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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