Response to The Boston Globe Spotlight Series

The Globe Spotlight series titled “The Desperate and The Dead” tells a story that is both out of context and distorted. The story essentially alleges that the current mental health system is killing people and ignores the fact that we used to simply put these people away – out of sight and out of mind. I have been working in the field of mental health for nearly forty years, am the CEO of a community-based provider organization and was interviewed for the story. To say I am dismayed and disappointed is an understatement.

The system of community-based care – and yes it is a system – is an alternative to the sad warehousing that was the prior system of care. If you never smelled the urine in the old State Hospital buildings or saw the broken spirits of the thousands of people who lived in the previous system which ostensibly made sure patients were “safe,” you cannot know the remarkable stories of the tens of thousands of people who were not mentioned, even once, in this first article. These tens of thousands of people used to be locked up and are now working, have meaningful relationships, and are successfully living in your community.

The Secretary of Health and Human Services was quoted as critical of the current system of care. I have heard her use the words that appeared in the story – making the case that we all have a lot of work to do and that we can do better. She is, in fact, working hard and is key to the ongoing improvement of the system, and is not the problem. Yes, as hospitals closed an imperfect system took their place.  The aim was right – the money and the skills were not always there. The Secretary, like me and my colleagues, holds the system to the highest standards. The money will never be enough, and we will always have a lot to learn. But it is misleading to ignore the thousands of people who are in fact receiving excellent community-based care.

Every individual and family that has suffered from violence (which the Globe story mentions is no more prevalent among those with mental illness but then moves on) is one too many. The system of care can do better and we are working at it – but it is a process, not a moment in time. Community providers, hospitals, and, yes, government are working hard to continually improve services. This takes place in a context of limited dollars and frankly, deferred attention in some areas such as emergency room boarding and adequate access to key levels of care – including outpatient services.  Ironically, these specific areas are being addressed by the current Governor and Secretary with skill and full attention.

Finally, the argument that underlies the article – that forced treatment would have eliminated the deaths that occurred is simplistic at best. Massachusetts has committed itself to treating people with respect and dignity. The system has succeeded in enabling thousands of people to accept and benefit from care, including the very small minority people who have had a risk for violence.  We have chosen a more complex path than forced care. Many thousands have benefited. We will keep working at it.

~Scott M. Bock, Founder and President/CEO