Criminal Justice and Mental Health in Massachusetts: Connections, Challenges, and Collaborations
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Criminal Justice and Mental Health in Massachusetts: Connections, Challenges, and Collaborations


Hi everybody. We are going to start. I’m Lissy Medvedow,
executive director of the Rappaport Center
for Law and Public Policy here at BC Law School. And along with Professor Mike
Cassidy, faculty director, and Danielle Rivard-Warford,
our administrative assistant, welcome. We are truly honored to have
three special people here who care deeply and passionately
about the welfare and safety of individuals and communities. Thank you to Secretary Dan
Bennett of the Executive Office of Public
Safety and Security and to Secretary Mary Lou
Sudders of the Executive Office of Health and Human
Services for being here and for grappling on a daily
basis with the interwoven complexities of criminal
justice and mental health. That’s all I’m actually
saying about the panelists. They’re going to be
introduced momentarily by our third special guest,
our moderator Tiziana Dearing. She is Professor for macro
practice and co-director of the Center for
Social Innovation at BC School of Social Work. And before coming
to BC, her work in the nonprofit sector
combating poverty was legendary. Yes, legendary. She laughs. She headed up Boston Rising, she
was the first woman president of Catholic Charities for
the archdiocese of Boston, and she was the
executive director of the Hauser Center for
Nonprofit Organizations at Harvard. Now in her spare time, which
she could also laugh at, she’s a media star. We can often hear her
on Friday afternoons on WBUR’s radio
Boston, and she writes a blog for BUR’s Cognoscenti
and the Huffington Post. And just to add to all of her
other credentials, most notably from my perspective, she’s
on the board of the Rappaport Center as well as on the board
of our sister organization the Rappaport Institute at
Harvard’s Kennedy School, where she received a Master’s
of Public Policy and served as a fellow. So, welcome to Tiziana. Thank you again, Secretary
Bennett and Secretary Sudders. I leave you to
the three of them. At the conclusion, please join
us outside for a reception. Thank you so much. I want to– can you hear me OK? Is the volume all right? I wonder if I should move it
a little bit, just for now. Thank you for that really
lovely introduction. I’m very excited and a
little nervous to be here. Excited, because of
the amount of learning that I think it’s possible
to do in an hour and a half when you have people with
this much perspective and expertise and a willingness
to have a conversation. And nervous because I want to do
justice both to that expertise and to the learning agendas
of people in the room. So I talked to a few
of you in advance to try to get a
sense for what it is you’re interested in here. We have set an agenda together. In addition, what I
heard from the audience was a lot of interest about both
challenges and opportunities to coordinate
across the offices, and how that works
or doesn’t work, and where the
opportunities are there. So know that that’s what I
learned from the audience when I was walking around. We’re going to– I have no idea who this is, so– Hi, I’m Mary Lou Sudders. How long have you
been secretary? Three years. And you control 58% of the
budget, and I control 1%. He’s my favorite
1%-er, as I say. So it’s going to be that kind
of panel, which is great. I’m not going to do a
traditional introduction, because I was warned not to. So what I am going to do is
try to give some perspective on both the responsibility–
sort of the sacred trust and the stewardship– that these two panelists
bring with their work and with their
career dedication. They did both just allude
to the in total $23 billion in the state budget for
which the two of them are responsible. And between them, more than
20,000 employees who are focused on public safety,
criminal justice, and service to the people of
the Commonwealth. So just to get a sense for
the magnitude of the trust and responsibility that our
two secretaries represent, I think is important. Both of them have spent their
entire careers in service to the communities that
we’ll be discussing today. Secretary Sudders spent
time teaching as a colleague at the Boston College
School of Social Work, was the head of
the Massachusetts Society for the Prevention
of Cruelty to Children, has worked in state
government as the commissioner of mental health in
the past, and really has dedicated her career
and been recognized throughout her career to a
really, really deep commitment, not only to social work, but
to the vulnerable, the poor, and those experiencing
mental health crisis. Secretary Bennett has
spent his entire career on how a non-lawyer
sees sort of both sides of the law and the
courtroom, has moved in and out of public service and
private service which gives him a full perspective
of who you represent, how the system works, what
does and doesn’t work. He’s been with the Executive
Office of Public Safety since 2015, if I
have that right. Is that right? That’s right. And oversees 9,500
state employees whose job it is to
secure the safety of the citizens of the
Commonwealth of Massachusetts. Today we’re going to focus
on successes and challenges. And how we agreed together
that we can break that down is to begin with a
conversation about successes using Bridgewater State
Mental Hospital as an example. I said to somebody
the other day, I was thinking about
Bridgewater State, and they’re like,
the university. And I said, no,
not in this case. We are talking about
something else. Yeah. Then we’re going to
talk about challenges in terms of treatment
capacity having to do with women incarceration,
the intersection of addiction, criminal justice,
and mental health, and also civil commitments
and involuntary commitments. So that’s going to
be the landscape of the initial portion. Each secretary is invited to
speak on those topics for about 15 minutes. I will then ask some questions
that I’ll be developing real time as I’m listening. I have backup questions but
