A painful loss for mentally ill

More than 100 people have benefited from a ‘hospital without walls,’ but state cuts are threatening their gains

Linda Ivy Crowder prizes her independence, her apartment, and her beloved cat, Tyler. Linda Ivy Crowder prizes her independence, her apartment, and her beloved cat, Tyler. (Suzanne Kreiter/Globe Staff)
By Carolyn Y. Johnson
Globe Staff / December 19, 2009

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Suffering from bipolar disorder and experiencing psychotic episodes, Linda Ivy Crowder used to wander the streets all night and frequently get picked up by the police and taken to the hospital. Nearly as soon as she was released, she would end up back in the emergency room.

Finally, she was told she would have to go to a state psychiatric hospital, a prospect that devastated Crowder, who prizes her independence, her apartment, and her beloved cat, Tyler.

Then in August 2008, she began to work with a new team designed to provide intensive support for mentally ill people like Crowder who do not do well with existing treatments. Not only has PACT, short for Program for Assertive Community Treatment, kept Crowder out of the hospital, it has helped her get to a point where she pursues hobbies such as painting, reading, and writing and is even looking for a volunteer job.

But now Crowder and more than 100 other people in the state are bracing for the loss of the program, sometimes called “a hospital without walls.’’ Because of a drop in tax revenues caused by the economic downturn, the state Department of Mental Health is cutting $10.3 million from its $644 million budget. That reduction has very real consequences for people like Crowder and others served by the PACT program, because two of its 16 locations will shut down to save nearly $1.2 million.

“I have my own apartment. I have a cat, it just wouldn’t make any sense - I’m not the type who needs to be hospitalized for long periods of time,’’ Crowder said.

PACT teams are being cut at North Suffolk Mental Health Association, which serves 53 people in Chelsea, Winthrop, East Boston, Revere, Cambridge, and Somerville; and the Center for Human Development, which serves 60 people in Springfield and Holyoke.

Marcia Fowler, assistant commissioner for mental health services, said that tough choices had to be made because of the budget cuts, which follow a deeper budget reduction of about $40 million last year. The two PACT programs were chosen because they were in locations where similar programs could absorb the clients, Fowler said.

In addition to cutting the two programs, more than 200 managers will each take up to nine furlough days, and administrative and operational cuts are being made, among other actions.

“There are no good choices here. Cutting staff and cutting programs or cutting services is never easy,’’ Fowler said. She added that the PACT programs will shut down when each client has made a transition to other services, including a program called Community Based Flexible Supports.

But to the staff members of PACT and the clients themselves, the end of the program will be devastating.

The program brings Crowder her pills in bags labeled for each day of the week, so she will not forget to take them. Staff come to her Cambridge neighborhood and take her out for coffee and talk about how she is feeling and whether she has any problems. A group that includes nurses, a psychiatrist, and social workers coordinates her care and helps her set goals. Program specialists also help clients get housing or manage their finances.

Jackie Moore, chief executive of North Suffolk Mental Health, said that in 2008, 44 clients in the PACT program racked up 523 days in acute care hospitals. This year, those clients plus new referrals had only 148 days in the hospitals through the end of November. The program costs about $50 per client per day, in contrast with hospitals that cost hundreds of dollars per day.

“We would like them to rethink this,’’ Moore said. “We think it’s actually going to cost the Commonwealth more money in other ways: These people are going to end up in hospitals and emergency rooms, or in jails.’’

Jim Goodwin, president of the Center for Human Development in Western Massachusetts, said that the program costs roughly $15,000 a year for each client - an amount easily racked up by two hospitalizations. He and others say that the new services are not sufficient and that the transition will be a major crisis for people who were finally beginning to thrive.

For Eve Spagnola, 46, of Chelsea, what happens next is a big concern. Just a few years ago, Spagnola was in and out of hospitals, hearing voices, hallucinating, and getting medications that were not helping. Now, the PACT team drops off her medication every day. She talks to her sister on the phone several times a day. She takes her medications and is learning to be more honest and open about how she is feeling. She is doing things she could have never imagined, including decorating a Christmas tree and making plans to spend Christmas Day with her daughter.

“They have helped me so tremendously,’’ Spagnola said. “I have a life again. I’m independent. . . . I can make my own appointments. I was never able to do that.’’

Carolyn Y. Johnson can be reached at