Patrick unveils overhaul for Bridgewater hospital

Wants more staff, additional facility

Bridgewater State Hospital.David L. Ryan/Globe Staff/Globe Staff

Governor Deval Patrick unveiled an ambitious and potentially costly plan Tuesday to reform the way the state’s criminal justice system handles mentally ill people, proposing a dramatic increase in staff at troubled Bridgewater State Hospital and a new facility where potentially violent patients could receive care.

The plan, expected to cost $12.3 million in the short term and far more over the long term, calls for Massachusetts to move away from treating mentally ill people as prisoners and more like patients, including better training for staff at Bridgewater State Hospital to reduce the use of seclusion and restraints, which was blamed for the death of a young mental health patient in 2009.

The proposal would move many patients at Bridgewater, a medium-
security prison, to less restrictive facilities. It declares that mentally ill people “should receive the appropriate care in the appropriate setting.” At least 100 of the 300 inmates at Bridgewater are being held there while awaiting trial and are not serving criminal sentences.

Patrick’s proposal, which follows a series of Globe articles on the often- harsh treatment of Bridgewater patients, drew praise from advocates for the mentally ill after months of intense criticism, as well as a class action lawsuit filed against the state on behalf of patients.

Roderick MacLeish Jr., the lead attorney representing patients in the lawsuit, called it “a very promising step forward.”

He said he was impressed by the reach of the plan, which aims to increase collaboration among mental health, prison, and court officials to address needs of people whose illness makes them prone to outbursts of violence.

“The governor’s proposal is thorough and comprehensive, and I commend him for it,” MacLeish said.

“But it is still a proposal, contingent on funding and commitment,” he said, adding that he is not withdrawing the suit.

The costliest aspect of Patrick’s plan is likely to be creation of a facility to perform psychiatric evaluations of potentially violent mental health patients in a secure setting. It calls for converting an existing facility or building a new one.

State Representative Kay Khan, a Newton Democrat who is a longtime advocate of improving treatment for the mentally ill in the criminal justice system, also praised Patrick’s initiative, but said proponents will have to work hard to win legislative support for such a potentially costly plan.

“I don’t think think the Legislature is just going to jump up and do it,” she said. “We’re going to have to educate legislators about the need for this.”

Public Safety Secretary Andrea Cabral, who oversees the state’s prison system, said the administration is ready to work with the Legislature to achieve the plan’s goals.

“I’ve spoken with legislators who are very positive about the direction we’re taking,” Cabral said. “It’s not something we’re going to accomplish in a five-minute conversation.”

Cabral also said legislative support will be required to maintain some of the strides the Department of Correction has managed at Bridgewater with existing resources, including a reduction in the use of restraints, strapping a patient to a bed, by more than 90 percent since January, and a reduction in the use of isolation by more than 50 percent.

“Even though there’s been a significant reduction in seclusion and restraints, there’s also been an increase in assaultive behavior” by patients,” Cabral said. “We have to increase staff and increase training in order to maintain a plan that is sustainable in the long term.”

The eight-page plan, provided to the Globe, acknowledges that the treatment of mentally ill people who are prone to violence is “complex and cannot be solved with a ‘magic bullet.’ . . . Nonetheless, we can and must do better.”

Specifically, the plan calls for new spending in several areas:

■  $10 million for an additional 130 full-time mental health clinicians at Bridgewater. Patrick administration officials said that if the Legislature approves this funding promptly, the additional staff could be working at Bridgewater by September.

■   $1 million to increase the number of court clinicians trained to conduct psychiatric evaluations, including evaluations for a defendant’s competency to stand trial, reducing the state’s reliance on Bridgewater for those services.

■   $500,000 for physical improvements to the Bridgewater complex, including creation of de-escalation rooms where staff can help to calm down patients rather than automatically place them in seclusion and restraints.

■  $500,000 to study the possibility of retrofitting an existing state facility, such as Taunton State Hospital, or building a new facility to treat and evaluate potentially violent people accused of committing crimes. The plan gives no cost estimate for the new facility.

■  An unspecified amount of funding to free up about 150 new beds in Department of Mental Health facilities by moving about 100 current patients into community settings and using 50 unoccupied beds in the newly opened Worcester Recovery Center and Hospital.

Advocates for the mentally ill say the proposed improvements at Bridgewater State Hospital are long overdue after decades of complaints and lawsuits charging that the facility provides little mental health care and sometimes needlessly injures patients.

“I’m very pleasantly surprised,” said Christine M. Griffin, executive director of the Disability Law Center in Boston, a federally funded watchdog group now investigating Bridgewater. “This is not window dressing. It’s not a quick fix. It’s clear that a lot of thought went into it.”

Earlier this year, the Globe reported that Joshua K. Messier, a mental health patient facing misdemeanor assault and battery charges in an alleged assault in a private mental health ward, was killed while guards were placing him in restraints. His death was ruled a homicide. Patrick has disciplined six Department of Correction officials involved in the incident and its aftermath.

The Globe also reported that, despite Messier’s death, prison guards and clinicians at Bridgewater increased reliance on seclusion and restraints by 27 percent through 2013, at a time when many similar hospitals were dramatically reducing the use of these measures.

Mental Health Commissioner Marcia Fowler said she welcomes the new responsibilities Patrick’s plan places on her department, and she praised other Patrick administration officials and mental health advocates who met with the governor at Bridgewater in early May after Patrick toured the facility.

“We had all the right people at the table,” she said. “That’s why we were able to figure this out in a relatively short period of time.”

But advocates for the mentally ill pledged to monitor the administration’s progress, despite their admiration for Patrick’s plan.

“We’re not going away,” Griffin said. “I think we can provide some healthy tension for them.”