1980-89 Danvers State Hospital Chronicles

Suit Filed Over Ill Mental Patients Jean Dietz, Boston Globe February 27, 1985

A class action suit, alleging that more than 200 patients in state mental health facilities with serious medical problems are receiving inadequate care, will be filed against state officials in US District Court in Boston today.

Naming eight plaintiffs, whose illnesses range from epilepsy to congestive heart failure, as victims of grave medical and nursing care problems in various facilities, the suit seeks money damages for all such patients and court judgment that the facilities violate state and federal constitutional rights. The suit is brought on behalf of the patients by Palmer and Dodge, a Boston law firm, and the Lawyers' Committee for Civil Rights under Law of the Boston Bar Assn. The action was taken following a year of effort to negotiate with human services officials to correct conditions surrounding the care of patients, Barbara Arnwine, executive director of the legal group, said yesterday. Patients cited in the case are confined at Lindemann Mental Health Center, Solomon Carter Fuller Mental Health Center, Metropolitan State Hospital and Danvers State Hospital. They include a 55-year-old Spanish-speaking woman who has diabetes, arthritis and chronic schizophrenia, a 33-year-old woman who has chronic bleeding from a peptic ulcer, asthma, chronic renal failure, hypertension and a borderline personality disorder, a 52-year-old man with hepatitis, nephritis and organic brain damage and a 56-year-old man with temporal lobe epilepsy and a chronic urinary tract infection who fell while being bathed and fractured his hip. "Our information shows that physically ill mental patients are constantly neglected due to the lack of minimally adequate medical care on state hospital and mental health center units," said Darcy DuMont, an attorney at the Mental Health Legal Advisors Committee, one of the groups that investigated medical care for mental patients.

The group found that "with so few staff, limited staff training, totally inconsistent medical record-keeping and faulty or nonexistent medical equipment, there is no way anything approaching adequate medical care can be provided," Dumont said. A suit by the US Justice Department against Worcester State Hospital, charging the state with depriving 435 patients at the hospital of their constitutional rights to proper and safe care and medical treatment, was filed in the same court last week. The suit also follows disclosure of three deaths at Solomon Carter Fuller Mental Health Center of patients whose medical complications allegedly went undetected.
In a related development, legislation has been filed by Sen. Jack Backman (D-Brookline) to provide needed medical services or appropriate placements for physically ill state mental patients. Backman said yesterday that his investigators at the Solomon Carter Fuller Center found that "there were no doctors or nurses on the ward for the eight- hour period in which each of the three Fuller patients died." Named as defendants in the new suit are Mental Health Comr. James Callahan, Dr. Mona Bennett, deputy commissioner; Public Health Comr. Bailus Walker, Human Services Secretary Philip W. Johnston and Gov. Michael S. Dukakis.

New Chief At Danvers Aims High Ray Richard, Boston Globe March 14, 1988

The message surprised Peter Van Almkerk, a 36-year-old forensic medicine specialist who was nearing the end of his requirements for a doctorate in human organizational development. Call the commissioner's office right away, he was told in mid-January while doing casework at Bridgewater State Hospital. He was even more startled the next day, Van Almkerk recalls, when the state commissioner of mental health asked him to become the new head of Danvers State Hospital, a crowded institution for the mentally ill whose director had resigned a week earlier in the wake of criticism over the death of a patient. I was on another career path," Van Almkerk said. "I had just about finished my doctoral studies, I was at the end of my dissertation and my orals were scheduled for July." But he had worked with health institutions for 17 years, and he was familiar with many of the hospital's problems because his office as a regional forensic field manager had been in the same building as the hospital director's office. He also knew the North Shore and many of the workers in the health care agencies with whom he would be working. So he accepted.

