new suit are Mental Health Comr.
James Callahan, Dr. Mona Bennett, deputy commissioner; Public
Health Comr. Bailus Walker, Human Services Secretary Philip
W. Johnston and Gov. Michael S. Dukakis.
Chief At Danvers Aims High Ray Richard, Boston
Globe March 14, 1988
message surprised Peter Van Almkerk, a 36-year-old forensic
medicine specialist who was nearing the end of his requirements
for a doctorate in human organizational development. Call
the commissioner's office right away, he was told in mid-January
while doing casework at Bridgewater State Hospital. He was
even more startled the next day, Van Almkerk recalls, when
the state commissioner of mental health asked him to become
the new head of Danvers State Hospital, a crowded institution
for the mentally ill whose director had resigned a week
earlier in the wake of criticism over the death of a patient.
I was on another career path," Van Almkerk said. "I
had just about finished my doctoral studies, I was at the
end of my dissertation and my orals were scheduled for July."
But he had worked with health institutions for 17 years,
and he was familiar with many of the hospital's problems
because his office as a regional forensic field manager
had been in the same building as the hospital director's
office. He also knew the North Shore and many of the workers
in the health care agencies with whom he would be working.
So he accepted.
Van Almkerk has put his doctoral studies on hold and is
breathing new life into the hospital that has served northeast
Massachusetts since 1878. Instead of the 20 hours he was
working for the department while teaching and pursuing his
doctorate, he now finds 12-hour days normal and acceptable,
Van Almkerk said recently while moving from one staff meeting
to another and checking his calendar to see what meetings
he had later in the day. Crowding at Danvers State Hospital
is one of several major problems Van Almkerk hopes to address.
For the last 10 years the mental hospital has been located
in what had once been an acute-care medical facility. Before
that, the mental hospital was located in the massive red
brick and sandstone Kirkbride Building atop Danver's highest
hill. The 110-year-old castle-like Kirkbride Building near
Route 1 had housed up to 2,500 patients until it was closed,
badly deteriorated by a century of use and too big and outdated
to be needed any more for mental patients. The development
of medicine to control aberrant behavior, an enlightened
approach to mental illness and the establishment of a statewide
system of community health centers since the early 1960s
had shifted the treatment of mentally ill from institutions
to community centers.
and the six other state mental hospitals had 25,000 patients
in 1960. Today they have about 2,500. There are not fewer
mentally ill people today, according to Assistant Mental
Health Commissioner Kevin Preston. "If anything, there's
more. But vast majorities of them can now lead relatively
normal lives in the community through medication,"
Preston said. After Kirkbride's doors were locked, its patients
were transferred to the nearby Bonner Building, which had
been the acute-care hospital. While many patients left the
institution at that time, the severest cases remained. Van
Almkerk's hospital now houses about 300 patients in a facility
built for 160. In addition, the hospital has trouble hiring
-- and keeping -- employees, including doctors, because
of low pay and the poor image many people have of working
directly with the mentally ill, said Van Almkerk. "My
major concern," he said, "are life-safety issues
in terms of who is missing, the medical care we can provide,
the whole issue of: Can we evacuate the building in a safe
way if there were a fire or the electricity went out."
Staff morale fell after widespread publicity followed the
death of a patient who wandered out of the hospital last
December, Van Almkerk said. The body of Ann Houghton, 61,
of Lowell, was found the next day, 200 yards from the hospital.
A preliminary autopsy report said she died of a heart attack.
Because of the 17-hour lapse between Houghton's disappearance
and the finding of her body, relatives of patients and advocates
for the mentally ill charged that administrator William
Bonnes was lax in the attempt to locate her. Bonnes resigned.
