A Brief History
Massachusetts has been a national leader in caring for people with mental illnesses since it built the first public asylum in America – Worcester State Hospital. Built in 1833, it served as the model that other states soon followed.
A new era in mental health care emerged in the 1960s when President John F. Kennedy signed the Community Mental Health Centers Act of 1963, which espoused treating people with mental illnesses locally rather than in large isolated state hospitals and led to the construction of federally funded community mental health centers across the nation, including several in Massachusetts.
A community-based system of care has been evolving in Massachusetts since 1966 when the state Legislature enacted the Comprehensive Mental Health and Retardation Services Act. This measure decentralized the Department of Mental Health and established a robust network of services within each community so that people could receive treatment, services and support close to their homes. The federal Brewster Consent Decree in the western Massachusetts area, from 1978 to 1992, asserted the rights of individuals with mental illness to receive care in the least restrictive setting and increased the availability and quality of community programs.
In 1984, Executive Order 244 prohibited children under 19 from being treated on adult inpatient wards of state hospitals and led to the creation of new residential programs and a contracted vendor network for most services for children and their families. Executive Order 422 of June 2000 continues this prohibition but permits placement of certain forensically involved 17- or 18-year-olds on adult inpatient units in DMH facilities and permits youths under 19 to be admitted to certain specialty units in DMH facilities.
In 1986, Chapter 599 split DMH into separate departments of mental health and mental retardation and created a new mission for DMH to “provide for services to citizens with long term or serious mental illnesses and research into the causes of mental illness.” The Department’s enabling statute is M.G.L. Chapter 19 and its operating statute is M.G.L. Chapter 123. DMH is also governed by Regulations (104 CMR). These regulations outline the Department’s authority, mission and organizational structure, citizen participation, licensing and operational standards for service planning, fiscal administration, research, investigation procedures and designation and appointment of professionals to perform certain statutorily authorized activities.
Between 1973 and 2010, DMH closed 10 of its public psychiatric hospitals, most of them built in the mid-1800s and early 1900s. This coincided with a significant effort to place clients who were ready to transition to appropriate community settings with the necessary supports.
Recognizing the continuing need for inpatient psychiatric care for individuals who need this level of treatment, and after a seven-year planning, design and construction process, 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. DMH’s 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.
Today, DMH and the statewide mental health system are organized like this:
As the State Mental Health Authority, the Department of Mental Health (DMH) assures and provides access to services and supports that are person-centered and recovery-focused to meet the behavioral health needs of individuals of all ages, enabling them to live, work and fully participate as valuable, contributing members of our communities. The Department’s network provides services to approximately 21,000 individuals with severe and persistent mental illness across the Commonwealth, including children and adolescents with serious emotional disturbance and their families through a continuum of care. DMH is also statutorily responsible for admitting 8,000 to 9,000 forensically involved individuals to our hospitals who are referred from the courts for evaluation and aid in sentencing.
The large majority of DMH clients (more than 90 percent) are served in the community. DMH’s Community First initiative has resulted in an expansion of community services such that we are able to rely much less heavily on institutional settings such as state hospitals. Advancement in our community service system means that more individuals are living and working in the community, contributing to the fabric of our society, as they experience recovery. While the majority of DMH clients are served in the community, there are some individuals (approximately 10%) whom will require inpatient services at any given time during the year.
In order to serve these individuals that require inpatient services, the Department’s Statewide Inpatient System consists of various components, largely in the private sector with some state-operated services.
- Continuing inpatient psychiatric care provides ongoing treatment, stabilization and rehabilitation services to the relatively few individuals who require longer term hospitalization that are beyond the capacity of the acute inpatient system. These individuals are generally transferred to DMH after the conclusion of an acute inpatient course of treatment in a general hospital psychiatric unit or private psychiatric hospital licensed by DMH and admitted to the first available bed in a DMH-operated inpatient unit or state hospital.
- Acute inpatient psychiatric care provides short-term, intensive diagnostic, evaluation, treatment and stabilization services to individuals experiencing an acute psychiatric episode.
- DMH also contracts for six Intensive Residential Treatment Programs (IRTP) for adolescents (85 beds total) and one Clinically Intensive Residential Treatment Program (CIRT) for children ages 6-12 (12 beds total).
- There are more than 65 general hospital psychiatric units or private acute psychiatric hospitals licensed by the Department (including more than 360 beds in DMH licensed facilities in the Southeast). More than 70,000 individuals, most of who are not involved with DMH, are admitted to inpatient psychiatric hospital settings each year.
Structure and Organization
The DMH structure is Area-based and operates in a way that recognizes the unique characteristics and needs of each community and the people who live in them. DMH is organized into five geographic Areas, each of which is managed by an Area Director. The Areas are: Metro Boston, Western Massachusetts, Central Massachusetts, Southeast and Northeast-Suburban.
Each Area also has a full-time medical director, a half-time child psychiatrist, a director of community services, a director of child/adolescent services and a director of quality management and is further subdivided into local service sites. There are 28 DMH Site Offices statewide, each of which is overseen by a Site Director. Site Offices provide case management and work with an integrated system of state and vendor-operated adult and child/adolescent mental health services.
The DMH Central Office in Boston has four divisions in addition to the Commissioner’s Office and the Legal Division. They are: Mental Health Services, Child and Adolescent Services, Clinical and Professional Services and Management and Budget.
The DMH Central Office is responsible for service and program planning; setting and monitoring Department policy and standards; and oversees fiscal, personnel and legal functions.
The Department allocates funds from its state appropriation, trust fund and federal block grant to the Areas for both state-operated and contracted services which include two state hospitals, six community mental health centers (three with inpatient units), adult continuing care inpatient units at two Department of Public Health hospitals, contracted adult and adolescent inpatient units. DMH also funds through mostly contracted service providers a community based system that provides services and supports to about 19,000 DMH consumers.
This information is provided by the Department of Mental Health.