Today, Van Almkerk has put his doctoral studies on hold and is breathing new life into the hospital that has served northeast Massachusetts since 1878. Instead of the 20 hours he was working for the department while teaching and pursuing his doctorate, he now finds 12-hour days normal and acceptable, Van Almkerk said recently while moving from one staff meeting to another and checking his calendar to see what meetings he had later in the day. Crowding at Danvers State Hospital is one of several major problems Van Almkerk hopes to address. For the last 10 years the mental hospital has been located in what had once been an acute-care medical facility. Before that, the mental hospital was located in the massive red brick and sandstone Kirkbride Building atop Danver's highest hill. The 110-year-old castle-like Kirkbride Building near Route 1 had housed up to 2,500 patients until it was closed, badly deteriorated by a century of use and too big and outdated to be needed any more for mental patients. The development of medicine to control aberrant behavior, an enlightened approach to mental illness and the establishment of a statewide system of community health centers since the early 1960s had shifted the treatment of mentally ill from institutions to community centers.

Danvers and the six other state mental hospitals had 25,000 patients in 1960. Today they have about 2,500. There are not fewer mentally ill people today, according to Assistant Mental Health Commissioner Kevin Preston. "If anything, there's more. But vast majorities of them can now lead relatively normal lives in the community through medication," Preston said. After Kirkbride's doors were locked, its patients were transferred to the nearby Bonner Building, which had been the acute-care hospital. While many patients left the institution at that time, the severest cases remained. Van Almkerk's hospital now houses about 300 patients in a facility built for 160. In addition, the hospital has trouble hiring -- and keeping -- employees, including doctors, because of low pay and the poor image many people have of working directly with the mentally ill, said Van Almkerk. "My major concern," he said, "are life-safety issues in terms of who is missing, the medical care we can provide, the whole issue of: Can we evacuate the building in a safe way if there were a fire or the electricity went out." Staff morale fell after widespread publicity followed the death of a patient who wandered out of the hospital last December, Van Almkerk said. The body of Ann Houghton, 61, of Lowell, was found the next day, 200 yards from the hospital. A preliminary autopsy report said she died of a heart attack. Because of the 17-hour lapse between Houghton's disappearance and the finding of her body, relatives of patients and advocates for the mentally ill charged that administrator William Bonnes was lax in the attempt to locate her. Bonnes resigned. A departmental investigation into the death criticized the hospital for not conducting a more efficient search of the 37 buildings and 540 acres of grounds.

That controversy was the second to hit the state facilities complex since last summer, when a series of articles in the North Shore Sunday newspaper criticized the way the Hogan/Berry Regional Center for the mentally retarded was run. The articles triggered protests charging mismanagement and civil rights violations by Superintendent Edward Budelmann. The Department of Mental Retardation, which was established last July, later cleared Budelmann of wrongdoing. But both reports pointed to problems at "Danvers," once solely a mental health facility that now houses operations for the departments of mental retardation, public health and youth services, and food and agriculture. Because of the crowded conditions and the need for more modern facilities, the state plans to build a 135- to 160- bed hospital on the Danvers State Hospital grounds. Designers are being hired, Preston said. Meanwhile, Danvers officials and private developers look longingly at the landmark Kirkbride Building 15 miles from Boston and the rolling hills and fields that surround it. "The town has had a definite interest in that property for many years," notes Town Manager Wayne Marquis. "It's a very valuable piece of property. It's the largest piece of open space in the town of Danvers. Developers driving by it become glassy-eyed." Kirkbride, which is listed onthe National Register of Historic Buildings, should be preserved because of its architectural and historical significance, Marquis said. The Kirkbride Building, "although impressive, is neither appropriate for or capable of cost-effective rehabilitation for modern hospital standards," a 1985 state study said. The towns of Danvers or Middleton, where some of the property is located, could get the building or some of the land -- but only if the state gives it up.

State Says Patient Release Was Not Due To Crowding Rene Loth , Boston Globe June 23, 1988

Edward Murphy, the state commissioner of mental health, said yesterday that the release of a Danvers State Hospital patient who stabbed and critically wounded his mother last week was "categorically" not related to chronic overcrowding at the facility. "The reason we have overcrowding is that we're not discharging indiscriminately," Murphy said. "The overcrowding situation at Danvers has actually gotten somewhat worse because of our caution on discharges." Murphy has directed two of his deputies to conduct a full review of the release and follow-up care of Daniel Connolly, 21, who was discharged from Danvers State Hospital two months ago. Connolly, who had been a patient at the hospital for five years, allegedly stabbed his mother seven times with a steak knife and screwdriver in her Lawrence rooming house last Wednesday night. Connolly's mother remains in critical condition at Lawrence General Hospital and friends said yesterday they had been told by the hospital she was in a coma. Connolly was charged with attempted murder and sent to Bridgewater State Hospital for psychiatric evaluation. Murphy said the investigation will focus on the "clinical judgments" made by an evaluation team at Danvers State Hospital in releasing Connolly, described by friends of his mother as a disturbed young man prone to violent behavior. The investigation will also center on the follow-up care Connolly received from the hospital.

