NANCY CHIERO WAS as devoted as she was patient with her son Lee. The 35-year-old Uxbridge man had spent his life struggling with psychotic delusions, which would periodically send him to the emergency room for a prescription for medications. Those brought a brief respite, but Lee, who lived in his mother’s basement, would soon cycle off the meds and the visions would return. In 2007, caught in the grips of paranoia, he pushed her down the stairs and fatally stabbed her in the eyes — capturing the murder on videotape.
The story of the Uxbridge mother and son is emblematic of the state’s failed policies for treating those with serious mental illness. In a powerful series called “The Desperate and the Dead,” the Globe’s Spotlight team chronicled decades of tepid response, persistent underfunding, and governmental neglect that has thrown mentally ill patients into the streets and left families, police, and ER doctors with an enormous burden of care.
Since 2005, the series reported, more than 10 percent of all state homicides in which a suspect is known were allegedly committed by people with a history of mental illness or its clear symptoms. The Globe built a first-ever database of such cases; the numbers show that over the past 11 years at least 139 people in Massachusetts have died violently at the hands of a person with a diagnosed mental illness, or strong signs of one.
The arc of mental health care was supposed to be different, especially in the Bay State, where Frederick Wiseman’s shocking 1967 documentary, “Titicut Follies,” exposed humiliations inflicted on patients at Bridgewater State Hospital for the criminally insane and prompted pledges for change. State officials moved to shut down mental hospitals, with the aim of placing patients in more humane community clinics. The number of inpatient psychiatric beds in the state declined to 671 as of last year, from a peak of 23,560 in 1953, according to Spotlight.
But that robust system of community care never materialized. State officials slashed funding for inpatient mental health care by more than half from 1994 to 2013, at the same time that some treatment was being farmed out to private companies and nonprofits. But nearly a third of community mental health providers in Massachusetts reported closing clinics from 2013 to 2015, including the sort of intensive programs that could have benefited Nancy Chiero and her son.
Closing the gaps left by the legacy of deinstitutionalization is, front and center, an essential job of government. Cities like San Antonio provide a model, with aggressive funding of a system to handle psychiatric and substance abuse crises and move people from jails and ERs into treatment, Spotlight reports. There are other signs of progress in Massachusetts: In 2015, the state received nearly $1 million in federal seed money intended to establish pilot community clinics. And Governor Charlie Baker’s administration has put $41 million into MassHealth reimbursement rates — as private insurers seem to be fleeing in droves.
Finally, change is needed in state law in order to protect families, friends, and the public from mentally ill patients who pose a danger to others. Massachusetts, with its strong support for civil liberties, is one of only four states without a law that allows courts to compel patients with a history of noncompliance to undergo treatment. Such “assisted outpatient treatment” laws have led to better health outcomes in other states: patients are escorted to settings where they receive required medications. And while psychiatric medications can cause unwanted side effects — and research sometimes seems stuck in another era — they can also be effective in quelling symptoms.
It’s important to note that the vast number of those with mental illness are not violent, and feel stigmatized by any broad-brush approach. But legislators could couple the law with more funding for community clinics, as well as education and training. It could ultimately help patients like Lee Chiero and those who love them.
Washington, DC – SEIU International President Mary Kay Henry issued the following statement in response to an increase in premium rates from insurance companies for some plans offered through healthcare.gov:
“The fact that insurance companies are increasing healthcare premiums is not news to working people, but it is a warning bell for the next Congress. For six years and more than 60 repeal votes, opponents of the healthcare law have refused to share a serious, comprehensive plan to strengthen and improve it. Today, we are seeing a direct result of their inaction.
“As Americans are getting ready to choose a healthcare plan starting November 1, they should know that higher tax credits will be available for plans with the greatest increases. In fact, more than 8 in 10 people shopping on healthcare.gov last year received tax credits to help pay for their insurance and this year 75 percent of people will still be able to find a plan for less than $75 a month.
