|Deshawn James Chappell is brought into Chelsea District Court where he was ordered to be held for mental evaluation. (Aram Boghosian for The Boston Globe)|
Murder in Revere group home shows need for criminal checks
THE SYSTEM of privately operated group homes and day rehabilitation centers for people with mental illness is a historic advancement over the prior practice of confinement in large institutions. But there is a flaw — now a fatal flaw — in a system that assumes nearly every person with mental illness, including those with violent criminal pasts, is ready to live in a community setting.
Earlier this month, police arrested Deshawn James Chappell for the Jan. 20 murder of Stephanie Moulton, a 25-year-old counselor at a five-person group home in Revere where Chappell lived with other mentally ill clients of the state Department of Mental Health. Chappell had a history of violence and threats, including a 2006 assault on his stepfather that led to three months imprisonment. He was nevertheless deemed an acceptable risk to live in a group home operated by North Suffolk Mental Health, which maintains 10 group homes for 90 clients under contract to the state.
With the exception of the bloody crime itself, the most shocking revelation to come out of Moulton’s murder may be how little information is known and shared about the people living in group homes.The system is designed to counter the stigma faced by people with mental illness. The Americans with Disabilities Act, for example, gives providers the right to set up shop without undue interference of local authorities or neighbors.
That’s a defensible policy. Few municipalities would welcome group homes with open arms. But it’s far more disconcerting to learn that some staffers and even managers are operating in the dark about their own clients. North Suffolk Mental Health, for example, did not conduct criminal background checks on clients at its group homes. Jackie Moore, chief executive of North Suffolk, said that criminal background checks require a resident’s permission and that medical privacy issues prevent such information from being shared with staffers even if it were collected.
Yet other providers make wider use of criminal background data. Bay Cove Human Services, one of the Boston area’s largest providers of group homes, conducts criminal background checks on every resident, according to executive director Stan Connors. Criminal records don’t rule out placements. But they do trigger a meeting of an in-house risk committee to determine whether a person should be admitted and at which level of staffing intensity.The state should ensure that other contractors follow Bay Cove’s policy. But even in the wake of Moulton’s murder, mental-health officials demur. “We haven’t found CORI (Criminal Offender Record Information) helpful in predicting an act of violence,’’ said Barbara Leadholm, the state commissioner of mental health. There are less intrusive ways, she said, to conduct risk assessments.
That policy is too risky. The safety of counselors and neighbors, as well as the quality of care of the person with mental illness, depends on equipping care providers with a thorough history of the client. And criminal history is certainly as relevant as family history in determining a care plan that protects the safety of both the clients and staffers. The information should be shared not only with managers but with direct care workers. If group home workers can be trusted to handle and chart a patient’s medications, they can be trusted with criminal history information.
Moulton’s murder indicates a need for a wider investigation into whether state officials are steering mentally ill clients into community settings before they are ready. Deinstitutionalization of the mentally ill proceeded with a fervor in the 1970s. In 1970, the state maintained 12,500 beds in secure state mental institutions. By 1980, that number dropped to 2,200. Now only 626 beds are available in a handful of secure units. And that number could fall by another 100 based on Governor Patrick’s latest budget proposal, which includes a $21 million cut to the Department of Mental Health.
A former program manager at North Suffolk told the Globe that mental health workers are “often provoked and attacked.’’ Yet state officials say they logged only 14 attacks on staff in 2010 across the entire community-based mental health system serving about 18,000 people. That may reflect a communication or reporting problem between the private vendors and state mental health officials.
As secure beds go off line, there is a likelihood that more mentally ill people with violent tendencies will find their way into some of the roughly 553 group homes serving about 2,800 clients. Theoretically, providers can refuse such clients. But they risk alienating state officials on whom they depend for their livelihoods. Group home managers negotiate with the state for money for extra staff to deal with difficult clients. But as the state budget crisis deepens, the outcomes of those negotiations are likely to be less satisfactory.
Moulton’s death is weighing terribly not only on her family but on her coworkers and state officials. Her death cries out for an honest look at whether health care workers are being put at unnecessary risk in the quest for providing autonomy to the mentally ill.