A departmental investigation into the death criticized the
hospital for not conducting a more efficient search of the
37 buildings and 540 acres of grounds.
controversy was the second to hit the state facilities complex
since last summer, when a series of articles in the North
Shore Sunday newspaper criticized the way the Hogan/Berry
Regional Center for the mentally retarded was run. The articles
triggered protests charging mismanagement and civil rights
violations by Superintendent Edward Budelmann. The Department
of Mental Retardation, which was established last July,
later cleared Budelmann of wrongdoing. But both reports
pointed to problems at "Danvers," once solely
a mental health facility that now houses operations for
the departments of mental retardation, public health and
youth services, and food and agriculture. Because of the
crowded conditions and the need for more modern facilities,
the state plans to build a 135- to 160- bed hospital on
the Danvers State Hospital grounds. Designers are being
hired, Preston said. Meanwhile, Danvers officials and private
developers look longingly at the landmark Kirkbride Building
15 miles from Boston and the rolling hills and fields that
surround it. "The town has had a definite interest
in that property for many years," notes Town Manager
Wayne Marquis. "It's a very valuable piece of property.
It's the largest piece of open space in the town of Danvers.
Developers driving by it become glassy-eyed." Kirkbride,
which is listed onthe National Register of Historic Buildings,
should be preserved because of its architectural and historical
significance, Marquis said. The Kirkbride Building, "although
impressive, is neither appropriate for or capable of cost-effective
rehabilitation for modern hospital standards," a 1985
state study said. The towns of Danvers or Middleton, where
some of the property is located, could get the building
or some of the land -- but only if the state gives it up.
Says Patient Release Was Not Due To Crowding Rene
Loth , Boston Globe June 23, 1988
Murphy, the state commissioner of mental health, said yesterday
that the release of a Danvers State Hospital patient who
stabbed and critically wounded his mother last week was
"categorically" not related to chronic overcrowding
at the facility. "The reason we have overcrowding is
that we're not discharging indiscriminately," Murphy
said. "The overcrowding situation at Danvers has actually
gotten somewhat worse because of our caution on discharges."
Murphy has directed two of his deputies to conduct a full
review of the release and follow-up care of Daniel Connolly,
21, who was discharged from Danvers State Hospital two months
ago. Connolly, who had been a patient at the hospital for
five years, allegedly stabbed his mother seven times with
a steak knife and screwdriver in her Lawrence rooming house
last Wednesday night. Connolly's mother remains in critical
condition at Lawrence General Hospital and friends said
yesterday they had been told by the hospital she was in
a coma. Connolly was charged with attempted murder and sent
to Bridgewater State Hospital for psychiatric evaluation.
Murphy said the investigation will focus on the "clinical
judgments" made by an evaluation team at Danvers State
Hospital in releasing Connolly, described by friends of
his mother as a disturbed young man prone to violent behavior.
The investigation will also center on the follow-up care
Connolly received from the hospital.
clear that there was deliberate clinical review by qualified
clinicians," Murphy said of the decision to allow Connolly
to leave the facility. "The question is to look behind
the procedures to the clinical judgments." Murphy would
not comment on the specifics of Connolly's case, citing
patient confidentiality. But he said Connolly was assigned
a "very aggressive" case manager after his release,
who visited him daily. He refused to comment on police reports
that Connolly had apparently stopped taking prescribed medication
before the stabbing.
said he agreed with mental health advocates who have charged
that a lack of sufficient community residences can often
leave former mental patients with no place to go after they
are released from state institutions. He said bureaucratic
delays and community resistence have slowed the construction
of halfway houses and other transitional residences Gov.
Michael S. Dukakis promised in a $110 million initiative
in 1985. But he said at least 60 new residential units would
be placed "on line" between July and October in
the area served by Danvers State Hospital. Speaking to reporters
yesterday, Dukakis said the community residences are proceeding
"as expeditiously as possible." He added: "We're
not going to release patients from the hospitals . . . unless
we know that there are good community services and facilities."
In Connolly's case, however, the former patient simply moved
into a room in a boarding house at 53 Bradford St. in Lawrence,
a neighborhood state Rep. Kevin Blanchette (D-Lawrence)
described yesterday as "troubled" and "marginal."
