Community housing better than custodial care

The castle of which the 54-year-old Mr. Sanborn is king is his own apartment on Pleasant Street. It is all the more rewarding to be in that apartment, which is part of Genesis Club’s community housing network, because of the hurdles he jumped to get there.

Mr. Sanborn was one of the 268 patients that the state Department of Mental Health reported in March 2004 — based on a September 2003 survey — were in 900 continuing care beds in its psychiatric hospitals, but did not need to be. If the department had sufficient resources in the community, those patients would not have had to languish in hospitals, according to DMH Commissioner Elizabeth Childs.

The department set out to get all of those patients out of the inpatient units and into the community by July 1 of this year, closing eight adult continuing care units along the way. DMH has gotten 236 of those patients out by the deadline, according to Patricia Mackin, DMH chief of staff.

The department plans to get the remaining 32 patients out by June 30, 2007, but could not be more specific as to how much before then. With the $2.08 million those will cost, the total cost of finding community placements for the 268 patients will total $17.42 million, Ms. Mackin said.

Community placements will cost an average of $65,000 a year for each of the patients who comprised 30 percent of the 881 continuing care patients in DMH’s hospital in 2003. The census currently is 785 continuing care patients in a system with capacity of 882.

DMH plans also to reduce its adult continuing care inpatient capacity to 740 beds. Part of that is the plan to combine the 156-bed Worcester State Hospital and the 198-bed Westboro State Hospital into a new 260-bed adult continuing care hospital (plus 60 beds for adolescents) to be built on the grounds of Worcester State Hospital.

Plans to open the new hospital by the end of 2010 are threatened by the Legislature’s failure last month to approve a bond to fund the hospital.

Advocates for people with mental illness were concerned about whether there were enough programs to take good care of those discharged from the hospitals. They were even more concerned that to make room for the 268 hospitalized patients, DMH, without adequate supports, would force their loved ones out of the hard-won community residential programs they already had.

DMH says that is not the case.

“We’ve addressed everyone’s needs appropriately,” Ms. Mackin said.

Group homes accepted half of the hospitalized patients in existing slots and expanded their programs for another 21. Others went into supported housing — typically private apartments to which social service workers are sent to check up on the residents — and still others went to newly created programs, according to DMH.

At Worcester State Hospital, all 51 patients identified as not needing to be there have been discharged, according to Elaine Hill, DMH area director. Of those, 49 went to group homes and two to supported housing.

In Central Massachusetts, 70 percent of DMH’s community residences are supported housing, with 30 percent being in group homes.

Of the 24,000 people DMH supports through a variety of programs from hospitals to community residences, day programs, and case management, 6,877 are in community residences. Of those, 752 are in Central Massachusetts.

Ms. Mackin said DMH will create 198 new residential slots this year for its clients, 166 more than the 32 it will need for the patients who will be discharged because they did not need to be in the hospitals.

Stanley J. Eichner, executive director of Disability Law Center, said, “We are pleased with this effort to move people into the community. Commissioner Childs has really dedicated herself to finding quality programs for the people discharged.”

Disability Law Center, based in Boston, is designated as the protection and advocacy agency for Massachusetts under federal law and monitors progress on the plan to get people out of the hospitals when they don’t need to be there. The Center for Public Representation in Northampton complained a number of years ago to the Department of Mental Health that keeping patients in the state hospitals when they don’t need to be there may be a violation of federal law.

Although the DMH did not meet its deadline, “we think that’s a good faith effort to move people into the community as required by law,” Mr. Eichner said.

Nor has Tobias Fisher, executive director of the National Alliance for the Mentally Ill of Massachusetts, heard of problems stemming from the movement of patients out of the state hospitals. He said there remains a need to increase community residential capacity because of the wait list to get into the community residences.

So long as there is a waiting list, people in the hospitals will suffer as Mr. Sanborn did. Although he had been committed to Worcester State Hospital June 25, 2003, suffering from bipolar illness, he said the commitment expired in May 2005 and that his treatment team agreed he did not need to be in the hospital.

“They told me you could leave, but you have nowhere to go,” he said. “I felt penned in.”

“I was at a loss,” he said. “I felt kind of robbed.”

His treatment team warned him of the consequences of failing to endure the test that lack of community programming was putting him through.

“If you yell out or punch a wall,” Mr. Sanborn said his therapist warned him, “even if it’s because you’re in the hospital, it’s going to keep you here.”

The North Brookfield native, who graduated from Quinsigamond Community College and Worcester State College, had to count fewer days than many others in the hospital unnecessarily before he found a way out. He found a bed in a Community Healthlink group home some seven weeks after he was told he was ready to leave the hospital, staying there 8-1/2 months before moving into his own apartment.

Now he does office work four hours a day, five days a week in a temporary employment job Genesis Club found for him in the same place he had been unable to leave: Worcester State Hospital. Mr. Sanborn also jogs regularly and spends time at Genesis Club, a psychiatric rehabilitation clubhouse.

Best of all is going home to his own apartment at day’s end.

“I know I’ve been to work that day, and I did as good as I could,” Mr. Sanborn said.