Paraphrasing Mark Twain, psychiatric administrators in Boston are happy to say that "reports of our death are greatly exaggerated." After extensive teamwork by numerous concerned physicians and patients, as well as state and city mental health officials, Boston’s Beth Israel Deaconess Medical Center (BIDMC) is working out how to maintain its significant presence in psychiatric care and training.

Facing severe budget cuts amid bulging deficits, BIDMC had announced last September that it was closing its psychiatric inpatient units, the largest among Boston’s general hospitals, and significantly scaling back its outpatient services as well (Psychiatric News, November 5, 2000). Originally, the inpatient units were slated to close by mid 2001, and both psychiatric research and the widely respected Harvard Longwood psychiatry residency program were going to have to find new clinical sites. Only scaled-down outpatient services were going to remain.

Facing intense pressure from its own physicians and patients and from numerous public officials, the hospital agreed in December to maintain many of its psychiatric services as well as to seek alternatives to closing its inpatient psychiatric units.

"At this point," Mary Anne Badaracco, M.D., chief of psychiatry at BIDMC, told Psychiatric News, "Harvard Longwood will now be going forward; basically all of our outpatient services will remain intact, our consultation-liaison service will continue, emergency psychiatric services will continue, and perhaps one of our inpatient units will be able to stay open. The hospital is actively reviewing the inpatient situation with both state and local officials."

The financial woes of the hospital and its decision to cut psychiatric services as well as other significant clinical offerings were not an unfamiliar story in this era in which managed care controls so much of health care decision making and funding. However, the victory of psychiatric services over the looming budget problems at BIDMC is the latest in a growing list of examples in which the clinical community and the public have risen to the defense of embattled psychiatry programs.

Winning this battle was the work of a large team, made up of basically three groups, said Badaracco. First and foremost was the response of the chiefs of other clinical departments at the medical center.

"The response from the chiefs of the nonpsychiatric departments demonstrated across-the-board support for our programs," Badaracco said. "The other chiefs said, ‘Look, we can’t treat many of our patients effectively without full psychiatric services.’ The hospital listened to them. The focus was really on the patients’ needs."

William Greenberg, M.D., director of the Harvard Longwood Psychiatric Residency Program, agreed. "The reaching out among the heads of the various departments was the most significant factor," Greenberg told Psychiatric News. "Certainly psychiatry reached out to the other departments, but the other departments also reached out to us, saying we can’t do it without a fully active department of psychiatry."

Maintaining BIDMC’s commitment as one of three main clinical sites for the Harvard Longwood residency program is a clear victory as well. High-quality psychiatric training, said Greenberg, "is alive and well in Boston." The program is currently reviewing applications for its next class of 14 residents.

The department of psychiatry also received strong support from primary care doctors in the community who feared the pending reduction in services would leave patients with no access to adequate psychiatric services. Psychiatric residents in the Harvard Longwood program were enormously active, organizing their own grass-roots campaign—writing letters to the hospital, the medical school, and mental health officials at the city and state levels.

Soon state and local officials made it clear that they were determined to keep the beds open. During a meeting between hospital administrators and government officials held in Boston Mayor Thomas M. Menino’s office, the mayor threatened to invoke a new state law that would allow him to review publicly, and potentially block, the decision by BIDMC to close all of its inpatient beds. It was noted that BIDMC’s psychiatric inpatient beds make up about 20 percent of the total available in the Boston-Cambridge area.

"A 20 percent loss of beds," said Massachusetts Mental Health Commissioner Marylou Sudders during the meeting, "would take what already is a tight system and put it into chaos."

BIDMC officials have committed to maintaining a minimum level of inpatient services, the exact level of which was still being decided at press time. However, the clear victory of saving all outpatient programs, the academic department of psychiatry, and the hospital’s commitment to the Harvard Longwood psychiatry program is significant.

"This was a triumph of good clinical sense," Badaracco told Psychiatric News. "Good patient care prevailed." ▪