hopefully won’t need them. And then we’re going
to turn to you. So that’s how you can expect
three 30 minute chunks basically. The two of them presenting,
some panel conversation, some Q&A with the audience. With that, I think
we didn’t flip a coin but just decided that
Secretary Bennett was going to get stuck going first. So why don’t I turn
it over to you. And would you like me to give
you, at 10 minutes, maybe a five minute warning? Would that be
comfortable for you? That would be fantastic. And if I take that long, I
haven’t learned my lesson because Secretary Sudders is
just going to take 25 minutes. Oh. She said the opposite– I said the opposite. –just to be clear. OK. All right, all right. Well I was a criminal defense
attorney for about eight years, and I was a prosecutor
for about 12 years, so I was in the criminal justice
system for my whole career after I got out of law school. The last job I had
before this job was first assistant
out in Worcester county as Assistant DA. And I thought I was
getting a judgeship, and I didn’t get there
for whatever reason. I called my friend
George Hardiman, and I said, do you
think the governor’s going to appoint new judges. And he said, he’s going to be
too busy for the first year, but you know, you’d be a good
secretary of public safety. And I said, well that’s
kind of ridiculous. It’s always a sheriff,
or a state senator, or somebody like
that for that job. And so he said, no, no, no. This is a different
type of governor. Would you like to meet him? And I said, sure,
that would be great. And so I talked to my
brother-in-law and said, what do you think I should
do in the interview. And he said, be yourself. You’ll either get thrown
out in five minutes, or you might actually
have a chance at the job. So I walked in, and the
governor said to me, so this is a job you’ve been
pointing at your entire life. And I said, no I just had
never met a governor before, so I thought I’d come
in and talk to you. And I could tell the
governor was really tired. He had interviewed probably
for all these jobs. And suddenly he looked up,
and he had an interest. And he said, well, what would
you do if you were in this. And Souza-Baranowski, which is
the maximum security prison, happened to be in
Worcester county where I was the first assistant. And I had been up
there for a lot of murders which I
had prosecuted or been in charge of, and one
significant stabbing where a correctional officer had
been stabbed through the neck. Barely survived, and the actual
shiv had been left in his neck. And I had actually
prosecuted that case. The other thing that had
happened during my career was I had had witnesses down
at Bridgewater State Hospital. I had had defendants
who I represented down at Bridgewater State Hospital. And I had had people I
prosecuted who ended up at Bridgewater State Hospital. And I read the
records over and over of people because of
the things that I did. So I said to the
governor, I think that our Department
of Corrections does not protect the
corrections officers, does not protect the inmates,
does not provide the services, and I think Bridgewater
State Hospital is the worst example of it. And when I said that
to him, he said, OK. I saw that there was
a real interest there. And I saw that the
governor wanted to do something about that. And the rest of
the conversation, we discussed some of the
other agencies, some of which I knew nothing about,
like [? MEMA. ?] And the best thing
about this is, there’s a weather call
going on in a half an hour, and I don’t have to be on it
because they talk about snow the whole time. And I couldn’t care
less about snow. But we talked the
rest of the time pretty much about recidivism
and helping people with mental health disorders. And so when I got in there,
Secretary Sudders, and myself, and Secretary Lepore
who’s in charge of A and F, one of
the things that we concentrated on for the first
two years, essentially– 18 months. 18 months. Just felt like two years. Yeah, it was painful. Was what could we do
about Bridgewater. And when you went through
Bridgewater before, if you called it
anything but a prison, you were being dishonest. And I had spent a lot
of time in prisons both as a defense
attorney and a prosecutor. The patients were
treated like prisoners. The mental health help
was virtually nonexistent. There were
correctional officers. The seclusion and
restraint policies that were taking
place there, they could say it was
treatment, but the reality was, it was punishment. And those things
had to be changed. And they couldn’t be changed
by corrections officers. Corrections officers are
courageous individuals, men and women who go
into an environment where there are two
corrections officers in a tier at a time with 120
maximum inmates, many of whom would be happy to stab
them at a moment’s notice. But they are not
mental health workers. So what were Secretary Sudders,
myself, and Secretary Lepore going to present to the governor
and lieutenant governor that was going to work? And we all had a little
bit different expertise. Secretary Sudders had the
most expertise by far. And that was in
mental health and what was going to be the
treatment of the patients. And that was the
most important thing. I did have experience dealing
with the corrections officers, however. And how to get the corrections
officers to be willing to leave Bridgewater State Hospital. How to talk to them,
work with them, to let them know that it was
not a failure on their part that they were leaving
Bridgewater State Hospital. But they had an alternative. They were not going
to lose their jobs. It was just that they had
a different job to do. And that’s where I focused on. What happened was, we
went out and looked for an independent company,
a third party contract, to come in and provide
the mental health and get the corrections
officers out of there. The difference– and people
don’t realize it right now– in the past, the inmate
population has been rising. I don’t know how long that
goes back, maybe 20 years. But for some reason– and I don’t know the reason– I’ve heard a lot of different
