Disability Law Center Report Provides Indictment of State's Community-based Mental Health System
The article below tracks a recent report by the Disability Law Center which provides an indictment of the DMH’s community-based system of care. This report underscores the failure of state’s mental health system and the crisis patients face on all fronts. These findings track the findings of a 2009 DMH task report, which found that the entire system was failing its clients, both in providing inpatient services and in the community. This is why the MNA/NNU fought so hard to convince the legislature to create an independent commission to evaluate the crumbling mental health system, and to make recommendations for its improvement. As participants in this process, we will be using our influence to ensure that patients in all settings receive the care they deserve.
The Disability Law Center of Boston, a federally mandated protection and advocacy agency for the state, spent 18 months examining the state Department of Mental Health’s “community based flexible supports” program and made 14 recommendations to improve the system.
The state adopted the system about a year before closing Westboro State Hospital. Instead of state-employed social workers, employees of social service agencies began coordinating community care for adults with mental illness, said Walter Noons, a DLC senior staff attorney.
The state social workers generally had relatively good educations and were committed to the job over a long time, he said, while private agencies with their own standards for hiring chose their own employees, who frequently have low pay and don’t stay in the job for long.
He said the law center is not opposed to the newer system, but any system depends on the quality of employees for its success.
Some of the agencies and employees are good, Mr. Noons said, but the quality varies.
All three groups solicited for their opinions by the law center — the state Department of Mental Health, the agencies it has contracts with, and more than 200 people at “clubhouses” for people with mental illness — agreed there is inadequate funding to pay contracted employees enough or have enough of them. One of the top recommendations the law center made was for the state Legislature to increase funding for the agencies.
But there was not agreement on all topics. The Disability Law Center said clients view their group homes as their homes, where they should be able to live for as long as they like. The providers who set strict rules at group homes “have unanimously stated that they are transitional group living environments in accordance with the philosophy of CBFS as constructed by DMH,” the law center report said. “The goal is to move individuals into less intensive services as they progress” and thus they are not “homes.”
Nevertheless, the law center said, the Department of Mental Health “specifically defined them as the clients’ home.”
Still, the private agencies “report feeling pressure from DMH to move clients along from residential living to supported housing and beyond, in order to accommodate the more involved clients coming out of” Taunton State Hospital, according to the DLC report. “The fear of prematurely discharging clients from services is a real challenge to these vendors, and a concern for DLC.”
No one has been available since Friday from DMH to comment. Paulette Song, spokeswoman for the Executive Office of Health and Human Services, said Friday, “DMH has received the report and looks forward to reviewing it.”
The law center report said, “DMH contends that vendors are not asked to discharge clients prematurely, but rather to adjust service levels as clients progress in their recovery.” The state is reducing Taunton State Hospital from 169 beds to 45.
Among the human rights concerns that the law center listed are some providers locking refrigerators and snack cabinets in group homes where some clients pay a fee; locking people out of group homes if they miss curfew; and not allowing residents to stay in the group homes during the day, even people with serious illnesses such as pneumonia and influenza.
It also raised concerns about some providers placing conditions on accepting hospital patients in a group home, such as requiring a GPS monitor, guardianships and court-ordered treatment plans that were not considered necessary by the treatment team.
The law center is critical of the Department of Mental Health for removing human rights enforcement from its licensing standards and relegating it to contract enforcement, especially given what it says is the poor state of some aspects of contract enforcement.
Jennifer Ives, a member of MPOWER, an organization run by people with mental health disabilities, said she likes it that community based flexible support is “people centered,” allowing her to design her own individual action plan. But the Worcester resident agrees with the need for more oversight over provider performance.
She gets her services from Community Healthlink in Worcester, but she said the agency rarely provides her with the two meetings a week with her contact worker as her individual action plan calls for. And even though Ms. Ives is a member of DMH’s area advisory board and has directly let DMH area officials know of her situation, she said, nothing has been done about it.
Ms. Ives praised Community Healthlink for hiring certified peer specialists, but she said it should have more of them.
Mr. Noons said that DLC is not advocating for return of the previous model of community services.
“This is the model,” he said. “It behooves all of us — advocates and professionals alike — to make this work.”