Mass. is poised to spend millions on forced addiction treatment, reigniting debate over system

Every year, thousands of Massachusetts families make the gut-wrenching decision to ask a judge to force a loved one into addiction treatment. In the last fiscal year, more than 6,000 people filed such petitions, although they have no say in where or for how long a loved one must remain in treatment.

While many states use civil commitment, Massachusetts is believed to be the only state that court-orders some men to treatment inside jails and prisons — even if they haven't committed any crimes.

As legislators seem poised to add millions of dollars in funding for involuntary commitment programs under the law called Section 35, there are concerns among legislators, public health advocates and families on the state of forced treatment here.

A lack of control for families

About a month ago, Jim Derick, of Franklin, petitioned a court to "section" his 31-year-old son to treatment for the fourth time in three years.

Derick, president of the SAFE Coalition, a substance use support and education nonprofit, said he opted for forced treatment after Franklin police found his son using drugs with another man who died of an overdose.

Derick's son was sent to Stonybrook Stabilization and Treatment Center, one of two Section 35 programs operated in state-run correctional settings. Hampden County Sheriff Nick Cocchi helped launch the program in 2018 to address what he saw as a dearth of treatment options in western Massachusetts.

Derick was surprised when his son called him recently from Stonybrook, in Ludlow.

"[My son] was telling me how good he felt about the care he was receiving," Derick said. "He said that it feels like one of the better treatment places he's been in. He's been to well over a dozen private and public rehabilitation centers."

Derick said his son, who six months earlier was sent to the other Section 35 program inside a correctional facility, the Massachusetts Alcohol and Substance Abuse Center (MASAC) in Plymouth, described a "radical difference" between Plymouth and Stonybrook.

"It's completely different," Derick said. "Down to the clothing they're issued. They get khakis and t-shirts, not prison jumpsuits. The other times that he was in that setting, he developed a lot of animosity and vitriol toward the system. A lot of mistrust, and frankly, a renewed reluctance to continue with treatment. I'm not saying the correctional facility causes that, but it certainly can amplify it."

State law allows a person to be involuntarily committed under Section 35 for up to 90 days. On average, people stay at Stonybrook for 55 days and about half as long at Plymouth, according to the Department of Correction's website. Gov. Charlie Baker moved the center from Bridgewater to a former minimum security prison in Plymouth in 2017.

Victor Kassel, 29, was sent to MASAC about a year ago after cycling through treatment programs and detox facilities.

"I've been through the whole wringer in terms of treatment," Kassel said. "But I would say MASAC is the worst place I've been to."

After several weeks at MASAC, Kassel was released. He relapsed a few days later.

"I ended up back in a detox, and I actually saw a few people that I was with in Plymouth — in that same detox," Kassel said. "Clearly, this is not working."

He said he's now been drug-free for almost eight months. He and his father, Phil Kassel, both believe the Section 35 system should be reformed.

The Department of Correction said it has taken steps to improve MASAC. It said  treatment is now provided by medical staff, and three types of medications to assist addiction treatment are available. A $36 million capital improvement project is underway to upgrade the facility, which is also preparing for accreditation and licensure from the Department of Public Health.

"The Massachusetts Alcohol and Substance Abuse Center is committed to its mission to provide treatment and detoxification services to men in crisis and has made a series of improvements to its operations in recent years," a DOC spokesman said in a statement. "A multi-year upgrade of the facility is underway to provide an enhanced therapeutic environment, including improved programming spaces and patient privacy."

Hampden County Sheriff Nick Cocchi declined to comment for this story. He cited a pending lawsuit that alleges men are discriminated against based on their gender because they are allowed to be civilly committed to treatment inside jails and prisons. In 2016, a similar lawsuit ended the practice of committing women to correctional facilities.

"To have this sort of Russian roulette for people who file Section 35 petitions, where they don't know if their child is going to get treatment or incarceration, the system is ridiculous."

Phil Kassel

Phil Kassel said he petitioned the court hoping his son might get a spot at the Men's Addiction Treatment Center in Brockton, the only Section 35 program for men that is not in a correctional facility and is run by the Department of Public Health. The way the system works now, he said families fear bad outcomes because they can't control where a loved one will be committed or withdraw their court petitions.

"To have this sort of Russian roulette for people who file Section 35 petitions, where they don't know if their child is going to get treatment or incarceration," Phil Kassel said, "the system is ridiculous."

A 'disempowered' advocate 

Catherine Nash, of Holden, thought she understood Massachusetts' involuntary commitment law when she petitioned the state to send her son, Jesse Harvey, to addiction treatment.

