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.
On the heels of our court victory on CBFS just a few weeks ago, I write with disappointing news on the future of state-run Emergency Mental Health and Crisis Intervention Services in the Southeast Region.
On Friday, the Supreme Judicial Court (SJC) issued its ruling in our case to stop the privatization of programs in Southeastern Mass, the Cape and Islands, Service Employees International Union Local 509 vs. Auditor of the Commonwealth. Unfortunately, the SJC ultimately deferred to Auditor Bump’s approval of the DMH privatization scheme, despite obvious flaws in the process and the negative impact on area families. Having exhausted our legal options to halt the process outright, it seems this ill-conceived plan will now move forward.
In her statement to reporters this weekend, our union president, Susan Tousignant, blasted the decision — and gave voice to what many of us on the front lines have felt for quite some time:
“Front-line clinicians have been clear in our view that any action that jeopardizes critical care for at-risk families is unconscionable — whether through unnecessary budget cuts or irrational policy initiatives. This holds especially true in a region that has been devastated by the opioid crisis and suicide rates that are four times the rest of the state.
“In deferring to the State Auditor’s illogical decision to allow cuts to vital services, the Supreme Judicial Court has played an unfortunate role in endangering the lives of thousands of children and adults throughout Southeastern Massachusetts, Cape Cod and the Islands.
“After ignoring months of warnings from front-line crisis clinicians, legislators, and affected families, Governor Baker and Auditor Bump must now accept the repercussions of their shared scheme to slash life-saving mental health and crisis intervention services throughout the Southeast Region.”
Given the significant gaps we all know need to be repaired in our broken mental health system, it remains terribly concerning that the Department has spent so much time and money on this harmful privatization effort. But now we must begin the work of addressing the impact of this unfortunate scheme — both on front-line staff and the communities we serve through our ESP and MCI programs.
Over the next few months, we will meet with DMH officials to discuss their next steps and work to mitigate the effects of any proposed layoffs related to the privatization effort. We are fortunate that our union contract contains strong language that grants employees threatened with layoffs very broad “bumping options” based on seniority. We expect many of the affected front-line workers in the region will be connected with comparable state positions soon.
We will certainly keep everyone posted with updates on our meetings and other available details regarding implementation of this plan. This is a difficulty time for all of us, so please do not hesitate to contact me with questions or concerns in the meantime.
DMH Chapter President
FOR IMMEDIATE RELEASE
Wednesday, March 30, 2016
Contact: Jason A Stephany, (617) 286-4430, email@example.com
WATERTOWN, MA – The Massachusetts Human Service Workers Union, SEIU Local 509, released the following statement today regarding State Auditor Suzanne Bump’s approval of cuts to Emergency Mental Health, Mobile Crisis Intervention and Substance Abuse services throughout Southeastern Massachusetts. The statement is attributable to union president Susan Tousignant.
“In a region that has been devastated by the opioid crisis and suicide rates that are four times the rest of the state, any action that jeopardizes critical care for at-risk families is unconscionable. The State Auditor’s decision to slash vital mental health and crisis intervention services defies logic – and endangers the lives of thousands of children and adults throughout Southeastern Massachusetts, the Cape and Islands.
“Front-line mental health clinicians and substance abuse workers will continue to fight to maintain these critical state-run services for individuals and families throughout the region.”
The Commonwealth’s Emergency Service Program (ESP) and Mobile Crisis Intervention (MCI) units provide vital mental health and substance abuse services to more than 70 cities and towns throughout Southeastern Massachusetts, Cape Cod and the Islands. These longstanding initiatives place more than 140 clinicians and crisis workers on the front lines each day to intervene in severe cases where children and adults pose a danger to themselves or others in the community. Last year alone, these combined programs served more than 5,700 at-risk clients and their families — including nearly 1,700 children.
The plan approved today by State Auditor Suzanne Bump would significantly slash life-saving emergency and crisis intervention services throughout the Southeast Region — including a 28% reduction in the number of licensed mental health clinicians and a 32% cut to medical professionals. The number of client advocates who help parents and families work through mental health and substance abuse challenges, would be cut by more than half. Licensing requirements for service providers would be eliminated altogether.
If implemented as written, these drastic cuts stand to disrupt client care, extend wait times and expose area communities to unpredictable risk. A broad, bipartisan coalition of legislators, community leaders, affected families, and mental health and substance abuse advocates strongly opposes the move.
