How should the state have handled the closing of Somerset?

Here is how the state could have managed the closing of Somerset more competently:

  1. Take the facility into receivership.  Locate, hire and install one of the best administrators available with a demonstrable history of success in managing facilities with a severely disturbed mentally ill population.  Provide that administrator with expert consultants and resources.  Then, bring the facility into ‘substantial compliance’ and ensure quality services. As the state expected the facility to develop a plan in 24 hours and correct the problems in a couple of weeks, presumably a top-notch administrator could have things fixed in short order.
  2. Consult with experts and develop the new pass screening instrument that includes a risk assessment (as recommended by the task force) and begin to re-screen Somerset residents with the new instrument.
  3. Develop the ‘special certificate’ care and services for high-risk individuals, as the task force recommended.  Presumably, this would be at another facility, though with the expertise now installed at Somerset, a unit could be devoted to developing this program; after all, the state, not the owners, are now in charge.
  4. Comprehensively assess available community services, housing options and the degree of acuity that these current resources are able to manage.  As the task-force recommended, begin to develop and augment these community based services.  They are currently inadequate in relation to need, as everyone agrees.
  5. Comprehensively assess how many of what types of placements are needed (ie., how many for high risk, special care, how many for community care, etc.).   Compare this need to the available placements and develop additional placements where needed.  For example, additional funding many need to be allocated to excellent current community agencies to expand their programming in order to accommodate increased demand and possibly the need for more intensive services.
  6. Systematically move residents into the now developed services according to an assessment based on the newly developed pass screening tool.
  7. Negotiate with the owner on the disposition of the property.

The advantages of such an approach are obvious and numerous:

  1. The receivership management will immediately resolve the ‘hell-hole’ situation and establish safety and quality care, removing the ‘immediate jeopardy’ situation that is the state’s basis for action.  This would also immediately resolve the concerns of the community as the place would now be under competent management (ie., in contrast to the assertion it currently is not).
  2. The task-force recommendations, which are critical to addressing the underlying problems for which Somerset is merely a symptom, can begin to be implemented, tested and given public scrutiny.
  3. The state would develop a working model of how to make the transition from primarily institutional-based care to largely community-based services.  In the long run, they are going to have to empty out most of these facilities in order to fully implement the task-force recommendations.
  4. Residents would be ensured better placements as well as time to cope and adjust to this dramatic change in their lives.  Dangerous offenders would be placed where they could be managed and treated securely and residents would be more likely to obtain the level of community-based care and services they require.
  5. Staff would have time to find new jobs, decreasing the impact on unemployment and local businesses would have time to adjust to a loss of revenue as the large facility—staff and employees—are no longer customers.

So why did the state not do this?  Simple: they would have failed, for several reasons:

  1. Cronyism.  Had the state taken receivership, they would not have sought out the best and brightest to take on a challenging situation.  Instead, without doubt, they would have installed some poorly qualified, mediocre muckety-muck currently in the department that has, for the past ten years, been demonstrably ineffective at accomplishing any significant change in the first place.
  2. Accountability.  Had the state taken this approach, they would have had the same problems the administration of Somerset had.  If they attempted to prevent residents from loitering, they could not restrict them to the building (a violation of their rights).  Nor can they prohibit anyone, resident or not, from standing on a public sidewalk.  And like Somerset, they would find the police refuse to enforce laws against loitering, begging and public nuisance against residents but instead say ‘it’s your problem, manage it.’ The list goes on.  The state, like staff, would have found it very difficult to engage residents in programming without meaningful incentive or means of compelling participation.  And like Somerset, with some irony, they would have found that community based services had been cut as a result of state budget cuts.
  3. Visibility.  It is easy for the state to say they are going to develop an instrument to screen for risk, easy to say they are going to develop special services for high-risk individuals, easy to say they are going to substantially increase community based services.  Actually doing it is an entirely different matter.  To have the actual implementation of these services in the spotlight during the closing of Somerset, though logical, is the last thing the state wants.

As a result, they charge in and allow only 30 days to re-locate 300+ extremely difficult to place people.  The available community services are limited and those that exist, though in many cases of high caliber, are not necessarily prepared to deal with the severity of illness among Somerset residents.  There are no special services for high-risk residents, nor any specialized tool for determining who those people are.  The whole thing is poorly planned and haphazard and amounts to essentially shuffling people around.   Why did they do this? I’m not sure whether to attribute it to general incompetence or, more cynically, to strategic effort to play public relations rather than do the hard work to truly address the needs of the people they are purportedly rushing in to help.  The result is the same.

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2 Comments

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2 responses to “How should the state have handled the closing of Somerset?

  1. Marc Vieux

    The State acted appropriately when it closed Somerset. Relocating patients will always be perceived as ‘too difficult’, etc, etc. Somerset proved time and again that it did not place the welfare of the patients ahead of easy profit. So Yes relocating patients was difficult, but it was clearly possible.

  2. Marc, once again I think you miss the point here. The above post is not arguing whether Somerset should or should not have been closed. The question is whether or not the state handled the closing competently.

    I argue, with clear supporting reasons, why I believe they did not handle the closing competently. In fact, I think they did it exceptionally poorly and violated resident rights in the process.

    If you believe the way in which they went about it was the best way, please respond to specific points in my post. You seem to want to just keep saying ‘the state did good’ without providing any evidence whatsoever. I will continue to say ‘the state did bad’ and providing evidence and argument to support my claims.

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