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.”
The average per-employee monthly premium for coverage of state government employees in the United States was $963 in 2013, according to a study of state spending on employee coverage, which pegged the average in Massachusetts at $1,089.
The study, by the Pew Charitable Trusts and the MacArthur Foundation, was released Tuesday with its authors hoping to inform public policy debates and decisions with new information. The study’s authors told reporters in a conference call Tuesday that management of state employee health benefits affects the fiscal health of states, the ability to recruit and retain employees, and the physical, mental and financial well being of workers.
The study found the average employer premium contribution percentage across 49 states at 84 percent, with the average state employee premium contribution percentage at 16 percent. In Massachusetts, that split was 75 percent employer and 25 percent employee. The average total premium across the states for employees plus dependents was $1,238, compared to $1,418 in Massachusetts.
States collectively spent $30.8 billion to insure 2.7 million employee households in 2013.
It’s no secret that front-line workers at the Department of Children & Families have faced unprecedented challenges in recent weeks. From ever-increasing caseloads to disjointed and inconsistent directives, the critical work we do has grown more difficult with each passing day.
While initial steps have been taken to address issues related to staffing shortfalls and technology deficiencies, it has become clear to those of us on the front lines that change has not come quickly enough. Even worse, many of the systemic problems that we have collectively raised for months — or years, in some cases — continue to go unaddressed.
Commissioner Roche and her management team need to understand just how severe these challenges have become — and they need to hear it directly from us, the front-line workers who are charged with protecting the safety of at-risk children.
That’s why we’re circulating this formal sign-on letter. With your help, we’ll be able to put in writing the concerns front-line workers have expressed across the Commonwealth — in a format that can’t be ignored.
There are three ways to sign on to the letter to Commissioner Roche:
Among a number of big-ticket items in Governor Patrick’s FY2015 budget announcement is a $9.2 million investment in staffing and technology improvements at the Department of Children & Families. A copy of the governor’s announcement is included below, along with the statement issued by the union following preliminary review of the proposal.
“The number one priority of front-line social workers at the Department of Children & Families is keeping at-risk kids safe from abuse and neglect. That is why we have pushed so aggressively to identify and address key challenges at DCF – from crisis-level caseloads and outdated technology to insufficient resources devoted to training, support and supervision.
“Today’s announcement marks an important acknowledgment of the systemic issues front-line social workers have raised for many years. We thank Governor Patrick for taking an important first step in providing DCF social workers with the resources and tools they need to keep children safe – and we look forward to working with our partners in the legislature
to ensure the department receives the critical investments needed to fulfill its mission.“
BOSTON – Wednesday, January 22, 2014 – Governor Deval Patrick today announced a $9.2 million FY15 budget investment in the Department of Children and Families (DCF) to further enhance the agency’s work to protect the over 100,000 youth served by the Department each year and strengthen families across the Commonwealth. The investment will allow the Department to move towards its 15 to 1 caseload goals, and enhance its screening, investigation, and case review practices. In addition to the FY 15 budget funding, the Department will also provide mobile technology solutions for workers in the field.
“DCF has one of the most critical missions in government, and their workers perform countless miracles every day,” said Governor Patrick. “This investment will ensure that the Department has the resources it needs to be successful, and I look forward to working with the Legislature to support our shared goals to protect the Commonwealth’s children and families.”
MOVING FORWARD WITH 15 FAMILIES:
The Governor’s budget invests in staffing that will allow the Department to move forward with the goals outlined in the 15 Families Memorandum of Understanding signed last year between DCF and SEIU 509. The 15 Families plan will be implemented over the coming years in accordance with the agreement by meeting additional staff needs to achieve the 15 to 1 caseload goals.
“As a former social worker, I know how challenging this job can be, but I also know how rewarding it is to help a family succeed,” said DCF Commissioner Olga Roche. “Our front line workers deserve all the support we can provide, and that’s why we are moving forward with the 15 Families plan and additional technology enhancements.”
UTILIZING NEW TECHNOLOGY SOLUTIONS:
The Department will provide mobile technology solutions for workers that will allow them to access DCF case files remotely in the field, enhancing their ability to communicate and record information on families, and eliminating existing lag time in processing reports. This will also allow workers to quickly access sensitive and historical information and better communicate with law enforcement partners.
After the Department’s thorough review of the Oliver case, Commissioner Roche launched additional actions to strengthen engagement with children and families, including enhanced case reviews and additional communications with school districts.
