HomeMy WebLinkAbout1987-07-08-HSC-rpt.pdf Report of Lexington Human Services Committee to the Board of Selectmen on
Events Surrounding the Loss of the Partnership Agreement by the Mystic Valley
( Mental Health Association with the Massachusetts Department of Mental Health
July 8, 1987
Summary
The Town of Lexington has had a longstanding interest in, and commitment to,
the continuing provision of mental health services to Lexington residents For
many years the Mystic Valley Mental Health Association has played a significant
part in responding to the need for such services, and it has received annual
grants from the Town for this purpose The Human Services Committee, which is
advisory to the Selectmen, has monitored the Association's clinical services
as a condition of the grants Lexington board members of the Association are
Jacqueline Davison, George Eisenberg and Robert Snuggs
The Association whose Director is Richard M. Weiss, Ph.D. and Acting President
is Marc F Lally serves the towns of Wilmington, Burlington, Woburn, Lexington,
Winchester and Arlington and offers services to 292 chronically mentally ill
clients, 300 to 350 clients at risk of becoming chronically mentally ill and
approximately 500 additional patients The Association estimates that 90%
of its clients are severely disabled. 280 Lexington residents are served.
The organizational structure in which the Association operates is one of a
partnership with the State Under such an agreement a DeparLirent of Mental Health
( Area Director delegates authority so that the Mental Health Association is
expected to implement goals and policy as defined by the Department. Dr
Robert Cole is the present MassachnsPtts Department of Mental Health Area
Director having succeeded in January Dr Ernest Cook who died of a heart attack
The Association Director is accountable to him as well as to the Association
Board The Area Director is advised by an area mental health board of citizens
Lexington members of the Area Board include Jacqueline Michelove, Ruth Nablo,
Connie Dineen and Irwin Alterson. Frank Donnelly, a Lexington resident,has been
a member of both the Association and Area Boards and is the present President
of the State Mental Health Advisory Council.
In March the Association undertook negotiations seeking a "workable partnership
agreement" which the Department viewed as a process bringing into question the
continued viability of that agreement and calling for putting the agreement
out to bid in order to ensure continuity of service Shortly before,the De-
partment had completed a "systemic review" in which concerns were raised especially
concerning 24 children who, according to the Massachusetts Department of Social
Services, had been hospitalized during the past year without prior involvement
of the Association. Bidders included the Mystic Valley Mental Health Association,
the Community Partnership Association (newly formed to ensure continuity of
services in the Iexington area) and the Center for Mental Health and Retardation
located in Watertown. It was the Center which received the award.
The Association raised a question about due process in meetings which led up
to this action, but the Court ruled that due process had essentially, if not
totally, been observed and that there should be no stay in the implementation
of the agreement. At present services are continued with all clients at the sites
where they have received services in the past, but the Area office will eventually
provide services in one site and probably restrict services to the most disabled clients
Services will not be provided in Lexington. A recent inquiry by the Human
Services Committee and Coordinator concerning emergency psychiatric services
revealed that RePlace did not participate in regular case conferences of
psychiatric patients and discussions pertained to adults only
Report on Mystic Valley Mental Health Partnership Agreement, page 2
( Chronoloav
In early May the Human Services Coordinator heard through the RePlace Director
of a possible dissolution of the partnership agreement between the Mystic
Valley Mental Health Association and the Massachusetts Department of Mental
Health On May 6 or May 7 a meeting was convened by Ken Minkoff, Chief of
Psychiatry, Choate Sym es Health Services and Patsy Kline of Arlington
Youth Consultation Center and attended by (among others) Bab Cushman, member
of the Human Services Committee; Bill Blout, Director of lePlace;and Richard
Weiss, Executive Director of the Mystic Valley Mental Health Association.
The participants were concerned that Department of Mental Health planning
seemed to envisage adopting a new provider with lack of local representation
and participation. This led to the creation of the Community Partnership
Association. Cn May 18 at its meeting the Human Services Committee decided
to invite Dr Robert Cole, Area Director, to discuss plans for future mental health
and mental retardation services
On June 1 Dr Cole appeared for the first time before the Human Services
Committee. He explained that he had been in office since January and began
by undertaking a "systemic review" for planning purposes A report of the
review was issued dated 3/23/87, and shortly after the report was issued
MV?HA sent Dr Cole a letter requesting a "workable partnership agreement"
This led to meetings to negotiate around certain concerns brought by the
Association, but Dr Cole, feeling that the negotiations were not having a
satisfactory outcome, decided to put the partnership clinic agreement out to
bid (a precedent, apparently, in the history of mental health services in the
Commonwealth) He told the Committee that he had been aware of previous
relationship problems with the Area Office, with Special Education Directors
in the school systems, lack of response to problems of children who received
psychiatric hospitalization in the last year (according to the Massachusetts
Department of Social Services) , and problematical response to mental health
crises The Request for Proposal which preceded the bidding process emphasized
giving priority to the needs of the chronically mentally ill including a new
generation of younger, chronically mentally ill adults and responding to the
needs of severely disabled children and young adults who have turned 22 and
are in need of housing Bidders for the partnership included the Association,
the Community Partnerships Corporation and the Center for Mental Health and
Retardation Services (Met-Beaverbrook) in Watertown. The Center was awarded_
the agreement by a panel of three area directors who conducted the review
Dr Cole said he hoped "to meet the general need without
turning anyone away, but the priority will be on children with major disabili-
ties" A transition would have to be made away from one-to-one pschotherapy
as the usual treats nt in favor of prevocational, day activity and clubhouse
programs with heavy emphasis on case management to track, engage and coordinate
necessary health, mental health and social services 6 rase managers had just
been hired by the Department for this purpose
On June 15 the Human Services Committee met with Marc Lally, Acting President
of the Association Board, Jacqueline Davison, Lexington Board member; Richard
( Weiss, Executve Director; and other Board members and staff
Among the grievances enumerated by the Board were the following a history
of the Department's withdrawing and replacing partnership positions with the
losses having a deleterious financial effect; an unexpected and abortive
Report on Mystic Valley Mental Health Partnership Agreement, page 3
- termination of a negotatiation and planning process leading to the opening of the
bidding procedures; an inexplicable failure of the Department to respect
facts such as their allegation of lengthy waiting periods when these did not
exist; failure to bring direct criticism of practices; a bidding process that
seemed unduly brief; inclusion of bidders without legal standing to bid;
withdrawal of a partnership agreement jeapordizing the continued existence
of a system of services and of certain programs depending on continuation of
the partnership clinic license (Adult Day Activity Program,
Adult Day Treatment program) ,failure by DMH to review records as input into
decisionmaking even though records would support that 90% of clients had
"chronic" or "serious" problems; lack of recognition that closing down clinic
locations would result in clients failing to continue treatment; failure to
recognize that loss of partnership agreement would force MV?HA to require
State mental health clinicians (there are 30) to provide services at other
sites since the building space wouldhare to be utilized for other, revenue-
producing programs
The Association representatives alleged that the genesis of the above events
was related to insistence by the Association that board members should not be
permitted to serve on both the &ea and Association beards, failure of the
Association to defer to the wishes of the former Area Director who had sought
the position of Association Director on three occasions, and a desire by the
top LEH administration to see Richard Weiss replaced.