“The law is here to stay, but as the nation’s largest union of healthcare workers, we know it must be strengthened. Americans are beyond frustrated by a Congress that has put politics before their health and by healthcare headlines that are their daily reality, whether it’s drug company CEO’s making millions from life-saving cancer drugs, or the lack of transparency when it comes to what a doctor visit or procedure actually costs.
“The nurses, doctors and healthcare workers of SEIU know that Hillary Clinton will be a president who will come to the table with new ideas and new solutions to lower healthcare costs, and improve a law that is covering more Americans than ever before in our history. Every member of Congress should be prepared to do the same.”
El alza a las primas de seguros indica que el próximo Congreso debe tomar en serio el costo de atención médica
WASHINGTON, D.C.— La presidenta del sindicato SEIU internacional, Mary Kay Henry, hizo la siguiente declaración en torno al aumento al costo de las primas por parte de las compañías aseguradoras para algunos planes que se ofrecen a través del portal cuidadodesalud.gov:
“El hecho de que las compañías aseguradoras estén aumentando las primas de atención médica no es noticia para los trabajadores, pero es una advertencia para el próximo Congreso. Durante 6 años y más de 60 votos para revocarla, los opositores a la ley de atención médica se han negado a compartir un plan serio integral para fortalecerla y mejorarla. Hoy en día, estamos viendo el resultado directo de su inacción.
“Mientras que los norteamericanos se preparan para elegir un plan médico a partir del 1º de noviembre, deben saber que habrá un incremento de créditos de impuestos para los planes con los mayores aumentos. De hecho, más de 8 de cada 10 personas que compraron en el portal, cuidadodesalud.gov el año pasado recibieron créditos fiscales para ayudarles a pagar su seguro, y este año, el 75% de las personas todavía podrá encontrar un plan por menos de $75 al mes.
“La ley llegó para quedarse, pero nosotros, como el sindicato más grande de trabajadores del sector de salud, sabemos que debe ser fortalecida. Los norteamericanos están más que frustrados con un Congreso que ha puesto la política por encima de su salud y con titulares de prensa sobre atención médica que son su realidad diaria: ya sea que los ejecutivos de las compañías farmacéuticas están ganando millones con medicinas contra el cáncer para salvar vidas, o bien la falta de transparencia cuando se trata del costo real de una consulta al doctor o de un procedimiento.
“Las enfermeras, los doctores y los trabajadores del sector de salud de SEIU saben que Hillary Clinton será una presidenta que acudirá a la mesa de negociaciones con nuevas ideas y nuevas soluciones para bajar los costos de la atención médica y para mejorar una ley que está cubriendo a más estadounidenses que nunca antes en nuestra historia. Todo miembro del Congreso debería estar preparado para hacer lo mismo.”
By Danielle McLean
SOMERVILLE – While the people tasked with caring for clients at Vinfen’s group homes earn not much more than minimum wage and have frequent turnover, the non-profit’s upper management is earning six-figure salaries.
Vinfen’s staffing policies have come under question after Allen Harmon, a resident at the organization’s group home at 155 Central St., was charged with sexual assault and attempted murder after he reportedly attacked a woman in the B’nai Brith parking lot up the road last month. The victim in the alleged assault has sued Vinfen for $5 million in damages, claiming the company’s negligence led to her assault, and residents in the Winter Hill neighborhood had long complained about issues at the home.
Vinfen officials told the Journal that low wages – about $12.75 per hour – for counselors are due to the non-profit’s contract with the state Department of Mental Health, the state organization whose referrals account for nearly all of Vinfen’s more than $100 million income. Senior Vice President of Psychiatric Rehabilitation Susan Abbott said Vinfen has not had a structural cost-of-living adjustment to their contract with the state Department of Mental Health since 1988.
“As in any company, the lower people are paid, the less likely they are to stay. I don’t think we are unusual in that,” Abbott said. “Turnover is an issue for us and low wages is the cause.”
