By Kellianne S. Munichiello
For the many families across Massachusetts watching someone they love struggle with an alcohol or substance use disorder (A/SUD), the last resort is to seek a civil commitment court order to force involuntary treatment. Such petitions under Massachusetts General Law Chapter 123, Section 35 are commonly referred to as “Section 35 petitions.” Unfortunately, what feels like the only option for many families can end up causing considerable anxiety when the subject of the petition is committed to a correctional facility.
Section 35 allows Massachusetts courts to involuntarily commit a person to treatment if that person has an A/SUD and presents a risk of serious harm to himself or others because of his A/SUD. Family members, police officers and certain medical professionals may file a Section 35 petition alleging such circumstances in any Juvenile or District Court. The court may issue a summons for a hearing or a warrant allowing police officers to locate the individual and bring them to a hearing. Petitioners and the person alleged to require treatment attend the hearing and present their sides. The court orders an examination by a qualified health care professional or social worker. The individual has the right to refuse the examination, which is not a prerequisite for commitment. After considering all the evidence, the court may order the person to be committed for a period of up to 90 days. This already difficult process becomes more difficult when the person is male and is committed to a correctional facility.
Under Section 35, a court can only commit women to facilities managed by the Department of Public Health (DPH), unless they are the subject of a pending criminal matter. The current law does not afford men the same protection and a number of citizens and legislators have demanded that Massachusetts end its practice of committing men to correctional facilities under Section 35. Currently, bills pending at the Massachusetts State House would eliminate language that allows commitment of men to facilities approved by the Department of Corrections (DOC), add language that limits Section 35 facilities to those designated by DPH, and provide for case management services by DPH for up to one year following commitment.
Currently, the Section 35 Frequently Asked Questions (FAQ) page on the state’s website, https://www.mass.gov/section-35, lists the three different Section 35 treatment programs for men with no additional information about the nature of the available facilities: Men’s Addiction Treatment Center (MATC), Massachusetts Alcohol and Substance Abuse Center (MASAC), and Stonybrook Stabilization and Treatment Centers (SSTC). The website explains that petitions cannot be withdrawn out of a desire to avoid commitment to a correctional facility but fails to explain the differences in treatment that would motivate that desire. For someone who is filing a Section 35 petition, this is insufficient information. At the very least, the state needs to take affirmative steps to inform Section 35 petitioners of the high likelihood of commitment correctional facility and the difference in treatment a person committed to a correctional facility can expect as opposed to those administered by DPH.
In 2018, the legislature and Governor Baker created a Section 35 Commission (the Commission) to study the efficacy of involuntary inpatient treatment and to evaluate and develop a proposal for a consistent statewide standard for the medical review of individuals. On July 1, 2019, the Commission released an 87 slide Power-point of its report, which provided detailed information on Section 35 facilities. According to the report, the only men’s facility overseen by DPH is MATC in Brockton, capacity: 108 beds. The largest men’s facility is MASAC in Plymouth which is run by DOC, capacity: 251 beds. The two newest men’s facilities, branches of SSTC, are both administered by the Hampden County Sheriff’s Department (HCSD). One SSTC is in Ludlow with 85 beds, while the other SSTC is in Springfield with 32 beds. So, roughly 77% of the available beds for men committed under Section 35 are inside correctional facilities.
Another thing that petitioners may not understand about Section 35 petitions is that not every facility has equal access to Methadone. While all four treatment facilities now offer Buprenorphine and Naltrexone, MATC in Brockton is the only men’s facility licensed to offer methadone and the only non-correctional men’s facility licensed to do so. Therefore, a man committed under Section 35 has less than a 25% chance of having access to Methadone. Methadone is a controversial topic when it comes to treating substance use disorders, but according to Dr. Alexander Y. Walley of the Grayken Center for Addiction at Boston Medical Center, who presented to the Commission, methadone has the best rates of retention for patients.
Petitioners should also be informed that the quantity of therapy services offered by MASAC is significantly less (nearly 1/3) than MATC and SSTC. Each week MATC offers CSS clients 25 hours of group care and 4.5 hours of individualized care, for 29.5 hours total. SSTC offers 32 hours a week of group and individual counseling. SSTC Springfield also offers an additional 15 hours a week in outpatient services through a hospital, although it is not clear what these outpatient services entail. On the other hand, MASAC only offers 17 hours of group care and 1.5 hours of individual care, for 18.5 hours total per week. As MASAC houses more than half the available beds for men committed under Section 35, this information should be readily available to petitioners.
