Freelance Writer
Saving Worcester State Hospital
11.28.06 | No Comments

As published in Worcester Magazine on Jan. 20, 2005

During a sticky hot summer in 1989, Richard “Rick” LaFortune thought he was the Messiah. “Jesus” descended on the park in downtown Leominster, where, to begin saving the world, he stripped naked, and folded his clothes neatly in a pile. The local police spotted him, pulled a fast U-ey, swooped him into a blanket and off to jail.

LaFortune had been under a lot of stress, coaching at the Special Olympics, and was getting sloppy about the small dose of medication he was supposed to take. Stress and med changes preceded many of his breakdowns, which had initially started to rear in 1968, when he was 16 attending high school in Fitchburg.

He doesn’t elaborate on what precipitated his initial crack (sometimes he does elaborate, sometimes he veers off the question), but just says he wasn’t adjusting well in school. LaFortune, forever the class clown, had poor coping skills, and was failing certain courses like algebra and languages. He landed in a hospital in Jamaica Plain, where they diagnosed him as paranoid schizophrenic.

“I wound up in a hospital that was, quite frankly, brutal,” says LaFortune. “It was something that made One Flew Over the Cuckoo’s Nest

look like a picnic. And I got electric shock treatments there. I was terrified.”

The shocks jolted him from his psychosis, but he’s still got horrible memory problems because of it. He had episodes that landed him in facilities every few years or so, including Worcester State and Gardner State hospitals. He talks highly of both, and attributes much of his wellness to the staff there; to him, state hospital care beats private hospital care hands down.

His diagnosis has now changed to bipolar with psychotic and manic tendencies. Mental illness labels change as often as pop music terms. Among the books, teddy bears, calendars and certificates scattered about his house, he’s got a copy of A Beautiful Mind

tucked into his bookshelf. He says he loves the story, which details math prodigy John Forbes Nash’s struggle with schizophrenia. LaFortune can relate.

But he hasn’t been committed to a hospital for about seven years now. He now lives in a subsidized apartment in Fitchburg by himself, one of many countless mentally ill who cope in the community.

He is luckier than a lot. He’s had a family structure to cushion the blows and get him the right help when he was going off the deep end. He’s also found the right programs, had caseworkers to negotiate his insurance (now Mass. Health), and psychologists to tinker with his meds and keep an eye on him. Not everyone has that, argue advocates for the mentally ill, which indirectly contributes to the homeless and jail population.

LaFortune credits state facilities like Worcester State Hospital for helping him. He’s been in many, and he talks highly of them. He liked the care. He liked the structure and familiarity. To him, and many others, it provides a sense of security that can’t be felt elsewhere. In fact, to some mentally ill people, he points out that just leaving yesterday’s newspaper on the coffee table can disrupt their sense of reality.

“There is a part of the population, myself included,” says LaFortune, “that when I become very sick or very manic and psychotic, I need a safe place to be and for me that is usually a locked unit where they can be forceful with me but in a gentle way. You need a place like Worcester State for that. You need a place where people can be safe and you need a place where they can get tough love. One of the biggest things Worcester State did for me is give me discipline. There are two or three people that I know who are still at the state hospital that have told me that they would rather live there than in the general community because people accept them there.”

Governor Mitt Romney’s administration has been hot on shutting down the place since he took office. In his February budget speech, he announced his proposal to close Worcester State Hospital and its $24 million budget, which sparked a flurry of backlash from advocates for the mentally ill. The facility, which houses 156 inpatient beds, was built in 1833 and celebrated its anniversary yesterday.

“He wanted to take all the people and move them out here, there and everywhere,” says State Senator Harriette Chandler, who battled the closing. “The largest number would have gone into community services. There was no question in anybody’s mind that there weren’t appropriate services. There wasn’t careful thought given to what the whole movement meant. It sounds good on paper, but these are human beings who are very sick people.”

The state Legislature responded quickly, requiring a study from the DMH to justify closing the hospital. DMH Commissioner Elizabeth Childs expanded the study to examine the entire department and its inpatient capacity needs. By March, rumors flew that the Romney administration was looking to shut down Worcester State Hospital as well as Westboro State Hospital to make room for a new hospital, reducing the beds and placing discharged patients in community facilities and treatment.