Lawrence Police have described Bradford Street as an area
where drugs are dealt openly. Louise Ferris, commissioner
of inspectional services in Lawrence, said the boarding
house is in good condition and passed a licensing inspection
in May. But she said neighboring buildings had numerous
sanitary code violations. Some have been the site of fires
and others have been condemned, she said. The lack of transitional
housing has resulted in a steady increase in the patient
population in state hospitals such as Danvers, at more than
double its capacity. Murphy said that at least 500 patients
in hospitals statewide are "clinically ready for discharge
with no place to go." In addition, 270 mentally retarded
citizens have been inappropriately placed in the state mental
hospital, he said. He also said several hundred elderly
patients suffering from medical problems contribute to overcrowded
Unveils Plan to Buy Houses for Ex-Mental Patients.
Richard Kindleberger, Boston Globe July 9, 1988
mental health officials are getting into the real estate
business with a $9.5 million pilot program aimed at speeding
up the creation of community residences for discharged patients.
By acquiring existing houses rather than contracting for
space through private agencies or other public organizations,
the state hopes to reduce the time it takes to create group
homes and thus relieve pressure on crowded mental hospitals.
The issuance of a Request for Proposal asking homeowners
and real estate brokers to consider selling houses to the
state was announced at a news conference by Philip W. Johnston,
secretary of human services, and Edward M. Murphy, commissioner
of mental health. "The significance of this RFP is
it's unprecedented," said Murphy. "Never before
has the Department of Mental Health gone directly into the
real estate market." Johnston and Murphy explained
the new program from behind a kitchen table at a model group
home on Poplar Street. Eight men and women, who were away
at jobs or day programs, live in the supervised residence,
which is run by the Northeastern Family Institute, a private
social services agency based in Danvers.
push to produce more group homes comes as the department
is under pressure to relieve overcrowding at its hospitals.
Danvers State Hospital, which serves Danvers and 49 other
cities and towns in Essex County and part of Middlesex County,
is the most crowded of the state's mental hospitals, with
more than twice the number of recommended patients. It has
been plagued recently by administrative resignations. The
shortage of community residences was highlighted after the
June 15 stabbing of a Lawrence woman, allegedly by her 21-year-old
son, who had been released two months before from Danvers
state. The son had been living in a rooming house in Lawrence
following his release. Murphy, while acknowledging that
bureaucratic delays and community opposition had slowed
the creation of group homes, has denied that the man had
been released prematurely because of overcrowding at the
hospital. Murphy said yesterday that there are about 55
patients at Danvers who are well enough to be released if
space were available in an appropriate community residence.
Officials said the Danvers region has 311 beds in community
residences. Another 121 are in preparation and expected
to become ready between now and next July, while the new
direct-purchase approach is expected to produce an additional
100 beds. Overall, the Dukakis administration has plans
for 3,500 new community-residence beds across the state.
Later this year the direct-purchase approach will be applied
in the southeastern Massachusetts and Boston areas, Murphy
said. Geoffrey Brahmer, director of the Alliance for the
Mentally Ill, reacted enthusiastically to the state's initiative.
"I think it's a fantastic idea and we wish them well,"
he said in a telephone interview.
Is Under Criticism For Poor Care of the Mentally Ill. Susan
Diesenhouse, New York Times August 21, 1988
The Massachuetts system
for the mentally ill, now in the midst of a five-year overhaul,
is being faulted for poor care and unsafe conditions by
legislators, patient advocates and mental health professionals
and administrators. The Massachuetts system for the mentally
ill, now in the midst of a five-year overhaul, is being
faulted for poor care and unsafe conditions by legislators,
patient advocates and mental health professionals and administrators.
Delays in paying for part of the overhaul plan have led
some to doubt that it will be fully carried out. A string
of patient deaths in the past year, meanwhile, has led some
mental health experts and patient advocates to question
whether the plan will solve the problems in the system of
7 hospials and 10 community health centers that treat 110,000
people a year.
