Mass. DOC, DOJ reach agreement on mental health reform

By Christina P. O'Neill
February 5th, 2023

Massachusetts prisoners with behavioral health problems will receive heightened levels of care while in custody of the state Department of Corrections (DOC), under an agreement reached between DOC and the U.S. Department of Justice (DOJ).

The DOJ’s Civil Rights Division published Investigation of the Massachusetts Department of Corrections on November 17, 2020, in conjunction with the Massachusetts U.S. Attorney’s Office. The report advises that its findings indicate that the practices it found interfered with prisoners’ rights under the Eighth Amendment of the U.S. Constitution.

The DOC released its detailed response to the DOJ report on December 20, 2020. It includes: policies and procedures for supervision of prisoners in mental health crisis; training and staffing plans; therapeutic response to and supervision of those prisoners; development of an intensive stabilization unit; behavioral management plans; and quality assurance measures.

The DOJ report charged the DOC with providing inadequate supervision to prisoners under Mental Health Watch (also defined as restrictive housing or solitary confinement), resulting in failure to protect prisoners from “serious harm.”

The DOJ documented 18 cases of prisoners self-mutilating, attempting or committing suicide while under Mental Health Watch, citing staff’s failure to remove instruments of self-harm or to keep sufficient watch on prisoners under 1:1 supervision.

The DOJ recommended the following reforms: ensure prisoners cannot access instruments of self-harm or engage in self-injury; develop policy and training for officers and mental health staff and discipline officers for non-compliance; ensure communication and coordination between officers and mental health staff; conduct daily out-of-cell mental health assessments and document prisoners’ requests for or refusal of assessments; provide meaningful therapeutic interventions and clinically appropriate; and hire a sufficient number of mental health clinicians to provide those interventions.

In addition, the DOJ called for individualized crisis treatment plans for prisoners who repeatedly self-harm, as well as behavioral management plans; transfer of prisoners to inpatient psychiatric care when clinically appropriate; policies and procedure for step-down placement of prisoners coming off Mental Health Watch; and report and review data regarding lengths of stay.

The agreement between the DOC and DOJ, with an effective date of December 20, 2022, outlines the steps the DOC has taken or in process of taking and gives timelines for completion.

A December 20 statement by the DOC outlines the following: Appointment of an independent qualified expert agreed upon by DOJ and DOC to review the care of individuals in crisis and ensure ongoing compliance with the agreement.

That expert is Reena Kapoor MD, a professor at Yale School of Medicine, who has worked as a psychiatrist in correctional facilities, served as a consultant to litigants and as an independent monitor in other jurisdictions with the goal of facilitating improvements in policies and practices as they relate to prisoners with mental illness.

At the federal level, Kapoor serves as a consultant to the Department of Justice on concerns related to correctional mental healthcare. She previously served as a consultant to plaintiff-prisoners in their claims against the Federal Bureau of Prisons. At the state level, her experience includes overseeing settlement agreements involving prisoners with mental illness in Illinois, Louisiana and Connecticut.

Other provisions outlined in the agreement are: improved data collection requirements regarding Mental Health Watch, now known as therapeutic supervision; enhancement of clinical interventions, out-of-cell therapeutic contacts and adjusted property allowances for prisoners on therapeutic supervision; expansion of existing crisis intervention training for DOC personnel; development of an intensive stabilization unit to provide individualized treatment for those on extended therapeutic supervision who do not meet statutory requirements for in-patient hospitalization; retention of support persons through a contracted healthcare provider under the supervision of qualified mental health professionals, to engage in non-clinical interactions with individuals on therapeutic supervision.

A DOC spokesman noted the DOC “remains focused on fulfilling the terms of the agreement, which it believes will further advance the significant improvements already implemented with respect to mental health care policies and practices. While DOC has already made many changes over the past three years, the agreement will help the department achieve its goal of providing greater supervision and the highest standards of care for those experiencing a mental health crisis.”

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