ideas about the reason. The inmate population
across the country, but particularly
in Massachusetts, has been dropping like a rock. We’re down under
9,000 inmates now in the Department
of Corrections. And we’re closing prisons. Now what does that mean? That means for the
corrections officers that they were not
running classes. We weren’t adding
corrections officers. So by closing Bridgewater
State Hospital, they weren’t going to lose jobs. I could guarantee
them that they could go to Concord MCI, or
Souza-Baranowski, or to Norfolk and keep their jobs. And that was a key component. And I had to earn their
trust, and Commissioner Turco had to earn their trust that
were being honest with them. Now that could be done
over a negotiating table. That could be done over
a lot of different ways, over signed contracts. This is why my
brother-in-law thought I would be thrown out with the
governor within five minutes. I did it over a
lot of breakfasts at diners, sitting down,
eating cheese steaks, hanging out with them. And by the end of a lot
of times sitting around– different bars and
places like that– the corrections
officers trusted me enough that they would leave
Bridgewater State Hospital and know that I was
being honest with them and that they were not
going to lose their jobs. And Commissioner Turco and I,
when we shook their hands– and it wasn’t contractual– and we’ve kept our
word all along, they knew we were
telling them the truth. And none of them
have lost their jobs. They’re all still employed. They’re all got their places. And that gave an
opportunity to put into place what
Secretary Sudders was telling us was the right thing. Now through it all, I
would go and went down to [INAUDIBLE] down
in Connecticut. And I’d look and see what
other places were doing, other treatment
centers were doing, what other states were doing. So I was informed, but
I never tried to impose and tried to take a step
beyond my own knowledge, a step out of the area
where I understood. I knew about
corrections by the time this was over because I’d
gone to every jail and house of correction in the state. I’d gone to conferences
in the state to learn about corrections. But I didn’t try to step
into Secretary Sudder’s area. I trusted Secretary
Sudders to do her job. I did my job. And Secretary Lepore did
her job with the finances and making sure the contracts
were right and making sure we had the money for it. So if you ever want
to see a success, it’s what happened
at Bridgewater. Secretary Bennett, that’s the
perfect time with five minutes left in your opening
comments, to ask you to move from
the Bridgewater part now to some of these challenges
that we are discussing. And what do you
see as challenges in coming down the
road, especially around treatment capacity? Well the one thing
I looked at was– and this goes to
Secretary Lepore– we went from spending less
than about $17 million on Bridgewater, in some
ways, to $55 million. The government went
to the legislature and the legislature– I’m not going to pick on anybody
in the federal government– but the legislature and
the governor are partners. And when they go as
partners and they’re trying to do the right
thing, they work together. And so they came
up with $55 million to make Bridgewater
a reality and make it so that it works together. If you don’t have the finances
to get the mental health treatment for the, in that case
it’s patients, it can’t work. Now the big challenge
right now in the DOC is we’re spending $55
million at Bridgewater and [? Mass At ?] we
spend $12 million, which is about the same
number of patients. But we only spend $3 million for
the 9,000 inmates that we have. I’m not suggesting we spend
$1 less at Bridgewater or $1 less at [? Mass At. ?]
But $3 million on mental health treatment
for all the inmates is a very small amount,
because a lot of the inmates are in there because
they have substance abuse or mental health disorders,
or they wouldn’t be there. For a lot of them–
there’s a lot of reasons why
inmates end up there– but for a lot of them,
that’s why they’re there to begin with. Great, thank you. Thank you. Secretary Sudders,
shall I turn it to you? It’s a pleasure to be here. So you’re going to
hear a little bit of the differences between a
lawyer and security approach and a social worker and a
lens through mental health in solving some of these, I
would say, intractable issues. And I would say Bridgewater
State Hospital was– so unlike Secretary Bennett
who actually apparently had a job interview. So I’ll just tell you my
quick how I became Secretary of Health and Human Services. And it was a text the
morning after the governor became the governor-elect of the
Commonwealth of Massachusetts. And I received a text from him. And, of course, I
thought it was to ask me to be a member of
his transition team, because I’ve known
him for a long time. So I thought, well of course
I’d be on his transition team. And then when I looked at it
a little closer, I thought, didn’t exactly
look like inviting me to be on a transition team. I won’t tell you
what the email said. But basically I
showed it to my spouse to ensure that I was not
reading into the text message. And my spouse said,
I don’t think this is a part-time volunteer thing. I think he’s inviting you
back into public service. So that’s how I
became Secretary. So I didn’t have an interview. But Bridgewater is
an example of how this administration and
the leadership of Secretary Bennett and the governor’s
former Chief of Staff Steve Kadish, Secretary
Lepore who’s A & F, and so we came together
around Bridgewater. And it’s a slightly
different path to– let me give you the outcome. And these are words
that probably he would almost never use. So the goal at
Bridgewater State Hospital was to reduce the use of
restraint and seclusion which, as Secretary Bennett
has honestly said to, is being used as a
form of punishment. The best I would have
ever said about it was the facility used as a form
of treatment, maybe punishment. And yet, we know
that that’s actually contrary to what the laws
of the Commonwealth are, which is that restraint
