June 18, 2009
Dear Commission Members:

Anthony J. Caso Executive Director

Donene M. Williams President

Kenneth Fanjoy
Vice President

Natalie Baker Recording Secretary

John G. Wagner Treasurer

Frank Greco 
Sgt. at Arms

On behalf of the 35,000 Massachusetts public employees represented by AFSCME Council 93, we write to offer recommendations to the members of the Department of Mental Health's Inpatient Study Commission as the commission concludes the important work of advising the administration on the immediate and long-term future of inpatient care.
As the union representing the majority of men and women providing "frontline" direct care to the individuals and families who rely on the state for care, we urge you to carefully consider our input and incorporate it into the commission's final report to administration officials. Our recommendations are as follows:
Maintain Current Number of Inpatient Beds
First and foremost, we urge administration officials to strive to at least maintain the current level of inpatient beds available to those in need. While we fully recognize the scope and depth of the commonwealth's fiscal crisis, we also firmly believe that the commonwealth has a responsibility to provide a full continuum of professional mental health services. Obviously, the inpatient services provided at our state facilities are a critical part of that continuum of care.
Maintain Existing State Facilities
Several years ago, when the Romney/Healey Administration was aggressively pushing for the closure of Worcester State Hospital, AFSCME was a leader in the fight to save the hospital and prevent the scattering of its patients into community-based facilities that were unable to provide adequate levels of care. The passion and energy devoted to saving Worcester State Hospital was subsequently channeled into the effort to secure approval and funding for construction of the new, state-of-the-art hospital currently in progress on the grounds on the existing hospital in Worcester. We did so with the understanding and knowledge that construction of this new facility would impact the status of the DMH facility in Westborough. While the well documented demand for inpatient beds is a clear indicator that the state and mental health consumers would benefit from maintaining the Westborough facility, we realize that current fiscal realities would make such a scenario extremely unlikely. However, we can not and will not support any recommendations that would foster or condone the full or partial closure of any additional state facilities.
8 Beacon Street • Boston, MA 02108 • 617-367-6000 • www.afscmecouncil93.org

Retain Qualified, Experienced State Staff
A critical component of delivering and maintaining quality services to individuals and families that rely on the state for mental health care is the hiring and retention of qualified and experienced staff. Of course, this is true not only in state human services programs, but in virtually every arena - both public and private. The formula for doing so is simple: Treat workers with dignity and respect and provide them with fair wages and benefits. As members of AFSCME, our workers receive such treatment and it translates into a far superior level of care than the care provided in privately operated programs.
In 2007, then U.S. Attorney Michael Sullivan conducted an exhaustive study of state and private community care for the mentally retarded, which strongly supported this point. Sullivan noted a significantly higher incidence of abuse, neglect and sexual assault by staff against residents in privately operated/staffed group homes. The Sullivan report states in part, " "Unfortunately, after reviewing data from the Disabled Persons Protection Commission our office did note some very disturbing abuse and neglect trends in contract operated community residences as opposed to state intermediate care facilities and state operated community residences. These neglect and abuse trends, particularly sexual abuse, were of great concern to our office and show that residents in these group homes are at a greater risk of being abused or neglected. " While this report deals with DMR services, the lessons learned from it can and should be applied to any service delivered by the state - especially in human services where the quality of service or lack thereof, can and often does have life and death consequences.    As such, we encourage commission members to look closely at this report in the hope that it will help to prevent DMH from duplicating the same reckless and irreversible facility closure plan that DMR is presently implementing. We also strongly encourage commission members to consider the testimony of people such as Eileen Nicole Simon, Phd and RN. In testimony submitted on 6/7/09, Dr. Simon wrote that her son "was progressing well at Westborough State Hospital until he was discharged to a community group home six and a half years ago." Dr. Simon noted that Westborough "was a community with long-term professional staff," but "staff at the group home have minimal training or experience." She further noted that "staff turnover at group homes is high, as they seek better pay in other jobs."
Generating Sufficient Resources
While the fiscal future of the commonwealth remains unclear, it is abundantly clear that we can not provide the continuum of care needed with existing resources. As such, we believe part of the commission's recommendations should include a call to do whatever is necessary to generate adequate funding 
for state mental health services.

We believe Commission Leadholm and Secretary Bigby have both a professional and moral obligation to fight for sufficient resources for mental health services and in the absence of such resources, to encourage the Patrick Administration to support the raising of additional tax revenue. As a critical part of the campaign to deliver federal aid to our state; increase the state's sales tax; and provide municipalities with various options to increase local revenues; we know that this is not an easy and politically popular task. We know it takes a great deal of personal and professional courage. But we also know it is what we must do for the thousands of vulnerable men, women and children who do not have a voice in government. We hope commission members will see that they too share in that responsibility.
Thank you for your consideration. Should you have any questions or require any additional information please do not hesitate to contact us.

James W. Durkin
Legislative Agent

Peter P. Wright
Director of Legislation,
Political Action and Communications