Massachusetts Department of Mental Health

Service authorization in an underfunded health system

by  Grace Turner

An Overview

The Massachusetts Department of Mental Health (DMH), is a state organization that provides support services to those with severe mental health problems. Services include caseworkers, community centers, and inpatient care, among others. I worked in the Fitchburg office which was responsible for the North County catchment area which covered North central Massachusetts. This catchment area presented many challenges to our clients and our work as an office. Large portions were rural with little access to supportive services without a personal car, to which many of our clients did not have access. Most medical appointments were conducted in the nearest major city, Worcester, which was outside of the catchment area and as far as a one-hour drive from some North County towns. 

Working across the welfare state

The North County (the lightest green section) office often worked with health services contractors that were employed by the state, community-based organizations, the police, the judicial system, the prison system, the state Department of Developmental Services (DDS), Statewide Head Injury Program (SHIP), and some specialized case workers that specifically worked with addiction and HIV. Often many of these clients were also interacting with other state social services such as Medicaid, cash assistance, and food assistance. Beyond matching clients with the right mental health services, professionals, and medicine, we often had to help them navigate the larger welfare system such as finding housing and applying for unemployment support, among countless other welfare applications. In this way, employees of DMH have to be experts in the United States and Massachusetts welfare systems, interacting directly with the medical side of mental illness as well as social determinants of health and how society can help or harm these individuals.



My Responsibilities

At DMH I assisted with needs and means assessments, matching clients to services, checking in on respite and group home services, and level-of-care meetings, as well as working in the internship data science track. Needs and means assessments were interviews conducted with potential clients in the process of assessing if the person needs services. Importantly, all of these individuals needed to have been diagnosed with a severe mental illness before applying. The actual assessment was to review mental health history and determine from what services the person could benefit from. The service team, a group of employees at the local DMH office, would meet and place individuals on waitlists for appropriate services such as case management, group homes, and respite homes, among others. During these meetings, existing clients were also moved around services based on their needs and other changes. In my time checking in on respite and group home services, I–along with another North County DMH supervisor–would check in on the residents of the group home and assess their needs and experiences, as well as take time to see if the home was in proper condition and if the contracting agency was performing to state standards. Level-of-care meetings are conducted yearly to assess if current clients need to be moved into different programs and if their current care team is working for them. The data science track was conducted via Zoom with other interns across the state DMH offices. We learned the data science tools such as Access and Tableau, used to evaluate DMH performance as well as statewide incidents at facilities. In addition to these responsibilities, I updated the county’s resources on homeless shelters, food pantries, and other community mental health services along with their ability to service those who speak another language besides English. 

Lessons Learned

At DMH I learned a lot about the complexities of the state healthcare system and individual experiences with the welfare system. I saw the devastating impacts of falling through the cracks of government bureaucracies and the U.S. healthcare system. Individuals are often claimed as not an agency’s responsibility due to other co-occurring diagnoses or not being sick enough. This often leads them to end up in the emergency room, homeless, or incarcerated. The staff I have met working here have been some of the most caring and generous people I have encountered. They, however, do not have the resources to support everyone who needs or wants help, even in a state that funds healthcare and welfare more so than many others. Every clinical program, residential program, substance use treatment facility, therapist’s office, case management service, and homeless shelter is chronically understaffed and has a waitlist for people who cannot wait. My time at the DMH has reinforced the idea that more health policy needs to be designed and passed to increase resources and fill in the gaps between agency responsibility, feeding into what I want to pursue in graduate school and then with my career. 


About Me

I am Grace Turner and I am from Northborough, Massachusetts. At Macalester, I am studying Political Science, Biology, and of course, Community & Global Health. I have also been on the women’s swimming and diving team here at Mac for the last four years. I am passionate about health policy and creating meaningful change using politics. After graduation, I will attend a Masters of Public Policy program at the University of Chicago where I will concentrate my studies on health policy.