Overview of the Department of Mental Health

This section describes the makeup and responsibilities of the Department of Mental Health

Overview

The Department of Mental Health (DMH) was established by Section 1 of Chapter 19 of the Massachusetts General Laws, operates under Sections 1 through 36B of Chapter 123 of the General Laws, and is supervised and controlled by the Commissioner of Mental Health. According to DMH’s regulations (Section 25.01[2] of Title 104 of the Code of Massachusetts Regulations), the department’s primary mission is as follows:

The Department, as the state mental health authority, assures and provides access to services and supports to meet the mental health needs of individuals of all ages, enabling them to live, work and participate in their communities.

DMH operates through its central office in Boston and five area offices, located in central Massachusetts, the Boston metropolitan area, northeast Massachusetts, southeast Massachusetts, and western Massachusetts. These area offices supervise continuing care¹ inpatient services and community-based services at locations such as state-operated or contracted hospitals, community mental health centers, clinics, site offices, and other service locations established directly within DMH or through contracted vendors. According to DMH management, there were approximately 2,720 acute short-term inpatient treatment beds in hospitals throughout the Commonwealth as of October 10, 2018. These hospitals are licensed by DMH but not operated under DMH’s supervision or control. In addition, throughout the Commonwealth, DMH operates two state hospitals, units in two Department of Public Health hospitals, one mental health center, and one contracted unit that provide continuing care beds for Commonwealth citizens who have mental health disorders.

DMH Hospital or Facility	Number of Units*	Continuous Care Bed Capacity as of September 2018
Worcester Recovery Center and Hospital	10	260
Worcester Recovery Center and Hospital (Adolescent)	1	30
Taunton State Hospital	3	45
Solomon Carter Fuller Mental Health Center	3	60
DMH Units at Tewksbury Hospital	5	153
DMH Units at Lemuel Shattuck Hospital	5	115
DMH Contracted Units at Vibra Hospital of Springfield†	1	30
Total	28	693

*    Each hospital and facility may define “unit” differently. For example, one unit can be 30 beds in one facility and 9 in another.

†    Vibra Hospital of Springfield was planned to close in March 2018; however, it was still open in November 2018. Because this hospital provided care to DMH clients throughout our audit period, it was included in our audit work.

 

 

DMH had annual appropriations of approximately $207.4 million for fiscal year 2017 and $210 million for fiscal year 2018 for continuing care. In total, DMH expended $410.3 million to provide continuing care services to people with mental health disorders during these two fiscal years, as illustrated in the table below.

Continuing Care Appropriations and Expenditures

Account	Fiscal Year 2017 Appropriations	Fiscal Year 2017 Expenditures	Fiscal Year 2018 Appropriations	Fiscal Year 2018 Expenditures
5042-5000*	$0	$0	$2,900,930	$2,860,114
5046-0000	0	0	1,185,000	1,157,775
5095-0015†	207,398,658	201,778,317	205,955,340	204,545,972
Total	$207,398,658	$201,778,317	$210,041,270	$208,563,861

*    This appropriation, for child and adolescent mental health, includes the costs of psychiatry-related services for clients who are deemed medically ready for discharge from mental health facilities and are experiencing delays in discharge because of a lack of more appropriate settings.

†    The appropriation for inpatient facilities and community-based mental health is for the operation of hospital facilities and community-based mental health services.

 

The inpatient continuous care bed capacity for psychiatric clients has dramatically decreased since 1970, from approximately 12,000 beds to the current level of 693 continuous care beds. The reduction of beds over the years raises concerns over bed availability. In fact, according to DMH, as of September 30, 2018, the waiting period for a client to be admitted to a DMH hospital held steady during our audit period at about 79 days, underscoring the need to get clients ready for discharge and then properly discharged in a timely manner when possible.

DMH Client Discharge Process

According to DMH management, the discharge process begins as soon as the client is admitted to the hospital. It consists of treatment for the mental health and behavior of the client, with routine treatment plan meetings, and the involvement of family if applicable. As the client improves mentally and behaviorally and approaches his/her treatment goal, the social worker and a community representative work to identify a discharge location that will help the client continue to improve in a less restrictive living arrangement. The location could be a family home, a group home, or independent living arrangements, or the client could receive community-based clinical and rehabilitative services while living on his/her own as much as possible. The anticipated discharge date is entered in the patient file as the date approaches.

Some barriers to timely discharge include the volatility of a client’s mental health, unavailability of a discharge location, or inability to pay for housing after discharge.

Under Section 3 of Chapter 123 of the General Laws, DMH can transfer any client from any facility to any other facility that the department deems suitable to provide treatment. If transfer to a private facility is the best option for the client, the DMH area director must first approve the transfer.

Area directors review the Section 3 transfer list (known as DMH Admission Referral Tracking) of people who have been referred for transfer to DMH continuing care facilities from acute psychiatric facilities pursuant to Section 3 of Chapter 123 of the General Laws. People on this list either have been civilly committed² while at the acute psychiatric facility or are conditional voluntary³ patients.

DMH works with acute care hospitals to try to find alternative treatment locations for clients who are waiting for admission to DMH hospitals/facilities. DMH works with community providers and acute care hospitals to ensure that clients’ continuous care treatment is not in an overly restrictive environment, where they might occupy one of the scarce inpatient beds, if they do not need that level of care.

Mental Health Information System

DMH uses an information system called the Mental Health Information System (MHIS). MHIS contains all client records, including those of clients who have been admitted to, and discharged from, DMH hospitals. MHIS contains data related to admission and discharge as well as the data generated at monthly treatment plan meetings, including textual data to document the results of those reviews. DMH can query and export certain fields from the Meditech company’s Health Care Information System, such as admission date, discharge date, facility name, patient identification number, and legal status (i.e., type of admission) to MHIS. According to the Executive Office of Health and Human Services’ (EOHHS’s) information system security manager, MHIS has approximately 188,900 patient records, 84 clinical user profiles, and 54 care manager user profiles. EOHHS provides independent oversight of all DMH’s information technology systems and data.

1.    Patients admitted for continuing care generally present serious and significant psychiatric symptoms requiring extended hospital stays with levels of care beyond those of an acute care hospital. They may also have complex co-occurring medical conditions.

2.    “Civilly committed” refers to patients who have been committed by a court pursuant to a petition filed by a DMH facility (typically under Sections 7 and 8 of Chapter 123 of the General Laws). Some patients are sent to DMH directly by the criminal courts for evaluation of their competency to stand trial or criminal responsibility (pursuant to Section 15[b] of Chapter 123 of the General Laws). Patients who are found to be incompetent or to lack criminal responsibility may be committed for treatment pursuant to Section 16 of Chapter 123 of the General Laws.

3.    Conditional voluntary patients are those who have requested admission to a facility and been accepted by the facility (pursuant to Sections 10 and 11 of Chapter 123 of the General Laws).

Date published:	August 1, 2019