New Troubles at Bridgewater State

A troubling development repeated itself at the famed Bridgewater State Hospital in Massachusetts, the place where the “Boston Strangler,” Albert DeSalvo, and the model for the cult classic movie of the 1860’s, “TheTiticut Follies,” occurred in late June. Another patient death by suicide within the facility.

In an  article entitled “Suicide spurs call for receivership at state hospital,” written by Katie Lannan of the STATE HOUSE NEWS SERVICE of the Newbury Port Daily News detailed the now repetitive tragedy. The Center had tardily reported on April 8, 2016 the death of Mr. Leo Marinio from Lawrence MA who killed himself by “ingesting large quantities of toilet paper while in isolation.” The local state advocacy organization, The Disability Law Center of Boston was calling for the entire facility to be placed into “receivership” and for the state to move on plans to transfer the control and operation of the hospital from the Department of Corrections to the Department of Mental Health.

Two aspects of this case are troublesome to this reader. First, the report of the death appears from this and media reports to have been delayed by weeks, and deceased had somehow in isolation been able to stuff enough foreign material into his throat to block his own airway and have time to die possibly unobserved.

Where I practice in the state of North Carolina, a death within any state institution whether it be a mental health, nursing home, hospital, or correctional facility, MUST be reported to the state authorities within a time limit of 24 hours. How this may have been delayed this long is astounding to this writer. Any unnatural or unexplained death even in any kind of hospital must so be reported within such a time frame to permit timely review and objective investigation of the cause of death and its circumstances, in a constant effort at self-correction of procedures and public airing of findings. We see the same kind of hush-hush delays nowadays in correctional, meaning police related deaths going on and receiving national news coverage when people die in police custody, being taken into police custody and it seems nowadays to take a judicial order to release timely records involved in such untimely deaths, such as on the spot videos that are so common now.

Second, this facility which has dealt with the forensically seriously mentally ill for generations, was run by the Department of Corrections, not an agency tasked with dealing with complexities of the mentally ill, though it must be stated that it is still possible and does happen also in mental health run forensic facilities that suicides occur. But it was a real surprise to this writer than Bridgewater State was not in my mind a “hospital,” as I had always thought, but a correctional facility with all that that circumstance can bring with it, such as overuse of isolation for corrective measures, and a lack of training in dealing with the seriously mentally ill.

The article sadly, in my mind reports that it had recommended such a move nearly two years ago the then Governor Duvall in 2014 because of similar issues detailed in this blog in which three deaths were involved.

This writer will watch this situation and monitor how the state machinery and political system handles this in the future and “report back” to the reader.



Progress in Washington State in Obtaining Emergency Access to Psychiatric Care

Big Strides for mental health reform, but work remains,” published originally May 16, 2015 as an editorial in the Seattle Times, provides some encouraging news in the national efforts, state by state, to improve incrementally mental health services delivery approaches.

This editorial provides a concise summary and history of the development of the current crisis in that state’s public mental health services that have long been coming. Like so many other states, the economic hits suffered especially since the great housing bubble and “Great Recession” hit the funding of public services ranging from state’s higher education university and public education funding to public mental health care resources, mandated huge budgetary cuts nationwide.

Washington state’s Governor Jay Inslee signed “Joel’s Law,” nearly two weeks ago a bill named for Joel Reuter, a bright, young software engineer whose illness made him believe he was shooting zombies when he was killed in 2013 by Seattle police.

Joel’s Law for the first time gives parents or guardians in Washington state finally, the right to directly appeal to judges for involuntary commitment of a loved one, a power previously reserved for mental-health evaluators. As I had commented in another post concerning Wisconsin’s surprising and highly tragic, misguided laws which permits only police to initiate involuntary commitment petitions for emergently needed psychiatric care, Washington had a very restrictive process to allow commencement of emergency psychiatric care.

The Washington Legislature has moved in exemplary fashion to adapt helpful legislation from other states such as New York and California in creating  new programs to allow judges to mandate outpatient treatment in House Bill 1450 for people with serious mental illness. This sort of program has been utilized to great benefit in many states in the last 10 years or so, including my home state of practice, North Carolina involving “ACT” teams which operate on a public health model of providing follow up and on site, meaning in the patient’s place of residence to supervise compliance with reliable of taking of psychiatric medications to prevent relapse into psychosis, and many kinds of social supports, entree’ into day programs, educational pursuits and keeping up even with their routine medical health maintenance.

This kind of proactive assisted outpatient treatment program can overcome the endemic lack of recognition that many of the chronically mentally ill that they indeed have their condition, which causes them to not take their medications, relapse into psychosis over and over, ending up needing otherwise needless expensive re-hospitalizations. These kinds of programs are from the public health model utilized over decades ago in ensuring tuberculosis patients took their daily curative anti-TB medications. Similarly syphilis was reduced from an all too common scourge to a relatively uncommon sexually transmitted infection by use of public health workers who not only tracked down carriers but also were able to utilize legally supported powers of enforced treatment. Somehow these massively protective and effective treatment approaches were lost in the anti-institutionalization fervor that held sway decades ago with the unintended consequences of not providing for effective outpatient public health like treatment models that would have prevented much of the national mental health crisis we confront daily.

But these kinds of programs are expensive as it takes serious money to pay for these outreach workers, frequent health care worker contact etc. Unfortunately the editorial cited above, are not yet budgeted to their needed levels. The Seattle Times pointed out sadly that perhaps only less than half of the projected $9M cost has been budgeted to date.

Joel Reuter’s father, himself notably, a former Republican Minnesota state lawmaker, was quoted concerning the ongoing reform efforts as stating: “It’s a monumental accomplishment to get both parties and both (legislative) bodies on board for this large of a change,” and that “the system here was so broken.”

My sad comment is that in the past year or so, we have had two legislator or former legislator families suffer the deaths of their sons, one due to his psychotic behaviors forcing lethal intervention, and the other to suicide. It took the grief driven but enormously selfless dedicated efforts of these two men, fathers who lost their sons to psychosis, to prod, shame and lead their states toward enlightened action on the behalf of the severely mentally ill and their families to facilitate securing even emergency psychiatric intervention. This goes against the political ethos and ideology that this country has suffered under for the last 30 years; that of cutting taxes no matter the human costs. Hopefully the public is finally catching on to these nationwide mistakes that this cruel approach has cost us in many areas, slashing teachers’ salaries, cutting our investments and support of our stellar state educational systems. All this has been under the banner of the self proclaimed boasting of resisting “raising taxes.” I submit that the time for this cruel shortsighted approach is approaching the end of the time when this was true and needed. But even now in this slow recovery, novel revenue streams are waiting to be enacted and tapped that would not be as onerous as our dogmatic politicians would have use believe. This ideology itself is becoming too costly to maintain for the health of our country in multiple arenas of essential functioning.

It is time for more enlightened leadership that politicians love to espouse but few are able to demonstrate in times of our need.