Framingham Day Hospital was started in 1974. Director Iris Carroll, had worked in the field of mental health for a number of years both in state institutions and in private mental hospitals. She had also personally seen a childhood friend go through the painful and isolating experience of schizophrenia and was struck by the stigmatizing effects of mental illness then and in her future work. She wanted to create a program in which members would feel accepted and retain their sense of dignity, a program that would emphasize not only problems but strengths and abilities, as well.
Staff was hired both on the basis of training and experience and according to whether or not they had a deep personal commitment to people afflicted with mental illness, and to helping them learn and grow.
The name "member" was initially chosen for participants in contrast to "patient" and staff were referred to by their first names in order to lessen stigma so often associated with mental illness, but now the field of outpatient mental health generally refers to its patients as "clients" which the program does today. Staff wanted to create an atmosphere of openness and to reduce the feeling of secrecy and mystery so often associated with psychiatric treatment. They wanted clients to feel empowered rather than "acted upon" and decided that instead of making treatment plans "for" the client, each client would be the head of his/her treatment team. Each client would choose his/her own personal goals for change and select his/her own array of services to use, and goals would never be imposed. Staff feedback to clients would be open and honest.
Staff also felt that it would be more helpful for clients to focus upon their lives in the community rather than to become dependent upon the program as an alternative life style. Before opening the program, staff borrowed a van and toured the surrounding community to learn about existing services and activities that might be useful to members in the process of their recovery and in the future. They also initiated the community's first "liaison system" between psychiatric agencies and hospitals whereby specific staff were designated as liaison to each facility to promote the smooth transition of clients from one agency to the other and to coordinate treatment.
The first clients of the program were patients from Westborough State Hospital. Staff actually went to Westborough to choose patients whom they felt might be able to use the program to successfully transition to community life. Some patients began by making a series of visits to the program over an extended period of time so that they could gradually adjust to being in the community. Then, shortly after the program's inception, Framingham Union Hospital (the local general hospital now known as MetroWest Medical Center) opened a psychiatric unit with the help of federal Community Mental Health Center (CMHC) funds and, in so doing, designated Framingham Day Hospital as the psychiatric day treatment program for the community-at-large. As a result, people began to be referred to the program from a wide variety of places, i.e. psychiatric clinics and hospitals, social service agencies, high school psychologists, clergy, local therapists, and so on, but the program maintained its mission to serve low income citizens. This influx of clients with differing backgrounds and needs led to the beginning of an evolutionary process whereby Framingham Day Hospital gradually enhanced its program by adding new services to its program in direct response to the emerging needs of its clients.
The first services to be added were job-related, and led to the formation of the Employment Services program. It soon became clear that the majority of Framingham Day Hospital clients wanted to eventually become employed. Some had never been employed due to long years of institutionalization. Others had been able to get jobs, but had not been successful in keeping those jobs for more than short periods of time. Still others had jobs to which they planned to return but felt uneasy about their ability to return, given the severity of their symptoms. A survey of existing employment resources available in the community for these clients revealed a clear lack of services that could accommodate their special needs. Thus the Employment Services program began, first by asking the local Massachusetts Rehabilitation Commission (MRC) if it would conduct job-related groups at Framingham Day Hospital so that clients could receive the extra help they needed in preparing for work. This was the beginning of a longstanding relationship with MRC, during which contracts were obtained over the years to provide a variety of employment services for clients.
Fairly early in the life of the program it became evident that often relatives or spouses of clients wanted to be involved or at least to be informed on a regular basis as to how they were using the program. As a result, counselors began to call relatives often and to meet with them personally, if needed, so that relatives could be included as part of the program's "team." Eventually, a staff member enrolled in a series of training programs in order to learn new ways to help families and clients work together in behalf of the client's growth. Currently, meetings with families (or other people who are significantly involved in their lives) and clients are offered to all who would like them.
After a few years it also became evident that addiction to alcohol or drugs was a problem for many clients either currently or in the past, and that they needed more help than they were getting to address this issue. Some were essentially unable to fully benefit from the program due to substance abuse issues. Consultation and training for staff were obtained from a substance abuse treatment program that agreed to conduct groups for those who needed help, and eventually the program incorporated those groups into its own schedule as part of the services provided.
Help with general health and fitness as well as assistance with learning to manage problems such as diabetes and high blood pressure also become necessary. Help with gaining access to tutoring, training, and higher education were added until the program became more comprehensive in its commitment to serve the mentally ill, especially those who would not otherwise be able to afford treatment.
In 1987 the program's Director, Iris Carroll was awarded the Massachusetts Department of Mental Health's Human Rights Award "in recognition of outstanding contribution to the human rights of individuals with mental disabilities."