"It's clear that there was deliberate clinical review by qualified clinicians," Murphy said of the decision to allow Connolly to leave the facility. "The question is to look behind the procedures to the clinical judgments." Murphy would not comment on the specifics of Connolly's case, citing patient confidentiality. But he said Connolly was assigned a "very aggressive" case manager after his release, who visited him daily. He refused to comment on police reports that Connolly had apparently stopped taking prescribed medication before the stabbing.

Murphy said he agreed with mental health advocates who have charged that a lack of sufficient community residences can often leave former mental patients with no place to go after they are released from state institutions. He said bureaucratic delays and community resistence have slowed the construction of halfway houses and other transitional residences Gov. Michael S. Dukakis promised in a $110 million initiative in 1985. But he said at least 60 new residential units would be placed "on line" between July and October in the area served by Danvers State Hospital. Speaking to reporters yesterday, Dukakis said the community residences are proceeding "as expeditiously as possible." He added: "We're not going to release patients from the hospitals . . . unless we know that there are good community services and facilities." In Connolly's case, however, the former patient simply moved into a room in a boarding house at 53 Bradford St. in Lawrence, a neighborhood state Rep. Kevin Blanchette (D-Lawrence) described yesterday as "troubled" and "marginal." Lawrence Police have described Bradford Street as an area where drugs are dealt openly. Louise Ferris, commissioner of inspectional services in Lawrence, said the boarding house is in good condition and passed a licensing inspection in May. But she said neighboring buildings had numerous sanitary code violations. Some have been the site of fires and others have been condemned, she said. The lack of transitional housing has resulted in a steady increase in the patient population in state hospitals such as Danvers, at more than double its capacity. Murphy said that at least 500 patients in hospitals statewide are "clinically ready for discharge with no place to go." In addition, 270 mentally retarded citizens have been inappropriately placed in the state mental hospital, he said. He also said several hundred elderly patients suffering from medical problems contribute to overcrowded

State Unveils Plan to Buy Houses for Ex-Mental Patients. Richard Kindleberger, Boston Globe July 9, 1988

State mental health officials are getting into the real estate business with a $9.5 million pilot program aimed at speeding up the creation of community residences for discharged patients. By acquiring existing houses rather than contracting for space through private agencies or other public organizations, the state hopes to reduce the time it takes to create group homes and thus relieve pressure on crowded mental hospitals. The issuance of a Request for Proposal asking homeowners and real estate brokers to consider selling houses to the state was announced at a news conference by Philip W. Johnston, secretary of human services, and Edward M. Murphy, commissioner of mental health. "The significance of this RFP is it's unprecedented," said Murphy. "Never before has the Department of Mental Health gone directly into the real estate market." Johnston and Murphy explained the new program from behind a kitchen table at a model group home on Poplar Street. Eight men and women, who were away at jobs or day programs, live in the supervised residence, which is run by the Northeastern Family Institute, a private social services agency based in Danvers.

