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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.

By The Spotlight team

Lead image by Suzanne Kreiter.

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.

Dorothea Dix is credited with the movement to build state psychiatric institutions in the 19th century. George M. Crushing/Boston Athenaeum
Dorothea Dix is credited with the movement to build state psychiatric institutions in the 19th century.

1963 — President Kennedy announces a “great national effort” to replace mental institutions with a system of community-based care.

President Kennedy signs a bill authorizing $329 million for mental health programs during a ceremony at the White House, Oct. 31, 1963. Bill Allen/Associated Press
President Kennedy signs a bill authorizing $329 million for mental health programs during a ceremony at the White House, Oct. 31, 1963.

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.

A still image from Frederick Wiseman’s film “Titicut Follies.” 1967 Bridgewater Film Co. Inc./provided by Zipporah Film
A still image from Frederick Wiseman’s film “Titicut Follies.”

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.

A patient sits in a ward at Northampton State Hospital in 1982. Richard Carpenter for The Boston Globe
A patient sits in a ward at Northampton State Hospital in 1982.

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.

Boston State Hospital in Mattapan, shown here being demolished in 1997, was one of many psychiatric institutions that once dotted the state. Suzanne Kreiter/Globe Staff/file 1997
Boston State Hospital in Mattapan, shown here being demolished in 1997, was one of many psychiatric institutions that once dotted the state.

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.

Medfield State Hospital closed in 2003 after more than 100 years of housing and treating patients. Essdras Suarez/Globe Staff/file
Medfield State Hospital closed in 2003 after more than 100 years of housing and treating patients.

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.”

Pericles Clergeau (right) is arraigned in Lowell District Court on Jan. 31, 2011, in the fatal stabbing of Jose Roldan, a homeless shelter worker who had tried to help him. David H. Brow/Pool via AP/file
Pericles Clergeau (right) is arraigned in Lowell District Court on Jan. 31, 2011, in the fatal stabbing of Jose Roldan, a homeless shelter worker who had tried to help him.

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