For the past three decades the topic of the proper role of state mental hospitals has been vigorously debated as a major public policy issue in Massachusetts. The state has had two runs at hospital closings: the first between 1973 and 1981, when the deinstitutionalization policy flourished, the second between 1991 and 1993, when the privatization policy was developed. In making the case for this seismic shift, a governor's special commission concluded that the state had too many hospitals for too few patients at too high a cost. This study provides a detailed analysis of the problems that beset the Department of Mental Health when it sought to implement the hospital reduction strategy and restructure its service delivery system. From a practical perspective, it focuses on the closing phenomenon in general, and the closure of Metropolitan State Hospital in particular. Overall, the specific problems presented a formidable challenge that placed what appeared to be inordinate demands on the stakeholders involved — patients, families, providers, and advocates. The major emphasis is on mental health politics and the many participants who influence policy and programs. These experiences offer much to be understood by and transmitted to policymakers.



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