“they are coming Quiet,” said the announcement. they I was an emergency medical technician in an ambulance carrying Justice Thompson* from the hospital’s psychiatric ward to his first day at Guild School. The ambulance sirens were silent, but nothing was quiet about Justice’s arrival at the guild.
Two paramedics loaded onto the stretcher, carrying a long, skinny 15-year-old boy, belted and precariously covered in damp white sheets. As Justice’s limbs hit the restraints, he moaned and made his way to the special school. The EMT dropped him on the classroom floor, naked and scared. They left immediately without explaining much about what had happened on the 45-minute drive from the hospital.
Justice spent the better part of a year in the inpatient ward of a mental hospital. This ward was designed to stabilize adolescents with developmental disabilities who endanger themselves and others. Such units are intended for short-term interventions in which patients undergo evaluation, medication, and prompt discharge to their home or place of residence.
For patients like Justice, there is no safe enough place to leave the hospital.we need more psychiatric beds Desperately Stabilize short-term crises. However, they are poor replacements for systems that support lifelong needs. The psychiatric boarding crisis is really a residential services crisis for people with complex developmental and behavioral health needs.
Justice has always been a complicated child. Shortly before his hospitalization, Justice began pulling pictures from walls, throwing furniture, and hitting his head. He headbutted walls, floors, concrete stairs, and his grandparents. He was about six feet tall and as he grew he could no longer be at home. This is not the case for most people with intellectual disabilities, but 10-15% exhibit self-harm, aggression, and destruction of property. Justice’s behavior was harsh.
At the hospital, Justice slammed his knee into his head, requiring seven staples near his temple. He wore a splint on his arm and a mitt on his hand until his injury healed. Within weeks, Justice no longer met the criteria for admission. He was not in a “critical situation.” The hospital needed Justice’s bed immediately for patients waiting in the emergency department.
Like any other family in this situation, Justice’s grandparents faced a painful situation. The psychiatric hospital uses behavioral controls that cannot be replicated at home, including 24/7 watch, chemical sedation, mechanical restraints, and a locked time-out her room. They wanted to avoid the frequent cycle of patients going from home to the hospital and back to the hospital. Justice needed a residential special education school to keep him safe and teach him coping skills.
For nearly a year, Justice’s grandparents worked through a system with a long waiting list to get the housing arrangement Justice needed. Meanwhile, Justice stayed in the hospital for too long, which, according to social workers, worsened his behavior.
Federal law and Massachusetts law guarantee free and adequate education for students with disabilities, which may include residential special education programs. Unfortunately, the law does not guarantee that schools receive market prices for their labor, facilities, or program development. Therefore, special education schools lack the capacity to meet the overwhelming demand for services.
As a result, young people with complex developmental needs, such as Justice experienced, are in precarious situations that create bottlenecks for emergency services and psychiatry. Sadly, the problem is even more acute for adults (22+) with intellectual disabilities.
The Massachusetts Department of Development Services (DDS) is committed to providing a supportive residential program within 90 days for individuals in urgent need of security. Due to capacity issues, the reality of that pledge is often respite care, psychiatric evaluation units, or other temporary containment situations.
Labor shortages are certainly hampering program capacity. But what’s more tricky is the state’s lack of funding to buy expensive group homes or pay down payments on those properties. Instead, nonprofit agencies have funded state commitments to provide supportive housing for people with complex developmental disabilities for decades. may help change this disparity.
In December 2022, DDS released temporary funding to encourage nonprofits to open group homes for adults in need. These incentives can be used to address workforce challenges, but may also support down payment or new group home renovations.
Still, nonprofits need to leverage their limited assets to take out mortgages at a time when both housing costs and interest rates are very high. We hope that Massachusetts nonprofits will try and survive. These days, many are overburdened and succumbing to economic pressures, further exacerbating the stalemate of the housing crisis and psychiatric hospitals.
As a teenager, Justice’s crisis turned around. Supported by his grandparents’ tenacious advocacy, he found a safe home at the Guild School. He learned to communicate more effectively and made new friends. In the coming year, justice will need its advocacy again, perhaps more than ever. Justice is turning 22 and his placement in the Guild School is ending just months after his DDS pilot program expires.
Extended DDS funding could provide Justice with a safe place to call home. Still, without such incentives, he might end up in another psychiatric ward like the dozens housed in state evaluation units. Unless we make funding supportive housing services for people with complex disabilities a permanent priority, the fate of justice is uncertain and depends on temporary measures.
*Last names are pseudonyms to protect privacy.
Amy C. Sousa is CEO of The Guild for Human Services, a Massachusetts non-profit organization that helps people with complex developmental disabilities. Dr. Sousa is a Board Representative of the Massachusetts Association of 766 Licensed Private Schools.
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