Psychiatric Quarterly, Vol. 76, No. 2, Summer 2005 (
AGAINST THE GRAIN? A REASONED
ARGUMENT FOR NOT CLOSING
Jeffrey L. Geller, M.D., M.P.H., Helen Shore, M.S., Albert J.
Grudzinskas, Jr., J.D., and Paul S. Appelbaum, M.D.
In the face of the Massachusetts Governor’s attempts to close one of the state’s
four remaining state hospitals, Massachusetts legislators overrode the Gover-
nor’s veto of funding for the hospital, but required the state’s Mental Health
Authority to author a study of the implications of further loss of public sector
inpatient beds. The Center for Mental Health Services Research of the Uni-
versity of Massachusetts Medical School conducted its own study concluding
that maintaining a longer-term inpatient capacity in the public sector in cen-
tral Massachusetts was both necessary and accrued a signiﬁcant number of
beneﬁts. This article can serve as a model for the reasoned position that a state
hospital in 21st century psychiatry can be looked at as a multiservice center
that fulﬁlls a key role in a public sector, integrated system of treatment, care,
training and research.
KEY WORDS: state hospital; reimbursability; Medicaid; care and treatment; closing.
All authors are afﬁliated with Center for Mental Health Services Research, Department
of Psychiatry, University of Massachusetts Medical School, Worcester, MA.
Address correspondence to Jeffrey L. Geller, M.D., M.P.H., UMass Medical School,
Department of Psychiatry, 55 Lake Avenue North, Worcester, MA 01655; e-mail:
2005 Springer Science+Business Media, Inc.