The push to produce more group homes comes as the department is under pressure to relieve overcrowding at its hospitals. Danvers State Hospital, which serves Danvers and 49 other cities and towns in Essex County and part of Middlesex County, is the most crowded of the state's mental hospitals, with more than twice the number of recommended patients. It has been plagued recently by administrative resignations. The shortage of community residences was highlighted after the June 15 stabbing of a Lawrence woman, allegedly by her 21-year-old son, who had been released two months before from Danvers state. The son had been living in a rooming house in Lawrence following his release. Murphy, while acknowledging that bureaucratic delays and community opposition had slowed the creation of group homes, has denied that the man had been released prematurely because of overcrowding at the hospital. Murphy said yesterday that there are about 55 patients at Danvers who are well enough to be released if space were available in an appropriate community residence. Officials said the Danvers region has 311 beds in community residences. Another 121 are in preparation and expected to become ready between now and next July, while the new direct-purchase approach is expected to produce an additional 100 beds. Overall, the Dukakis administration has plans for 3,500 new community-residence beds across the state. Later this year the direct-purchase approach will be applied in the southeastern Massachusetts and Boston areas, Murphy said. Geoffrey Brahmer, director of the Alliance for the Mentally Ill, reacted enthusiastically to the state's initiative. "I think it's a fantastic idea and we wish them well," he said in a telephone interview.

Massachuetts Is Under Criticism For Poor Care of the Mentally Ill. Susan Diesenhouse, New York Times August 21, 1988

The Massachuetts system for the mentally ill, now in the midst of a five-year overhaul, is being faulted for poor care and unsafe conditions by legislators, patient advocates and mental health professionals and administrators. The Massachuetts system for the mentally ill, now in the midst of a five-year overhaul, is being faulted for poor care and unsafe conditions by legislators, patient advocates and mental health professionals and administrators. Delays in paying for part of the overhaul plan have led some to doubt that it will be fully carried out. A string of patient deaths in the past year, meanwhile, has led some mental health experts and patient advocates to question whether the plan will solve the problems in the system of 7 hospials and 10 community health centers that treat 110,000 people a year.

The hospitals hold about 2,200 seriously ill patients while most of those treated at the health centers live at home, with some housed at the facilities. To balance state budgets for 1988 and 1989, Gov. Michael S. Dukakis, the Democratic Presidential candidate, has withheld about $17 million that the Legislature allocated to expand care for the mentally ill, according to Edward M. Murphy, the Commissioner of the Department of Mental Health. The Governor inherited a system of badly deteriorated state hospitals after his first election in 1974. But well into his third term, some patients in the state system for the mentally ill are kept in rooms where temperatures reach more than 100 degrees and sleep on bare mattresses in crowded facilities that are in need of repair. None of the hospitals are accredited and in 1986 the system was ranked 41st among the states in a survey by the Public Citizens Health Research Group, a consumer advocacy group in Washington. $558 Million Voted for Plan In 1985, amid concern that a Federal court would take over the mental hospitals as it had the state's institutions for the retarded in the 1970's, the Governor proposed his five-year plan to improve care and facilities for the mentally ill. The legislature approved the plan that called for renovation of hospitals and health centers, the construction of some new facilities and increased staffs and improved services. The Legislature has allocated $558 million for the program so far.

Philip W. Johnston, Secretary of the Executive Office of Human Services, said that despite withholding funds, ''The Governor has recognized the problem in care for the menally ill which resulted from a generation of neglect and made the financial and political committment to radical reform.'' Mr. Dukasis, after being defeated in the Democratic primary in 1978 in his first re-election bid, won a second term in 1982 and his third in 1986. As for the quality of care today, Mr. Johnston said, ''At the moment there is a lag between the allocations and implementation of the plan.'' In the past year, the deaths of nine patients at Worcester State Hosptial and the deaths of seven at Danvers State Hospital have been questioned by patient advocacy groups. Commissioner Murphy found poor emergency medical care and a lack patient supervision by hospital staff members in four of the seven deaths for which investigations have been completed. Two of the other deaths are under investigation while Mr. Murphy has not called for inqueries in the other cases. After public hearings on eight of the deaths in Worcester, the Legislature's Committee on Human Services found ''major systemic problems'' leading to seriously deficient care. In a letter to Commissioner Murphy last week the committee chairmen, Representative Paul Kollios, a Democrat, and Senator John P. Houston, Democrat, called for an end to ''Band-aid' solutions'' and the start of ''major changes which are long overdue.''

