NAMI Responds to Governor Baker and DOC on Bridgewater Overhaul

Bridgewater State Hospital is targeted for an overhaul.  Over the past several years, there has been a groundswell of support for separating the incarcerated mentally ill from the genreral prison populations as well as transferring the care, treatment and oversite of this populations from the Department of Correctiions to DMH.

A Request for Response RFR) was issued September 13, 2016 for just such a move, but there was no provision to move the treatment from a prison environment. As such NAMI responded as below:

Introduction: Bridgewater State “Hospital” is a medium-security prison that evaluates and treats men who have mental illness. For people with histories of trauma and mental illness, being confined in a prison is uniquely harmful, inhumane and punishing. Bridgewater has had a complicated history riddled with decades of negative media attention about the treatment of the men held at the facility resulting in senseless tragedies like those of Joshua Messier and Leo Marino. On September 13, 2016 the Department of Correction publicly announced at an informational hearing held by the Joint Committee on Mental Health and Substance Abuse that it would be rebidding and reconfiguring services provided at Bridgewater State Hospital. The deadline for submissions is November 1, 2016 and the anticipated start date for the new changes is February 1, 2017. Several important changes will be carried out by the Department of Correction regardless of the Vendor chosen for the Contract.

  • Uniformed correctional staff will no longer remain inside of the main Bridgewater State Hospital Facility.
  • A small portion of correctional staff (approximately 36 officers) will continue to guard the perimeter of the facility.
  • The other 180 correction officers not selected to stay at Bridgewater State Hospital will be reassigned elsewhere.
  • All patients identified as state sentenced inmates (about 50 individuals) will be transferred to a new Bridgewater State Hospital Annex located at Old Colony Correctional Center.

This makes space for the 200 or so inmates currently housed at Bridgewater State Hospital who have been sent there for forensic evaluation, treatment, or as the result of “civil commitment”. Extensive provisions were made in the Request for Response for how the new Contractor would operate Bridgewater State Hospital. Below are a few provisions of interest:

Good Provisions:

1)  Included in the specifications for the coordination of services between the Department of Correction and Bridgewater State Hospital, is a statement that the new Contractor will collaborate with the Department of Mental Health on topics including “prevention of seclusion and restraint” to “foster a culture that places the Patient first”.

2)  Notable staff members included in the Request for Response are: o Medical Director of Bridgewater State Hospital – a Board Certified Psychiatrist, preferably with a subspecialty in forensic psychiatry; o Hospital Administrator; o Director of Forensic Services – a Designated Forensic Psychiatrist or Designated Forensic Psychologist who will oversee all court-ordered forensic and clinical evaluations.

3) Forensic evaluations will be carried out by designated forensic psychiatrists, psychologists, and other professionals; o Chief of Social Work; o Director of Intensive Treatment Planning – will consult, as necessary, with the Department of Mental Health and other agencies, to identify and complete plans for patients who have required emergency use of seclusion and restraint; o Family Engagement Clinical Specialist – will serve as a point of contact for families and be responsible for giving them information about their loved one. They will also facilitate semi-annual family meetings and Family Support Groups. One complaint several family members of patients voiced was the lack of communication with Bridgewater State Hospital. Family serves as an important source of support for many individuals with mental illness; hopefully, the Family Engagement Clinical Specialist will help family stay well-informed and involved in their loved one’s treatment.

4)  Every patient will receive an initial treatment plan at the time of admission, a review of that treatment plan will occur within ten (10) days, and a formal treatment plan will be developed no more than thirty (30) days from admission.

Bad Provisions:

1)  According to the Department of Correction, when selecting the new Contractor, bidders with “experience providing forensic mental health, mental health, medical and dental services in a correctional setting (i.e. prisons or jails) will be preferred”. This could perpetuate a punitive culture that is at odds with the therapeutic milieu necessary for treatment to be successful.

2)  The Medical Director of Bridgewater State Hospital and Hospital Administrator will report to the Superintendent. Furthermore, the Superintendent of Bridgewater State Hospital will maintain oversight of day-to-day operations of the facility in addition to securing the perimeter. We have heard from several stakeholders that medical personnel at Bridgewater are too intimidated by Correction staff to intervene on behalf of their patients when they feel their needs are not being met. It is possible that this same feeling of intimidation will continue if the Medical Director and Administrator report to the Superintendent.

3)  The Department of Correction will evaluate the quality and efficiency of the provision of services under the Contract to ensure that “evidence-based clinical criteria/pathways and best practices from within forensic mental health” are utilized. NAMI Mass believes this would be best accomplished by the Department of Mental Health who possesses the knowledge and qualifications necessary to carry the evaluation of services.

Too Soon to Tell Provisions:

1)  Every story we have heard about violence related to Bridgewater State Hospital has occurred inside of the facility, not at the perimeter or in the surrounding communities. This violence is the result of conflict between patients who are not only mentally ill, but have also been given inadequate treatment in a stressful environment. Maintaining the elements of a medium-security prison, even just at the perimeter of the campus, may  hinder the development of the therapeutic milieu necessary for successful treatment. Security should be approached in a way that guarantees the safety of the patients and staff at Bridgewater State Hospital, but does not perpetuate the current punitive climate.

2) The Contractor is required to provide all personnel with annual training in areas including: introduction to mental illness; prevention and reduction of seclusion and restraint; trauma informed care; and de-escalation. While the RFR states “the department of Mental Health is available for consultation regarding training content and materials,” there is no requirement for the Contractor to include the Department of Mental Health in personnel training. A stronger inclusion of the Department of Mental Health would ensure that the training provided to personnel would fit the needs of the population at Bridgewater State Hospital. 

3)  The Department of Correction leaves program construction and security, staffing patterns, the range of disciplines represented in lower-level staff and staff schedules to the discretion of the bidders. While the Request for Response outlines criteria for what laws need to be met and what kind of qualifications upper-level staff members must carry, there is not a tremendous amount of direction given in any other area. This could allow important programming decisions to be determined by a knowledgeable and well qualified Vendor, but if a poor Vendor is selected it could lead to poor programming and substandard treatment.

While we welcome change to Bridgewater State Hospital and appreciate many of the proposed changes laid out in the Request for Response, NAMI Mass believes that any improvements will be limited by the Department of Correction’s continued responsibility for the evaluation and treatment of men with mental illness.

As long as the Department of Correction maintains oversight of the facility, Massachusetts will stand alone in the country by requiring its state prison authority to assume responsibility for men who, in any other state, would fall under the jurisdiction of the Department of Mental Health. The entire Request for Response can be found at the following link: 00000009793&parentUrl=activeBids

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