The System Disassembles
Of the eleven state hospitals still in operation, three were closed within a span of three years. In 1973 Grafton was the first to be shut down, in 1974 Gardner was closed, and in 1975 Foxborough followed suit. These were the so-called snake pits, but they were hardly the worst. Most of their clients were transferred to other state hospitals. No money was saved in closing Grafton, but the state did manage to save $5 million in closing Gardner.
Activists continued to disclose that the Massachusetts mental health system was fraught with abuses, neglect, filthy and unsafe conditions, and mismanagement on a system wide scale. Slapped with a class-action lawsuit in 1976, state officials at Northampton State Hospital were hauled into court. In the famous case Brewster v. Dukakis, the plaintiffs charged that they had a legal right to psychiatric treatment in a less restrictive setting than a state hospital and, conversely, that the state had an obligation to provide such a treatment setting. A similar fate befell the schools for the mentally retarded at Belchertown, Fernald in Waltham, and Monson, which allowed their clients to live in squalor. These recalcitrant institutions had to be dragged unwillingly into court before they would do anything to improve the despicable conditions that prevailed. The consent decree was the preferred instrument of judicial intervention. In effect, the courts became the administrators. The world of mental health practice was becoming more complex.
After Foxborough was closed, Lee Macht stepped down as commissioner. Dukakis replaced him with Robert Okin, who was strongly committed to community mental health services. Only thirty-three years old, Okin had served as commissioner in Vermont from 1973 to 1975.
Metropolitan State Hospital was supposed to be closed in 1978, but that did not happen. The plan was for McLean Hospital to replace Met State in terms of acute and longterm care, but the Public Health Council turned down the plan.48 Meanwhile, the eight remaining state hospitals continued to decline and decay, becoming little more than holding cages for the acutely and chronically insane. All eight were guilty of flagrant neglect and harm to nearly helpless people. The back wards were filthy and appallingly inhumane. Patients were not only stripped of their self-esteem and human dignity, but the restive and unruly ones were forcibly placed in seclusion and mechanical restraints, some forced to take medication against their will. Grim stories about physical and sexual abuse abounded. Hospital attendants often played mind games with patients by threatening to send them to Bridgewater with the criminally insane if they acted up or otherwise caused trouble. Since the law called for strict security, this kind of intimidation and cruelty was no idle threat.
Northampton was not the worst mental hospital. That dubious distinction belonged to Boston State Hospital, which housed 3,600 patients as late as 1964, when it was considered a disaster. The hospital was slated to be closed in 1975. In fact, some 100 geriatric patients were transferred to Lemuel Shattuck Public Health Hospital in 1976. But this phasedown proved to be politically sensitive and unacceptable to the community, so Okin was forced to back off. He subsequently accelerated the pace of deinstitutionalization. In March 1981 the average daily census at Boston State had dwindled to 147 patients, and, after its 142 years of operation, Gerard O'Connor, its superintendent, closed this venerable institution.
Without going into the horrors of what one finds inside the walls of a state hospital, suffice it to say that it is not a pretty picture. Only those who have endured such experiences or seen what goes on can describe the reality of such an institution. The cruel and sadistic treatment therein was vividly portrayed in Ken Kesey's book and movie One Flew over the Cuckoo's Nest. Unitization was supposed to have corrected these abuses, but they still persisted. Despite the similarity of all mental hospital experiences in their broadest outlines, each carries its own daily agonies with occasional small triumphs.
Displeasure with the mental health system was widespread at the end of the seventies. The recurring public outcry for better treatment grew louder and more persistent. Administrators such as Rae O'Leary, who had spent most of their careers in state hospitals, were thrust into crisis management. O'Leary's experience was typical for many, who ended up frustrated and angry. O'Leary expressed her anger by saying, "Conditions were so horrible in these hellholes that they should have been blown up.
Met State Rocked by Scandal
What goes on inside a state mental hospital is typically a mystery to the public and elected officials alike until dramatic events draw attention to it, usually when a dangerous patient escapes or when a scandal breaks. Such incidents usually prompt an investigation and sensational media coverage. A major scandal occurred at Met State in February 1990, when four male employees - a security guard, a mental health worker, a nursing supervisor, and a plumber - were charged with having sexually abused five female patients. This sordid affair reached into a fairly high level of management, and the story was widely reported in the local press.
Implementing the Phase-down
The initial phase down began on November 5, when the Central Middlesex area closed its admissions. This decision allowed for the shutdown of a receiving ward on December 17, but the administrators soon realized that it would be necessary to maintain admissions to serve patients from the Cambridge-Somerville area. The Tri-City area made alternate plans to divert acute admissions to Danvers, which enabled them to close their admissions by January 1. The census at Met State on November 30, 1990, was 382 patients. The medical director of Westborough met with Met State clinical staff to review clients identified for transfer on December 7. A reciprocal meeting was held at Westborough the following week. On January 2, 1991, two weeks before Governor William Weld was sworn into office, the initial twenty-five patients were transferred into existing vacancies at Westborough, where a new ward was established later that month to accommodate an additional twenty-five to thirty clients.
Once the phasedown began, the work and commitment of hospital employees allowed for the supportive and orderly transfer of patients. The first few months were the most difficult, mainly because the institution was still reeling from the sex scandal. Local telephone lines for towns surrounding Met State were installed at Westborough and Worcester hospitals, thus facilitating family-to-client and client-to-client communication at no increased expense. A twice-a-week van service was established. Family support meetings run by Worcester and Westborough staff were begun at Met State and transferred to the receiving facilities.
Movement of state hospital patients continued throughout the summer and fall. As of November 19, the census was down to 180 patients. By this time 324 employees had left, and the remainder of patients and workers would leave within the next two months. The other significant development was the opening of a DMH replacement unit at Cambridge Hospital. A contract was signed on December 16 to provide seventeen acute-care beds to accommodate Cambridge and Somerville patients. As Metropolitan State headed for closure, there was an increase in petty theft as some wards were closed. This was stopped by moving all furnishings and equipment from the unit and sealing off the closed area immediately after the last patient had left. When all was said and done, the final displacement of the 382 patients. On January 25, 1992, the last group of patients and staff was moved out and relocated. Six days later, with the hospital wards completely empty.
The transfer to Danvers presented a special problem. Careful consideration was given to the fact that patients were being moved from one closing state hospital to one that was scheduled to close six months later. Since the newly built psychiatric unit at Tewksbury Public Health Hospital was not ready for occupancy, these patients would have to be moved twice. This troublesome issue was thoroughly discussed with family members and the affected patients, and only with their concurrence would this move take place. On June 24, 1992 the last clients were transferred to Tewksbury and Danvers State Hospital closed.
New England Journal of Public Policy: Special Issue: Vol 12, No 1 John W. McCormack Institute of Public Affairs, University of Massachusetts at Boston, 1996. Edited for length.