Lawsuits Filed in Two Deaths
On July 26, two lawsuits were filed in State Superior Courts by the families of two of the patients who died at Worcester State Hospital, seeking compensation for what the suits said were the violations of the patients' civil rights. Steven J. Schwartz, the lawyer for the families, said one man was mentally retarded, should not have been admitted to the hospital and did not receive medication, which led to a fatal sezure. The other patient developed pneumonia that was not treated and neither patient received proper emergency care, Mr. Schwarts said.

On June 1, the Alliance for the Mentally Ill, an advocacy group, filed suit in State Supreme Judicial Court, asking the court to declare unconstitutional the Governor's withholding of the allocated funds without legislative consent or public hearings. Geoffery G. Brahmer, the group's director, said he feared that the five-year plan might not be fully implemented if such cuts continued. He said, ''Delays mean more time people must spend in barbaric conditions and shows the Governor's commitment to mental illeness.'' Commissioner Murphy said that the funds withheld had been designated to pay for construction of supervised group homes for the mentally ill who do not require hospitalization.

Of the 2,200 hospital patients, Mr. Murphy said that several hundred are well enough that they could have been moved to the group homes had they been constructed. Those discharged would have relieved overcrowding in hosptials that are 104 percent to 220 percent of capacity, he said. ''If private psychiatric hospitals we license did this, we'd close them down,'' Mr. Murphy said. Mr. Murphy called the building where hospitalized patients are treated at the Dorchester-Mattapan Community Mental Health Center in Boston ''an embarrassment.'' On one recent day, some of the 60 patients in the building, who receive no vocational training, paced the floor muttering. One slept on a bare mattress on the floor in a cell. Bathrooms had clogged toilets, sinks filled with stagnant water and towels tucked around leaky tubs. Pieces of the bathroom walls were missing. 'Totally Unacceptable' Gerry Morrissey, the Mental Health Department's director for that region, said such conditions are ''totally unacceptable and clearly not what we want for our patients.'' At Metropolitan State Hosptial in Waltham, temperatures that recently reached 93 degrees in the patient areas contrasted to the air-conditioned administrative offices. Many windows at the hospital do not open, 20 patients may sleep in one dormitory and share one shower and a day room where cigarette butts litter the floor. Anne M. Corapi, president of the Alliance for the Mentally Ill, said: ''It took months to get the administration to open the window in the seclusion room where it gets to 105 in the winter.'' Audrey Y. Deloffi, chief administrator for Metropolitan State Hospital, said refurbishing started in June in some areas and that an $18 million rennovation was being planned.
Angela K. Leech, a member of the board of the alliance, called for ''a blue-ribbon panel to get the Department of Mental Health back on track.''

Mental Health System Ailing Despite State Plan. Diane E. Lewis, Boston Globe September 11, 1988

On the grounds of an abandoned state hospital in Mattapan, there is an old brick building where 50 mentally ill patients have been waiting for new quarters for nine years. A group touring G Building last month found toilets caked with excrement, bathtubs filled with dirty water and cracked windows lined with rags. Soiled clothes lay on a tiled bathroom floor; antiquated showers were caked with soap and scum. Nearly three years after Gov. Michael S. Dukakis announced a five-year plan to upgrade Massachusetts' ailing mental health system, G Building -- on the grounds of the former Boston State Hospital -- is a vivid example of the conditions in which some of the state's most profoundly disturbed residents still live. At the same time, it is becoming increasingly apparent that Massachusetts has a dual system of care. The westernmost counties provide an improved array of court-mandated counseling, housing, emergency and employment programs for the chronic mentally ill.
Elsewhere, the state has a spotty record of achievement. New programs have opened and new staff have been hired, but the major reforms that advocates had hoped for have not occurred. Funds for some hospitals and inpatient community centers have dwindled, freezing plans and delaying programs. Part of the problem stems from long-standing policies that poured money into selected areas while others got less.
Overcrowding is still a problem and patients continue to languish in jammed, outmoded facilities where it is difficult to improve the quality of care. "General conditions are still so deplorable in many state-run institutions that quality care and treatment are almost impossible," said Stan Goldman, executive director of the Mental Health Legal Advisors Committee. Patients who are ready to leave must wait months before they can move into a neighborhood group home. Their situation is aggravated by indifferent or hostile communities whose residents fight against homes for the mentally ill in their neighborhoods. Often, opposition in the suburbs drives the mentally ill into cities, where they are ignored. Many of the problems the mentally ill face are not new, but stem from the system's failure to develop comprehensive plans for the care of the thousands of disturbed men and women who were released from institutions in the 1960s and 1970s. Many are still living on the streets, in shelters or at home with relatives who must shoulder much of the burden for their care. Aware of the problems of deinstitutionalization, mental health observers now fear that the commitment Dukakis made in 1985 is waning. Officials contend the administration is doing all it can to improve care for the mentally ill.

