Commonwealth of Massachusetts
Department of Mental Health
Annual Report
Fiscal Year 2013
MISSION
The Department of Mental Health, as the State Mental Health Authority, assures and provides access to services and supports to meet the mental health needs of individuals of all ages, enabling them to live, work and participate in their communities. Recognizing that mental health is an essential part of healthcare, the Department establishes standards to ensure effective and culturally competent care to promote recovery. The Department sets policy, promotes self-determination, protects human rights and supports mental health training and research. This critical mission is accomplished by working in partnership with other state agencies, individuals, families, providers and communities.
VISION
Mental health care is an essential part of health care. The Massachusetts Department of Mental Health, as the State Mental Health Authority, promotes mental health through early intervention, treatment, education, policy and regulation so that all residents of the Commonwealth may live full and productive lives.
What We Do
DMH is a person- and family-centered agency with the goal of involving people with lived experience and their families to support people recovering from mental illness by following their own individual paths. DMH provides consumers and families with services and supports for successful community living that includes social connections, physical and mental health, employment, education and above all, personal choice in the path to recovery.
AUTHORITY
Massachusetts General Law: Chapters 19, 123
“The Department shall take cognizance of all matters affecting the mental health of the citizens of the Commonwealth.”
Regulations: 104 CMR
DMH is also authorized/required to:
• Approve MassHealth prior authorizations on psychotropic drugs
• Add new diagnoses to the Mental Health Parity statute
• Monitor the Department of Corrections - Segregated Units
• Monitor the House of Corrections - Step-down Units
GENERAL RESPONSIBILITIES:
· Operates the state psychiatric facilities
· Funds an extensive community service system for qualifying adults and children
· Licenses all private psychiatric facilities and units of general hospitals, as well as community mental health programs providing residential services
· Establishes standards of care
· Provides mental health training and research
· Promotes recovery and self-determination
· Protects human rights
Brief Description of DMH Services
SErvices / DescriptionInpatient/Continuing Care System / DMH-operated psychiatric inpatient facilities: two psychiatric hospitals; psychiatric units in two public health hospitals; five community mental health centers that promote treatment, rehabilitation, recovery.
Community Based Flexible Supports (CBFS) / The DMH community service system: Rehabilitation, support, and supervision with the goal of stable housing, participation in the community, self management, self determination, empowerment, wellness, improved physical health, and independent employment.
Respite Services / Respite Services provide temporary short-term, community-based clinical and rehabilitative services that enable a person to live in the community as fully and independently as possible.
Program of Assertive Community Treatment (PACT) / A multidisciplinary team approach providing acute and long term support, community based psychiatric treatment, assertive outreach, and rehabilitation services to persons served.
Clubhouses / Clubhouse Services provide skill development and employment services that help individuals to develop skills in social networking, independent living, budgeting, accessing transportation, self-care, maintaining educational goals, and securing and retaining employment.
Recovery Learning Communities (RLCs) / Consumer-operated networks of self help/peer support, information and referral, advocacy and training activities.
DMH Case Management / State-operated service that provides assessment of needs, service planning development and monitoring, service referral and care coordination, and family/caregiver support.
Emergency Services (ESP) / Mobile behavioral health crisis assessment, intervention, stabilization services, 24/7, 365 days per year. Services are either provided at an ESP physical site or in the community.
Homelessness Services / Comprehensive screening, engagement, stabilization, needs assessment, and referral services for adults living in shelters.
Child/Adolescent Services / Services include case management, individual and family flexible support, residential, day programs, respite care and intensive residential treatment.
Forensic Services / Provides court-based forensic mental health assessments and consultations for individuals facing criminal or delinquency charges and civil commitment proceedings; individual statutory and non-statutory evaluations; mental health liaisons to adult and juvenile justice court personnel.
DMH Leadership
FY2013
Marcia Fowler, Commissioner
Clifford Robinson, Deputy Commissioner, Mental Health Services
Kathy Sanders, M.D., Deputy Commissioner, Clinical and Professional Services
Joan Mikula, Deputy Commissioner, Child and Adolescent Services
Robert Menicocci, Deputy Commissioner, Management and Budget
Lester Blumberg, General Counsel
Liam Seward, Chief of Staff
Department of Mental Health
Organizational Structure, Site Offices and Facilities
In Massachusetts, responsibility for providing public mental health services falls under the umbrella of the Executive Office of Health and Human Services (EOHHS). DMH is one of 14 EOHHS agencies.