The hospitals hold about
2,200 seriously ill patients while most of those treated
at the health centers live at home, with some housed at
the facilities. To balance state budgets for 1988 and 1989,
Gov. Michael S. Dukakis, the Democratic Presidential candidate,
has withheld about $17 million that the Legislature allocated
to expand care for the mentally ill, according to Edward
M. Murphy, the Commissioner of the Department of Mental
Health. The Governor inherited a system of badly deteriorated
state hospitals after his first election in 1974. But well
into his third term, some patients in the state system for
the mentally ill are kept in rooms where temperatures reach
more than 100 degrees and sleep on bare mattresses in crowded
facilities that are in need of repair. None of the hospitals
are accredited and in 1986 the system was ranked 41st among
the states in a survey by the Public Citizens Health Research
Group, a consumer advocacy group in Washington. $558 Million
Voted for Plan In 1985, amid concern that a Federal court
would take over the mental hospitals as it had the state's
institutions for the retarded in the 1970's, the Governor
proposed his five-year plan to improve care and facilities
for the mentally ill. The legislature approved the plan
that called for renovation of hospitals and health centers,
the construction of some new facilities and increased staffs
and improved services. The Legislature has allocated $558
million for the program so far.
Philip W. Johnston, Secretary
of the Executive Office of Human Services, said that despite
withholding funds, ''The Governor has recognized the problem
in care for the menally ill which resulted from a generation
of neglect and made the financial and political committment
to radical reform.'' Mr. Dukasis, after being defeated in
the Democratic primary in 1978 in his first re-election
bid, won a second term in 1982 and his third in 1986. As
for the quality of care today, Mr. Johnston said, ''At the
moment there is a lag between the allocations and implementation
of the plan.'' In the past year, the deaths of nine patients
at Worcester State Hosptial and the deaths of seven at Danvers
State Hospital have been questioned by patient advocacy
groups. Commissioner Murphy found poor emergency medical
care and a lack patient supervision by hospital staff members
in four of the seven deaths for which investigations have
been completed. Two of the other deaths are under investigation
while Mr. Murphy has not called for inqueries in the other
cases. After public hearings on eight of the deaths in Worcester,
the Legislature's Committee on Human Services found ''major
systemic problems'' leading to seriously deficient care.
In a letter to Commissioner Murphy last week the committee
chairmen, Representative Paul Kollios, a Democrat, and Senator
John P. Houston, Democrat, called for an end to ''Band-aid'
solutions'' and the start of ''major changes which are long
Lawsuits Filed in Two Deaths
On July 26, two lawsuits were filed in State Superior Courts
by the families of two of the patients who died at Worcester
State Hospital, seeking compensation for what the suits
said were the violations of the patients' civil rights.
Steven J. Schwartz, the lawyer for the families, said one
man was mentally retarded, should not have been admitted
to the hospital and did not receive medication, which led
to a fatal sezure. The other patient developed pneumonia
that was not treated and neither patient received proper
emergency care, Mr. Schwarts said.
On June 1, the Alliance
for the Mentally Ill, an advocacy group, filed suit in State
Supreme Judicial Court, asking the court to declare unconstitutional
the Governor's withholding of the allocated funds without
legislative consent or public hearings. Geoffery G. Brahmer,
the group's director, said he feared that the five-year
plan might not be fully implemented if such cuts continued.
He said, ''Delays mean more time people must spend in barbaric
conditions and shows the Governor's commitment to mental
illeness.'' Commissioner Murphy said that the funds withheld
had been designated to pay for construction of supervised
group homes for the mentally ill who do not require hospitalization.
the 2,200 hospital patients, Mr. Murphy said that several
hundred are well enough that they could have been moved
to the group homes had they been constructed. Those discharged
would have relieved overcrowding in hosptials that are 104
percent to 220 percent of capacity, he said. ''If private
psychiatric hospitals we license did this, we'd close them
down,'' Mr. Murphy said. Mr. Murphy called the building
where hospitalized patients are treated at the Dorchester-Mattapan
Community Mental Health Center in Boston ''an embarrassment.''
