Fresh air sought for mental patients
Bill calls for daily outdoors time; some hospitals say it’s not needed
By Lee Hammel TELEGRAM & GAZETTE STAFF
The Legislature is considering a bill that would make fresh air not just a welcome break from the dreary walls in a psychiatric hospital, but a right of patients.
The bill is being pushed by a coalition of mental health advocates, some of whom had to take up smoking just to get outside a hospital building. It’s being opposed by an association of officials who run private psychiatric hospitals and wards.
“I think it’s a great bill,” said Julia Prentice of 25 Wiles Farm Road, Northboro. “I really feel like people in hospitals have enough things to deal with in their lives without being denied fresh air.”
She works in three state hospitals as an employee of M-POWER, a member-run organization of former and current psychiatric patients. M-Power and the Disability Law Center have joined to form CFAR, the Coalition for Fresh Air Rights, which is advocating for the bill in the Legislature’s Joint Committee on Mental Health and Substance Abuse.
The bill would guarantee daily access to fresh air for patients in both public and private psychiatric hospitals, according to Jonathan Dosick, an advocate at the Disability Law Center in Boston. “We believe that exposure to the outdoors and nature is an essential part of daily human life. Fresh air has been proven to have a therapeutic effect,” he said.
Under the bill proposed by CFAR, the right to daily fresh air would be added to five other rights guaranteed by Chapter 123 of the Massachusetts General Laws to patients in psychiatric facilities. Like two other of those rights — the right to reasonable access to a telephone and the right to daily, private visits of a patient’s own choosing — the right to go out into fresh air could be suspended by the superintendent or director of the inpatient facility if it “would present a substantial risk of serious harm” to the patient or others.
The bill proposed by CFAR does not detail how much fresh air access per day must be granted.
The Massachusetts Association of Behavioral Health Systems, which represents eight psychiatric hospitals and 36 hospitals with psychiatric units, opposes the bill. Executive Director David Matteodo said he saw no need for the bill.
“Most of the hospitals allow it now anyway,” he said. “I said to the advocates, where they are having issues let’s talk about it and maybe we can work it out on a hospital-specific basis.”
State Rep. Jennifer M. Callahan, D-Sutton, became a co-sponsor of the bill after some constituents with mental health diagnoses spoke to her about the importance of the bill. Not that she needed much convincing.
A registered nurse, Ms. Callahan grew up on an apple orchard in Sutton. As a daughter of two Worcester State Hospital employees, she knew about psychiatric patients and fresh air before some of the bill’s advocates were breathing it.
State hospital patients came to help harvest the McIntoshes and the Baldwins and “they loved coming. I remember lots of smiles, and I remember my parents saying they really did enjoy the visits,” the legislator said.
The goal of the bill, whose principal sponsor is Rep. Frank I. Smizik, D-Brookline, “is to fully integrate people to the maximum of their potential,” Ms. Callahan said. “But I recognize that institutions also have to make sure they have the staffing and resources to do so.”
Marc D. Cohen, director of the 51-bed inpatient psychiatric unit at St. Vincent Hospital in Worcester, called the bill “well intentioned but uninformed.” He said the bill’s sponsors did not consult the state Department of Mental Health, and the bill legislates clinical care.
“Denying a patient access to fresh air solely as a punishment, absent a valid clinical indication, is not in keeping with good quality care and should not be condoned,” Mr. Cohen said. But, he said, the fact that psychiatric patients meet the need for hospital level care means “they present a substantial and credible risk of harm to themselves and/or others, (and) is indicative of the need to place certain restrictions on their actions and movements.”
While only two of the 42 members of the Massachusetts Association of Behavioral Health Systems who responded to a survey said they prohibit outside access for their patients, Executive Director Stanley J. Eichner of the Disability Law Center said an informal survey found several hospitals whose policies are so restrictive that they amount to a denial of fresh air even if they don’t ban it outright.
Regarding the hospitals directly operated by the state DMH, DLC managing attorney Kelly Sullivan said, “We’re satisfied with what they do as far as providing access to fresh air.” Mr. Dosick said Worcester State Hospital may be the best.
But Mr. Eichner points out, “The largest number of people receiving psychiatric services are not at state facilities” and the bill is to benefit them. He acknowledged that fresh air access means hospitals need a secure area, and opponents consider the bill burdensome or too costly.
“There could be issues around phasing it in,” the DLC director said. “We indicated to the leadership of the committee, if there needs to be some slight adjustment, we’re open to” that.
Rep. Ruth B. Balser, D-Newton, House chairman of the Joint Committee on Mental Health, said, “My goal (is) to balance the wish of the patient to get fresh air with the hospital’s responsibility to ensure the safety and psychiatric care of the patient.” She expects the committee to report the bill out today.
A clinical psychologist, Rep. Balser said she plans to propose a redraft of the bill to the committee. It would give the Department of Mental Health oversight over all of the hospitals it licenses and to “ask hospitals to make a reasonable effort” to provide patients with access to fresh air when a patient’s clinical condition permits it.
It would not describe fresh air access as a right, however, Ms. Balser said. Her proposal would make the decision more clinical than administrative, she said.
The DMH takes no position on the bill, said the agency’s chief of staff, Patricia Mackin. “We have a human rights policy that every client has the right to a reasonable opportunity for physical exercise and access to the outdoors consistent with requirements for safety,” she said.
While there is no definition on most DMH units of what is reasonable, she said the practice is “probably two or three times a day, under optimum circumstances and depending on staffing. The presumption is everyone can be outdoors.”
While some hospitals say their urban location prevents fresh air access, the DMH spent the money to establish an exercise perimeter even at the Lindemann Mental Health Center in urban Boston’s government center.
While the Massachusetts Chapter of the National Alliance for the Mentally Ill has taken no position on the bill, the Manic-Depressive and Depressive Association in Boston, as well as the Massachusetts chapter of National Association of Social Workers, the Massachusetts Association for Occupational Therapists, and the American Occupational Therapy Association support it. Even though “the question of safety is a very real one,” said Karl Ackerman, Boston MDDA president, “a blanket use of that reason to not provide access to open sky and fresh air is something which the bill does seek to stop.”
He said he has had people with mental illness tell him they were in institutions that allowed only smokers to go outside “and they have actually had to take up smoking again just to get outside. Not a good thing.”
Pete Foulkes, 59, of 1050 Main St., has been in at least six inpatient psychiatric facilities. He said the bill is “a good idea because my experience has been that getting off the ward and out into the fresh air has helped me recover from my episodes of mental illness.”
Still, he said, in his experience, he got off the ward for fresh air when he could handle it, but when he felt unsafe, he and his clinicians agreed he should not go outside.