The Commissioner also directed staff to screen in for investigation all allegations of abuse or neglect involving children age five and younger with young parents; or parents of any age who have a history of substance abuse, domestic violence, mental health issues, or unresolved childhood trauma. The Governor’s budget investments will allow DCF to continue these enhanced practices.
“These additional investments will ensure that DCF has the tools in place to be successful and well positioned to serve the Commonwealth’s children and families well into the future,” said Health and Human Services Secretary John Polanowicz.
On January 9, Secretary Polanowicz announced that the Child Welfare League of America (CWLA) will conduct a full, independent review of DCF over the coming months. This review will look at broad areas of DCF’s practices, including supervision, management, home visits, processing of reports of abuse and neglect, and how the Department deals with families with young children. CWLA has been provided with the flexibility and latitude they need to conduct a thorough review and will be interfacing with members of the Legislature as they work to develop action steps going forward.
“We have made great strides recently to expand kinship placements, increase adoptions and enhance foster care supports to help provide high quality services and keep our children safe,” said Commissioner Roche. “The Governor’s budget investments will help us keep this progress going to ensure the very best for our children.
I don’t need to tell you that the last week has been an incredibly trying time for all of us at the Department of Children & Families. There are no words to describe the tragedy that has occurred in Fitchburg, and our hearts go out to the families and friends of Jeremiah Oliver and all those impacted by this case.
I’ll lay the situation out plain: if the allegations put forward by Commissioner Roche are proven true by a formal investigation, then the individuals involved — including DCF managers — must be held accountable. Those who played a role in this tragedy must accept responsibility. And in an effort to get to the truth quickly in this specific case and ensure accountability for everyone involved, we have agreed to an expedited grievance hearing process. But the Department cannot afford to let this single case paper over the real, systemic caseload crisis that overshadows the critical work we do each day.
Those of us who are on the front lines, working to protect our communities’ most at-risk kids, know just how serious this crisis has become. Promises of movement are no longer sufficient. And as Judge William Young so succinctly put in the Connor B case weeks ago, immediate action is needed to address the crisis before another tragedy occurs.
No one has done more to take on and address the systemic issues at the Department of Children & Families than this union. Over 1,000 of us have come to highlight the critical need for additional caseworkers at DCF. We put years into securing a monumental agreement to bring caseloads closer to safe and manageable levels. And we’ve consistently pushed real, tangible solutions in face-to-face meetings with the Commissioner and her staff — including some ideas that wouldn’t cost any money.
As you’ve undoubtedly noticed, we’ve been working hard to educate the media about what’s really at stake with the caseload crisis at DCF. Nearly two dozen media outlets have addressed the caseload crisis in their reporting over the last three days — be sure to check out stories from State House News, WBUR Radio and theWorcester Telegram, among others.
These have been tough days for all of us, and there will likely be more to come. We’ve already heard of new proposals from the administration that will pose both challenges and opportunities — and will be addressing those in short order. I will be sure to keep everyone up to date as information becomes available.
We know that, working together, we can bring about the real, systemic change that is needed to ensure each and every child in Massachusetts receives the best care possible.
Thank you for all you do,
DCF Chapter President, SEIU Local 509
In response to comments made by Department of Children & Families Commissioner Olga Roche on a pending case at the agency’s North Central Office, SEIU Local 509 released the following statement, attributable to union spokesman Jason Stephany:
“We are disappointed that Commissioner Roche is more interested in finger-pointing than accepting responsibility for yet another tragedy on her watch.
“The sad truth is that caseloads at the Department of Children & Families have long stood at crisis levels, yet Commissioner Roche has done little to address them. Instead, the Commissioner has chosen a convenient scapegoat to deflect blame from department administrators – terminating caseworkers without any formal investigation, whatsoever.
“If the actions of the caseworkers in question warrant termination, Commissioner Roche should proceed with a formal investigation and make her case, as legally required. But without immediate action to address the Commissioner’s caseload crisis, it is only a matter of time before another tragedy occurs.”
SEIU Local 509 represents caseworkers at the Department of Children & Families, along with more than 17,000 other human service workers and educators throughout the commonwealth. SEIU 509 members provide a variety of educational and social services to at-risk children, elders and people with mental illnesses and developmental disabilities. Local 509 is part of the Service Employees International Union, the largest and fastest-growing labor union in the United States.
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