Bridgewater State Hospital

In the wake of recent troubling incidents at Bridgewater State Hospital, the state’s facility for the dangerously mentally ill, the Governor has filed legislation that would limit the population of Bridgewater to persons who have actually been convicted of a crime. We recently held a hearing on the legislation before the Judiciary Committee.

Under the proposed legislation, those awaiting trial or sent only for evaluation would be housed in a new “enhanced security facility” under the management of the Department of Mental Heath. The premise is that Bridgewater, a unit of the state prison system, is focused on punishment and that a facility led by mental health professionals would treat patients more humanely and achieve better outcomes.

It’s tragically difficult to treat patients who are at once (a) truly dangerous and (b) badly in need of mental health care. The cycle of bad outcomes and bursts of reform has going on for decades at Bridgewater. I’m eager to contribute to improvement, but we need to recognize that many patients in the population at Bridgewater are uniquely challenging and that the proposed legislation raises real dilemmas: Good legislation on the subject will take some time.

The dilemma is well stated by the exchange I had with Marylou Sudders, a well-respected former Commissioner of Mental Health, which is reproduced below with her permission.

Dear Chairmen Brownsberger and Markey –

Please excuse the informality of this communication but I am out of the country with very limited email access. I write to you as a longtime advocate for persons with mental illness and as a former Commissioner of Mental Health in support of the bill before you to create treatment, rather than punishment, for individuals with serious mental illness. The creation of a public psychiatric hospital operated by the Department of Mental Health for the treatment of men with serious mental illness currently incarcerated at Bridgewater State Hospital will correct a longtime injustice. The public expose’ by the Boston Globe highlighted the systemic failure by the executive branch to ensure that these individuals received treatment, rather than punishment.

My support of this bill however is not universal. I have strenuous objections to section 23 as originally filed by the governor and the compromise language that some mental health and correctional advocates have tried to broker with the administration in order to ensure the bill’s passage. This section attempts to amend the law commonly referred to as “the five fundamental rights law for persons with mental illness.” This law was passed overwhelmingly by the Legislature to ensure that individuals with mental illness had some basic rights regardless of where they were psychiatrically hospitalized – in either a DMH operated or licensed psychiatric hospital or psychiatric unit in a general hospital. The present law allows for a facility head to temporarily suspend an individual’s rights in the event of an urgent situation involving that individual.

The governor’s bill as filed would allow the facility head to suspend one or all of the rights across the entire new psychiatric hospital and the proposed compromise language offered by some would allow the facility greater power to suspend these rights. I urge you to stay firm on the existing rights.

We have witnessed the abuse of power in a correctional facility that was supposed to provide treatment. The entire thrust of the bill before you is to ensure that treatment in a humane psychiatric facility is the primary objective. This would be the ONLY DMH licensed or operated psychiatric facility where the five fundamental rights could be abridged; these rights occur in current DMH forensic units. The rationale put forth behind seeking the executive latitude is to “manage potential gang visit concerns”. The rationale itself suggests that a quasi correctional mindset rather than a psychiatric treatment milieu is envisioned.

Working closely with the Legislature and mental health advocates, we were able to secure passage of these most basic rights when I was commissioner. I ask that you support the bill and remove section 23.

Thank you for your consideration.

Best,

Marylou Sudders

I replied to Ms. Sudders as follows:

Got this and we won’t move the bill as it is.

It will take some real conversation through the Fall.

I understand what went into achieving the Bill of Rights and the reluctance to dial it back. However, I think we also need to grapple with what it means to house dangerous criminals who are awaiting trial in DMH facilities.

For example, in normal jails or at Bridgewater, there are strong security provisions that prevent them from tampering with trial witnesses, etc. Those provisions include monitoring all phone calls. I don’t think the courts or law enforcement will actually use a DMH “enhanced-security” facility that does not somewhat curtail the privacy rights of detainees in making phone calls.

I do understand that the patient bill of rights includes provisions for removal of those rights, but those provisions can only be invoked based on specific bad behavior of the patient. In a secure facility that includes dangerous criminals, possibly gang members, many would feel that phone rights need to be curtailed prophylactically, without a showing that the patient has abused the rights.

I have great respect for your work as an advocate for persons with mental illness. I’d welcome your further thoughts about how to put together the concept of a jail and the concept of a treatment facility for the mentally ill. We have to have rules that reflect the dual nature of the population — we can’t swing from treating patients like criminals to treating criminals like patients.

Looking forward to continued dialog. I feel strongly that we need much more discussion before this bill can move.

Ms. Sudders further replied as follows:

Greetings. I fully concur that there needs to be much more conversation and that the individuals at the new facility include a broad population and needs. I welcome the continued conversation and of course you are welcome to post our conversation. As always am grateful for your leadership on this matter.

That’s the bottom line, as I see it: We don’t have consensus about what an “enhanced security” hospital would look like — security involves deprivation of liberty and it’s unclear how to reconcile security goals with treatment goals in the proposed new facility model.

I look forward to working with my colleagues, with advocates, with the judiciary and with the correctional and mental health leaders to build some consensus around a workable approach to meaningful reform.