and seclusion is actually to be used as emergency
procedure only. Was to institute a
recovery-oriented and trauma-informed treatment
program at our maximum state hospital. Now those are probably
words he would never utter 18 months, two years ago. And to improve the hospital’s
facility, the physical plant, to actually provide a more
therapeutic environment. Since last January, there’s
been a 99% reduction– this is January
through August data– 99% reduction in seclusion and
a 98% reduction in restraints. Anyone who has gone
to Bridgewater– I talked to family members,
so I am a family member. So that’s code for meaning
that you have family with serious mental illness. And we had a meeting with
NAMI, a bunch of families who had family members at
Bridgewater State Hospital before we started the change. And, for me, it was probably one
of the most difficult meetings I’ve had in my
professional life. And for Secretary
Bennett, it was what he was sort of expecting to hear. And, while I was
expecting to hear it, I would say that the rawness
of what we heard that night was one of those
times when you go home and you think, why
are you doing this. It was because we
had a commitment to make things better. Early on in our journey,
before the administration, before we really started on
the path of significant changes at Bridgewater– I don’t know if I’ve
ever told you this. So I might be disclosing
something here I’ve never said to Secretary Bennett. I am scared. Yeah, I’ll bet. I’ll bet. Can you tell he’s
really scared of me? I arranged a visit at
Bridgewater State Hospital, remember this? Without Secretary Bennett, with
Secretary Lepore for after 3 PM on a weekday at
Bridgewater State Hospital. And if any of you’ve ever been
to Bridgewater State Hospital prior to these changes, what
the staffing looks like before 3 o’clock in the afternoon
on the weekdays in the past is very different than what
it looks like after 3 PM. Again, this is
before the changes. So before 3 PM, there were
actually some clinical staff around. But basically the
mental health workers, or what we would think
in the treatment side, were correctional officers. But there was the
cadre around, there was some movement
and people around, and there was some
clinical staff. After 3 PM on a weekday,
it was a prison. It was a prison, in any event,
but it really was a prison. So I deliberately
took Secretary Lepore who was the keeper of
the budget, if you would, to visit Bridgewater
State Hospital after 3 PM. I then took her, the next
day, to the Worcester Recovery Center, Worcester State
Hospital, for her to see– which also has
forensic units in it– for her to see the possibility
of what change could look like. That was quite
conscious on my part. And a number of us had been
down to visit Bridgewater before 3 PM. You were there, the governor’s
general counsel had been there, I was there, and some
others for people to see it. I know there’s probably
many in this room that would want to know. So why isn’t it under the
control of the Department of Mental Health? And we can certainly
have that question during questions and answers. But we made a commitment
in the administration to completely
change Bridgewater. So Secretary Bennett, who really
needs a lot of credit on this, worked with the
correctional officers union. If any of you have ever
worked with unions– this is probably one of
the unions I’m glad– I work with nine unions– this
is probably one of them I’m glad I don’t have to work with. Because it just has a different
kind of culture about them. And he made a
commitment to move them outside of the walls of
Bridgewater State Hospital. So instead of being inside the
walls within the hospital that they would be outside the walls. Those were very
quiet negotiations. They were offline negotiations
with the commitment that people would
not lose their jobs. You may think that that’s easy. I can just tell you, that
is not an easy conversation. Meanwhile, he put
his staff together. I put the departmental health
staff together to redesign, basically, what
the services will look like and understanding
that the budget he had was not sufficient. This is also 2015. So I don’t know if
people go back that far. That was not a
great revenue year in the Commonwealth
of Massachusetts. So it was like us sitting there
saying, we need more money. It was not exactly a
conversation starter, but we were very
clear, both of us, that this was not rearranging
dollars within anyone’s particular budget. We jointly wrote the RFP. There were some definite
language issues, I think, in early RFP. His staff wrote it. Because you can’t co-write. I mean, one person writes. You edit back and forth. I think actually you said
inmates in it at one point. And seclusion restraint
was a former treatment, and I’m like, no! But this was all as
we were building up the trust between our staffs. Because this was still pretty
new in the administration. Went out to bid,
hired a company that provides mental health treatment
in correctional facilities and DYS facilities. Mental health, generally
civilly commitment. You moved out the– This was key. I think it was key. Yes, it was key. So we separated the populations,
the civilly committed populations from the
incarcerated populations. The inmates– From the patients. –from the patients. We moved them to exactly
the same treatment level. But they moved to Old Colony,
which was a prison next door. Because the inmates were taking
advantage of the patients. The civilly
committed population. They were stealing
their medicine. They were intimidating them. They were convicted
murderers, and inmates were choosing to
go to Bridgewater because the word around the
DOC was, this is an easy place to do your time. And you’ve got some people
you can push around. Sorry. No, no. That’s all right. See I’ve got five minutes. So the head of the contract
is a former commissioner of mental health, which,
from my perspective, was exactly what
I was hoping for. You walk in, there’s
electronic medical records. People have iPads. They do five minute
checks from their iPads. I don’t know. Has anybody been to
Bridgewater State Hospital in the recent past? I’m hoping what I’m