The administration says shutting the two suffering hospitals would streamline the budget. We’d get a nice, new state of the art facility. And though it would mean fewer beds for the mentally ill in the state, the money saved could be pumped into the community to buffer the wave of de-institutionalization that is already beginning to occur. Much like what occurred in the ‘80s when Gov. Michael Dukakis instigated de-institutionalization, 268 patients out of the 900 in the state will be discharged this year. The Department of Mental Health thinks it’s a great idea. Advocates for the mentally ill and workers at the hospitals are asking more than a few questions.

After two date extensions, the DMH delivered that feasibility study that was demanded of them in March.

It favored the idea of building the new hospital and recommended “community placements of 268 adult continuing care inpatient clients who are ready to leave.” It was critical of the efficiency of both the Worcester and Westboro State facilities, too, pointing out ancient heating systems, lack of cooling systems and old electrical units. It estimates that $59 million in capital costs would be needed to keep both facilities in operation over the next ten years. “Existing facilities at either Worcester State Hospital or Westboro State Hospital do not provide a sound option for consolidated impatient capacity in central Massachusetts over the long term,” reads the report.

“The existing infrastructures at either Worcester or Westboro are insufficient to sustain a capacity of 270 beds,” says Blumberg, “which is the number we have estimated we need for the Central Massachusetts facility. Not only is the physical plan inadequate, but we have learned so much more about the environment of care in the decades since these buildings were built. They are institutional in look and feel, and they therefore promote institutionalization.”

In other words, we need a building that doesn’t seem that Nurse Ratched is inside administering pills in Dixie cups through small windows, the air smelling of Pine Sol and stainless steel dominating the hallways.

A commission of 15 was chosen to study Romney’s plan, and it just met for the first time on Monday, Jan. 10, when it was announced that the state Designer Selection Board brought on Ellenzweig Associates Inc. to study where, and how, to build the new 320-bed hospital. The motion is toward building this hospital. The commission just has to decide how and where it gets done.

In the meantime, the discharges have already started to occur. A MHW (mental health worker) at Westboro State Hospital agreed to talk with us, anonymously, and said that they’ve already felt the movement. “I talked to my supervisor about this,” he said, “and she said that although it may mean that some people may lose their jobs, she thinks it’ll be beneficial for the patients because the conditions at the hospitals are deplorable.” The employee went on to say that most are simply concerned about their own jobs, though, but essentially think that a new hospital would be the right way to go if it’s done right.

Still, he is seeing the effects already. The discharge rate, he explains, seems to have sped up so much that the units are getting cleaned out far earlier than they used to be. “In the past, we’d get residents from the locked units and then put them into residential settings,” he says. “They had much more time to follow their treatment plan and cope with their problems. They’re now sending people through so fast that they’re not confident in these [residential] houses. I think in the long run, the patients are going to suffer in a sense that they have deadlines to meet. They’ll get into the community when they’re not ready to go into the community and end up homeless. I mean, it’s really bad. They’ve cut down the amount of staff in the houses. That’s really an unsafe staffing pattern.”

Not only are the stays shorter and the push is to move patients out into the community quicker, but the policies have changed since the last time LaFortune stepped into Worcester State Hospital. Now, there must be a direct transfer from an another acute facility such as UMass or AdCare.

Lester Blumberg, chief of staff for the Department of Mental Health, argues that no one is left behind, and references as an example the closing of Medfield State Hospital, where of the 255 patients discharged, only seven percent has required hospitalization again. The DMH’s discharge plan, he says, is being timed to allow for development of these services to support those clients.

“Each person who is discharged has an individually developed community treatment plan that is designed to meet their needs,” says Blumberg. “We are enhancing existing community residential services to provide these individuals with the support that they need. For the most part, they are moving into existing residential settings that have vacancies created by other clients who are ready to move through the continuum of care to less intensive services.” He points out visiting nurse services, supported living services (where staff visits the home), day treatment and clubhouses.

“I feel that it would be a good idea to rebuild a new hospital,” says an RN who currently works at Worcester State Hospital. “Both buildings are quite old and do need to be updated. So a new hospital would be in the best interests of the patients. I’ve already been through a bumping process and I ended up working at Westboro State and now back at Worcester State. As far as keeping a job working for the hospitals, I don’t think that that’s guaranteed for everybody. We don’t know what’s going to happen. We’re just kind of going day by day and week by week. I feel that we do an excellent job in caring for these patients. I’ve been doing it for 16 years.”

