It was nearly a year ago that widespread abuse at Lakeview Neurorehabilitation Center in Effingham came to light. Now, Lakeview is shutting down.
The facility is a treatment center for people with brain injuries and intellectual disabilities. And as New Hampshire faces a future without Lakeview, families and state regulators are deciding where to send people with highly challenging behaviors.
But as it turns out, the state has been facing these same tough decisions for more than 100 years.
Lakeview billed itself as a short-term treatment facility for people with complicated needs: sometimes autism and a mental illness, rare genetic conditions, and often a history of aggression. Despite that wide range of conditions, all those clients did have something in common, says Roy Gerstenberger of Community Bridges.
"Lakeview has become a resort for people who have nothing else, where other options are not available," says Gerstenberger.
Community Bridges is one of ten Area Agencies tasked with helping people with disabilities live independent lives across the state. Last year, those agencies served a majority of people – about 5,000 – right at home, in their communities. And that’s the state’s policy goal: to help people in the least restrictive environment possible. That’s why Lakeview was a last resort. On the side of a mountain near the Maine border, it’s highly restrictive.
"A place like Lakeview is seen as an environment where somebody can be secure," says Gerstenberger, "where somebody cannot injure somebody else in public."
Lakeview has a total of 88 beds. But now it has fewer than ten clients. A few other companies like Crotched Mountain and Easter Seals still work with people with such complex needs.
Just 25 years ago, New Hampshire was a national model for the care of people with disabilities and mental illness. Now the state is shutting down a facility with a long track record of abusing and neglecting those same people. So how did we get from there to here?
To understand, you actually have to go back a little further and visit other facilities the state shut down.
"Society did not want to deal with us"
Paul Shagoury is a retired psychologist who worked at New Hampshire State Hospital in the 1970s, when it was an asylum for people with mental illness. Most of the old hospital grounds are now state offices, but down in the basement of the oldest building, Shagoury is reminded of the bleak living conditions for some.
"So these were actually patient rooms at one time – the more violent patients," he says as he scans the walls of small, dank room. "You can see the thickness of the brick walls, and, I mean, the size of it, which is probably, what, maybe twelve feet by eight feet. One window."
There was a second institution in New Hampshire called Laconia State School. That was the state-run facility for people with intellectual disabilities - people like Roberta Gallant of Concord. Gallant has become an outspoken advocate for people with disabilities. In 1956, her parents dropped her off at Laconia. She was five years old, and she’d be there into her 30s.
"They slapped and kicked us, pulled our hair," she says. "They burnt some of the residents with their cigarettes. Other staff physically performed sex on me."
Abuse and neglect at the Laconia State School started to come to light around the time Gallant arrived. But its very existence was emblematic of a trend in care nationally.
"Society did not want to deal with us," says Gallant. "So they warehoused us in an institution."
That was a mindset that had begun with good intentions. Asylums were built as refuges in the late 1800s and early 1900s. But by the mid-1900s they were overcrowded and understaffed, like at New Hampshire’s state hospital.
Shagoury says there were many talented, honorable staff. Still, he's haunted by what happened in these institutions.
"I can sort of feel some of the anguish of the patients who came here," he says. "Nobody came here because they were happy. And there are tens of thousands of stories of unhappy people that were here."
From institutions to communities
Things began to change when new drugs allowed people with mental illness to leave asylums. News reports exposed inhumane conditions, shifting public sentiment. Between 1955 and 1980, more than 400,000 Americans left institutions.
Lawsuits also drove public policy. Dick Cohen is the outgoing Executive Director of the Disability Rights Center, which uncovered abuse at Lakeview last year. Cohen also blew the whistle on Laconia in 1978. He helped file the lawsuit that would shut Laconia down.
"So what we alleged," Cohen says, "was that, number one, they weren’t getting treatment, number two, they were also in many instances being actively harmed, which the state didn’t have a right to do, and, number three, they could all be treated with appropriate supports in the community."
In the 1980s, the state backed this idea of community-based care, and New Hampshire became a national model for it. But support still lagged for people with co-occurring problems – people with similar conditions and behaviors to those who would ultimately wind up at Lakeview.
Public funding dried up
And then, money started to dry up: first, federal funding in the 80s, and then state funding in the 90s and early 2000s.
In stepped a private company called Lakeview. It opened in 1992 as a facility for people with brain injuries. But as public money continued to be cut, Lakeview accepted the people New Hampshire had the hardest time serving, often people with both a mental illness and an intellectual disability. Then in 2009, the legislature cut funding for an acute-care psychiatric unit at New Hampshire Hospital.
"That event was pretty significant, but I don’t think we realized how significant that event was until time passed," says Health and Human Services Commissioner Nick Toumpas. "We went back and we looked at the data and saw that for the five year period leading up to November, 2009, we had 12 admissions into Lakeview. In the roughly five years since the closure of that unit, we’ve had 77."
It isn’t just New Hampshire that has struggled to meet the needs of people with the most complex behaviors and conditions. Until recently, Lakeview had clients from across the country, even as far as Hawaii.
The next steps for New Hampshire are not entirely clear. Since Governor Hassan shut down new admissions to Lakeview last fall, people who would have wound up there are instead in and out of nursing homes, psychiatric facilities and jails.
Others, though, are finding themselves in a more hopeful place. But as tomorrow’s story will show, that place is not without controversy.