But a Journal review of Vinfen training and employment documents from 2011 show the company only requires high school or GED diplomas for its counselors, who are required to escort, restrain, evaluate, resuscitate clients, who can include convicted criminals with psychiatric disabilities. Several pages of one training document urge employees not to unionize.
State Representative Denise Provost said councilors earn less than what she pays people to clean her house and questioned the company’s pay structure.
“The rate of pay is inadequate. What is the most efficient way to house and provide services for the population served by the Department of Mental Health? I don’t know,” Provost said. “It’s clear we are not going to go back to confining people in hospitals but I would be interested in seeing how the cost of operating the system is broken down.”
Minimal experience, big responsibilities
According to Vinfen training documents obtained by the Journal, group home councilors are charged with a wide-range of responsibilities that essentially dictate the well being of the residents, some of whom have long criminal histories such as Harmon. The documents said councilors are responsible for giving clients medications, transporting clients, giving first aide and CPR, dealing with sexually active clients and protecting their basic human rights.
Documents also said counselors are tasked with helping administer individual support plans for clients, which outlines their goals and vision for their future. Abbott told the Journal those employees are trained to react the same way when a client presents a risk, regardless of their criminal history.
But according to Vinfen documents, the training job requirements for Vinfen group home residential counselors are a high school diploma or GED, and six months of experience in some capacity in the mental health field is preferred but not required. The training documents said no mental health experience is required or preferred for staff members tasked with watching group homes at night, however they are required to have a Massachusetts drivers license and a “good” driving record for three years.
What is not preferred, though, is union representation. Vinfen orientation materials from 2011 urged new hires not to sign a union card, citing large union dues, potentially losing the right vote on union representation, and possibly being forced to go on strike. It also said if the workers unionize, jobs or programs could be cut.
Jason Stephany, spokesman for the Massachusetts Human Service Workers Union, which represents human service workers, said the rate of $12.75 an hour amounts to a “poverty wage.” According to the U.S. Census Bureau, the federal poverty income threshold for a four-family household in 2013 was slightly less than $23,834 per year. At $12.75 per hour, full-time Vinfen employees earn $25,500 per year before taxes, which is slightly above the poverty level.
“Front line human service workers are caring for some of the most vulnerable and at risk populations in the commonwealth,” Stephany told the Journal. “We need to ensure that their compensation, their benefits, and the policies and procedures that are in place, recognize the valuable services these individuals provide for the community.”
More money at the top
Vinfen executives, on the other hand, earn six-figure salaries. According to figures compiled by state Representative James Lyons of Andover, CEO Bruce Bird earned $353,151 in 2013, its former Treasurer Yi J. Jung earned $227,151, and Psychiatrist Kenneth Duckworth earned $205,943. Abbott earned $170,358 in 2013.
Michael Weekes, president and CEO of the Boston-based Providers Council of Health and Human Service Providers Inc. told the Journal the state covers $163,682 of employee’s salaries. The rest is covered by non-state related revenues. Vinfen did not immediately respond to questions from the Journal asking how the remaining amount of Bird’s salary is funded.
The Providers Council is a human service trade association, which Vinfen is a member of. Weekes said employee salaries are decided by the company’s board of directors and comparable to similar positions at other organizations. He said the salary levels of non-profit employees are subject the IRS and state Attorney General’s office review.
Weekes said paying direct care staff higher wages is not tangible, due to a lack of funding by the state. He said a state law passed in 2008 was supposed to provide additional state funds to service providers such as Vinfen, which would help boost salaries. But he said the state has been slow in implementing the law.
Human service providers with the state, “Have historically been low and confining and been restricting service providers across Massachusetts in providing salaries that are truly sufficient wages for the direct care workforce.”
In yet another victory for workers’ rights in the Bay State, a majority of direct care workers at Woburn-based NuPath, Inc. overwhelmingly voted ‘Union Yes!’ in their recent election. The win caps off Merrimack Valley service providers’ aggressive, months-long effort to secure better pay, safer working conditions and a greater voice in the workplace. With the December vote, more than 200 front-line service providers joined the Massachusetts Human Service Workers Union, SEIU Local 509 – marking the union’s second successful organizing drive in the Merrimack Valley in 2013.