"You won't find another state that remotely approaches the commitment Massachusetts has made in terms of mental health," Human Services Secretary Philip W. Johnston said recently.

G BUILDING'S SAGA

Most of the men playing dominoes in the basement of G Building on a hot day last month were black, poor and hailed from Dorchester or Mattapan. Seated around a table, they talked quietly in a cramped, poorly equipped recreational area.
A scarred, lime-green piano with one leg missing and yellowed keys stood in the corner of an empty meeting room upstairs. The room had new pastel furniture. The walls were dingy and bare. A man in a locked room peered out of a small window covered with mesh. He screamed, muttered and screamed again.

Outside, cigarette butts, plastic cups and other trash littered an entrance surrounded by weeds. Following a tour of the facility some time ago, Richard H. Rowland, executive deputy director of the Massachusetts Association for Mental Health, said he felt as if "I was walking through an underdeveloped country. All I could think to myself was, 'Is this the best we can do?' " The story of G Building is not unlike others in the system. Nine years ago, the patients were transferred there temporarily. They were to remain at the facility until officials could fully implement a $2 million plan and move them into newer quarters in a research building nearby. The money never came through.
Last month, about two weeks after reporters toured the facility, state officials announced a $1.2 million plan to upgrade G Building. They also discussed plans to construct a multimillion dollar mental health research and residential center in the area.
"I'm glad they finally decided to fix up G Building," an advocate said.

FUNDS HELD UP

More than $500 million has been targeted for expanded mental health services, but bureaucratic red tape and legislative procedures held up the appropriation of a $340 million capital outlay until December. Critics contend the Dukakis administration chipped away at the rest.
This year, the governor's secretary of administration and finance, Frank Keefe, recalled approximately $100 million in mental health and human services + funds to balance the budget. The move placed funds for research, additional case managers and spending money for institutionalized persons in limbo. Angry members of the Alliance for the Mentally Ill of Massachusetts sued Dukakis and Keefe, charging them with illegally returning to the general fund money already appropriated by the Legislature. A spokesman for the Department of Mental Health maintained the reversions had little impact on the expansion program, but said funding delays for capital improvements stalled most of their plans. "We just got approval from the Legislature to spend the capital money last December and that was two years after the governor's message," said Kevin Preston, assistant commissioner of community relations. "That included fast- track money, which we've used to move quickly on a number of things." Thus far, the Department of Mental Health has received $140 million in expansion funds, including "fast-track" money for emergencies, general repairs and safety code improvements at hospitals and inpatient centers, according to Mental Health Commissioner Edward Murphy. "The problem is that the fast-track money is on a slow track," said Rep. David Cohen, a Democrat from Newton who is chairman of the Committee on Bills in Third Reading. "Basic things like fire alarms, carpeting, showers, heating, air conditioning, plumbing -- things for which money was fast-tracked in 1986 -- weren't received by many of the hospitals as of May 1988," he said. "Some of it is in the pipeline, but the majority of it is not," Cohen continued. "Why the holdup? It was part of a larger picture that involved the budgetary crisis: A decision was made to slow down spending." Edwin Newman, a retired Harvard University professor and a member of the governor's Advisory Council on Mental Health, said recently that he had high hopes when he first got involved in the expansion program. That has changed. "I don't want to represent that some good things have not been accomplished, but they have been accomplished at great cost," he said. "The loss of headway that goes into starting and stopping are dollars down the drain, a loss of morale and a loss in planning that has not gone anywhere.

