"Titicut follow-up": successful transfer of assaultive patients from a high security facility to a less restrictive...

Currently many state mental health agencies are redoubling their efforts to close or downsize state hospitals and place their populations in less restrictive settings. Prior to 1990, certain assaultive non-criminal male patients from public facilities operated by the Massachusetts Department of Mental Health (DMH) could be transferred to prison psychiatric facilities operated by the Department of Corrections (DOC). In 1989 that practice was declared illegal, and clients so placed were ordered returned to DMH facilities. This case study describes the liaison process by which patients remaining in the DOC facility returned to DMH facilities, describes their subsequent hospital course, and reviews the validity of policy assumptions made about these patients' needs in the context of this follow-up data. The results of this analysis indicate that many fewer patients in this group of primarily chronic schizophrenic men required a secure facility upon their return than was previously assumed.