saying is resonating with what you’ve experienced. The physical plant is
obviously still compromised. I mean, there’s
not a whole lot you can do about that physical
plant, but people are trying. Patients are in their
clothes rather than in his favorite color,
which I think is beige. Just kidding, just kidding. I know, I know. I know. Orange– I don’t know what
the favorite color is. Families have much less
restricted hours to visits. There’s open access. There’s NAMI groups going on. And there actually is treatment
that’s being provided. And that is a success
story between, I would say, two secretariats. I don’t know what the history
is of the secretariats, but certainly two secretariats,
historically, probably have not worked as closely
as in this administration it’s actually expected
that we work together. So that’s sort of the Health
and Human Services version of Bridgewater State Hospital. And why don’t I
leave it at that? OK. Thank you. I appreciate that. I have a number of questions. I’ll bet you do. So, what struck me in
listening to the two of you, actually, was how much– so I have some students
and former students out in the audience, and I
kept wanting to catch their eye and say, do you
remember from class, do you remember from class. Because there was a lot
of change management skills that the two
of you actually had. I guess I was sort of thinking
from the corrections frame and the mental health frame. But this is about leadership
and change management as well. And so actually, my
first couple questions are more down that path. Secretary Sudders,
at the very end you said there were these two
offices, for lack of a better word, that historically had
not worked well together and now were. And that was an expectation. Is that what it took? So something before didn’t
work, and now it did. Was it that there was an
expectation set from the top? Or what else was going on that
made these two offices work together in a way that
they historically hadn’t? And Secretary
Bennett, I’d really love both of your perspectives. So there’s no question. I mean, one of the reasons I
came back into public service– and I’m an Independent,
and anybody who knows me would
probably say that about me in the governor’s cabinet– is that this governor will
take on intractable issues. He doesn’t simplify them. He understands they’re complex. He’s often said to us, if
this stuff had been easy, other people would have
figured this out by now. And it would be really easy
for politicians and others to ignore Bridgewater
State Hospital, because it’s a population
that the public– it’s easier out of
sight, out of mind. A lot of people are not
sympathetic to people with serious mental
illness who may or may not have committed crimes. It has a dark, dark
history in the Commonwealth of Massachusetts. It’s not something for us to
be proud of, historically. And the governor– it took
some time in the beginning part of administration, because
you’re dealing with so much. But a clear
expectation that EOPSS couldn’t do it by themselves. Certainly it’s not even
within my jurisdiction. But, I think, as
Secretary Bennett said, he understands the correctional
world, and security, and the like. And being shy and
retiring, I will just force the mental health
on him even if he didn’t want to listen to it. But the reality was,
you heard Dan say. I mean, he knows what he knows. I know what I know. I would never assume to
be a security expert. And it is around
change management, because the language
is different, the orientation is different. And when our staffs hit
challenging moments– I mean, I think the fact is
they would see the two of us at the table and just say, we’re
just going to work it through. But that would be my
perspective on it. Right. I think the fact that we both– Don’t like each other. That’s not true. Well, maybe it’s
true from one side. No. I think when the
goal is the same– Right. We shared the same goal. Same goal. Then you can– Work through the differences. You can work through
the differences. That was the key, having
the same goal in the end. And, I think, in this case,
seeing the people who were there and knowing the people– I don’t mean knowing them as– I could look and see
the people that I knew. Either they were my clients,
or they were the witnesses, or they were the
defendants I had tried. I could see them there. And that made it very
easy to make that a goal that you could work toward. So, picking up on that,
if part of the answer is that when you’ve got clarity
of vision and clarity of goals, people know where they’re
supposed to be trying to go. And, again, I welcome an answer
from either or both of you. What’s the next goal? That was a really
clear goal that got us to change in a
key place of intersection between criminal justice
and mental health. What’s the next goal? I’m going to let you go. Oh, thanks. I think it’s opiate addiction. Oh, wow. We’re doing a mind meld. See? The same goal. You were here to
see it, just saying. I think that the
governor has said that. And I think– Yeah, addictions. Whether it’s inside DOC
facilities or outside. I mean, hopefully inside the DOC
facilities, opiate addiction– hopefully inside
the DOC facilities, houses of correction,
is limited because we have the individuals
for a long time, though we have a severe
Suboxone problem coming into our facilities,
unfortunately. But it’s really in
the greater society. The opiate addiction is killing
way more people than violence is right now. And so what we
can do is, what we can do with the police,
or parole, or things like that and helping. Because I think everybody
knows the police aren’t going to solve the problem. But if we can work
with Health and Human Services and the
things they provide, I think we can make a
difference on that side. I would say opioids in general. I mean, the governor
had a working group. And I think he announced it
in his inaugural address. I chaired the governor’s
working group. And it gave us three months
to come out with a work plan, a blueprint for change. And in the governor’s
working group, one of the first
