The Boston Globe
The Editorial Board
April 27, 2026
Training, staffing, and separating violent patients could help
Just in April, the Globe reported that there have been four violent incidents at Tewksbury State Hospital, a state-owned facility for people with mental and physical illnesses. One patient assaulted another patient with a sharp object; a patient acting erratically hit a staff member; a visitor assaulted a pregnant staffer; and a patient hit a staffer in the face.
These incidents aren’t isolated problems. The Tewksbury police said their agency responded to 26 assaults at the hospital in 2025, and the Tewksbury State Hospital Public Safety Department responded to 478 assaults. (The police are called if a crime is alleged — for example, a patient intentionally punches a nurse. Other incidents include behavior that’s not criminal, like a dementia patient slapping a nurse handling their IV.)
Data from the state’s Executive Office of Health and Human Services suggests the rate of incidents at Tewksbury State Hospital is similar to other state inpatient mental health facilities. For example, Lemuel Shattuck Hospital, which is smaller than Tewksbury, had 121 incidents of physical assaults involving mental health patients in 2025, up from 73 in 2024.
Still, that rate of violence is alarming. Massachusetts Public Health Commissioner Robbie Goldstein told the editorial board that any increase in assaults in recent years likely reflects problems statewide and nationwide, with patients entering hospitals more acutely ill and hospitals at capacity with stressed staff.
In response to violent incidents, recent debates have centered on the state’s decision to prevent Tewksbury hospital security staff from using pepper spray, handcuffs, and batons. Other hospitals run by state health care agencies already don’t allow these tools, which hospital officials say are inappropriate in a therapeutic hospital setting. The Tewksbury police have countered that the restriction will place staff and patients at unnecessary risk.
But the debate, while important, misses the core issue: how to prevent assaults in the first place. That will involve ensuring the hospital is properly staffed, with staff trained in deescalation. It might include creating behavioral emergency response teams trained in deescalation, a model used in some private hospitals. It may also involve separating court-involved patients from other patients, a step hospital unions have long advocated for.
To its credit, the state is working to improve training. State officials have been piloting programs training staff on techniques for deescalation, aggression management, and patient-centered restraint strategies. Initiatives that work will be scaled up. Tewksbury State Hospital improved its camera surveillance technology, made changes to which doors are locked, and changed entry protocols to register visitors and use metal detectors. The state and the Massachusetts Nurses Association recently established a workplace safety council.
But the ongoing violence suggests more may need to be done to ensure a safe environment for patients and staff.
To be sure, policing the 800-acre Tewksbury State Hospital campus is a tall order. According to the Executive Office of Health and Human Services, the hospital has 323 beds, including 170 inpatient psychiatric beds and the rest serving complex, chronically medically ill patients. The average patient has been denied admission to three other health care facilities, often due to behavioral issues. Another approximately 300 residents are undergoing substance-use disorder treatment elsewhere on the campus, and 30 adolescents with behavioral health needs are in locked units.
The hospital also houses a growing number of court-involved patients, some referred from courts for a psychiatric evaluation to determine if they are competent to stand trial, while others are transferred from Bridgewater State Hospital, the Department of Correction’s mental hospital.
State health officials told the editorial board that annually, the percentage of mental health state hospital patients who are referred by the courts, including at Tewksbury, is between 20 and 23 percent. But union officials say the figure can be higher. At one time recently, according to the Massachusetts Nurses Association, 112 of 160 hospital psychiatric patients came from the correctional system.
David Schildmeier, a spokesperson for the Massachusetts Nurses Association, told the editorial board that Tewksbury State Hospital “has become a de facto mental health corrections facility but without the increased staff and protocols that are required to provide the care this specific population needs.’’
Jean Calvert McClure, Department of Mental Health chapter president for SEIU509, told the editorial board that staff have seen more violence involving court-involved patients than the general population. Schildmeier said many court-involved patients have oppositional disorders or a history of violence. Someone who was incarcerated might have learned in prison to make a weapon from a toothbrush.
A white paper published by the Massachusetts Nurses Association and SEIU509 said there hasn’t been an increase in security, training, or staffing as more court-involved patients entered treatment.
Whether someone poses a risk of violence depends on their specific illness and circumstances. Mental illness is not in itself a predictor of violence, and not all court-involved patients have a violent history. But some do. The hospital should have an internal system to evaluate risk and place patients accordingly, with consideration given to criminal charges.
Tewksbury State Hospital treats some of the state’s sickest patients who have nowhere else to go. These patients need a safe, therapeutic environment.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