Programs For People's Framingham Day Hospital was started with a three-year federal grant from the National Institute of Mental Health (NIMH) and matching state funds from the Massachusetts Department of Mental Health (DMH). Director Iris Carroll, hired the staff, renovated the first rented building and, together with the staff, developed the program. Shortly after the program's inception, Framingham Union Hospital opened a psychiatric unit utilizing Community Mental Health Center (CMHC) federal funds, and in so doing designated Framingham Day Hospital as the psychiatric day treatment program for the resulting "Community Mental Health Center," (CMHC) which consisted of Framingham Union's new unit plus a group of existing local mental health agencies of which Framingham Day Hospital was one. As a result, Framingham Day Hospital was now open to clients from the community-at-large.
However, in becoming part of the CMHC, Framingham Day Hospital did not receive any additional funds and, in fact, almost lost all of its remaining federal funds due to a regulation that did not allow the program to be part of a CMHC and continue to receive its NIMH grant. The problem was resolved when the staff sought the help of Congressman Robert Drinan, who came to the aid of the program and became a personal friend and advocate for a number of years.
During the third year of the NIMH grant (FY'75) state budget cuts to human services occurred and as a result, although additional state funds had been promised to replace the loss of federal funds when the NIMH grant ran out, state cutbacks did not allow for this. At the same time, Programs For People lost its site because the landlord needed to use the space for other purposes. The agency was in peril, and on the verge of closing. Ms. Carroll sought the assistance of a wide range of supporters of the program to mobilize efforts to save it.
Senator Burke helped get a "conversion" through the legislature that converted other state funds into salary positions for her previously federally paid staff. The Department of Mental Health added its political clout to the process and students from Framingham State College's psychology class mobilized a letter-writing campaign to legislators. A small Department of Mental Health contract was obtained to cover some of the expenses. Framingham Union Hospital offered to let the program move into one of its newly acquired buildings (rather than move to the basement of a state hospital, which was then seen as the only available space) and agreed to charge minimal rent. Ms. Carroll and her staff developed a board of directors for the program after seeking the advice of Paul Marks (who helped start the Danforth Museum) and the President of the Chamber of Commerce. The newly formed Board of Directors established the program as a private nonprofit corporation (Programs For People, Inc.) in 1976, and then Department of Public Health licensure was obtained for third party billing. Gradually the program found its way to solid footing and achieved financial stability.
This, in retrospect, was only the first in a series of financial "hurdles" over which the program has had to progress during its history of operation. In essence, bit by bit, "pieces" of its funding were lopped off along the way, including what remained of its DMH contract, as budgetary constraints plagued the Department of Mental Health. Nevertheless, one way or another with the support and resources of the Board and friends, the program continued to grow and flourish in spite of these losses. New sources of funds were obtained from the Massachusetts Rehabilitation Commission (MRC) to develop vocational services.
Then suddenly in the fall of 1989, additional state cutbacks had a catastrophic impact upon the program. In one crushing blow it lost 40% of its remaining DMH funds as four of its employees were redeployed to state institutions (one after 16 years of service to the program, another after 15). This loss had such a devastating effect upon the members of the program that they instantly rose up to defend it. Without any prompting or suggestion from the staff the members organized a press conference completely by themselves on the very next day at Framingham Day Hospital. Television cameras from Channel 7 arrived and in an incredibly moving testimonial members stood up one by one to let the public know how much the program had helped them, meant to them personally, and would suffer from the loss of its staff. They wrote a letter to the Commissioner of Mental Health condemning the redeploying of community workers to hospitals and urging the restoration of the staff to the program. They even went to Boston to meet with DMH officials.
In spite of this extraordinary outpouring of support for the program on the part of its consumers, the DMH cuts continued as they did for all of the mental health services in the area and throughout the state. Finally, in a bold decision, the Board and staff decided to embark upon a long and challenging journey over the ensuing years, transitioning the agency to the independent, self-supporting status that it has today, without the help of DMH funds.
Loss of the Site
At the same time that the budget cutting process had its impact upon the agency Programs For People lost its site at 108 Lincoln Street, the building that it had occupied for the past 12 years. The building had to be demolished to clear the land to make a parking lot.
The agency searched and searched for a new site. Rental properties were either exorbitantly priced or in locations that were difficult for members of the program to get to. After months of looking for a new site (and many disappointments) the search came to a fortunate conclusion when Framingham Union Hospital kindly agreed to sell the building next door (formerly occupied by the Framingham Heart Study) to Programs For People.
The decision to purchase the building was based upon a number of considerations. The first was an unsolicited, spontaneous donation of $100,000.00 from local citizens in response to an article in the Middlesex News describing the plight of the program in its search for a site. This miraculous gift enabled the agency to consider the option of purchasing rather than again renting property, as these funds could be used for a down payment.
