“The whole system is backed up,” said Karen, a former nurse who treated criminal justice patients at Taunton State Hospital and director of the Massachusetts Nurses Association, the union representing nurses in the state hospital system.・Mr. Coughlin says. . “All of this creates a terrible standard of care.”
Forensic patients, who are admitted to state hospitals through the criminal justice system, are typically admitted either by court referral for psychiatric evaluation or by transfer from Bridgewater State Hospital, the Department of Corrections’ mental health hospital. Visit the hospital in this way. Since 2018, the number of transports from Bridgewater has doubled, to more than 200 in 2023, contributing to a 10% increase in forensic patient admissions systemwide. The number of court referrals, which had declined during the pandemic, has increased again.
The result is substandard care and difficult working conditions, hospital officials said. The Globe spoke to more than a dozen current and former Tewksbury employees who said they felt overwhelmed at work and constantly on guard against the possibility of violence. Workers interviewed included daily care providers and treatment staff. None of them wanted to be named because they could face retaliation at work.
The situation at Tewksbury Hospital and other DMH hospitals reflects a national mental health crisis. During the pandemic, many people in need of care lost access to therapists. Some of them became homeless, addicted, and committed crimes that attracted the attention of police.
“You can think of this as a public health crisis in our legal system,” said Daniel Murray, chair of the psychology department at the University of Virginia Law School’s Institute of Law, Psychiatry, and Public Policy. It has been pointed out that there is an increase in Mandated competency evaluations are putting a strain on mental health networks nationwide.
a 2023 DMH Report noted that increased referrals to court helped people Find treatment in the criminal justice system. However, it also acknowledged that these patients contributed to an overall increase in average length of treatment and delayed hospitalization for other patients seeking treatment outside of the criminal justice system.
The report includes plans to reduce long waiting times for hospitalization by 100 days and increase the number of inpatient beds by 65 over three years. The company also announced that it will invest in 500 beds in group homes.
“We recognized that we needed to expand our capacity with the resources we have,” said Department of Mental Health Secretary Brooke Doyle.
At Tewkesbury, forensic patients are now living with other patients, creating a demanding mix of demands on staff who spend much of their time with forensic patients. Coughlin said these patients often arrive without medication or recent mental health care. On the other hand, patients who are already suffering from mental health problems will witness aggressive or destructive behavior.
“It’s traumatic for everyone,” Coughlin said.
As of the second week of March, about 43% of patients in Tewksbury’s mental health unit had criminal court connections, according to SEIU 509, the union that represents many DMH workers.
Tewkesbury Hospital has a medical department as well as a psychiatry department, allowing us to provide both medical and psychiatric care. SEIU 509 Chapter President Jean Calvert McClure said that’s one reason for the population growth.
Overcrowding has been a consistent problem at Tewkesbury Hospital since mid-2022, according to DMH data. The hospital reported that it will have more patients than beds until mid-2023. The opening of an additional mental health unit in July added an additional 21 beds, which quickly filled and exceeded patient capacity. As of December, the hospital had 165 beds but reported 176 patients.
Workers said the new beds came at the cost of treatment and activity space. One person pointed out that mental health treatment was taking place in a space that had been used as a broom shed.
“These patients have nowhere to go,” said a former nurse at the hospital.
A DMH spokesperson said the department has not received any reports of closet treatment.
Staffing is also insufficient.Tewkesbury’s mental health department has increased staffing over the past two years, but will have fewer staff in 2023 The number of beds decreased by 8 percent compared to 2019, according to DMH data. There is a particular shortage of registered nurses. The number of registered nurses in Tewkesbury in 2023 is 14 fewer than in 2019.
DMH is hiring temporary staff, but the department acknowledged it is having trouble finding qualified staff amid a national workforce shortage in the health care field.
There are no forensic psychologists in Tewkesbury. DMH relies on contract psychologists to conduct court-ordered evaluations, but DMH said this gives it flexibility to deploy experts throughout the hospital system as needed. The evaluation is supposed to take place within 20 days, but Tewkesbury staff with direct knowledge of the process said it could take longer in some cases.
Many officials said Tewkesbury Hospital was not built to care for its current patient mix. Founded as an almshouse in the mid-19th century, the centerpiece of the hospital is the grand brick administration building, which is now a museum. But today’s mental health patients live in the upper floors of a 56-year-old monolith at the back of the sprawling campus.
The doors to the mental health wing are locked, but security on the lower floors, which are not reserved for mental health care, is lax, and some mentally ill patients simply leave. the workers said. Tewkesbury Police Department reports say they were called nine times last year for patients who left the premises without permission.
Meanwhile, opportunities for patients to get their permitted time outdoors are limited, multiple officials said. “You have to ride a bunch of angry people in a small elevator” to get to the only restricted outdoor space, a fenced-in courtyard slightly larger than a basketball court, one employee said. .
For some forensic patients, up to 10 minutes of their allotted 30 minutes outdoors can be spent just transporting them to a safe outdoor area, officials said.
“Fresh air is a human right and we have protocols in place to provide fresh air to our patients,” said DMH Secretary Doyle.
The Disability Law Center, a Massachusetts advocacy group, inspects Tewksbury monthly and is concerned that conditions at the hospital are hindering patients’ recovery.
“We may be holding them back,” said Tatum Pritchard, the center’s litigation director.
Mr Doyle acknowledged the problems stemming from: Although the building is old, the ministry said it has “special procedures in place to ensure safe movement in and around the facility.”
But workers say the crowded, tense environment too often leads to violence. Managers of mental health facilities should by law Notify your county district attorney of any incident that you believe is a crime that may result in incarceration. A spokesperson for the Middlesex District Attorney’s Office said Tewksbury filed 23 similar reports in 2023 and 47 in 2022, but could not provide details of the reports for privacy reasons. Ta. Seven cases have been submitted so far this year.
“You’re waiting for violence,” said a former mental health worker from Tewksbury. “I hope you have enough staff to help you.”
She said she was punched in the face by a forensic patient in 2022 while cleaning up another patient’s clothes, leaving her with a black eye. The former employee remains a state employee, but she requested anonymity for fear of retaliation.
Workers said threats of rape and other violence against women were common.
Mr Doyle said the department and the hospital We are in frequent contact with trade unions and are aware of their safety concerns.
Coughlin, the nurses’ union president, noted that workplace violence against health care workers overall has increased since the pandemic. He said violent incidents are typically underreported in the state’s psychiatric hospitals. Even if workers want to press charges, they often don’t receive support from hospital authorities, she says, and risk being shunned by favored colleagues if they complain about patients.
The Lowell Sun reported that in 2021, a patient at Tewksbury Hospital nearly strangled a staff member, prompting the hospital to create a way for staff to submit complaints anonymously. DMH reports that the system received 135 complaints in 2023, most of them related to issues like snow removal and parking. Workers said they are not using the system for more serious issues for fear of not getting results.
“There is no culture where it is safe to complain,” said one worker.
Despite safety concerns, Tewksbury staff are fiercely protective of patients. Some were reluctant to be interviewed for fear that articles reporting on hospital conditions would denigrate the people who live there.
“They are really sick,” said one worker. “They’re all sleep-deprived, overwhelmed, overstimulated, angry about being out there…and all of that manifests in behavior.”
Jason Laughlin can be reached at [email protected] him @jasmLaughlin.
