The desperate and the dead: community care
Massachusetts built one of the nation’s largest systems of institutional care for those with mental illness.
And then they closed the institutions.
Many hands have shaped the mental health care system Massachusetts presides over today, from crusading activists and judges to groundbreaking filmmakers and political leaders of all stripes. Here’s a look at some key moments over the years.
1848 — Dorothea Dix, a Massachusetts-bred mental health care reformer, tells Congress, “Humanity requires that every insane person should receive the care appropriate to his condition.” Her pioneering work spurs most states to build psychiatric asylums.
1963 — President Kennedy announces a “great national effort” to replace mental institutions with a system of community-based care.
1967 — The documentary film “Titicut Follies” by Frederick Wiseman exposes horrific treatment, including force feeding and solitary confinement, inside Bridgewater State Hospital. A series of legal disputes related to patient privacy prevents the film from being viewed by the general public until 1991.
1973 — A wave of psychiatric hospital closures in Massachusetts begins under Governor Francis Sargent with the shutdown of Grafton State Hospital. All but two state hospitals eventually close.
1978 — Michael Dukakis, haunted by the horrid conditions he’d witnessed while visiting institutionalized children, accepts a federal consent decree establishing extensive community treatment options in Western Massachusetts as alternatives to Northampton State Hospital.
In the same year, a decision by the state Supreme Judicial Court makes it harder to commit people with mental illness to hospitals involuntarily. With this decision, anyone seeking to confine a person on this basis has to prove “beyond a reasonable doubt” that the person is a danger to himself or others.
1981 — President Reagan takes power and dismantles Kennedy’s ambitious program to build federally funded community mental health centers.
1990 — William Weld is elected governor of Massachusetts and, with Charlie Baker, then a top health and budget aide, ushers in a new era of privatization, handing responsibility for mental health services over to an array of private vendors. As state oversight diminishes, Weld promises “equal or superior” care to what the public system provided.
1999 — A US Supreme Court decision requires states to treat people with disabilities in the most integrated settings possible.
2003 — Governor Mitt Romney eliminates Medfield State Hospital and a so-called Difficult to Manage Unit at Taunton State Hospital for men with severe mental illness and a history of violence.
2006 — A federal court decision in Rosie D., a class-action lawsuit, forces Massachusetts to boost behavioral health spending for thousands of children on Medicaid, leading to more than $200 million annually in additional funding.
2010 — The state shutters Westborough State Hospital two years early as Governor Deval Patrick targets mental health spending to close a budget gap made worse by the financial crisis.
2011 — Three people working with those suffering from severe mental illness are killed on the job. Soon after, the leaders of a state panel warn that the mental health care system lacks the beds, clinicians, services, and communication among its many different players to meet the increasing demands posed by people with serious mental illness. “If we care about safety, we cannot pretend that all is well,” the report says.
2016 — After one of the 2011 assailants, Pericles Clergeau, pleads guilty to second-degree murder, his lawyer, Keith Halpern, stands up in court to call for change. “There are thousands of people like this who need to be helped,” he says. “And we’re not giving them the help.”
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