On one recent day, some of the 60 patients in the building,
who receive no vocational training, paced the floor muttering.
One slept on a bare mattress on the floor in a cell. Bathrooms
had clogged toilets, sinks filled with stagnant water and
towels tucked around leaky tubs. Pieces of the bathroom
walls were missing. 'Totally Unacceptable' Gerry Morrissey,
the Mental Health Department's director for that region,
said such conditions are ''totally unacceptable and clearly
not what we want for our patients.'' At Metropolitan State
Hosptial in Waltham, temperatures that recently reached
93 degrees in the patient areas contrasted to the air-conditioned
administrative offices. Many windows at the hospital do
not open, 20 patients may sleep in one dormitory and share
one shower and a day room where cigarette butts litter the
floor. Anne M. Corapi, president of the Alliance for the
Mentally Ill, said: ''It took months to get the administration
to open the window in the seclusion room where it gets to
105 in the winter.'' Audrey Y. Deloffi, chief administrator
for Metropolitan State Hospital, said refurbishing started
in June in some areas and that an $18 million rennovation
was being planned.
Angela K. Leech, a member of the board of the alliance,
called for ''a blue-ribbon panel to get the Department of
Mental Health back on track.''
Health System Ailing Despite State Plan. Diane
E. Lewis, Boston Globe September 11, 1988
the grounds of an abandoned state hospital in Mattapan,
there is an old brick building where 50 mentally ill patients
have been waiting for new quarters for nine years. A group
touring G Building last month found toilets caked with excrement,
bathtubs filled with dirty water and cracked windows lined
with rags. Soiled clothes lay on a tiled bathroom floor;
antiquated showers were caked with soap and scum. Nearly
three years after Gov. Michael S. Dukakis announced a five-year
plan to upgrade Massachusetts' ailing mental health system,
G Building -- on the grounds of the former Boston State
Hospital -- is a vivid example of the conditions in which
some of the state's most profoundly disturbed residents
still live. At the same time, it is becoming increasingly
apparent that Massachusetts has a dual system of care. The
westernmost counties provide an improved array of court-mandated
counseling, housing, emergency and employment programs for
the chronic mentally ill.
Elsewhere, the state has a spotty record of achievement.
New programs have opened and new staff have been hired,
but the major reforms that advocates had hoped for have
not occurred. Funds for some hospitals and inpatient community
centers have dwindled, freezing plans and delaying programs.
Part of the problem stems from long-standing policies that
poured money into selected areas while others got less.
Overcrowding is still a problem and patients continue to
languish in jammed, outmoded facilities where it is difficult
to improve the quality of care. "General conditions
are still so deplorable in many state-run institutions that
quality care and treatment are almost impossible,"
said Stan Goldman, executive director of the Mental Health
Legal Advisors Committee. Patients who are ready to leave
must wait months before they can move into a neighborhood
group home. Their situation is aggravated by indifferent
or hostile communities whose residents fight against homes
for the mentally ill in their neighborhoods. Often, opposition
in the suburbs drives the mentally ill into cities, where
they are ignored. Many of the problems the mentally ill
face are not new, but stem from the system's failure to
develop comprehensive plans for the care of the thousands
of disturbed men and women who were released from institutions
in the 1960s and 1970s. Many are still living on the streets,
in shelters or at home with relatives who must shoulder
much of the burden for their care. Aware of the problems
of deinstitutionalization, mental health observers now fear
that the commitment Dukakis made in 1985 is waning. Officials
contend the administration is doing all it can to improve
care for the mentally ill.
"You won't find another state that remotely approaches
the commitment Massachusetts has made in terms of mental
health," Human Services Secretary Philip W. Johnston
G BUILDING'S SAGA
Most of the men playing dominoes in the basement of G Building
on a hot day last month were black, poor and hailed from
Dorchester or Mattapan. Seated around a table, they talked
quietly in a cramped, poorly equipped recreational area.
