Mass. nurses call for special hospital unit for court-involved psychiatric patients

Two major unions representing Massachusetts nurses and health care workers told lawmakers that there aren't enough beds in psychiatric hospitals to accommodate an influx of patients sent for evaluation by the courts.

Representatives from the Massachusetts Nurses Association and the Service Employees International Union 509, which represents human service workers, told the Legislature's Joint Committee on Mental Health, Substance Use and Recovery Tuesday that state officials should create special hospital units for forensic patients — meaning those sent to psychiatric hospitals by the courts, often for evaluations.

Such patients are typically criminally charged or awaiting trial, or are the subjects of petitions for civil commitment to mental health treatment. Civil commitments require a professional determination that a person poses a danger to themselves or others.

Union members presented research to the committee showing forensic patients now occupy two-thirds of the state's psychiatric hospital beds.

Nicole Doyle-Tedford, a nurse at Tewksbury State Hospital and a union leader, urged lawmakers to support legislation that would create the specialized units, saying forensic patients often need a different, more secure level of care than others in the hospitals.

"These are two distinct populations with fundamentally different needs, and they cannot be effectively or ethically treated in the same space," Doyle-Tedford said. "It's putting treatment at odds with safety, creating an environment where trauma survivors are housed alongside those who may have inflicted similar trauma on others."

State Rep. Steven Xiarhos, a Barnstable Republican and the ranking minority member of the committee, asked Doyle-Tedford to send the information to him for further review.

The unions' report found forensic evaluations for the courts accounted for about 60% of admissions to state hospitals in 2023. The authors cited the recent closures of two state correctional facilities, which they said could accommodate prisoners with severe mental illness. They also say a national health care worker shortage has contributed to the lack of long-term psychiatric hospital beds to meet demand. The report said some people wait months for long-term psychiatric care because of the growing waitlist.

"We would also argue that this trend, which limits beds available for non-forensic patients with acute and chronic behavioral health conditions, results in patients languishing in already overcrowded emergency departments or, even worse, going without care altogether and thus often becoming future forensic patients," the report said.

The Massachusetts Department of Mental Health oversees long-term hospital services for people with severe mental illness. The largest psychiatric hospitals in the state are Worcester Recovery Center and Hospital, and Tewksbury Hospital. According to a recent state report, Massachusetts' psychiatric hospitals are operating over capacity.

During the hearing, lawmakers also heard testimony about legislation that would transfer oversight of Bridgewater State Hospital, a psychiatric hospital for men charged with crimes and civilly committed, from the Department of Correction to the Department of Mental Health. The Disability Law Center has filed reports over the past seven years that found men held at Bridgewater have been mistreated. The organization has repeatedly urged the state to transfer hospital operations to the Department of Mental Health, which would oversee Bridgewater until a new hospital is built.

"We're the only state sending people with severe mental illness who have not been convicted of crimes to a correctional facility," said Danna Mauch, president and CEO of the Massachusetts Association of Mental Health. "This was never intended to be the job of the Department of Correction, and they're not equipped to run a therapeutic environment."

Correction: An earlier version of this report misstated the first name of state Rep. Steven Xiarhos. We regret the error.