In early June, we released a special e-newsletter blast about Worcester State Hospital and its new ‘trial’ restrictions. If you missed that e-mail, you can view it in full here. In brief, Worcester State Hospital (called “Worcester Recovery Center and Hospital” by some) implemented a 30 day ‘trial’ period of wide reaching restrictions throughout the hospital including shutting down much of the “downtown” area, restricting passes, eliminating the ability to order take out food, and so on. This was in response to two overdose deaths of people who were hospitalized there.
Some of you who’ve responded to our initial piece have called for protests, or other ways to push back on the state and these potentially temporary (and potentially not) restrictions that have been fully sanctioned by the Massachusetts Department of Mental Health. Others have felt we’re being too hard on the hospital. (Well, only one person has said that to us thus far.) Still others have just wanted to better understand what is at the root of our concern. Simply put, at the root of our concern is this:
People hospitalized against their will on a psychiatric unit (no matter how great it professes to be) are already a marginalized group of people who lack voice or control. Layering on additional ways in which they lose power and control is damaging. Allowing the state to do that in secrecy is absolutely unacceptable. (The state has been mostly unresponsive and unwilling to provide details as to what restrictions are in place. Most information we have obtained has been through other sources.) This is a serious issue, even if you are someone who believes that additional restrictions should have been imposed.
Some of you have also asked, “Well, what would you have done in the face of these two overdose deaths? Do you have any suggestions about what the hospital could be doing differently?”
That’s an interesting question, and not one easily answered. However, here is what we can offer:
The Western Mass RLC offers many different types of supports. Those supports include centers. At our center in Springfield, we have had three opioid overdoses. Two of them have been in the last six months. Fortunately, none of the people involved died, but they certainly could have. In one situation, the person collapsed in the bathroom, and no one knew it’d happened for who knows how long. He was only found because the people working in the space that day were checking rooms as they were getting ready to close up.
In response to all that, we could have imposed new restrictions. Maybe we could have chosen to start doing 15 minute room checks, or questioning everyone who came through the door about their drug use. We could have gotten harder on asking people who do show up high to leave, or asked people to empty out their pockets and show us everything they had on them (even though we’re pretty sure these particular people used the drugs before entering our space). That’s not what happened. Here’s what did:
1. We’ve implemented a requirement for the frequency of Narcan trainings. (Narcan is a drug that is easy to administer and can save someone’s life when they’re overdosing on Opioids.) Fortunately, we had Narcan on site (and people trained to use it) in each instance, but we wanted to be extra sure it stayed that way.
2. We’ve welcomed the people who overdosed back into our community whenever they were ready to return, and without judgment or any sort of consequence. In one of those instances, the person who overdosed showed back up during a community meeting that was being held to debrief and support other members of the community who were there when he collapsed. (Some of the community members were also a part of saving his life by administering the Narcan we had on hand.) He chose to participate in the debrief. It was powerful to have him there.
3. We are developing boards to be posted in each center that include safer drug use information. We are looking to our colleagues in the Harm Reduction world (such as those who put on the Reform Conference) for guidance on what information to share.
4. We are exploring adding additional groups specifically geared toward people who are actively using. It may take us a while to pull these groups together due to lack of resources, but when they are up and running, they will not assume that the goal is to stop using.
5. We are in the process of relaxingour restrictions on people being in the space who are high or drunk. We’ve always tried to maintain a non-judgmental response to people who use drugs, but have also asked people who are obviously intoxicated or who smell of drugs or alcohol not to be in the space. Although this will look somewhat different from space to space (based on size and set up of the space, etc.), we will no longer automatically be asking people to leave under these circumstances.
We don’t mean to suggest that these approaches would also be precisely the ‘right’ ones for Worcester State Hospital, and we certainly aren’t making the argument that psychiatric units and community centers have a great deal in common. However, we think there is something worth considering here. This is especially true given that research has indicated that abstinence-based approaches are not effective, even in inpatient hospital settings. In fact, research has found that abstinence-based approaches not only lead to more difficulties in the hospital, but also increase the likelihood of death by overdose once someone leaves. (For more, click HERE.)
The truth is that—while Worcester State Hospital is spoken of as the ‘best’ and most cutting edge hospital in Massachusetts, it was already seen as one of the most restrictive by people connected to other hospitals in the Commonwealth. The new ‘trial’ restrictions have now led to some people saying Worcester State Hospital has less to offer those hospitalized there than Bridgewater (a ‘hospital’ run by the Department of Corrections and widely recognized as offering a more prison-like environment).
Meanwhile, we also want to recognize the apparent discrimination taking place here. Psychiatric oppression (and other forms of discrimination) are widely known to be rampant within the mental health system. People’s voices get ignored. Their lawyers don’t adequately represent them. Black and brown people are more likely to be given harsher diagnoses, and more often subjected to force. And so on.
None of this is new, but we bring it up now because it at least appears that the Worcester State Hospital restrictions are being targeted strictly at those incarcerated in the hospital, and not the staff. Perhaps we are missing something here, given that the hospital has been so secretive about what is actually going on, but we’ve heard no sign of restrictions in that direction. That is particularly interesting because it is widely recognized that when drugs start showing up in places like jails and psychiatric hospitals, staff are usually playing a role.
Both in this country and others, there are dozens of stories about employees bringing in drugs to locked units. (Just try googling “employee smuggles drugs” into a jail or hospital!) Here are but a handful of examples:
Meanwhile, in December of 2018, the Prison Policy Initiative published the results of their survey that said that it is indeed staff and not visitors (or anyone else) who are typically smuggling in drugs to prisons, and that the restrictions prisons are placing to prevent visitors from smuggling in drugs (e.g., video calling rather than in person visits) are actually money makers that benefit the prisons overall.
No, we are not ultimately accusing staff at Worcester State Hospital of bringing in drugs. We have no idea what’s going on. However, we are saying that placing all the restrictions on people hospitalized there (if, in fact, that is what’s happening) is discriminatory and does not match the evidence the nation has to offer us.
We aren’t sure what is next. We are especially curious to see what happens with the restrictions at the hospital when the 30 day ‘trial’ period comes to an end. In the meantime, we welcome your input at firstname.lastname@example.org.