things that we took on was ending the long-standing
practice of civilly committing women to MCI Framingham which
had been in existence for more than 30 years. I actually found the
press clipping from when- he’s a good friend– when Phil Johnston was Secretary
of Health and Human Services in 1987 said that he was
going to end the practice. Took 30 years later to
actually in the practice of civilly committing
women to MCI Framingham. And worked in a very bipartisan
way with the legislature. Actually the bill
passed unanimously. And we created what we
refer to as the RAP program because everything has a name
at Taunton State Hospital, in lieu of MCI Framingham. That was a first step. And Secretary Bennett has
taken some of the learnings from what we’ve done at RAP. And in this governor’s
budget the changes at MASAC served to mirror the
treatment more closely to what we provide for the
women at Taunton State Hospital. But I will tell you that
one of the challenges is– and I happen to like the fact
that I’m 57% of state spending, and he’s my favorite 1%-er. But last year in the budget,
around opioids, I actually– I wanted all the
money, of course, because I always
want all the money. Because one in four people
in the Commonwealth touch Health and Human
Services directly. But actually advocated
for money for EOPSS around the trafficking
of fentanyl. Because it’s fentanyl that is
just such a killer right now. I mean, it takes four or
five Narcans with somebody, if you have that
opportunity, if the stuff is fentanyl, versus just
a tiny little trace. And actually advocated
for money for EOPSS. I’m not sure he
would ever advocate for more money for the
57% of state government, but I did advocate. I appreciate that because
we’re just about wiped out. Secretary Sudders, you
may have just touched on a piece of this answer. But when it comes to the next
goal being opioid addiction and the intersection
between addiction, mental health,
criminal justice– this is not a
general public room, this is a relatively
well-informed room. Yeah, I would think so. There’s a few judges in
the audience and people who like to sue us over
in this corner over here. Duh duh duh. Maybe not tonight. What is hard about that
that people might not know? What’s hard about–? What’s hard about
addressing the opioid crisis that people may not know? We can use Suboxone as an
example of a difference. Yes. Because you said it. I was going to be
nice and not say it. No, go ahead. So we know that some
evidence-based treatments for the treatment of
addictions– so, first of all, addictions– I have to just say this because
it makes me sort of crazy. People talk about addictions as
if it’s a homogeneous illness, just like mental illness
is a homogeneous illness. And I see one of
my former students here, so they would
know when I talk about mental illness in
my classes, I would say, it’s not a homogeneous illness. But we know that the treatment
for certain addictions includes– so we talk about
all the clinical tools in the toolkit,
and we talk about medication-assisted treatment. And Suboxone is an
evidence-based treatment of opioids, for example. So I promote, I
fund, pay for jails to introduce Suboxone when
someone is incarcerated, and then when they’re released
from jails and prisons, to continue their treatment. Suboxone is–
Vivitrol’s accepted within jails and prisons. Suboxone is difficult
in the culture of prisons because
of the ability for it to be diverted and used. So that’s my tee up
for you on Suboxone. And then we can talk
about injectables. OK. That’s fine. Vivitrol is something
that we do use and we’re going to use at MASAC. And the idea is it blocks
opioids and alcohol. So it’s not going
to be something that patients or inmates are
going to give out, or hide, or handoff. This isn’t really
a MASAC problem. Or it’s something that within
the Department of Corrections, the other facilities
that we run, no one is going
to come in and try to continue to get Suboxone. I mean, Vivitrol. But Suboxone’s
something that we’re trying to keep out of the
prison system on a daily basis. And for us in the Department of
Corrections to now do an about face and say, well we’re
trying to keep it out of every facility. We’re working on searching
people that come in. We’re working on searching
our corrections officers. We’re opening mail. And all of a sudden, we’re going
to start handing out Suboxone. Particularly when we’re very
concerned that it’s something that they’re going to start
trading around the facilities, it is not something
we’re willing to do. I’m planning on wearing him
down once injectable Suboxone is FDA approved and available. And he knows. He and I have already had
a couple conversations. Yeah. We talk. We talk. Do you think that’s
in the near offing. I mean, do you
that’s coming soon? The FDA approval? Yeah. I do. I do. So I’m going to shift
gears for a minute. And, folks in the
audience, we’re going to do about 10
more minutes of this. And then we’re going
to move to questions. So you can start thinking
about what you’d like to ask. Because you don’t want
us to sing and dance. It would be really not pretty. That’s right. And they won’t have
the snacks ready early, so we have to keep going. Yeah, good call. I’m going to come back to– we were talking
about Bridgewater. And one of the things that I was
thinking as I was listening– and I did some reading
in advance of this and was struck by the range
of commenters who have noted positive change there. And what I found
myself thinking– How about the reporter? Michael Rezendes. Yeah. What I found myself
thinking, especially from this change
leadership perspective, which again, keeps really– I mean, there are principles
of change leadership that you were both
talking about that are things that are
known approaches and are quite important
to get change to happen. But then there’s
getting change to stick. And one of the
questions on my mind is, what do we need to
be careful to avoid? Or, what do we need
to be watching for? Or what comes next to
avoid slipping back or avoid losing some of the
ground or some of the traction? I’m not sure the
