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By Phyllis Hanlon
In response to Gov. Mitt Romney's proposal to close Worcester State
Hospital last February, the legislature required the Department
of Mental Health (DMH) to conduct a clinical assessment of the Commonwealth's
inpatient situation. In March, the DMH issued a 31-page report that
proposes reducing the number of adult inpatient beds from 900 to
740 across the state and constructing a new facility that would
replace Westboro and Worcester State Hospitals.
Citing both external and internal disrepair in these two facilities,
the report notes that an investment of approximately $59 million
would be needed to upgrade and maintain the sites. Additionally,
conditions at the existing infrastructures do not meet environmental
safety standards. Lester Blumberg, DMH spokesperson, says, "Westboro
and Worcester do tremendous work with the physical plant they have,
but they are extremely limited."
The report also notes the challenges of providing patient care
because of outdated room layout and old-fashioned architectural
design. "It's clear that state-of-the-art mental health treatment
has changed so dramatically since these facilities were built,"
says Blumberg. "We have learned how to create an environment of
care. Facilities nowadays are bright, airy and light. There will
be space for family visits and as many private rooms as possible."
In addition to serving patient needs better, the new hospital would
enhance staff morale, he adds.
To achieve reduced bed capacity, DMH proposes discharging 268 patients
who have been identified as clinically ready to leave if sufficient
community resources exist. The savings generated by closure of the
160 beds would fund their community placements.
DMH Commissioner Elizabeth Childs, M.D., assures the public that
no individual under the care of DMH will be discharged inappropriately
or without proper housing. She acknowledges the proposal will require
careful orchestration to ensure patient safety and care during this
transition. "There will have to be a redeployment of resources to
the community," she says. "We will be working with the families.
It's important to involve them in the planning process."
Noting that DMH is fundamentally "a comprehensive, community-based
service system," Childs explains that an average $65,000 per patient
has been earmarked to facilitate the discharge and re-integration
into the community of individuals ready for the move. She adds that
the discharge process will occur over a 24-month period. "We anticipate
discharging 83 individuals across the Commonwealth between now and
December 31, 2004," Childs says.
Citing the smooth transition with the closing of Medfield State
Hospital - 93 percent of those discharged are living successfully
in the community - she anticipates a similar situation with Westboro
and Worcester.
Childs emphasizes no further reductions are imminent and no adolescent
beds will be lost. "Our [adolescent] resources are being used to
the maximum. Reducing them didn't make sense right now," she says.
Timothy O'Leary, deputy director for Policy and Research at the
Massachusetts Association of Mental Health, supports the commissioner's
proposal. "We appreciate the recognition that patients who require
continuing care will have a state-of-the-art facility," he says.
"It's been a number of years since we've had a new hospital." He
expresses some concern, however, about who will oversee the new
facility. DMH and UMass Memorial Medical Center have both been cited
as possibilities. O'Leary says, "We want the management structure
to make sure those clients with severe and persistent mental illness
will be cared for. We don't want this to become a psychiatric teaching
hospital."
A feasibility study will be conducted this year and project completion
is estimated to take five years, according to Childs. "This is the
last step toward deinstitutionalization that we envisioned," she
says. "The clinical reality is that we need some inpatient level
of care." Childs says that providing care in the least restrictive
setting, is a top departmental priority. "We've made tremendous
progress in the last 50 years. Dramatic increases in treatment have
made community living a reality for many."
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