The third in a series of articles by the Boston Globe Spotlight Team
(featured in the movie "Spotlight"), about the Massachusetts mental health system,
delves into the broken promises of deinstitutionalization. The article entitled "The
Broken Covenant" explains that:
"Governors from Francis Sargent to Deval Patrick, House speakers, Senate presidents,
and other legislative leaders, and federal officials together cut hundreds of millions of
dollars in mental health spending over the last 50 years. They closed psychiatric hospitals
but funneled comparatively little of the savings into community treatment programs -
once successfully defying a federal court order requiring that they spend millions more.
They stood by as community service providers withered and shrank, and as counseling, psychiatric prescribing, and other services grew harder to access. They allowed state
oversight to erode to dangerous levels."
Despite the documented failures, deinstitutionalization continues in the
In a 2005 study of state psychiatric bed shortages, Massachusetts
rated in the "severe bed shortage" category. Since then, 25% of beds have closed and
Massachusetts now has a "critical bed shortage." In the past 10 years, two state psychiatric
hospitals have closed, and Taunton Psychiatric Hospital is nearly closed.
"Massachusetts - with its culture of civil rights activism, vocal community of
people in recovery from mental illness, and influential voices such as Marylou Sudders,
the state secretary of health and human services - has gone further than most in
safeguarding the right to decline mental health care."
One result of these policies is that Massachusetts is one of only four states that
does not have a law allowing for court-ordered outpatient treatment before an individual
is in the criminal justice system.
Massachusetts General Court Mental Health Advisory
Committee (Mental Health Advisory Committee) reported that "prior studies have
demonstrated that mandatory mental health treatment in an outpatient setting
(e.g., involuntary outpatient commitment (IOC)) can 'reduce hospital readmissions
and total hospital days when court orders are sustained and combined with intensive
treatment, particularly for individuals with psychotic disorders,' and can reduce the
probability of re-arrest among individuals with SMI and 'with a prior history of multiple hospitalizations combined with prior arrests and/or violent behavior' as well as the
'severity' of said re-arrest. Such treatment also stands to reduce individuals' 'criminal
victimization indirectly by increasing [their] long-term participation in community
treatment and services [which improves] their mental health and social functioning
and eventually lower their risk of exposure to crime and violence.'"
"Nearly a third of community mental health providers in Massachusetts
reported closing clinics from 2013 to 2015, according to one study, a trend
that has continued this year. Two intensive day programs for adults in the
Boston area with severe mental illness closed in recent months, displacing
100 more people."
has a complex mental health system shaped by multiple regulators,
payers and providers
" according to a study, commissioned by the Mental Health Advisory
Committee. The report identified seven state and federal agencies that regulate mental
health care and at least eight state, federal and private funding sources. The report
the DMH "does not have the authority or resources to manage and
coordinate care for people across these complex payer and provider boundaries."