The History of the Department of Mental Health
Serious, long‑term mental illness describes disorders that cause severe disturbances in thinking, feeling and relating that result in a substantially diminished capacity for coping with the ordinary demands of life. Mental illness may affect anyone, regardless of age, sex, race, income, religion or education. One in every five Americans experiences an episode of mental illness at least once in a lifetime or experiences numerous or persistent episodes. In fact, people with mental illness occupy more hospital beds than people with any other illness.
Massachusetts has been a leader in caring for people with mental illness since it built the first public asylum in America. The Worcester State Hospital opened in 1833, serving as a model that other states soon followed. Over the next century, Massachusetts established a network of public hospitals, responding to needs as they arose. A Board of Health, Lunacy and Charity, established in 1879, was responsible for overseeing and inspecting the public asylums and eventually evolved into the Department of Mental Health (DMH) in 1938.
A study commissioned by Congress in 1955 eventually led to a report, "Action for Mental Health," published in 1961, that called for creating community mental health centers and reducing the size of state mental hospitals to no more than 1,000 beds. This in turn led to enactment of the Community Mental Health Centers Act of 1963, signed by President John F. Kennedy. This legislation espoused treating people with mental illness locally, rather than in large isolated state hospitals, and led to the construction of federally funded community mental health centers across the country, 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. The goal then was to decentralize DMH and set up a network of services within each community so that people could receive help close to their homes. A federal consent decree in the Western Massachusetts Area, from 1978 to 1992, asserted the right of individuals with serious mental illness to receive care in the least restrictive setting and increased and enhanced 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 prototypes and the privatization of most care for children. This order was replaced by Executive Order 422 in June 2000, which continues the prohibition but permits placement of certain forensically involved 17 or 18 year olds on adult inpatient units in DMH facilities and permits individuals under 19 to be admitted to certain specialty units in DMH facilities.
Chapter 599 of the Acts of 1986 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 illness 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 . From 1998 to 2000, DMH revised its Regulations (104 CMR). These regulations outline the Department's authority, mission and organizational structure, citizen participation, licensing and operational standards for inpatient facilities (DMH-operated and other licensed inpatient facilities) and community programs, and standards for service planning, fiscal administration, research, investigation procedures, and designation and appointment of professionals to perform certain statutorily authorized activities.
Between 1991 and 2009, the Department closed six of its antiquated hospitals as well as the Gaebler Children's Center. In 2012, the Department will open a new 320-bed state-of-the-art psychiatric hospital located in Worcester. The design of the new hospital, named The Worcester Recovery Center and Hospital, is a national model that fosters recovery and rehabilitation and is a remarkable collaboration among DMH, the Division of Capital Asset Management (DCAM) and a collective of talented architects under the lead of Ellenzweig Associates of Cambridge, Massachusetts. It incorporates elements of light and movement inviting consumers to move from the unit, into neighborhoods of shared clinical activity space, to the downtown area which will feature shops, a gym and other aspects of community living that will foster recovery and encourage community reintegration.
Today, we know that recovery from mental illness is possible. The Department of Mental Health supports recovery in many ways, most importantly through its Community First Initiative. "Recovery Through Partnership" is the guiding principle that supports Community First for adults, children, adolescents and families with serious mental illness and serious emotional disturbance. We champion people's right to live as independently as possible in the community, and it is DMH's responsibility to support recovery and success of individuals with the lived experience of serious mental illness.
Community support services are a critical component of recovery. Living independently, building social relationships, getting an education and holding a job are goals for most people with mental illness while others may need supports for longer periods to achieve and maintain independence.
Community First focuses on the individual and for every individual there are as many paths to recovery. DMH consumers include those with serious mental illnesses. These include schizophrenia, depression and manic depression. Current research indicates that many severe mental illnesses are biological diseases that interfere with normal brain function. Genetic factors, family history, psychological or social factors, chronic medical illness, substance use and severe traumatic life crises can create a predisposition to mental illness. Mental illness is not the result of a lack of "willpower" or weak character. Mental illness can strike at any age, even when a child is very young or in elderly people.
Researchers continue to pursue the study of how biochemical, psychological, genetic and environmental factors interact and contribute to the onset of mental illness and severe emotional disturbance. The majority of psychiatric disorders can be effectively treated. Treatment, which often combines medications with therapeutic and social rehabilitation interventions, can effectively alleviate the severe symptoms of schizophrenia, such as hallucinations and delusions, halt the downward spiral of those experiencing a depressive disorder and stabilize children and adolescents suffering from severe emotional disturbance.
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. Others include the Department of Public Health, Department of Developmental Services, Department of Children and Families, Department of Youth Services (juvenile justice), Massachusetts Rehabilitation Commission (vocational services), and MassHealth (Medicaid).
DMH is organized into five 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. This includes two state hospitals, five community mental health centers, adult inpatient units at two public health hospitals, contracted adult, adolescent and latency age inpatient units and latency and adolescent intensive residential treatment programs, and community-based services.
The DMH Central Office , located in Boston, has three divisions in addition to the Commissioner's office - Mental Health 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.
To support research concerning mental illness, the Boston Psychopathic Hospital was established in 1912 as the research arm of the existing Boston State Hospital. This renowned teaching and research center was renamed the Massachusetts Mental Health Center in 1956. Research, a critical mission of the Department of Mental Health, advances the treatment, rehabilitation, and recovery of adults with serious mental illness and children/adolescents with serious mental illness or severe emotional disturbance. Research is also one of the Department's statutory requirements in Massachusetts General Laws Chapter 19, which specifically calls for DMH to "conduct research into the causes of serious mental illness."
The vitality and strength of research into serious mental illness in Massachusetts is an important and powerful tool in the treatment of these diseases. The research community carries the message of hope - hope for more effective treatments and hope for an eventual cure for mental illness. The Department of Mental Health is committed to this vision and to putting research results into practice.
At any given time, approximately 100 research studies are taking place at DMH sites and is conducted in a variety of settings across the state, mainly through DMH funding of two Research Centers of Excellence:
- The Commonwealth Research Center, located at Mass Mental Community Mental Health Center and through Beth Israel Deaconess Medical Center Department of Psychiatry and Harvard Medical School.
- The Center for Mental Health Services Research, through the Psychiatry Department at the University of Massachusetts Medical School in Worcester.
This information is provided by the Department of Mental Health.