As Chandler stated, on paper, the new plan does sound good, but those inside the issue of mental illness have less faith. They don’t think the Romney administration’s heart is in the right place, and don’t think it, and the DMH, truly grasp the depths of care that a mentally ill person needs.

Jo Masserelli, who directs a training project to teach human service workers in conjunction with Catholic Charities and also offers a few beds to those in need, speaks to the issue in a highly rhetorical way. To her, the issue of mental illness is complex, and is a reflection and symptom in society. She approaches it philosophically, giving few concrete responses – but essentially advocates for a stronger support system to nurture de-institutionalization.

“I would say people need more than just programs,” says Masserelli. “They need more than just service involvement. Another presumption is that just because a human service exists that it takes care of everything. I think families need some assistance to become competent to help other family members. I think there are a lot of troubled people. Mental health services can address some of those troubles, but certainly not all. I would say I’m highly in favor of a responsive and well-done de-institutionalization, and that’s been the bulk of my work.”

So does Central Massachusetts have those programs in place? Will they have them in place to properly handle the movement? Will all these patients who are discharged be ready? Depends who you ask.

“I know that the patients that are being discharged are ready from what I see,” says the Worcester State RN. “They’re ready to go into the community. But to some, it’s a different thing. It’s almost like a home for them. I think there’s a lot of anxiety when a patient is being discharged because it’s what they’ve learned to know. There are others that do very well. As far as what I can see, the services have been in place in the community. Do we sometimes get the patients back? Yeah, that’s a definite. On the whole I say that they do pretty well. There is a plan in place before they are discharged as far as services go. They seem to be getting what they need. I’ve been back at Worcester for a few months and I haven’t seen many return, but I haven’t seen a large population of patients discharged.”

Phil Hadley, president of the National Association of the Mentally Ill, Massachusetts chapter, says he knows the system firsthand, and staunchly maintains improvements need to be made before de-institutionalization is even considered. There are 3,000 families among NAMI members who are affected by mental illness, and he says they struggle with a large degree of stigma and inability to get proper help.

One of Hadley’s family members went through a number of hospitalizations, which were met with short stays and lots of red tape with insurance.

“They limit people from 10 to 14 days and they’re not much better than when they went in,” says Hadley. “There is no follow-up after they get out of the hospital. When the patient is in the hospital and is seen by a psychiatrist and then when they’re discharged, if they have a psychiatrist on the outside – that’s important. There is no communication between the in-house doctor and out-house doctor. They don’t talk. It’s very frustrating. Unless they have a person who is an advocate for them, by nature of the disease, these people aren’t thinking correctly and they need an advocate. They don’t know what to do. They end up on the street.”

Still, Chandler walked away from that first commission meeting last Monday with a positive vibe, but with many questions, including not only where the money will come from to build it, but the issue of siting, which Chandler and others say will prove to be one of the hot buttons. NIMBY (not in my backyard) always plays a part in such moves.

To her, that siting issue is the looming cloud, but finding appropriate placement for the de-institutionalized is paramount. At the meeting, she says the commission brought the topic up in constant refrain. “It was like a chorus,” she says.

“If it’s not better, it shouldn’t be done,” says Chandler. “I’ve been led to believe by commissioner Childs, who is a psychiatrist who researched this carefully, that what she is talking about building is a state of the art building that will use the synergy of our neighboring institutions, like Umass or Tufts Veterinary School. We have a lot of things going on, but we can’t close it down in sort of a thoughtless manner as we did 10 years ago.”

State representative James Leary is also on the commission, and attended the meeting last week. He is confident, too. We’re headed in the right direction, he thinks, but he’s got similar concerns as the rest of the commission. To him, the key will be getting the bond authorization – which means, basically, that Romney’s administration approves the money they recommend the new hospital will cost. “I don’t want to waste everyone’s time coming up with a report and not have it acted on,” says Leary. “Hopefully we can get a real result on this one.

