Recent killings raise concerns about care of violent patients
By Michael Levenson
Globe Staff / February 11, 2011
Governor Deval Patrick’s proposal to eliminate one-quarter of the beds in the state’s mental hospitals has provoked strong opposition from mental health professionals who say it will increase the ranks of the mentally ill in the state’s jails, homeless shelters, and emergency rooms.
They say they are particularly concerned that hospital patients who are violent will not get the attention they need once they are released into understaffed group homes and other settings. While the vast majority of patients pose no threat, advocates point out that two workers, one in a group home and one in a homeless shelter, were killed by mentally ill men last month, slayings that advocates say underscore the gaps in a system already weakened by budget cuts.
“One would hope that having adequate resources would reduce the occurrence of such terrible events," said John Labaki, a social work supervisor at Taunton State Hospital. “I know it’s a cost. But what is the other cost?"
Patrick unveiled his plan to eliminate 160 of the state’s 626 mental health beds last month, calling it one of many painful choices he has to make to close the state’s projected $1.2 billion budget gap. Barbara Leadholm, the commissioner of mental health, said eliminating the beds will save $16.4 million next year.
“Obviously, we’ve had to cope with the effects of the economic challenges we’re facing," said Leadholm. “We have had to make difficult decisions."
She said the administration has not decided whether it will eliminate the beds by closing one hospital or spreading the cuts across the state’s five main mental hospitals.
“We understand there’s a budget crisis, but to close inpatient beds solely as a budget-balancing method is very, very risky," said Vicker V. DiGravio III, president of the Association for Behavioral Healthcare, which represents 100 companies hired by the state to run residential treatment programs. “The community system is already stretched incredibly thin."
Patrick has cut the mental health budget by about $60 million, or about 10 percent, since taking office in 2007, although some of those reductions were offset by federal stimulus funds. Now that the federal stimulus money has dried up, Patrick is proposing a $21.4 million, or 3.4 percent cut, to mental health services in his budget for the fiscal year that begins in July.
Mental health professionals and state officials have supported closing state mental hospitals over the past three decades, as part of a shift toward treating certain patients in less restrictive and less costly residential settings where they can learn job skills and see family and friends.
But advocates say this change is less about giving patients better care and more about cutting budgets.
“This kind of a cut is so overwhelming in its magnitude that it will really freeze up the entire public mental health system, so that no one will be able to transfer into Department of Mental Health inpatient beds, and individuals coming out of the hospitals will be at risk of being in the streets, or in highly marginalized settings," said Marylou Sudders, a former state commissioner of mental health who is now president of the Society for the Prevention of Cruelty to Children. “There is no positive out of a cut of this magnitude."
Currently, 96 to 98 percent of the beds in the state’s mental hospitals are filled on any given day, often by patients who pose a threat to themselves or others or cannot take care of themselves without intensive attention.
The governor contends that his plan will only release those who can care for themselves into group homes and other residential treatment centers. Those who need intensive care would remain in hospitals. Leadholm said there are 100 to 150 patients who are ready to be discharged.
Advocates, however, say they have not been released because the state’s network of group homes and residential treatment centers are already filled and overburdened. The hospital cuts, combined with another 1 percent cut to residential programs, would only exacerbate the overcrowding or force more people onto the streets, they say. Indeed, some workers in residential treatment centers say they are already stressed and cannot imagine taking on more patients from the hospitals.
“Already, we are overworking ourselves, and if you close these facilities, that means you’re going to dump more people on us,’’ said Tony Xatse, a group home worker in Worcester, who takes care of veterans with post-traumatic stress disorder, schizophrenics, and others addicted to drugs and alcohol. “It will worsen the caseload, and the attention we give won’t be enough."
Mental health workers say the risks they face were cast into sharp relief with the two killings last month.
On Jan. 20, Stephanie Moulton, a 25-year-old manager at a group home in Revere, was beaten to death by a patient with schizophrenia, police said. She was working alone, and her family has expressed outrage that the home did not have a security guard. Nine days later, Jose Roldan, a 34-year-old working at a Lowell homeless shelter, was stabbed to death by a man with a history of paranoia and violence, police said.
Sudders, DiGravio, and eight other mental health advocates have written to Leadholm, asking her to conduct a independent review of the state’s mental health services in light of the killings. They said the review should examine, among other issues, the impact of budget cuts, the safety and training of mental health workers, and the safeguards used to make sure patients are taking their medication.
Leadholm said she is considering what to do in response to the killings. But she said the administration remains committed to moving patients from hospitals into group homes and other residential settings. Last year, she said, the administration closed Westborough State Hospital, which had 160 beds, and successfully moved most patients into residential treatment facilities. That closing, however, was the result of years of planning.
“It’s challenging," Leadholm said, “but we have a very talented staff who are committed to serving the patients."
Last night, about 60 mental health workers gathered on the State House steps, holding candles and calling on the governor to pay more attention to workers’ safety. The crowd included Moulton’s parents and other relatives.
“We want him to take this seriously," said Maria Battaglia, a Woburn group home worker. “I’ve worked in this field for 15 years and I’ve never seen such violence against human services workers."
Michael Levenson can be reached at mlevenson@globe.com.
© Copyright 2011 Globe Newspaper Company.
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