With core facilities in Woburn and dozens of independent living locations in Andover, Billerica, Burlington, Lexington, Lincoln, Lynnfield, Medford, Reading, Tewksbury, Westford and Wilmington, NuPath, Inc. provides services to hundreds of individuals people living with developmental disabilities, autism spectrum disorders and acquired brain injuries. From day habilitative care to independent living support, human service workers at NuPath play a vital role in communities throughout the Merrimack Valley, yet many earn close to minimum wage and see limited opportunities for training or advancement. The conditions led workers to seek – and win – a greater voice in the workplace with SEIU Local 509.
“This is a major win for direct care staff at NuPath, who have worked tirelessly to secure the voice they deserve on the job,” said Susan Tousignant, president of the Massachusetts Human Service Workers Union, SEIU Local 509. “Human service workers at NuPath play a vital role in the community – meeting the needs of families throughout the Merrimack Valley. We are proud to welcome them to the Massachusetts Human Service Workers Union.”
SEIU President Mary Kay Henry offered this statement today in response to the U.S. Department of Health and Human Services’ release of enrollment numbers for the federal marketplace under the Affordable Care Act:
“Before the new federal marketplace opened on Oct. 1, the vast majority of Americans knew very little about the Affordable Care Act and the that fact that it offered a future of more secure, lower-cost healthcare coverage that could transform their lives and their health.
“By now most people have heard about the insurance coverage available under the new law, and today’s figures show that more than 26 million people are exploring their options. More than 500,000 Americans are well on their way to affordable coverage, based on individuals who have picked a plan or qualified for expanded Medicaid coverage.
“Today’s numbers also show that in states where governors, healthcare providers, faith leaders, labor and business are working together, the law is working and saving lives. Where obstructionism and foot-dragging rule the day, hard-working Americans are being left behind.
“For the past six weeks, thousands of SEIU nurses, doctors, librarians and child care providers and our partners in local communities have done everything we can to close this knowledge gap about the benefits of the law, while far-right Republicans have done nothing but convene hearings to obstruct, delay or take away healthcare from the very people they are supposed to represent.
“They are supposed to represent Americans like Cecilia Fontenot of Houston, who is uninsured and cannot afford a follow-up mammogram. Ms. Fontenot is not a number; she’s a person whose life may be hanging in the balance.
“And when working Americans have had serious questions about how the law works for them, SEIU nurses and doctors on the front lines of healthcare have not said the law is perfect, but instead, ‘we will do everything we can to address your concerns and help improve the law.’
“Given all that is at stake for individuals like Ms. Fontenot, working families are wondering why more Republicans in Congress are not capable of standing up and doing the same thing.”
In light of tragedies that befell three human service workers in 2011, we had two meetings with OSHA, to discuss a growing epidemic, i.e. violence in the workplace. We have decided to work closely with OSHA on this, both to create safer working environments and to monitor and report incidents of violence in the workplace. To this end, we have formed a Private Sector Safety Committee. Those who met with OSHA are Jon Grossman, the Local 509 Private Sector Team Leader, who was on the 2011 Massachusetts Department of Mental Health Task Force on Staff and Client Safety, and has great insight regarding our increased need for safety on the job. Mike Capasso from Eliot Community Human Services attended the OSHA initial meeting and will chair the committee. I attended both OSHA meetings and brought Mary Hoye from OSHA to do a “violence in the workplace” training of over 20 members on October 28. We will have more workplace safety trainings, statewide, in 2012.
We will have our first Safety Committee meeting on Tuesday, December 6, 7 p.m., at the Local 509 offices in Watertown, 100 Talcott Ave. We will have teleconference available; please dial in around 6:55 so that you are on the line when the meeting commences. If you have ever been physically assaulted at work or fear physical attacks, you should join this meeting.