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1 Special Senate Committee On SENATE No. 1776 ©l}* (Comntnmiipalih of Haaßartpiarits REPORT OF THE SPECIAL SENATE COMMITTEE I ON MENTAL HOSPITAL ACCREDITATION REPORT I: Recommendations for meeting standards for care and treatment of the mentally ill 1 January 1975 tUhr (CommomucaUb of Masaarhxtafttß In the Year One Thousand Nine Hundred and Seventy-Four. RESOLVE CREATING COMMITTEE: Senate Order #lB4O of 1974 a special consist of five Ordered, That committee, to members >1 of the senate, is hereby established for the purpose of making an investigation and study of the causes for the failure of certain state mental hospitals to receive accreditation and the alternative courses of action that the state might take. Said committee shall report the results of said investigation and study, and recommenda- tions, if any, together with drafts of legislation necessary to carry said recommendations into effect, by filing the same with the clerk of the senate on or before the last Wednesday of December, nine- teen hundred and seventy-four. Approved July 10,1974 (Enmtttomupalth of MaaaarljttErtta In the Year One Thousand Nine Hundred and Seventy-Five. RESOLVE CONTINUING COMMITTEE Senate Order #1675 of 1975 Ordered, That the special senate committee established by Senate Order #lB4O of 1974 to make an investigation and study of the causes for the failure of certain state mental hospitals to receive accreditation and the alternative courses of action the state might take is hereby revived and continued until the fourth Wednesday of June, 1975. Approved January 2,1975 LETTER OF TRANSMITTAL signatures Senator John W. Olver Senator Michael LoPresti, Jr. Senator John F. Parker Senator William L. Saltonstall t Qltjr (Commonwealth of itaortarhiiarttg MEMBERSHIP appointed by the President of the Senate: SENATOR JOHN W. OLVER of Amherst, Chairman SENATOR DANIEL J. FOLEY of Worcester SENATOR MICHAELLoPRESTI, JR. of Boston SENATOR JOHN F. PARKER ofTaunton SENATOR WILLIAM L. SALTONSTALL of Manchester 1 STAFF MARCIA MATZ, Executive Director PATRICIA LYNCH, Project Director ROBERT NARKEY, Research Associate U% (EommomuraUty of HaHaarlptaftta January 1975 To the Honorable Senate: The Special Senate Committee was established for the purpose of making an investigation into the failure of certain mental hospitals to receive Accreditation. That investigation led inevit- ably to an examination of alternative policy directions the Commonwealth could pursue to deliver more and better mental health services with available state funds to comply with nationally recognized standards for care and treatment. The Committee maintains that efforts to reform the existing mental hospital system to meet Accreditation standards are in- extricably linked to the development of a network of community mental health services. Decisions to appropriate funds to maintain or upgrade an institutionally dominated mental health system of care must be weighed against community oriented alternative uses for the same dollars. The Committee will deliver two Reports to the Senate. This first Report on Standards of Care is an analysis of the Accreditation situation and deals with humane, fiscal, and political considerations in upgrading our care system for the mentally ill. Report Two will focus in depth on several of these considerations, with particular emphasis on manpower issues. Senator John W. Olver Senator Michael LoPresti, Jr. Senator John F. Parker Senator William L. Saltonstall TABLE OF CONTENTS PAGE SUMMARY OF RECOMMENDATIONS i-ii INTRODUCTION 9 L STANDARDS FOR CARE AND TREATMENT 11 A. JCAH ACCREDITATION AND DPH CERTIFICATION 11 Chart. I: Accreditation Status of Massachusetts Psychiatric Facilities 12 B. ACCREDITATION OF AREA MENTAL HEALTH SERVICES Chart II: DPH Certified beds in Massachusetts Psychiatric Facilities 16 RECOMMENDATION 1 17 C. FISCAL INCENTIVES FOR MEETING STANDARDS OF CARE AND TREATMENT 17 D. RESOURCES OF THE DEPARTMENT OF PUBLIC HEALTH AVAILABLE ACCREDITED AND CERTIFIED SPACE 19 1. State Facilities that Meet Acceptable Building Standards 19 Chart IH; Bed Capacity and Occupancy Rates DPH Hospitals 20 RECOMMENDATION 2 22 RECOMMENDATION 3 22 RECOMMENDATION 4 22 2. Programmatic Standards for the Chronically Disabled Needing Residential Services 23 RECOMMENDATION 5 24 11. INSTITUTIONAL CHANGE IS INEXTRICABLY LINKED TO THE DEVELOPMENT OF COMMUNITY SERVICES 25 A. CLARIFYING ISSUES IN DEINSTITUTIONALIZATION 25 B. A WAY OUT OF THE FISCAL DILEMMAS 27 1. Fiscal Reallocation and Personnel Reassignment 27 RECOMMENDATION 6 28 Page 2. Budget Restructuring 28 RECOMMENDATION 7 29 3. Incentives for Generating Multi-Source Funding 29 RECOMMENDATION 8 30 CLOSING STATEMENT 30 FOOTNOTES 31 Appendix A: Admission to Gardner State Hospital from Fitchburg- Leominster Area 32 Appendix B: Letter