DMH is organized into four geographic areas, each of which is managed by an Area Director. Each Area is divided into local Service Sites. Each Site provides case management and oversees an integrated system of state and provider-operated adult and child/adolescent mental health services. Citizen advisory boards at every level of the organization participate in agency planning and oversight. DMH allocates funds from its state appropriation and federal block grant to the Areas for both state-operated and contracted services.
The DMH Central Office, located in Boston, has five divisions in addition to the Commissioner's office—Mental Health Services; Child and Adolescent Services; Clinical and Professional Services; Legal; and Management and Budget. It coordinates planning, sets and monitors attainment of broad policy and standards and performs certain generally applicable fiscal, personnel and legal functions.
A total of 28 DMH Area Site Offices serve adults, children, adolescents and their families throughout the state.
The Department operates the following facilities:
· Worcester Recovery Center and Hospital
· Taunton State Hospital
· The Hathorne Mental Health Units at Tewksbury State Hospital (a Department of Public Health hospital)
· The Metro Boston Mental Health Units at Lemuel Shattuck Hospital (a Department of Public Health hospital)
Community Mental Health Centers:
· Pocasset Mental Health Center, Bourne
· Massachusetts Mental Health Center, Boston
· Erich Lindemann Mental Health Center, Boston
· Solomon Carter Fuller Mental Health Center, Boston
· Corrigan Mental Health Center, Fall River
· Brockton Multi-Service Center, Brockton
Fiscal Year 2013 Overview
After more than seven years of extraordinary collaboration, effort and hard work, an historic moment arrived for the Department, the Commonwealth and the citizens we serve. Under the Patrick-Murray Administration, the Commonwealth invested $302 million to build and open a new, world class public psychiatric hospital for the first time in more than 100 years. The new state-of-the-art 320-bed Worcester Recovery Center and Hospital (WRCH) opened its doors to patients in August 2012 in Worcester. The capital bond-funded project was met with wide support and is the largest known non-road project in the history of Commonwealth. Not only an investment in infrastructure, the WRCH building design is the future of person-centered and recovery-focused care for individuals with serious mental illnesses and serves as a model nationally and internationally for the latest, cutting-edge psychiatric treatment.
An opening ceremony in mid-August 2012 for the new WRCH and shortly after that in early October patients and staff were transitioned to the new facility in the course of one day, representing a milestone in public mental health care and treatment for Massachusetts.
WRCH would not have been possible without the hundreds of individuals who worked together on a common goal over the course of years. We are proud of what we’ve accomplished together, all of us—the Patrick Administration, the Division of Capital Asset Management, many state agencies, consumers, youth, family members and staff of DMH, unions, legislative leaders, designers, architects, builders and scores of stakeholders in the mental health community made WRCH possible. Since 2005, when the first meeting of the Department of Mental Health Facility Feasibility Commission took place, the guiding principles for this historic project focused on recovery for individuals with serious mental illness and Community First, which overwhelmingly supports a person’s right to achieve recovery and independence with the right services and supports in communities of one’s preference. We believe that recovery from mental illness is not only possible, it is real.
The Department’s budget for FY2013 represented a strong acknowledgement and the achievement of our goals and objectives in our service to adults, children, adolescents and families living with serious mental illness. Governor Patrick, by including $9.9 million to develop an additional 80 community placements this year, demonstrated his unwavering support for our Community First initiative. The FY2013 budget also allowed us to realign our continuing care inpatient bed capacity in a way that reinforces our commitment to moving away from institutional settings toward an environment that emphasizes community support and self-reliance for consumers.
All of our accomplishments and every milestone we reach are the result of the efforts of dedicated DMH employees who each play a crucial part―large and small —in the success of our initiatives. It has been a busy year with many successes.
We opened the state’s first peer operated respite program and were awarded several grants such as those directed towards providing services to returning military veterans, training deaf and hard of hearing peer workers, and services to divert individuals away from the criminal justice system into much needed mental health treatment. We made significant strides increasing the number of persons with lived experience in our workforce.