OVERCROWDING CONTINUES

Six months ago, Murphy announced plans to cap admissions to state institutions and urged other agencies to claim patients who were not severely ill. At the time, mental health observers and professionals hailed Murphy for taking a stand against crowding. Today, there is little appreciable change. Of the more than 2,000 persons in state hospitals, 535 belong in facilities for the mentally retarded or in chronic-care medical hospitals. Other patients are ready to leave but cannot because of a lac k of group homes.
Overcrowding is apparent at Danvers State Hospital, where eight beds are jammed into rooms made to hold no more than four. In all, 137 new staff have been hired to work at Danvers since 1986, but staff complained recently of having too little space for meetings and activities. Too many patients and a cursory search apparently played a part in the disappearance and subsequent death last winter of a 61-year-old Danvers patient -- one of 12 at the facility to die in two years. Anne Houghton's body was discovered against a stairwell, just 200 yards from the building where she had lived. She was found, dead of a heart attack, 17 hours after she slipped away unnoticed.
Investigators reported that the hospital should have used emergency search procedures. Instead, security personnel searched the campus by car. According to the probe, 300 patients were housed at Danvers when Houghton disappeared. The complex was built to hold no more than 130. "The overcrowding situation is frustrating," acknowledged Preston. "But when we call up the Department of Mental Retardation or some other agency and we say, 'Look, we're at 220 capacity at Danvers; you've got to take some of your people,' they say they're 99 percent full." Part of the problem stems from the shortage of group homes. Since 1985, the Mental Health Department has created 771 residential beds in various communities, excluding those on the grounds of institutions. But the new beds do not even approach the need. In Greater Boston alone, close to 2,000 people were awaiting community placements this year. Yet only 270 beds were completed between fiscal years 1986 and 1988. Another 198 are scheduled to become available sometime in fiscal 1989.
The problem is compounded by community resistance. In Westborough, for example, residents formed a group that held up the opening of a home for months. In some cases, it has taken four years to open a residence. "The majority of the mentally ill are not violent," said Murphy, who has developed an antistigma campaign to educate the public. "They want the same things out of life that most of us do, but they are stereotyped by the public and the perception often stems from the media.

PROBLEMS IN WORCESTER

It was just a thud, but the sound echoed in a corridor at Worcester State Hospital. A patient had pushed another man out of a chair and onto the floor. At the end of the hall, a 21-year-old man wandered into an empty room. Diagnosed as self-abusive, he wore a red helmet, a sling on one arm and padding on another. He muttered to himself and then leaned his head against a wall. Across the hall, a row of men slept in chairs or stared vacantly at a television set. No doctors or nurses were visible on the ward. An administrator touring the ward found two mental health assistants sitting on the sidelines watching television, unaware of the scuffle that had taken place in the corridor.
In the past year, Worcester State Hospital has been dogged by reports of patient deaths and abuse. Former staff are now central figures in a suit filed by the relatives of two patients who died while receiving treatment at the facility. The suit charges that the patients might be alive today if they had received proper medical and emergency care. It also charges that patients were drugged against their will. The Department of Mental Health responded by requiring emergency medical training for hospital personnel at the facility. But one official acknowledged recently that there is still room for improvement: Mental health assistants who are regarded as frontline staff do not have to have high school diplomas and often receive no more than a we ek of training.