appropriate word there. At Bridgewater. From both of your perspectives. Oh, I don’t think there’s any
going back at Bridgewater. I don’t think anyone would
allow it to go back, frankly. But I think how we
approach change, while some may be critical of
how we approach change, to me it actually has more
lasting opportunities. And that is a
pragmatic approach. And I don’t want to
use the incremental, because the changes
at Bridgewater were pretty astounding. But if we had filed a bill
that moved Bridgewater State Hospital to the Department
of Mental Health, we would still be
debating that bill. It probably would have died. It might have gotten refiled. It would have died. And there would’ve been no
change at Bridgewater State Hospital. And you could say, why. Because I would say
there was no appetite in the correctional
union to do it. Quite frankly, if I was
to poll the legislature, and particularly the House,
but not exclusively the House, there would be no juice– I’m sorry, that’s
my technical term– to move it to corrections. And we needed to demonstrate
that we could actually make change. So I think the fact
that we’ve demonstrated the secretariats
work well together, our two departments
work well together. They work on the contract
with the contractor in a very collegial way. I don’t think the public
would allow us to go back. And they’ve seen
demonstrable change. But we approach
many of the issues within this administration in
a pragmatic, what can we do. Create success, and then
you build upon success. Some people are
critical of that, because they’re like, why
don’t you do the whole thing. It’s just never how I’ve
approached public policy. I can’t wait to
hear your answer. Well, I think that the
biggest danger on this is it’s a natural
reaction when something is successful, in
the public eye, to try to find something
that’s wrong with it. That’s true. Particularly what people
don’t like, not necessarily the absolute result, but
when they’ve said to you, this isn’t going to work. And when you’re dealing with
a correctional environment or an environment where there’s
potential disaster always to happen, eventually
there’s going to be something that goes wrong. Right, something’s
going to go wrong. And if it goes wrong and
that one thing happens, or those two things
happen, people are going to say, oh, see. I told you we needed
corrections officers in there. Look at that person
with that issue. He came and he beat up
that mental health worker. We need the corrections
officers back in there. Or, that person when he
was being transported to the hospital, they didn’t
have a correctional officer in that motor vehicle,
and he jumped out and he was running around
the streets of Middleboro. That’s my biggest fear. We were actually very worried. I remember the
night of the change. So the change went from
the correctional officers at 11:59 PM, remember? Mhm. And then the
contractors came in. They were coming in, but the
shift happened at midnight. And the two of us, the
next day, were waiting. I remember this because
you and I spoke. We were waiting for the
assault, some critical incident that the staff didn’t show up. Our own anxiety around– someone drops a dime
to some reporters or to the correctional
officers union saying, see, we told you it didn’t happen. This was not going to work. Which you have no control over. And then you’re trying
to manage the noise. I think that’s what
we were worried about. And there were people– Who were hoping
that would happen. –that we’re hoping
that would happen. We won’t name them,
but there were people. There were people
that had told me that if I did this with
Secretary Sudders and Secretary Lepore, that there
was 10 or 12 people that we were leaving in there
that were so dangerous that it was going to be a disaster. They could not be controlled
without seclusion and restraint and could not be controlled
without corrections officers. And I was creating a
disaster situation. And I am not going to go as far
as saying that they were hoping it was going to happen, but
they were giving me indications that they were not going to be
all that upset if it happened. I think that’s what
we were worried about. I actually don’t worry
about this eroding. I think there’s too many family
members, too many other people who have eyes. Disability Law
Center has access. There’s too much change,
too much positive change, for it to go back. And transparency,
it sounds like. And much more transparency
than there had been. I mean, it really does
act like a hospital, perform as a
hospital, rather than as a correctional facility. So my last question, before we
turn to the broader audience. I’ve been looking for some
elegant way to frame it, and I can’t find
it to save my life. But I don’t want to
go out of my section without talking about civil
commitment and the tensions there between the need
for treatment and support and the involuntary
component of it. We could go three different
ways with this question. What do we not understand
that we should understand? Should that tension
be there, or is this a no-brainer and the
two of you don’t agree on it? Or, I don’t even know
what the third one is. I’ve really struggled with this. But I don’t want to leave
it without asking about it. So, let me take the– I definitely want you
to go first on this one. So first of all, we all would
agree that voluntary treatment is the best course and
path for someone’s chances of recovery and good lives. It’s just no question. The best therapeutic alliance
is an alliance of trust. We have long accepted
in the United States, for a small number
of individuals with serious mental
illness, the need for involuntary
hospitalization when you meet an imminent
harm to self or others by reason of mental illness. At the same time– just for the record,
I’ve always been opposed to outpatient commitment. There was an Op Ed in the
Globe many, many years ago. I still stay true
the words, even though it’s a little dated. And we’ve had a section
35 process, which people just refer to as section. That for harm by
reasons of addictions that has run primarily
through the courts– and the courts have really