We accomplished the realignment of the DMH inpatient system by opening WRCH; improved treatment for individuals in our care who need not only inpatient psychiatric care but also increased medical care by opening the 45-bed Medically Enhanced Units at Tewksbury Hospital; and successfully complied with the Legislative requirement of a capacity of 45 beds at Taunton State Hospital. This statewide realignment was an immensely challenging and complex undertaking and was accomplished because of the dedication, perseverance, skill and high degree of professionalism of the DMH workforce.
We continue to improve upon our services by moving forward with the implementation of the Six Core Strategies in our inpatient facilities in order to provide effective recovery-focused treatment and increase patient and staff safety and we will expand that initiative to the community under development by DMH Staff Development called the Collaboration, Assessment, Recovery Environment curriculum, known as CARE. This is an interactive approach to treatment that is person-centered and team-based and you will be hearing more about this exciting training and treatment method in the coming months.
To ensure that our structure supports the Department’s strategic goals and objectives, several organizational changes in Central Office supported moving forward with our mission.
We welcomed Kathy Sanders, M.D., as Deputy Commissioner for Clinical and Professional Services (CPS) and State Medical Director. In the interim, Debra Pinals, M.D., Assistant Commissioner for Forensic Service served in that role and very ably maintained continuity, leadership and responsiveness for the CPS Division. We thank Dr. Pinals for her leadership and double duty. Dr. Pinals has fully returned to her duties as Assistant Commissioner for Forensic Services. Additionally, Carol O’Loughlin joined the Mental Health Services Division as Director of Training.
In the Department’s CPS Division, Eleanor Shea-Delaney, Assistant Commissioner for Program Development and Interagency Planning, joined CPS reporting to Dr. Sanders as did Beth Lucas, Director of Quality Improvement. The DMH Licensing Office remains within the CPS Division and is overseen by Assistant Commissioner Gary Pastva.
As part of the reorganization, the position of Director of Inpatient Services was eliminated and our hospital chief operating officers report to the Area Directors.
In May 2013, in which our community observes Mental Health Month and Children’s Mental Health Week, Commissioner Fowler named Joan Mikula as Deputy Commissioner of Child and Adolescent Services for the Department of Mental Health and creating a discrete division in our organizational structure. Child and Adolescent Services was previously part of the Mental Health Services Division. This reflects that our commitment to the services we provide to children and families will have the greatest impact on people of all ages across the lifespan and for many individuals will interrupt the trajectory towards debilitating adult chronic mental health conditions. Many in the mental health community and among the child-serving agencies and organizations across the Commonwealth know Joan and her tireless dedication to children, youth and families living with serious mental illness and emotional disturbance.
Joan had served DMH as Assistant Commissioner for Child and Adolescent Services since 1985 and her accomplishments are many. She is a driving force on the Commonwealth’s health care initiatives and reforms such as CBHI; the development of services for Transitional Age Youth (Emerging Adults); reducing the use of restraint and seclusion; including children and families in the design and delivery of services; and most recently on the first-of-its-kind interagency procurement with the Department of Children and Families called Caring Together.
We know that approximately one in five children and adolescents experience the signs and symptoms of mental health disorders. We know that half of all lifetime mental illnesses begin by age 14 and three quarters of them by age 24. It is vital to the health and well being of the people of Massachusetts, beginning with our youngest citizens, that we concentrate on early detection, intervention and prevention of chronic adult mental health conditions. Joan’s work in this area allows the Department to remain focused on the needs of children and their families.
Recovery, empowerment and peer support for individuals living with mental illness are vital guiding principles for the Department, shaping and informing the services and supports we provide to those who need them. It is a movement, a new way of approaching how we view mental illness, and we are proud that DMH and Massachusetts is on the leading edge of incorporating these principles into our policies, our services, and most importantly our workforce.
As we continue to transform our agency into a recovery oriented and person-centered environment, we welcomed Russell Pierce, J.D. as Director of Recovery and Empowerment, a new position within the Commissioner’s Office.
Russell’s expertise in peer support and programming, public policy and in engaging and bridging diverse stakeholders will help the Department continue to integrate recovery, consumer empowerment and the value of the lived experience perspective in all of our work, reinforcing our commitment to recovery from serious mental illness. His experience spans organizations such as the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA); the Center for Mental Health Services; and the National Institutes of Health, to name several, as a public health advisor, program and policy developer and community organizer.