SEVEN MONTHS AFTER the Department of Justice issued a scathing report about the treatment of inmates with mental illness in Massachusetts prisons, advocates for prisoners and people with mental illness are urging the Legislature to overhaul the way mental health treatment is provided to incarcerated people. 

“No one with a behavioral health condition should be treated the way these individuals are being treated right now,” said Monica Luke, chair of the National Alliance on Mental Illness’s Massachusetts advocacy committee. 

A bill sponsored by Sen. Jamie Eldridge, an Acton Democrat, and Rep. Brandy Fluker Oakley, a Boston Democrat, which had a hearing Monday before the Joint Committee on Mental Health, Substance Use, and Recovery, would institute changes at both state prisons and county jails and would require that many prisoners in crisis be moved out of jails into health care facilities. Eldridge said he filed the bill as a direct result of the Department of Justice report. 

Laura Wagner, executive director of the Unitarian Universalist Mass Action Network and a supporter of the bill, emphasized that a lot of training is required to become a mental health clinician. “The idea somehow that all changes and a person with a high school diploma, a Department of Correction correctional officer is somehow now responsible for providing care, assessing the seriousness of a situation, and deciding the best interventions — it violates any ethics in any profession,” Wagner said in an interview. 

The Department of Justice report, which was released in November 2020 after a two-year investigation, found that that the state Department of Correction was violating its constitutional obligations by failing to provide adequate mental health services to prisoners. The report detailed horrific stories of prisoners seriously harming themselves while correctional officers failed to intervene and even egged them on. The report found that rather than providing treatment, prisons kept suicidal prisoners in restrictive conditions similar to solitary confinement where they had limited access to books, personal items, or recreation. Many prisoners harmed themselves while on “mental health watch.” 

The bill before the Legislature, S.1283/H.2089, would require a mental health professional to certify when an inmate can be put on mental health watch and reassess their status based on an in-person interview every 12 hours. Anyone who has been on mental health watch for 24 hours and remains at risk of self-harm would have to be transferred to an inpatient psychiatric facility operated by the Department of Mental Health.  

The Department of Mental Health would have to write regulations requiring all state and county correctional facilities to have written suicide prevention policies, with a chain of command supervised by a mental health clinician for addressing suicidal inmates. The rules would require jails and prisons to provide confidential mental health treatment to inmates that includes medication and therapy when necessary. Any prisoner put on mental health watch because of a risk of self-harm would need to have a treatment plan that includes confidential individual therapy. 

The bill also lays out standards for the conditions of someone on mental health watch. These inmates would need to be provided with clothing, personal hygiene items, blankets, personal possessions, and time outside their cells.  

A correction officer who violates the polices would be barred from overseeing future mental health watches. 

Jesse White, policy counsel at Prisoners’ Legal Services, said the bill is necessary because today, prisoners at risk of committing suicide are placed in a cell, often without appropriate clothing or without any of their property, watched by an officer who is often antagonistic. She said a clinician visits daily to see if the inmate has stabilized and can return to the general population – without addressing the underlying problems that led the person to become suicidal. “This is a recipe for disaster,” White said. “A lot of people end up dying by suicide on mental health watch or shortly thereafter.” 

White said since the Department of Justice audit was released, the inmates she represents have not seen any change in circumstances. “We still have clients spending weeks, months, even upwards of a year or more on mental health watch suffering significantly,” White said. “There are still reports of guards taunting them, telling them to hurt or kill themselves.” 

A spokesperson for the Department of Correction declined to comment on the legislation. According to department officials, the Department of Correction maintained contact with the Department of Justice during the investigation and since its conclusion. It has consulted with the Department of Mental Health and retained expert consultants to provide input on inmate mental health services. Department of Correction administrators hold regular meetings to discuss the histories of inmates who harm themselves and develop intervention strategies, and the department has given additional training to staff in mental health housing units.  

According to a Department of Correction report from 2019, 28 percent of male prisoners and 75 percent of female prisoners have been diagnosed with serious mental health conditions. 

Bob Fleischner, senior consultant at the Massachusetts Association for Mental Health, cited Department of Justice statistics, which found Massachusetts ranked fourth nationally in suicide rates among inmates between 2001 and 2018, with 58 prisoners who died by suicide in state and federal correctional facilities in those years. “There’s a real problem here,” Fleischner said. 

Fleischner said there is a general legal principle that when a prison cannot provide an appropriate level of care, the prisoner must be transferred to a facility that can provide that care. “DOC is not an inpatient mental health facility, it doesn’t pretend to be. It shouldn’t be providing that level of acute mental health care,” Fleischner said. “The person should be transferred somewhere else where they can get the appropriate level of care.” 

Eldridge said providing adequate mental health treatment “is not just about taking care of incarcerated people in prison but helping them become more productive citizens once they’re released, as well as improving public safety within the prison and when people are released.”