been the first responder and police are the
first responders. So the governor and I proposed
a couple of years ago, which the legislature
didn’t want to consider, was a secondary path of
involuntary treatment for addictions. It’s basically taking, for
people who live in this world, taking the section 12 process
and amending section 35 to create a section
35(A) process. And I’m going to tell you why. First of all, it really comes
from, now, family members and police chiefs. And working with the courts in
trying to improve the section 35 process. There’s about 10,000
commitments for section 35 now. So let me just walk
you through this. A person is narcaned
multiple times and brought to an emergency room
on a Saturday night, currently. And is offered what
the legislature created was a voluntary assessment. And 90% of the people
in emergency rooms are offered the voluntary
assessment, say, thank you, no, and leave. Because they’re
in the height of– if you’re narcaned, you’re still
very active in your addiction. And you want to go and
find your next fix. So that Monday morning, if it’s
your family, you go to court and you take out a warrant of
apprehension which I believe only lasts for that day. That’s right. Only that day. We rely upon our police
to then go find the family member, the person. And if they find the
person, they’re arrested. And they’re taken to court, and
they’re put in a holding tank. And they’re evaluated. And the courts are
wonderful in this. That’s pretty bad. That’s the governor’s
press person. I’m going to turn
that phone over. If it was the governor,
would you have picked up? Of course I would’ve. I would’ve walked out. And the courts have been
wonderful about this. And the court clinician
evaluates the person. And the judge,
we’re asking judges to make what is essentially
a clinical decision. The person is now
actively detoxing and they’ve been actively
detoxing for a number of hours. In most of our
counties, the sheriffs pick someone up once a day
from the holding tanks. That’s not true in
every county, but that’s true in a number of counties. So the person is now actively
detoxing til about 4 o’clock in the afternoon. And then at that
point, they’re then transported to a treatment
facility, a facility that takes a section 35. So what we have proposed, with
all the due processes in place, is that in that emergency
room, if a clinician makes a determination that that
person is at imminent harm by reasons of
addiction, they would be able to section 35(A),
new process, a person to a treatment
facility for 72 hours. This is that Saturday
night [INAUDIBLE] that you talked about? That’s right. I’m using Saturday night because
that’s the most dramatic. Friday night would probably
be the most dramatic. 72 hours. And hopefully, at
some point, a person will be able to
intervene and help that person accept treatment. And if the person was
still at imminent standard, then we would go through
the section 35 process. The governor’s
bill makes working with the courts, and
particularly Chief Justice Kerry, of trying to ease the
process for the information courts need and the like
for a section 35 process. But that’s the intent of it. That’s the reason behind it. And it’s interesting
two years later, perhaps it’s because
it’s fentanyl, perhaps because narcan’s done what
we wanted narcan to do, which is harm reduction. So it does save lives. But the difference is,
now, two years later, the police departments
don’t really want to– they are our first
responders, and they are frustrated at how many
people are narcaned and are taken to emergency rooms
and are immediately released back to the streets. So this isn’t blaming anybody. It’s like, are we in that place
for a small number of people– and I would expect
it to be small– for whom an involuntary
treatment path may need to be the
right path for them. It’s controversial. We understand that. It’s not proposed
lightly, and that’s why we have a legislative
process to go through. You want to take it on? And I’m going to be
really rude and just go– No, go ahead. –make sure nothing’s burning. You have ignored me on
this subject for two years. OK. And I don’t pretend to
be as in-depth knowledge as Secretary Sudders. But here’s why I do believe in,
it and it comes from a doctor that I have a lot of
respect for that actually trains the first responders. And it comes from the difference
between when he started out in emergency medicine 25 years
ago with people with alcohol addictions– and
for the most part, someone with an
alcohol addiction get’s a chance to get help
over a period of time. Now with fentanyl, you very
well may not get a chance. You’re not likely
to die, but you have a real possibility of dying. And people don’t
understand right now. I could stand out here, and
if there wasn’t potentially a federal agent that
was going to pick me up, I could sell car
fentanyl to Judge Heines, and there would be nothing
a state trooper could do. It’s not illegal. Go ahead, sell it. It’s not illegal
under the state. We don’t have a statute
that makes it illegal. There’s six more
kinds of fentanyl– I’m also responsible for the
medical examiner’s office– there’s six more
kinds of fentanyl where they’ve changed
either the nitrogen atom, or the oxygen atom, or
the hydrogen atom in it that is also not illegal. So we have people out there
who are overdosing on forms of fentanyl that we cannot even
make an arrest on the dealer. So you’re not going to
get a second chance. And if you have somebody
in the throws of addiction, I think that we
owe them a chance to get off the street, at
least for those moments, and get a chance
to get some help. Because they’re
not likely to get a second chance with fentanyl. It’s not like, it’s
oh, there’s 50 people that have died this way. We have, in one
year, more people who are from Massachusetts
die of heroin and fentanyl overdoses than people
from Massachusetts died in the entire Vietnam War. And that’s one every year. So, I do believe in it because
of the danger of fentanyl Thank you for those answers.

About Bill McCormick

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