“I’m cautiously optimistic that we’ll get a consensus on this. I think there are two major issues – one is the siting, and the second is we have to get an answer: is the Romney administration really ready to spear the cost on this? The bottom line has to be to take care of these patients. It has to be done in a humanitarian way. I don’t know that we always have the services. It varies. It’s something we have to address, and it often depends on year to year funding.”

“People need social workers, occupational training and at the simplest level, they need to be reminded to take their medication,” continues Chandler. “The people who are able to leave Worcester State are people for who modern medicines have made a difference, but it makes no difference if they can’t remember to take them. The need will never go away. Where are these social services? Can we have an inventory, please?”

The commission also voted to bring aboard three more members: a member of the trustees from Worcester and Westboro State, and also a consumer of the DMH.

But most of the bigger questions went unanswered as of yet, particularly the biggest of them all. Where will these people go? With a reduction in overall beds in Massachusetts for the mentally ill, where can they go? Advocates maintain that based on the services and housing Central Massachusetts offers now, it is far from adequate.

“We just don’t do a good job,” says commission member James McDonald, longtime advocate for the mentally ill, and vice president of the Central Alliance for the Mentally Ill (part of NAMI). “In the hospital, you have nurses, you have doctors, you have your meals served and social workers. You must have the same thing in the community. We don’t have that. We did at one time. We did have enough case managers. We did have enough apartments, but there are more and more people. You’re almost unable to get into the services of the DMH unless you’re very seriously ill.”

Partly, though, it will be the savings in the budget from building the new hospital that presumably will be pumped back into community service for the mentally ill.

So here’s what happens next: At the feasibility commission’s meeting, they rejected the Legislature’s deadline date and voted to move the final synopsis to be submitted on April 1, 2006. The previous deadline would have given the commission only two and a half months to report. Unworkable, they said. They also delayed their next meeting for 60 days in order to have a chance to tour two newer state hospitals and New Hampshire State Hospital as models.

The last big slip for LaFortune happened about seven years ago. He didn’t stray from his medication that time, but started to hallucinate while living alone in his apartment in Clinton. “I was seeing bugs,” says LaFortune. “Nobody else could see bugs but I could. I could see them crawling all over me and all over my bed. So I got two cans of Raid. I sprayed the whole apartment with it and sprayed myself with it. I had a meeting with a nurse for my shot, and they smelled it. They said, ‘you’re not leaving.’”

Today, he’s fairly well adjusted and spends his days taking care of his dad, who needs him now. He’s also licked smoking, cut down on sweets, and works out at the Y a couple of hours a day. It’s still tough to keep the weight down: years of mood altering drugs took a toll and sparked diabetes. He takes 13 pills a day, and some of them make him very tired.

“There are two meds that I’m taking now that haven’t changed in seven years,” says LaFortune, who says the “older” drugs work much better for him. “I’m feeling better than I’ve ever felt. Things are going great. I don’t see a psychiatrist as often as I used to. I have a therapist I see frequently. I’ve weaned myself off of being dependent on therapists and doctors. I have my own network now.”

So if LaFortune relapses, will he have the proper care? Probably so. He’s got people around him to shuffle him to the right place, and he knows the system well by now. But many say he’s a minority who has thankfully learned how to take advantage of the stretched services available.

“For the mentally ill we have very little,” says McDonald. “We do not have anything for the high intensity person. They need medical care. Mental illness is a medical illness. We don’t take a person who has cancer and say you can’t stay in the hospital, we’re going to put you in an apartment down in the Main South area. Or, you’ve got diabetes or heart problems .. Why do we, or why does this administration, do this? This administration has been brutal.”

“I think there could be a lot of improvement,” says LaFortune. “I am one of the real fortunate ones. I have friends that are suffering a lot right now. They’re not getting a lot of the benefits they could be getting, or the kind of care they should.”

Though the actual erecting of the new hospital may take years to materialize (spokespeople from the DMH estimate between 5 and 8 years), its effects will begin to ripple in the coming year when another wave of de-institutionalization begins. Those in favor say we are. Advocates pray we’re ready.

Websites with pictures of WSH
this site has 5 postcard pictures of WSH, including the clock tower/main entrance and the nurse’s home.
o this is a copy of a lithograph of the original “Insane Asylum” prior to its move to Belmont Street.

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