Riggs Clarifies Its License Status

Since the 1960s, Austen Riggs has been licensed as both a hospital and a Residential Treatment Center. Over time, credentialing agencies have increasingly defined “hospital” care as short-term crisis management focused on protection and safety. Given Riggs’ commitment to maximizing patients’ capacity to take authority over their lives, we gradually reduced the number of beds designated for “hospital care”—beds that provided more intensive nursing support during crises while preserving therapeutic relationships. However, these beds were rarely used. In the past five years, only four of our 71 beds have been hospital-licensed, averaging just 6.6 days of use per year. The last time they were used was December 2023.

These four beds, located in the Inn, formed our Voluntary Hospital Program (VHP), a short-term, fully open, and voluntary level of inpatient care. The VHP offered brief, intensive engagement with nurses and staff to help patients stabilize and assess whether they could safely continue treatment in our open setting or required transfer to a more restrictive facility.

Recently, in line with national trends, the Massachusetts Department of Mental Health (DMH) further tightened its interpretation of hospital regulations, requiring complete physical separation of “hospital” beds from our therapeutic community. This would have forced Riggs to wall off a section of the Inn, fundamentally altering our mission centered on patient authority and deep therapeutic relationships.

After careful consideration, Riggs has decided not to pursue re-licensure as a hospital. This decision does not affect our licensure as a Residential Treatment Center, nor does it alter our treatment model or non-profit status. During crises, we will continue to provide increased engagement and assessment for transfer when a higher level of care is needed.

“Our discussions with DMH over the past 10 months have been thoughtful and comprehensive,” said Medical Director/CEO Edward R. Shapiro, MD. “However, the increased restriction and isolation required for hospital beds would compromise the openness and therapeutic freedom fundamental to the Riggs model. Our decision reflects the broader shift in psychiatric care, where hospitals now primarily focus on protection and safety, while treatment increasingly takes place in Residential Treatment Centers. Riggs remains steadfast in its commitment to an open therapeutic environment, deep respect for individual autonomy, and a community that fosters meaningful engagement in treatment.”

Founded in 1919, Riggs provides intensive residential treatment for individuals with complex mental health challenges who are not in acute crisis but for whom outpatient care has been insufficient. Many Riggs patients have undergone multiple treatments—including medication, therapy, and inpatient care—without achieving lasting relief or the ability to take charge of their lives.

At Riggs, there are no locked doors, privilege systems, or physical restraints. Instead, patients balance freedom with responsibility. Our treatment pathway begins at the Inn Residence, where each patient has a private room and works with the same interdisciplinary team from admission to discharge. This care starts with 24-hour nursing support and transitions through step-down programs as patients take increasing authority over their lives and treatment costs decrease. Throughout their stay, patients engage in intensive four-times-per-week psychodynamic psychotherapy, active participation in our Therapeutic Community Program, medication management, family interventions, casework, and a diverse range of arts and education activities.

This decision reaffirms Riggs’ dedication to its core mission: providing deeply relational, psychodynamic treatment that helps patients understand and work through the meaning of their symptoms, fostering lasting change within a therapeutic community.