Movement of Taunton State patients still causing furor

Since 2012, when Gov. Deval Patrick announced plans to close Taunton State Hospital, proponents and opponents of the move have continued to clash over the decision. While the original plans have been amended – 45 of the hospital’s 169 beds remain open – the governor maintains his plan to transfer the remaining patients to the Worcester Recovery Center and Hospital (WRCH) and use the property for other purposes.

“Consistent with the department’s statewide vision for public mental health services, the department plans to transition the remaining 45 continuing care beds at Taunton State Hospital to the Worcester Recovery Center and Hospital. The department’s present adult continuing care capacity will remain the same at 626,” says Anna Chinappi, director, Office of Communications and Community Engagement at the Massachusetts Department of Mental Health.

“As the transition gets underway, the department will work closely with the patients and families at Taunton State Hospital to ensure discharge or transfer to the appropriate level of inpatient or community-based service. Individuals who need continuing care inpatient services will be transferred to an inpatient bed within the DMH network of services, based upon clinical determinations and the wishes of patients and their families.”

The decision to relocate Taunton State Hospital patients to the WRCH, some 50 miles west, has drawn significant criticism from staff, patients and their families, as well as from local legislators, but the state remains steadfast in its plans. “The department operates a state-wide system of inpatient hospitals. While the location of a patient’s home community is taken into consideration for placement, patients are placed where there are available beds and what makes sense clinically. All of our inpatient facilities treat patients from across the state,” says Chinappi.

Former Mental Health Commissioner (2003-2007) Elizabeth Childs, M.D., says, “We knew [WRCH] would draw patients from other parts of the state. But it was not designed to replace Taunton, Tewksbury or Boston. WRCH was meant to consolidate Worcester and Westboro state hospitals.” Acknowledging that the decision to close the two state-run facilities was cost and clinically driven, she notes that the state carefully analyzed the bed situation and concluded that the Commonwealth was “over-bedded at the time.” She says, “We could use less inpatient space, as long as resources were diverted to the community. These funds were not intended to offset budget funding shortfalls.”

As for moving patients from the southeast corner of the state to Worcester, Childs says that patients should be near family, jobs and other familiar surroundings. “Healthcare is best delivered as a customized, individualized service, not as centralized, bureaucratic services,” she says. “Healthcare should stay local. Connection is the most basic element of treatment for people with serious mental illness. Structural, geographic and logistical connections go to the heart of what it means to help people. That doesn’t happen when you are 100 miles apart from your home,” Childs says.

“In the whole department of mental health system, hospitals have been nodes of clinical expertise and capacity. The inpatient hospital system has the broadest specialist services of all disciplines. They are crystallized in a central place and can be innovative and creative. It’s harder to create this environment when done in disparate places.”

Childs says, “I fear that this decision is financially driven. As a policy leader, you have to make quality decisions.”

Although no psychologists would agree to speak on the record for this story, other Taunton State Hospital employees offered insight into the situation. Joseph Langlois, a licensed mental health counselor, has worked at the hospital for 43 years and believes the legislature sees value in keeping a facility in the southeast region of the state. He notes that in its heyday, Taunton served 2,000 patients. Advances in treatment and the trend toward community-based services saw that number dip significantly. “When I came here, we had 1,000 patients. Now we’re down to three wards and 45 patients,” he says. Although some funding has gone into community services, he emphasizes that a facility in this region is still needed.

Ellen Farley, R.N., who works in utilization management at Taunton State Hospital, points out that community-based services are not as plentiful and as structured as inpatient care. “There are a lot of patient deaths because there are not enough community services. These patients have metabolic issues, secondary to medications. In the community, these issues are not addressed,” she says. “We feel there is a huge need in the southeast due to the density of mental illness and most patients have comorbid illnesses.”

Senior level nurse and president of the Massachusetts Nursing Association Karen Coughlin, R.N., views the decision to eliminate the remaining 45 beds as a violation of mental health parity. “Patients in the southeast part of the state deserve continuing care services in their local community. They deserve all aspects of care – continuing, acute and community. Patients do better when they are able to access services in the area in which they live,” she says. “It’s easier to transition the patient from continuing care to the community when you have AA sponsorships, group home placements and day programs nearby.”

Coughlin reports that when the hospital eliminated 124 beds, many psychologists left the facility. “We do have two in-house psychologists on staff. They are not full-time though,” she says. “We should have more. Our psychology services are overwhelmed.”

David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, Inc., cites the “political brouhaha” that is complicating this issue. He says, “There are budget issues here. It’s a work in progress and a lot depends on how the legislative and executive offices weigh in. This is more of a political battle.”

Coughlin anticipates continued support from the legislature. “They acknowledge there should be continuing care beds in the southeast area,” she reports.

On April 9, the House Ways & Means Committee released its FY2015 budget, which includes $181.4 million for state psychiatric hospitals and community mental health centers and maintains funding for the operation of 45 beds at Taunton State Hospital through June 2015.