GEOGRAPHIC DIFFERENCES

Mental health care for the chronic mentally ill in Massachusetts varies greatly across the state.
"Historically, the communities with the best legislators and lobbyists got the most funding," explained Anita Pyatt, past president of the alliance. Figures appear to bear out Pyatt's statement. In 1985, for example, the per capita appropriation for mentally ill adults in Dorchester was $22.57. In West Roxbury, Roslindale and Hyde Park, the appropriation was $32.76. In Concord, which has received staunch legislative support over the years, the appropriation was $51.59 per adult. The state is gradually increasing funding to inpatient centers in Boston, which have been among the most underfunded in the state. But the most dramatic funding and service changes have not occurred because of legislative support, but because of court intervention and a 1978 consent decree. Today, western Massachusetts is the only region in the state with a completely new mental health system. Although many of its patients still need community housing, the area has a system of care that provides ongoing case management for years and offers a network of support services in the community to a region with 800,000 people. Of those, about 15,000 are believed to be severely mentally ill. This year, 24 elderly persons who would have been given up for lost a decade ago were transferred from Northampton State Hospital to a residential program in Holyoke. Hospital staff went with them. "At the time we sued the state, the history of mental health in western Massachusetts was one of low priority," recalled Steven Schwartz, an attorney with the Center for Public Representation, which filed the suit that led to reorganization. In 1978, western Massachusetts received $14.2 million from the state for hospital and community services. Today, it receives about $63 million, according to Andrew Phillips, director of mental health services for the region. "Nothing that we did here is technically impossible and can't be done without the court," said Schwartz. "But sooner or later any major change is going to run out of steam if it doesn't have moral and legal binding. "In our case, the momentum and persistent monitoring needed to reorder the system came from an external, nonpolitical entity," he said, referring to the court.

Ex-Patient Is State Hospital Official November 27, 1988

A woman who was misdiagnosed and kept in a state mental hospital for more than 15 years has returned to the hospital as a full-time administrator. She has earned a master's degree at Harvard. Marie Balter was 16 and clinically depressed when she was diagnosed as schizophrenic and sent to Danvers State Hospital. She was released in 1966 and went back to school; she has since then worked with psychiatric patients, given lectures around the country, and and written an autobiography.

Now Mrs. Balter, who is 58 years old, is devoting her efforts to helping improve the hospital. She began work as community affairs director earlier this month. ''I wouldn't have grown one bit if I didn't learn to forgive,'' she said in a recent interview. ''If you don't forgive your parents or your children or yourself you don't get beyond that anger. ''Forgiving is a way of reaching out from a bad past and heading out to a more positive future.'' 'A Model for Many People' Marvin M. McNally hired Mrs. Balter three months into his tenure as Danvers' chief operating officer. ''She is a model for many people,'' Mr. McNally said. ''I think she serves in that way for many people - not just ex-patients. She has faced adversity, has overcome it and has succeeded.'' She was born in Boston to an alcoholic mother and was adopted by a couple in Gloucester who disciplined her harshly, sometimes locking her in the cellar. Increasingly depressed, she was institutionalized in 1947 with symptoms that included muscle spasms, choking, hyperventilation and hallucinations. Mrs. Balter said she later learned she had suffered from a form of depression and panic disorder, not schizophrenia. ''It wasn't deliberate on the part of the doctors and the hospital,'' she said. ''Not much was known about panic disorders back then. A person who had panic disorders was identified as a little bit crazy.'' Her recovery was painful and gradual, as she overcame a despair that often left her unable to eat or move. She contemplated suicide more than once. Mrs. Balter credits her turnaround her own strength bolstered with the help of friends, mental health workers and her Catholic faith for her release.

After her release, married Joseph Balter, an accountant. He died suddenly, of a blood clot, as she studied for final examinations at Salem State College, where she eared a degree in psychology. She went on to earn a master's from Harvard in administration, planning and public policy. Patient Conditions a Priority In her new job, Mrs. Balter will serve as chief hospital spokeswoman, help train health workers, recruit volunteers, find grants and assist in fund raising - ''things that will help the hospital turn around,'' she said. Above all, Mrs. Balter said, she hopes to improve patient conditions, from adding curtains to reducing overcrowding. Danvers has about 260 patients, twice its recommended capacity. This is not Mrs. Balter's first return to the hospital in Danvers, a suburb north of Boston: from 1976 to 1979 she was a social worker on community outreach cases and has run a mental health program linked with Danvers. Two years ago a television movie about her experiences, ''Nobody's Child,'' aired and since then Mrs. Balter has lectured nationwide. Her book, ''Sing No Sad Songs,'' was finished last year and she has marketed it herself to raise money for the Balter Institute, a nonprofit community mental health training center. She plans to continue taking her message of hope, self-reliance and caring to high schools, community groups and mental health organizations. ''I don't believe on focusing on all the bad stuff that might have happened,'' Mrs. Balter said. ''Everybody has problems. Life is not trouble-free. I try to make people see that.''