Reforms proposed for Bridgewater State Hospital

One patient was held in seclusion for 13 months despite no evidence he showed a risk of imminent harm. Another was held in seclusion for five months, even though progress notes indicated he was “well behaved.” And a patient presenting symptoms of paranoia who was refusing medication was strapped in four-point restraints and forced to take medication – but no court decree had authorized involuntary medication.

Several of these cases of individuals with mental illness subjected to abuse and neglect at Bridgewater State Hospital are detailed in a July 11 report by the Disability Law Center of Massachusetts. Despite its name, the Bridgewater facility is a medium security prison for men run by the Department of Corrections and the state’s only facility for inmates with severe mental illness who are involved with the criminal justice system. Not all inmates have been convicted of a crime; most are initially admitted for court-ordered observation and evaluation. Women who meet these criteria are sent to a Department of Mental Health facility.

Bridgewater has a design capacity for 227 patients but typically holds more than 300 and has held as many as 400 within the past five years, according to the Disability Law Center’s report. There are eight psychologists contracted to conduct all initial forensic evaluations and any recommitment and competency to stand trial evaluations. Last year, they completed between 850 and 900 forensic evaluations. The report documented treatment staff’s concerns over a lack of therapeutic space such as a quiet room where patients can calm themselves away from excess light and noise.

Bridgewater State Hospital fell under intense scrutiny after a February Boston Globe article detailing circumstances surrounding the 2009 death of a 23-year-old man with schizophrenia as guards were subduing him. In May, the Joint Commission, which accredits hospitals, conducted a surprise inspection and gave the facility 45 days to respond to its findings or risk losing accreditation. By July, the facility’s superintendent had resigned and state legislators were contemplating a series of reforms proposed by Gov. Deval Patrick.

The Massachusetts FY15 budget includes $13 million in operating funds and $1 million in capital funds to implement policy recommendations developed last spring by stakeholders from DOC, DMH and the Executive Offices of Public Safety and Security and Health and Human Services. Patrick also submitted a $10 million supplemental FY14 budget request to hire an additional 130 clinical staff as early as September pending the legislature’s approval.

Spending for reform initiatives includes:

• $10 million to move 100 discharge-ready DMH inpatients into community placements.

• $2 million to use 52 unoccupied beds at the Worcester Recovery Center and Hospital, freeing up DMH space to accommodate step-down patients from Bridgewater.

• $1 million to increase the number of court clinicians trained to assess competency to stand trial.

• $500,000 for building improvements to create de-escalation rooms at Bridgewater.

• $500,000 for a study to examine whether to retrofit an existing state facility or design a new facility to house potentially violent patients who have not yet been sentenced.

The reforms aim to increase collaboration between DOC and DMH officials. The Bridgewater facility’s leadership and staff received training in trauma-informed care strategies to prevent the use of seclusion and restraint, such as sensory integration and the use of weighted vests to calm patients and avoid violent outbursts. Between January and May, the number of hours inmates spent in restraints decreased by more than 90 percent and seclusion by 50 percent as officials complied with statutory limits, states a DMH report outlining progress on implementing reforms. But patient assaults on staff and fights between patients increased during that time, according to the Disability Law Center report.

Disability Law Center Director of Litigation Stan Eichner, one of six attorneys who conducted interviews with Bridgewater patients and staff and reviewed two years of records, says patients were subjected to restraint and seclusion as punishment and discipline – against the facility’s own policy. Eichner describes an “abject failure to provide adequate psychological services.”

“We think the legislative response by the administration if it were enacted would be a strong step in the right direction,” Eichner says. “It doesn’t go as far as we would like it to.”

That’s because between 55 and 60 patients would still remain at Bridgewater under DOC control if all reforms are implemented, Eichner says. The center wants responsibility for all Bridgewater patients transferred to DMH to ensure they receive treatment they need. Massachusetts is one of only two states that has a correctional agency overseeing a forensic psychiatric hospital.

“Ideally, the entire BSH population would be transferred to a DMH-controlled facility, and I’ll continue to push for that model,” Rep. Kay Khan, D-Newton, a psychiatric nurse by training and founder and co-chair of the legislative Mental Health Caucus, says via an email.

Khan also calls Patrick’s bill “a great step in the right direction.” She adds: “The bill is not a panacea but it is the first serious and significant attempt to reform BSH for as long as I can remember.”

The Disability Law Center’s report can be found at www.dlc-ma.org/BSHReport.pdf.