A scarred, lime-green piano with one leg missing and yellowed
keys stood in the corner of an empty meeting room upstairs.
The room had new pastel furniture. The walls were dingy
and bare. A man in a locked room peered out of a small window
covered with mesh. He screamed, muttered and screamed again.
Outside, cigarette butts, plastic cups and other trash littered
an entrance surrounded by weeds. Following a tour of the
facility some time ago, Richard H. Rowland, executive deputy
director of the Massachusetts Association for Mental Health,
said he felt as if "I was walking through an underdeveloped
country. All I could think to myself was, 'Is this the best
we can do?' " The story of G Building is not unlike
others in the system. Nine years ago, the patients were
transferred there temporarily. They were to remain at the
facility until officials could fully implement a $2 million
plan and move them into newer quarters in a research building
nearby. The money never came through.
Last month, about two weeks after reporters toured the facility,
state officials announced a $1.2 million plan to upgrade
G Building. They also discussed plans to construct a multimillion
dollar mental health research and residential center in
"I'm glad they finally decided to fix up G Building,"
an advocate said.
than $500 million has been targeted for expanded mental
health services, but bureaucratic red tape and legislative
procedures held up the appropriation of a $340 million capital
outlay until December. Critics contend the Dukakis administration
chipped away at the rest.
This year, the governor's secretary of administration and
finance, Frank Keefe, recalled approximately $100 million
in mental health and human services + funds to balance the
budget. The move placed funds for research, additional case
managers and spending money for institutionalized persons
in limbo. Angry members of the Alliance for the Mentally
Ill of Massachusetts sued Dukakis and Keefe, charging them
with illegally returning to the general fund money already
appropriated by the Legislature. A spokesman for the Department
of Mental Health maintained the reversions had little impact
on the expansion program, but said funding delays for capital
improvements stalled most of their plans. "We just
got approval from the Legislature to spend the capital money
last December and that was two years after the governor's
message," said Kevin Preston, assistant commissioner
of community relations. "That included fast- track
money, which we've used to move quickly on a number of things."
Thus far, the Department of Mental Health has received $140
million in expansion funds, including "fast-track"
money for emergencies, general repairs and safety code improvements
at hospitals and inpatient centers, according to Mental
Health Commissioner Edward Murphy. "The problem is
that the fast-track money is on a slow track," said
Rep. David Cohen, a Democrat from Newton who is chairman
of the Committee on Bills in Third Reading. "Basic
things like fire alarms, carpeting, showers, heating, air
conditioning, plumbing -- things for which money was fast-tracked
in 1986 -- weren't received by many of the hospitals as
of May 1988," he said. "Some of it is in the pipeline,
but the majority of it is not," Cohen continued. "Why
the holdup? It was part of a larger picture that involved
the budgetary crisis: A decision was made to slow down spending."
Edwin Newman, a retired Harvard University professor and
a member of the governor's Advisory Council on Mental Health,
said recently that he had high hopes when he first got involved
in the expansion program. That has changed. "I don't
want to represent that some good things have not been accomplished,
but they have been accomplished at great cost," he
said. "The loss of headway that goes into starting
and stopping are dollars down the drain, a loss of morale
and a loss in planning that has not gone anywhere.
Six months ago, Murphy announced plans to cap admissions
to state institutions and urged other agencies to claim
patients who were not severely ill. At the time, mental
health observers and professionals hailed Murphy for taking
a stand against crowding. Today, there is little appreciable
change. Of the more than 2,000 persons in state hospitals,
535 belong in facilities for the mentally retarded or in
chronic-care medical hospitals. Other patients are ready
to leave but cannot because of a lac k of group homes.
Overcrowding is apparent at Danvers State Hospital, where
eight beds are jammed into rooms made to hold no more than
four. In all, 137 new staff have been hired to work at Danvers
since 1986, but staff complained recently of having too
little space for meetings and activities. Too many patients
and a cursory search apparently played a part in the disappearance
and subsequent death last winter of a 61-year-old Danvers
patient -- one of 12 at the facility to die in two years.