On July 6 Dr Cole was interviewed a second time by the Human Services Co-
( mmittee He was accompanied by Frank Donnelly, President of the State Ad-
visory Board and former President of both the Mystic Valley Area Board and
Association.
Dr Cole explained that a recently Lurpleted judicial review concluded that
the award process that had been challenged by the Association had been legally
conducted and that the award of the agreement could be implemented without
delay
Dr Cole repeated that curtailment of resources dictated that there would in
the future have to be a provision of services at one site in the cachment area,
that this would not be in Lexington, and that there would have to be a reduction
in the number of clients served so as to favor the severely disabled and chronically
mentally ill. On the basis of a review of clinic activity, data from partial
hospitalization and data from Metroplitan State Hospital there were around
150 clients who were eligible On the other hand, there would be further study
considering crisis intervention data, rase management data and data frau
day programs., and estimates of number of hard-to-reach clients
Both Dr Cole and Mr Donnelly noted that there was not as yet any formal
eligibility policy Both were in agreement that there needed to be attention
given to seriously mentally disabled children who were not old enough to be
"chronically" mentally ill. Mr Donnelly said that he and the Advisory Council
wished to place considerable emphasis on preventive services so that early
intervention would prevent problems from becoming serious and chronic Dr
Cole repeated in this respect the Depai ll ent's concern about the plight of 24
children known to the Mass Department of Social Services (reported by Joan
MacGregor, Area Director) who had been hospitalized for psychiatric treatment
without having been seen previously by the Association He commented again
that he understood that a number of directors of special education in the
area failed to make referrals to MVNRA.
Report on the Mystic Valley Mental Health Partnership Agreement, page 4
Committee members expressed some concern as to whether the process leading
up to rescinding the partnership agreeme nt was a fair one and whether there might
have been an expectation on the part of the Department that a condition of
continuation was the termination of the Association's contract with its
Executive Dr ector Dr Cole said that he considered Dr Weiss "an exceedingly
able mental health professional", that his criticisms of Dr Weiss were of a
"modest nature" while Mr Donnelly explained thatit was a prerogative of the
Association Board to hire and fire their administrator Dr Cole said that
he believed the bidding process was fair and that this was the opinion of the
Lexington residents on the Area Board as well. Moreover, three of the "wisest
area directors" who "had no axe to grind" led to the decisions which were based
an ranking of each proposal according to seven criteria. A complete record
and minutes of proceedings were open and available for inspection The Chair-
man and Other Committee members continued to express reservations about the
process which, they felt, still failed to be understandable It was agreed
that a report would be sent to the Selectmen and a letter sent to the State
Advisory Council.
Continuing concerns relate to how clients presently being served will manage
when services are discontinued, how accessibility or its lack will affect
continuation in treatment for some clients , if there will be local partici-
pation and eligibility issues
Dr Cole said that he felt an 18 month transition period would be necessary,
but for the time being services were being continued by the practitioners who
had been providing them in the past and at the same sites While there had
been some rumors that the Association might close its doors on clients being
treated by State employees, this had not yet happened. If it did, the State
employees who, for the time being, were reporting to the Area Office and not
to Mental Health and retardation Services would be available to meet the clients
"at the curb" Other sites could be found for contunation of care
Mr Donnelly assured the Caumittee that he believed the other programs operated
by the Association were reputable programs He had had a hand in developing
many of them as a parent and board member
Emergency Services for Youth
The Human Services Coordinator will be following up on the issue of psychiatric
emergency services to children. A netting was convened by the Coordinator
with Committee member participation on June 10 in which a number of community
representatives of agencies and departments participated along with Susan
Johnson, Director,Psychatric• Emergency Services, Choate-Symmes Health Services
It was brought out that while there was a "consortium" nutting regularly to
discuss adult psychaitric cases none existed for youth. Dr Weiss invited
Bill Blout, Director of PePlace to pursue this matter Mr Blout emphasized
the importance of peer networking for responding to youth crises, said that
his agency had dealt with 60-70 crises in the last year including 15 suicide
attempts