Why we must reform mental health in MA prisons - and how to do it

In Massachusetts, which has not allowed the death penalty since 1984, a prison sentence is never legally a death sentence. Yet the U.S. Department of Justice (DOJ) has documented that, too often, the Commonwealth allows prisoners with behavioral health conditions or in extreme distress to die in custody.

A November, 2020 report by the DOJ found constitutional violations and significant failures by the MA Department of Corrections (MDOC) to provide safety for people incarcerated in state prisons who are at risk of suicide. The report documented abuses including correctional officers falling asleep while charged with one-on-one supervision of suicidal prisoners; officers taunting and encouraging prisoners to engage in self-harm; and intentional delays in health interventions when prisoners had harmed themselves.

These problems seem to have vexed corrections administrators for decades. According to a new 2021 report by the Department of Justice’s Bureau of Justice Statistics, between 2001 and 2018 Massachusetts’ prisons had the fourth highest suicide rate in the country (31 per 100,000 prisoners–more than twice the suicide rate among the population at large). Moreover, according to other published reports, the rate of suicides in the Commonwealth’s jails was even higher. In 2014, for instance, the rate was 78 per 100,000, more than twice as high as that in the prisons.

It is widely recognized that people with behavioral health disorders are significantly over-represented in prisons and jails. We also know that restrictive and inhumane practices affecting prisoners with behavioral health needs exacerbate the inherent trauma of incarceration. Often, this leads to lifelong mental health conditions that disrupt successful transitions back into the community and undermine the efforts of incarcerated people to rehabilitate themselves. Nonetheless, Massachusetts’ prisons continue to allow prisoners’ mental health to deteriorate, untreated, to the point of death in custody and fail to address root causes of mental health crisis.

Significant reform is needed to rectify these critical policy, safety, and constitutional concerns. We do not have to start from scratch. The nation’s leading prison accreditation organizations and experts in prison suicide prevention have outlined best practices that our state can, and should, adopt in a comprehensive suicide prevention plan for implementation in our prisons. This plan must include the following components.

• Articulate a clear suicide prevention policy that establishes a mental health suicide watch chain of command supervised by mental health clinical supervisory staff, not security/correctional staff.
• Ensure that individuals on mental health suicide watch are placed in a clinically appropriate setting, not isolation or solitary confinement. We must minimize the trauma, isolation, and severity of any protocols or deprivations to those that are clinically necessary and not made by security staff.
• Provide meaningful therapeutic interventions using individualized treatment plans to individuals identified as at-risk for suicide, including regular and consistent counseling and therapy in individual and/or group settings.
• Obtain an independent review of all suicides, attempted suicides, and incidents of self-harm and implement lessons learned and recommendations after every incident.
• Ban from future mental health watch duty any correctional officer found to be in violation of the written suicide prevention policy, including sleeping on the job or verbally taunting prisoners.

Although MDOC currently is negotiating with DOJ about how to address the DOJ report findings, broad reform is needed to ensure that people in MDOC custody are treated humanely and that effective services are provided to minimize mental health crises wherever possible.

Legislation filed by Sen. James Eldridge (S.1283) and Rep. Brandy Fluker Oakley (H.2089) provides a critical roadmap for these reforms, and we urge lawmakers to pass this legislation during this session.