State expected to propose new mental hospital
Worcester complex eyed
Correction: Because of a reporting error, a Page One story March 28 gave an incorrect location for the architectural firm that is designing a proposed state psychiatric hospital. Ellenzweig Associates is based in Cambridge.
After pushing for decades to get mentally ill people out of state institutions, the Department of Mental Health is expected this week to propose its first new psychiatric hospital in almost 50 years, calling for one of the costliest building projects in Massachusetts history.
Massachusetts has closed 13 of its 16 state hospitals since 1973 as mental illness increasingly has been treated on an outpatient basis. But state officials say the push to deinstitutionalize patients has overlooked the needs of hundreds who are too sick or too dangerous to themselves or others to live on their own.
The nearly $300 million complex would replace two archaic hospitals in Worcester and Westborough and be located on the grounds of the Worcester hospital. In the existing facilities, patients are housed up to four to a room in dimly lit, monotonous wards, often for years at a time. In the new hospital, patients would have single rooms with natural light streaming in and easy access to parks, shops, and areas for socializing.
''The hospital has got to be the start of treatment, not the end. We really need spaces that give people hope that they will get better," said state Mental Health Commissioner Elizabeth Childs, who led the study commission that is expected to formally recommend a new hospital to the Legislature.
Advocates for people with mental illness praised the proposal, saying that the new hospital would greatly improve conditions for people in the throes of serious mental illness without undercutting the goal of reducing the institutionalized population.
Childs said construction of the 320-bed facility, combined with the planned closing of two hospitals, would reduce the number of psychiatric hospital beds in the state from 900 to 740, including beds at Taunton State Hospital and at two facilities for mentally ill people with chronic medical conditions. But the department projects that it could treat more people by reducing the average stay by each patient, which now hovers around 850 days.
If the plan is approved by the Legislature, the new Worcester hospital could be completed as soon as 2010.
State officials have not developed a firm cost estimate yet, but Commissioner David B.
However, Childs said, the high cost would be partly offset by savings in consolidating two hospitals into one and reducing the number of psychiatric beds, which cost $168,000 per year to run. In addition, she stressed that the hospitals in Worcester and Westborough would require $60 million in renovations over the next decade to remain open.
''There's a case to be made that this is a prudent, though large, investment," Childs said.
The proposal grew out of an attempt by Governor Mitt Romney to save money in 2003 by closing the Worcester State Hospital altogether and either deinstitutionalizing or transferring the 175 patients still treated there. But the Legislature blocked the move and instead called for the Department of Mental Health to study the long-term need for psychiatric hospital beds.
The study of psychiatric hospitals, completed in 2004, found Massachusetts had made great strides in reducing the institutionalized population more than 95 percent from the high of 23,000 in 1950, when people were sometimes wrongly committed for problems such as advanced syphilis or alcoholism. The report found that the department could reduce the number of patients still further by increasing services such as housing support that would allow patients with serious mental illness to live in their communities.
But the report also found that the state has badly neglected the remaining hospitals that serve some of the most vulnerable people in the state. It recommended that a commission led by the Department of Mental Health and the Division of Capital Asset Management look into the feasibility of building a state-of-the-art psychiatric hospital.
Unlike private psychiatric hospitals, where patients typically stay seven or eight days, state hospitals take patients whose recovery could take dramatically longer: people with schizophrenia that doesn't respond to drugs; those suffering from both mental illness and drug abuse; patients who repeatedly stop taking medications.
More than a quarter of the hospitalized patients are state prisoners being evaluated for their competence to stand trial or receiving treatment after being found not guilty by reason of insanity.
Childs said that a growing body of research suggests that a cheerful treatment setting helps patients with physical ailments heal faster. One study showed that patients left the hospital after abdominal surgery on average a day earlier if they were in a room with natural light compared with artificially lit rooms. ''If the setting is important in medical care, it's even more important in psychiatric care," Childs said. ''If we can get average length of stay down to a year, I'll be thrilled."
Elegant Romanesque-style stone buildings, with a commanding clock tower atop the administration building, now dominate the hilltop where the new hospital would be built. When it was built in 1873, the Worcester Insane Asylum embodied the humane care for the mentally ill championed by reformer Dorothea Dix. Quiet and imposingly beautiful, the campus was a city unto itself, with a nursery for babies born there and cropland to raise food.
''The idea was to give people peace and quiet and serenity," Childs said. However, ''once you went in, you didn't come out," she said, pointing out that many patients lived out their lives there and were buried nearby.
The state closed the old hospital in 1958, after completion of the nearby Bryan Building, still the main building of Worcester State Hospital. Lester Blumberg, general counsel for the Department of Mental Health, calls the building ''eight stories of institutional design" with long, dark corridors that encouraged patients to stay in their rooms because there was so little common space. Modeled on the medical centers of the time, he said, ''it's ready for retirement as a hospital."
The new hospital would require almost complete demolition of the boarded-up 1873 buildings, but the result, members of the study commission say, could be a national model for humane care.
Architects from Ellenzweig Associates of New York designed a decentralized campus loosely based on the idea of a New England village, with patients' rooms in clusters of eight to 10. Hallways, which would have rooms only on one side to avoid feeling institutional, would connect patients to meeting areas, a gymnasium, and a downtown area, where they could go to socialize, make purchases or attend meetings.
At their final meeting earlier this month, some members of the study commission -- which included legislators, hospital employees and advocates for the mentally ill -- talked about their role in mental health history, assuming that the Legislature approves the hospital plan.
''Perhaps 100 years from now, someone will be doing research on state hospitals and realize a new way of hospitals started with us," Perini said.
Scott Allen can be reached at allen@globe.com. 