It is also important for petitioners to understand he correctional procedures at MASAC because they are said to interfere with scheduled treatment programming. This casts further doubt on the ability of DOC to provide adequate therapy programming to individuals with A/SUD. For example, four times a day the patients at MASAC are instructed to “stand by the foot of [their] bed, fully clothed, refrain from talking, and remain standing,” while officers count them. This procedure often exceeds the time allotted, causing therapy programs to be cut short or cancelled with no alternatives provided.
Both MATC and SSTC provide access to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) for patients, but the Commission notes in its report that MASAC offers access to “peer led support groups -AA/NA.” Traditional AA/NA groups tend to include people in various stages of recovery because a key part of AA/NA is sponsorship, when a person with a longer track record of sobriety offers guidance and support to an individual in the early stages of recovery. Likely, individuals leading support groups in MASAC only recently achieved sobriety within the past 90 days upon commitment under Section 35, which might limit the experience they can offer to peers.
Patients treated at both MATC and MASAC have described the difference as “night and day,” among other things. WBUR radio reported in 2017 that MASAC’s staff consists of approximately 100 Correctional Officers and 17 substance use counselors, though those numbers have slightly increased. Correctional officers at MASAC receive no specialized training regarding A/SUD. MASAC patients are strip-searched upon admission (and at the discretion of Correctional Officers throughout treatment), subjected to solitary confinement for punishment, and come into contact with individuals who have been criminally convicted and sentenced. Patients have complained of officers at MASAC using abusive language, threats, and intimidation. Comparatively, SSTC houses its A/SUD patients in a wing completely separate from its criminal population. SSTC boasts a treatment team composed of 17 individuals with Master’s Degrees. This is close to the number of counselors employed by MASAC, but SSTC houses only half as many patients, meaning more individual attention can be given to each one. MATC’s facility does not have a criminal population or correctional staff. Statistics regarding the MATC staff are not immediately available. However, DPH oversees MATC. Patients have described MATC as providing comprehensive addiction treatment. Patients are not subjected to strip searches, solitary confinement, or correctional facility rules and procedures at MATC. Patients are treated the way they should be: as humans, not criminals.
People question whether involuntary civil commitment should be allowed at all, but most complaints are not about involuntary treatment – they are about being treated like a prisoner. Many disagree over the effectiveness of Methadone, AA/NA, Section 35, and the treatment of A/SUD generally, but if there is a difference between the treatment offered at Section 35 facilities, this information needs to be more readily available so that family members and loved one can make informed decisions about whether to petition for commitment.
It is worth noting that Sheriff Nick Cocchi of HCSD explains that his department opened SSTC in 2018 to address the lack of Section 35 facilities available to Western Massachusetts residents after an individual died in 2017 during the 2.5 hour transport to a facility in Eastern Massachusetts. In response to the criticisms of Section 35 programs at correctional facilities, he fiercely defended the success of and need for SSTC. In addition to providing the information necessary for Section 35 petitioners, making information about the differences in facilities readily available would give HCSD the opportunity to distinguish the SSTC program from the highly criticized MASAC program. This opportunity should be used alter the discourse away from whether correctional facilities are appropriate for treating A/SUD under Section 35, towards a discussion about which practices correctional facilities should be required to implement before they are allowed to treat A/SUD.
Kellianne S. Munichiello is a second-year law student at Suffolk University pursuing a concentration in Business and Financial Services, with an interest in trust and estate planning. Kellianne obtained her B.A. in Psychology from the University of Hawaii at Manoa in 2016. She is a Staff Member of the Journal of Health and Biomedical Law.
Disclaimer: The views expressed in this blog are the views of the author alone and do not necessarily represent the views of JHBL or Suffolk University Law School.
SOURCES
https://www.mass.gov/files/documents/2016/09/pg/chapter-55-report.pdf
https://www.ncbi.nlm.nih.gov/pubmed/26790691
https://www.ncbi.nlm.nih.gov/pubmed/29732697
https://malegislature.gov/laws/generallaws/parti/titlexvii/chapter123/section35
https://reason.com/2019/03/19/massachusetts-sends-men-to-prison-for-ad/
https://www.mass.gov/service-details/section-35-the-process
https://www.mass.gov/lists/section-35-commission-report
https://www.mass.gov/files/documents/2019/07/01/Section%2035%20Commission%20Report%207-1-2019.pdf
https://www.mass.gov/files/documents/2018/11/16/Section%2035%20PPT%20Walley%2011.5.pdf
https://www.wbur.org/commonhealth/2019/03/14/masac-section-35-lawsuit
https://www.wbur.org/commonhealth/2017/09/13/civil-commitment-substance-treatment