State may speed cuts in mental health
Panel suggests closing hospital early, other trims
A state commission has proposed speeding up the closure of Westborough State Hospital and a slate of other measures that would cut about 120 psychiatric beds at a time when the mental health system is already under significant strain.
The proposal is in response to a $13 million budget deficit at the state Department of Mental Health and would reduce its 788 adult continuing-care psychiatric beds - those that provide inpatient mental health services and are operating at 97 percent capacity. Yet a commission member said the impact would be partially offset by 200 people being discharged from hospitals into community programs.
Kristina Barry, a spokeswoman for the state’s Executive Office of Health and Human Services, said the recommendations were being reviewed by state officials. But the prospect of losing beds sparked deep concern among mental health workers, especially coming after significant reductions earlier this year - including the cutting of 100 case managers in January.
“To consider closing beds when you’re running at 97 percent occupancy on a daily rate really flies in the face of reality,’’ said Rhonda Bourne, a clinical social worker. “I just think that we’re headed for a really bad time. . . . We’re going to see an increase of what we already see - more mentally ill people in prison and more mentally ill people living on the streets and in shelters - and they don’t have enough beds either.’’
Westborough State Hospital, a psychiatric hospital with 162 beds, is already slated for closure in 2012, when a new 320-bed mental health hospital being built in Worcester will open. But the report finds that an earlier closure is feasible, depending on funding for community services for 200 patients in state hospitals who are deemed ready to be discharged with sufficient support. The money, an estimated $12 to $14 million, would come from the economic stimulus funding or a trust fund. The recommendations also stipulate that the state would have to commit money saved from closing the inpatient beds for those community programs.
The report also recommends closing one of the state-operated 16-bed acute inpatient units, most likely Quincy Mental Health Center, which costs $343,221 per bed per year. It also suggests reducing inpatient beds at Tewksbury State Hospital.
“Individuals with mental illnesses have dynamic needs, and I think what we have tried to do in this report is, given the realities, show what we think responsibly the system can look like,’’ said Marylou Sudders, a former commissioner of mental health. She was cochairwoman of the 15-member commission appointed to study the state’s psychiatric inpatient system.
Robert Fleischner, an attorney for the Center for Public Representation, a public interest law firm that represents people with disabilities, praised the commission’s recommendations to review and possibly revise policies that may keep people in the system longer than is necessary.
Dr. Scott Rauch, chairman of Partners Psychiatry and Mental Health, said bed closures are always of concern in psychiatry, but added that the recommendations laid out the breadth of considerations that need to be taken, such as an emphasis on outpatient and community services.
Still, there is growing concern about availability of psychiatric services overall.
Private or general hospitals typically provide acute psychiatric inpatient care and transfer patients to continuing care inpatient beds like the ones at Westborough State Hospital. Earlier this year, Cambridge Health Alliance made cuts to its psychiatric inpatient services, and the report expressed concern that such cuts could “portend the future.’’
Also, losing continuing care beds could exacerbate an ongoing problem in which patients may get stuck on medical floors or in emergency rooms as they wait for continuing care beds to open up.
Colleen Doherty, executive board member of Service Employees International Union 509, which represents social workers and rehabilitation counselors who work for the Department of Mental Health, said she visited Quincy and Westborough this week and heard many concerns.
“We certainly support people living in less restrictive settings,’’ Doherty said. “But we really think placement of clients has to be done thoughtfully and carefully and based on the individual needs of each client and not rushed because there’s a need to cut the budget.’’
Carolyn Y. Johnson can be reached at cjohnson@globe.com. 