This is a nightmare. Baystate Health Systems wants to consolidate all its psychiatric units into one stand-alone facility and set that up as a profit-making enterprise. This plan can and must be stopped.
There is no place for profit in the care of seriously ill patients. Issues of financial solvency of our nonprofit providers have brought us to our current deplorable situation. Adding a profit mandate to one of the major providers of psychiatric beds will make matters worse.
Thirty-five years ago I moved to Western Massachusetts. I was a young lawyer working for the Department of Mental Health. I had been given the exciting opportunity to expedite compliance with the consent decree entered in the class action Brewster v. Dukakis. Being a self-styled social warrior and a lover of Western Massachusetts, I was thrilled. This was an opportunity to join a group of similarly minded reformers and change the paradigm of mental health services in Massachusetts.
The Brewster decree required the closure of Northampton State Hospital and the development of an integrated comprehensive community-based system of mental health care. Through a combination of state and federal funds these services would be provided by a network of local nonprofit providers with volunteer boards. As with the old state hospital-based system, no one would be too ill to serve. If they had serious chronic needs, they would be served in array of residential programs: group homes, staffed apartments, subsidized apartments with community supports. There would be community mental health centers, peer support clubhouses and various vocational services. Comprehensive service planning for persons with serious and chronic mental health needs would be provided by the state through a large corps of service coordinators. The prime directive was to serve seriously mentally ill people in the least restrictive setting while maintaining their safety and autonomy.
Over the last 30 years, this system has eroded to the point that there is no system at all. There is no integration or coordination. Oversight by the Department of Mental Health is nonexistent. There are a handful of mega-providers like ServiceNet or Baystate Health who are independent of each other and have no commitment to meeting the needs of people with serious and chronic mental illness. These services seem more dedicated to avoiding long-term responsibility for mentally ill people than anything else.
People are held in emergency rooms waiting for beds, or are prematurely discharged with inadequate planning. The correctional system has become the largest provider of mental health care. Under the guise of maximizing individual autonomy, seriously disturbed people are discharged to shelters or the streets. Under the guise of privacy, the involvement of families and significant others is discouraged.
For better and worse, the old state hospital-based system was tangible evidence that the state was committed to serving the seriously mentally ill. If something was wrong, and there were many things wrong, at least the state was accountable for it. Today there is no such accountability. There is no guarantee that if you are seriously ill care is available. Your need for help will be left to the vagaries of insurance coverage and availability
The plan by Baystate Health to consolidate all of its psychiatric units into one stand-alone for-profit hospital is the latest blow to a deteriorated “system” of mental health care. It is not being done to support the community’s and the state’s commitment to the mentally ill. It is being done to protect Baystate’s bottom line and maybe make a few bucks. It will cause great disruption to the potential patients, many of whom are poor and disabled, and their families.
There will be a loss of psychiatric coverage at Franklin Medical Center and the other hospitals. Mentally ill people being served in these hospitals for medical problems are being abandoned. There will be less chance for integration between psychiatric and medical providers serving these patients. Connection with local social services, family and community supports will be more difficult to establish or maintain.
Even something like family visits will be more difficult. Believe me, the lives of families with a mentally ill member are difficult enough,.
David R. Roulston, an attorney, is a Greenfield resident.