Of primary consideration in the decision to buy was the fact that moving and renovation are extremely costly in terms of the time and money that this lengthy process requires. When a licensed program relocates, it must bring its new site up to stringent and extensive public safety, public health, and fire code requirements. The process of proceeding through all these inspections, renovating, and then being inspected again is arduous. The cost of code required renovations is often much, much higher than the cost of any programmatic renovations that an agency may need to make in order to provide services. Then, when a program is obliged to relocate again, all of that money is left behind, virtually going "down the drain." In addition, a licensed program that relocates must completely re-license, starting all over again, even if it is only moving next door. Finally, the lack of a permanent "home" always places an agency somewhat at risk. This is because the agency may be forced to vacate at a highly inopportune time, such as was the case in the years of budget cutting, when Programs For People was fighting for its very life
Purchase of the Building
Having been in the community since 1974, Programs For People had established itself as an essential service and had broad-based community support. Many, many individuals, organizations, corporations, and well-wishers came to the aid of the agency at its hour of greatest need.
Framingham Union Hospital provided a second mortgage for the purchase of the building. Citizen advocacy enabled Programs For People to obtain bank financing at a time when mortgages were extremely difficult to obtain. Local corporations such as Dennison, Perini, Liberty Mutual Insurance and others gave donations. An engineer volunteered to survey the new building's heating system and make recommendations. A Board Member obtained a computer from Polaroid Corporation for word processing so that proposals and other materials could be written with greater efficiency. A local building supply company donated sheetrock. A paint store donated paint. The local Alliance for the Mentally Ill made a contribution and the clients of Framingham Day Hospital offered to solicit contributions and help with fundraising activities. Even the contractor selected for the job donated many hours of time to help the Director with the building inspection process.
As a facility licensed by the Department of Public Health, renovation plans had to be approved at many levels. Local building and fire inspectors reviewed the overall plans for building code compliance, and added their own additional requirements. Then the Department of Public Safety reviewed the plans, and finally the state Department of Public Health. Consequently, the cost of renovation was considerably higher at the end of the reviewing process than it had been at the start. As it became clear that renovating the building would be much more costly than originally anticipated due to new and extensive code requirements, additional fundraising efforts were mobilized. This included proposals to foundations and appeals to individuals, civic groups, and corporations. Donations of handicapped bathroom fixtures, a commercial sink for The Lunch Box, and other material items were also obtained to help defray the cost. Staff, Board members, friends, and women from the Massachusetts Correctional Institute Framingham all worked nearly full-time over a four-week period to apply three coats of paint to the entire interior. The owners of the Sherborn Inn sponsored a fundraiser with the assistance, support, and contributions of many local citizens. Although a considerable amount was raised in the capital campaign, it was only sufficient to renovate the first and second floors of the building. Thus the agency had to "squeeze" itself into the first and second floors when it moved, and use of the third floor had to be put "on hold" until additional funds could be found to renovate it. It should be added that the primary reason that the cost of renovating was so high is the code requirement for a second egress, which necessitated our extending the front stairs up through the ceiling of the second floor in order to occupy that space. Without the third floor, there was only one large gathering place, located on the second floor. Therefore it was not possible to hold two groups at the same time. The third floor was needed for client groups and family meetings, group activities, and an arts area.
Thus during 1993, Programs For People started the ambitious project of converting the large, unused, third floor attic to five beautiful, usable rooms. With the help of The Boston Architectural Center, a federal Community Development Block Grant from the Town of Framingham, a Nonprofit Energy Efficiency Program grant for insulation, a grant from the Sudbury Foundation, and the donated services of Board of Directors Member and project contractor, Pasquale J. Teti, usable space was greatly expanded. The new space (complete with skylights) gave desperately needed rooms for individual, group and family therapy; an arts area; and an office for student interns. In addition, the agency was most fortunate to also receive a generous gift from the Rotary Club of Framingham which enabled counter space and cabinetry to be added to the arts area for work space and storage of art supplies.
In celebration of its 25th year of providing services to the MetroWest community, Programs For People held a public forum called, "Dispelling the Myths of Mental Illness" in downtown Framingham's town hall, which over 200 residents attended. The forum was free and open to the public thanks to financial support from TJX Companies, Inc. and Avery Dennison. It began with a presentation by a noted professor and author on the subject of stigma. The primary focus of the forum was an hour-long, interactive dialogue with the audience moderated by the Medical Writer for The Boston Globe, during which participants from a wide range of backgrounds raised concerns about stereotypes and the need for advocacy. Some spoke openly about their own battles with mental illness and described painful experiences of being stigmatized. Comments from a panel of representatives from the MetroWest community followed. The panelists included representatives from all aspects of the town including the Chief of Police, the Superintendent of Schools, a local clergyman, and a corporate representative. The panelists responded by offering to take action on behalf of changing attitudes and behaviors back in their own environments. The entire event was cable televised and aired repeatedly on local cable channels.
Programs For People has overcome incredible odds by keeping its services going in spite of its loss of state funds. When we lost our home, as well, we took a chance because we cared, believing that we would find a way to keep the program going. We did. We have come so far, but we still need help from people who believe in and support our cause. Contributions or gifts of goods and services truly make a difference for us. If you would like to help or find out more about Programs For People, please call Iris Carroll, MPH, Director, at (508) 879-3230.
Thank you for your interest in Programs For People!