to Senate Committee for HEW Regional Admin- istration 33 Appendix C: Legislation to alter the admissions policy of Public Appendix D; Health Hospitals 35-38 Appendix E; Appendix F: Appendix G: DPH Hospital Revenue Report 39 SUMMARY OF RECOMMENDATIONS: RECOMMENDATION 1: The Special Senate Committee recommends that no capital expenditures be made at state mental health facilities for the purpose of securing JCAH Psychiatric Hospital Accreditation Status. Future capital improvements should be in select buildings designated as essential parts of a comprehensive area service system that may lead to eventual Accreditation of area services. RECOMMENDATION 2: t The Special Senate Committee recommends that an intensive review be made of mental health facilities and under utilized Public Health hospitals to define their future functions in meeting the physical, emotional, rehabilitation, acute, and long term care needs of the clients of both agencies. DMH and DPH facilities should be fully analyzed to develop a plan for the appropriate mix of specialized units, geographically distributed throughout the State. RECOMMENDATION 3: The Special Senate Committee recommends that the Executive Office of Human Services, DMH, and DPH administrators elimin- ate artificial client classifications which now separate many chronic patients between mental health and public health insti- tutions. The total patient care needs, mental and physical, must be served in both agencies. RECOMMENDATION 4: The Special Senate Committee recommends immediate passage of legislation filed with this Report. This legislation will remove statutory barriers to caring for the mentally ill in DPH facilities. The Committee members are willing to assist if any constitutional or legislative recommendations or constraints arise. RECOMMENDATION 5: The Special Senate Committee recommends that the Executive 1 Office of Human Services coordinate the efforts of the DMH and DPH to jointly plan and develop specialized services for DMH clients served in the Public Health system, and to insure the avail- ability of adequate specialized programs prior to placement. Each placement decision must follow joint agency assessment of the i clients needs, exploring alternatives to hospitalization and be based upon the recommendations and the support of area program direc- tors and family members. RECOMMENDATION 6: The Special Senate Committee recommends that the legislature authorize a new DMH fiscal policy that reallocates empty job slots into relevant community positions via a $4.2 million reallocation request for fiscal year 1976. Furthermore, the Executive Office of Administration and Finance and the Legislature should authorize the reassignment of state hospital employees to community pro- grams as the institutional population declines. RECOMMENDATION 7: The Special Senate Committee recommends support of fiscal year 1976 DMH budget restructuring proposals to increase the authority of regional and area program administrators and to give DMH the flexibility to rapidly move staff and dollars as program requirements are altered. The limits of the flexibility should be set in advance by the legislature. RECOMMENDATION 8: The Special Senate Committee recommends that the Executive Office of Adminstration and Finance explore fully the fiscal advan- tages of various formulas for sharing collected third party revenues with program operators. ii 1975.] SENATE —No. 1776. 9 INTRODUCTION The Special Senate Committee recommendations resulted from a study of humane, fiscal, and political issues that confront the Commonwealth in determining state policy to improve the system of care for the mentally ill. • What effect does Accreditation have on state policy and what should its future role be? 0 • Where are mentally ill persons being served now and where should our efforts be directed programmatically? • How can we increase the effectiveness of every dollar spent? • What pressures are exerted on the system that impede efforts to deliver better services with prudent use of state funds? The ten state psychiatric hospitals 1 are no longer the primary source of care and treatment for the mentally ill in Massachusetts. Current to December, 1974, approximately 5400 mental patients2 were in residence at state mental hospitals. Over 100,000 clients3 were served during the year in a variety of mental health pro- grams in communities. In spite of this fact, in fiscal year 1974, approximately $87,000,000. in the Department of Mental Health (DMH) budget was expended to serve state hospital clients, while only $20,000,000. was the DMH contribution to mental health services in communities. Yet, although large amounts are spent, institutional treatment programs seldom meet acceptable standards of care. Our antiquated facilities
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