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SEIU Local 509 represents more than 19,000 human service workers and educators throughout the commonwealth, including front-line emergency mental health and crisis intervention clinicians at the Department of Mental Health. SEIU 509 members provide a variety of social services to elders, at-risk children and people with mental illnesses or developmental disabilities — as well as educational opportunities from early learning to higher education. Local 509 is part of the Service Employees International Union, the fastest-growing labor union in the United States. For more information, visit http://seiu509.org.
Contact your State Senator today regarding a key vote to maintain emergency services at the Department of Mental Health.
The personal stories of workers featured in the above video paint a clear picture of what’s at stake in House Bill 59 — Governor Deval Patrick’s proposed changes to retiree healthcare. Simply put, HB59 goes to far.
Under House Bill 59, workers just two or three years from retirement could see the rules changed so drastically they would have to work another 22 years to receive promised benefits. The legislation has its biggest impact on low-wage workers, and offers no real cost-saving measures other than spiking out-of-pocket expenses for seniors – meaning future retirees will bear 100% of the cost burden of these reforms. Even worse, HB59 penalizes workers who must take a leave of absence for the birth of a child or death of a loved one.
That’s why hundreds of workers across the commonwealth are taking action to educate their legislators about the negative impact of House Bill 59 — testifying at public hearings, sending letters to Representatives and Senators, and meeting face-to-face with key legislative leaders. You can take action today to protect retiree healthcare.
State contract negotiations are already in full swing, and Local 509 members are more prepared than ever for the potential fight ahead. Dozens of leaders prepped at Bargaining Team caucus meetings, and more than 1,700 members responded to our contract survey –- sharing their ideas, concerns and priorities for the upcoming negotiation sessions. This trove of information will serve as the foundation for many of the proposals we put forward in the coming weeks, and we are fired up and ready to go!
The first Alliance Contract negotiation session took place on July 31, and Local 509 members put their solidarity on full display. Thousands of state workers rocked their ‘Fair Contract NOW’ stickers to send management a clear message: let’s get this thing done! (Check out the Local 509 Facebook Page to see a few of the many photos members sent in throughout the day.)
With so much at stake in this contract — from wages to benefits to working conditions — it’s incredibly important that as many workers as possible get engaged in the negotiation process. A quick and easy way to get involved is to sign up for the Contract Action Team (CAT) for your chapter/worksite. As a CAT member, you’ll communicate important negotiation updates to co-workers at your worksite and help mobilize members for key contract actions as the process moves forward.
Workers have set a goal of building a 750-member CAT team in the coming weeks, so there’s no shortage of opportunities to make a difference. Together we can win a strong contract for all state workers!
Today, Wednesday the 15th, we will be filing suit against the Department of Mental Health in Suffolk County Superior Court. With this lawsuit, we are looking to secure the re-hire of the DMH case managers that were laid off in 2009.
During the privatization of case management duties in 2009, the department ignored their responsibilities under the state’s privatization regulations, commonly known as the Pacheco Law. The layoff of over 100 DMH case managers has had a serious impact on the services that individuals with mental illness receive in our state.
With the support of our allies at the Disability Law Center, MPower, mental health caregivers in the Local 509 Private Sector Human Services chapter, and the whole of Local 509, the DMH chapter is hopeful that these case managers will be re-hired.
Follow these links to view our press release and the details of the lawsuit
As the lawsuit progresses, we will work stewards and local union officers to get updates to the membership.
STATE HOUSE NEWS – Thirteen members of a task force convened after community-based mental health worker Stephanie Moulton was murdered in January are calling on the state to significantly increase funding in next year’s state budget.
In a letter Wednesday to Human Services Secretary JudyAnn Bigby, the task force members say their recommendations, released in June, point to the link between public funding of the mental health services system, the safety of workers and the quality of services provided to individuals with mental illnesses. The letter, signed by officials representing SEIU 509, the Pine Street Inn, The Providers’ Council and other groups, said funding increases beyond a $20 million increase this fiscal year are necessary over five years to implement the task force’s recommendations. Describing a system they say has been “decimated” and will take years to rebuild, signers cited a National Alliance on Mental Illness report asserting overall funding for the Massachusetts Department of Mental Health has been cut by more than $55 million since fiscal 2009.
The Executive Office of Health and Human Services will host a 2 p.m. hearing Friday on fiscal 2013 budget issues at the Agganis Arena at Boston University. 4:20 p.m.
Today, state workers voted overwhelmingly to ratify their contract!
3252 – YES
212 – NO
8 – blank
237 – YES
4 – NO
Thanks to all of the poll captains and volunteers who staffed the 26 balloting sites across the state. Your hard work was instrumental in making today’s vote a smooth process.
To see the details of the newly ratified settlement, click here to read the Memorandum of Understanding