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By Meredith Fine
In 1975, the newest judge at Dedham District Court in Massachusetts,
Maurice Richardson, J.D., was assigned to travel to Medfield State
Hospital to conduct commitment hearings. The rookies always got
the Medfield hearings.
Thus began Richardson's effort to improve the legal community's
understanding of mental health issues. The following year, Richardson
was appointed to a new commission designed to ensure the consistent
application of laws relative to mentally ill defendants and he served
as its chairman in the 1980s. He retired from the bench in 1998
and became an assistant professor at the University of Massachusetts'
law and psychiatry program.
"I got to be the local judicial authority on criminal justice and
the mental health system," he says. "It's an area of the law this
is not well understood by people in the legal profession."
Richardson's latest passion is the new Mental Health Diversion
Program, designed to train police officers to deal more effectively
with the mentally ill and to provide targeted, efficient services
to the mentally ill who sometimes flood a hospital emergency room.
The program would serve patients who appear mentally ill and/or
suffer from a drug or alcohol addiction but have no other physical
problems requiring medical attention.
In April, the diversion program hosted a daylong conference at
The Boston Foundation for mental health professionals, state health
officials, law enforcement, attorneys and hospital administrators.
The conference centerpiece was a presentation by David Wertheimer,
MSW, who runs a diversion program at a Seattle emergency room.
The Seattle program was created in 1998, after a mentally ill man
killed a retired firefighter. Just prior to the murder, the man
had been briefly detained by police but then released. The outrage
that followed the murder prompted the creation of a crisis triage
unit.
Aimed at mentally ill patients who frequently visit the emergency
room, Seattle's crisis triage unit is a voluntary, locked ward at
the hospital. The program provides an entry point to a wide array
of services. In addition, it reduces the number of mentally ill
patients sent to jail or admitted to the hospital. Wertheimer estimates
that the triage program saves the hospital about $3.7 million per
year, although he was careful to qualify those savings as somewhat
hard to tally with perfect accuracy.
Similar programs exist in Florida, Alaska and Tennessee. In Boston,
Mass., psychosis and substance abuse are the third- and fourth-leading
causes of hospitalization, respectively, according to a 2001 Boston
Public Health Commission report.
"I'm very much sold on the concept," says Richardson of the crisis
triage unit. "When it works, it's very effective."
He noted that a crisis triage unit is especially helpful for police
officers. The facility would give police officers a new choice for
dealing with the mentally ill, who usually are either arrested,
brought to a homeless shelter or simply told to move along. Police
could drop off a patient at the hospital quickly rather than spend
a lot of time processing paperwork for an arrest. And police could
be trained to deal more effectively with the mentally ill, to prevent
escalating an incident into a confrontation.
"When you train police, the statistics show police injuries go
way down," he says.
Richardson was hoping that the Boston Medical Center would host
a pilot program for a crisis triage unit, but that seems unlikely.
Peggy Johnson, M.D., who attended the conference in her capacity
as vice chairwoman of clinical services for the medical center's
psychiatry department, says that the medical center is not interested
in opening a specialized unit, for both financial and medical reasons.
She recognizes the problem Richardson has identified - that emergency
rooms could provide better-organized services for the mentally ill
- but she was concerned that the Boston Medical Center would get
stuck with providing the entire program.
"Yes, we are willing to play an enhanced role but what are other
stakeholders going to do to provide a back door?" she said about
the new services that come with a crisis triage unit. "We can be
a holder and an evaluator, but we can't assume responsibility for
back-door services."
She notes that often, physical and mental problems are inextricably
intertwined.
In addition to finding a location, Richardson also needs money,
which is in short supply these days. Richardson's written proposal
suggests that if a variety of agencies supported the program, the
funding for it wouldn't fall disproportionately on one group.
"No doubt, it's not a good time," says Richardson, "but everyone
is interested in it."
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