Anne Houghton's body was discovered against a stairwell,
just 200 yards from the building where she had lived. She
was found, dead of a heart attack, 17 hours after she slipped
Investigators reported that the hospital should have used
emergency search procedures. Instead, security personnel
searched the campus by car. According to the probe, 300
patients were housed at Danvers when Houghton disappeared.
The complex was built to hold no more than 130. "The
overcrowding situation is frustrating," acknowledged
Preston. "But when we call up the Department of Mental
Retardation or some other agency and we say, 'Look, we're
at 220 capacity at Danvers; you've got to take some of your
people,' they say they're 99 percent full." Part of
the problem stems from the shortage of group homes. Since
1985, the Mental Health Department has created 771 residential
beds in various communities, excluding those on the grounds
of institutions. But the new beds do not even approach the
need. In Greater Boston alone, close to 2,000 people were
awaiting community placements this year. Yet only 270 beds
were completed between fiscal years 1986 and 1988. Another
198 are scheduled to become available sometime in fiscal
The problem is compounded by community resistance. In Westborough,
for example, residents formed a group that held up the opening
of a home for months. In some cases, it has taken four years
to open a residence. "The majority of the mentally
ill are not violent," said Murphy, who has developed
an antistigma campaign to educate the public. "They
want the same things out of life that most of us do, but
they are stereotyped by the public and the perception often
stems from the media.
PROBLEMS IN WORCESTER
It was just a thud, but the sound echoed in a corridor at
Worcester State Hospital. A patient had pushed another man
out of a chair and onto the floor. At the end of the hall,
a 21-year-old man wandered into an empty room. Diagnosed
as self-abusive, he wore a red helmet, a sling on one arm
and padding on another. He muttered to himself and then
leaned his head against a wall. Across the hall, a row of
men slept in chairs or stared vacantly at a television set.
No doctors or nurses were visible on the ward. An administrator
touring the ward found two mental health assistants sitting
on the sidelines watching television, unaware of the scuffle
that had taken place in the corridor.
In the past year, Worcester State Hospital has been dogged
by reports of patient deaths and abuse. Former staff are
now central figures in a suit filed by the relatives of
two patients who died while receiving treatment at the facility.
The suit charges that the patients might be alive today
if they had received proper medical and emergency care.
It also charges that patients were drugged against their
will. The Department of Mental Health responded by requiring
emergency medical training for hospital personnel at the
facility. But one official acknowledged recently that there
is still room for improvement: Mental health assistants
who are regarded as frontline staff do not have to have
high school diplomas and often receive no more than a we
ek of training.
Mental health care for the chronic mentally ill in Massachusetts
varies greatly across the state.
"Historically, the communities with the best legislators
and lobbyists got the most funding," explained Anita
Pyatt, past president of the alliance. Figures appear to
bear out Pyatt's statement. In 1985, for example, the per
capita appropriation for mentally ill adults in Dorchester
was $22.57. In West Roxbury, Roslindale and Hyde Park, the
appropriation was $32.76. In Concord, which has received
staunch legislative support over the years, the appropriation
was $51.59 per adult. The state is gradually increasing
funding to inpatient centers in Boston, which have been
among the most underfunded in the state. But the most dramatic
funding and service changes have not occurred because of
legislative support, but because of court intervention and
a 1978 consent decree. Today, western Massachusetts is the
only region in the state with a completely new mental health
system. Although many of its patients still need community
housing, the area has a system of care that provides ongoing
case management for years and offers a network of support
services in the community to a region with 800,000 people.
Of those, about 15,000 are believed to be severely mentally
ill. This year, 24 elderly persons who would have been given
up for lost a decade ago were transferred from Northampton
State Hospital to a residential program in Holyoke. Hospital
staff went with them. "At the time we sued the state,
the history of mental health in western Massachusetts was
one of low priority," recalled Steven Schwartz, an
attorney with the Center for Public Representation, which
filed the suit that led to reorganization. In 1978, western
Massachusetts received $14.2 million from the state for
hospital and community services. Today, it receives about
$63 million, according to Andrew Phillips, director of mental
health services for the region. "Nothing that we did
here is technically impossible and can't be done without
the court," said Schwartz. "But sooner or later
any major change is going to run out of steam if it doesn't
have moral and legal binding. "In our case, the momentum
and persistent monitoring needed to reorder the system came
from an external, nonpolitical entity," he said, referring
to the court.
Is State Hospital Official November 27, 1988
woman who was misdiagnosed and kept in a state mental hospital
for more than 15 years has returned to the hospital as a
full-time administrator. She has earned a master's degree
at Harvard. Marie Balter was 16 and clinically depressed
when she was diagnosed as schizophrenic and sent to Danvers
State Hospital. She was released in 1966 and went back to
school; she has since then worked with psychiatric patients,
given lectures around the country, and and written an autobiography.
Now Mrs. Balter, who is
58 years old, is devoting her efforts to helping improve
the hospital. She began work as community affairs director
earlier this month. ''I wouldn't have grown one bit if I
didn't learn to forgive,'' she said in a recent interview.
''If you don't forgive your parents or your children or
yourself you don't get beyond that anger. ''Forgiving is
a way of reaching out from a bad past and heading out to
a more positive future.'' 'A Model for Many People' Marvin
M. McNally hired Mrs. Balter three months into his tenure
as Danvers' chief operating officer. ''She is a model for
many people,'' Mr. McNally said. ''I think she serves in
that way for many people - not just ex-patients. She has
faced adversity, has overcome it and has succeeded.'' She
was born in Boston to an alcoholic mother and was adopted
by a couple in Gloucester who disciplined her harshly, sometimes
locking her in the cellar. Increasingly depressed, she was
institutionalized in 1947 with symptoms that included muscle
spasms, choking, hyperventilation and hallucinations. Mrs.
Balter said she later learned she had suffered from a form
of depression and panic disorder, not schizophrenia. ''It
wasn't deliberate on the part of the doctors and the hospital,''
she said. ''Not much was known about panic disorders back
then. A person who had panic disorders was identified as
a little bit crazy.'' Her recovery was painful and gradual,
as she overcame a despair that often left her unable to
eat or move. She contemplated suicide more than once. Mrs.
Balter credits her turnaround her own strength bolstered
with the help of friends, mental health workers and her
Catholic faith for her release.
After her release, married
Joseph Balter, an accountant. He died suddenly, of a blood
clot, as she studied for final examinations at Salem State
College, where she eared a degree in psychology. She went
on to earn a master's from Harvard in administration, planning
and public policy. Patient Conditions a Priority In her
new job, Mrs. Balter will serve as chief hospital spokeswoman,
help train health workers, recruit volunteers, find grants
and assist in fund raising - ''things that will help the
hospital turn around,'' she said. Above all, Mrs. Balter
said, she hopes to improve patient conditions, from adding
curtains to reducing overcrowding. Danvers has about 260
patients, twice its recommended capacity. This is not Mrs.
Balter's first return to the hospital in Danvers, a suburb
north of Boston: from 1976 to 1979 she was a social worker
on community outreach cases and has run a mental health
program linked with Danvers. Two years ago a television
movie about her experiences, ''Nobody's Child,'' aired and
since then Mrs. Balter has lectured nationwide. Her book,
''Sing No Sad Songs,'' was finished last year and she has
marketed it herself to raise money for the Balter Institute,
a nonprofit community mental health training center. She
plans to continue taking her message of hope, self-reliance
and caring to high schools, community groups and mental
health organizations. ''I don't believe on focusing on all
the bad stuff that might have happened,'' Mrs. Balter said.
''Everybody has problems. Life is not trouble-free. I try
to make people see that.''