Harvey, a well-known recovery and harm reduction advocate, had been committed before.

He started sober homes in Maine, often spoke at conferences about addiction and created a program called The Church of Safe Injection, which distributes clean syringes and helps active drug users. His motto was "people who use drugs don't deserve to die."

In 2019, Harvey was enrolled in a master's degree program at the University of Southern Maine. But at the end of that year, he was having trouble controlling his drug use. He relapsed and thought another short stint in locked treatment might get him back on track.

"He wanted to go, and he knew that he needed help," Nash said during a recent interview at her Holden home. "It wasn't like I called the police or anything. We went to court and asked for the commitment because we both thought it would help."

Quickly, Harvey began to complain he was being treated like a prisoner at Stonybrook. He questioned why his phone calls were monitored, and why he was threatened with solitary confinement. He wanted to know who had access to his medical records.

But, his biggest complaint involved when he could leave Stonybrook.

"He had completed 85% of the programming required for discharge," Nash said. "I called the program to appeal and explain he needed to leave to finish his last semester, but they said that he wasn't allowed to leave."

During an interview with WBUR in early 2020, Harvey said he was told his stay at Stonybrook had been extended because he needed more treatment, but he claimed it was not clearly explained what he had to complete. He filed a half-dozen grievances with the sheriff's office and went on a hunger strike.

"I got no good answers about why my release was being delayed," Harvey said at the time. "All of a sudden, the rules can change, and I would argue that extending my stay was an Eighth Amendment violation against cruel and unusual punishment."

In February of 2020, Harvey was released, but not in time to return to school or his job. Nash said her son became despondent.

"What they did was harmful," Nash said. "They beat people down, disempowered them, didn't treat them well. Because of the delay in his release, he lost his health care, his behavioral health providers. He lost a stipend he was going to get for work that year. It was really tragic."

A few months later, Harvey died of an overdose in his apartment in Portland, Maine. He was 28.

The debate over results and funding

In the past 30 years, the number of states with laws allowing civil commitments for substance use has nearly doubled, according to a 2018 study. The study, which focused on Massachusetts, concluded the evidence on forced treatment is "largely mixed and inconclusive on whether criminal-court mandated substance use treatment improves clinical and legal outcomes."

Experts said much of the research on forced treatment is murky. There's no clear definition of "forced," and no consensus on desired outcomes or how to measure them. Critics said studies of forced treatment are inherently biased, because they're typically measuring success among patients with the most severe problems. Still, some studies have found people may be at an increased risk of overdose after being civilly committed.

The Massachusetts Society of Addiction Medicine does not support coerced treatment, especially in jail or prison settings, saying it violates medical ethics because it can harm patients.

"What's out there makes us very concerned about whether the potential benefits outweigh the risks," said Dr. Todd Kerensky, president of the Massachusetts Society of Addiction Medicine. "There's no reason that anyone in this state should go to a house of correction for a Section 35 commitment."

Kerensky argued the state should invest more resources in voluntary treatment run by health care professionals. He said the state should work to ensure people have immediate access to treatment, without having to ask the courts for it.

Resources for Section 35 will come before state senators as they begin debating budget proposals this week. Legislators will decide whether to approve spending more than $21 million for MASAC and $2.5 million for Ludlow's Stonybrook. The initial state Senate budget does not include the $14 million Gov. Charlie Baker proposed to strengthen Section 35 programs.

State Sen. Julian Cyr, a Cape Cod Democrat, also filed an amendment that calls on the Department of Public Health to explore operating regional Section 35 programs in non-correctional facilities in Hampden and Plymouth counties.

Although several state senators said they do not support the use of jails and prisons for Section 35, they expect the Senate will approve continued funding for the current programs. State Sen. Cindy Friedman, a Democrat from Middlesex County, sponsored legislation to prevent the use of correctional facilities for Section 35. She said there are times when a civil commitment is needed, and the current system cannot be quickly dismantled.

"People have an illness and you don't put them in jail because of it, I strongly believe that," Friedman said. "The truth is, I can get up and say I want to slash this, and everyone is going to say, 'yeah, that's great.' And they're not going to vote for it."

During budget debate in the House earlier this month, lawmakers rejected proposed amendments from state Rep. Ruth Balser, another Middlesex Democrat, that would have cut the funding to Stonybrook and Ludlow, and directed the state to create non-correctional programs for Section 35. Balser also filed legislation to prohibit the state from using jails and prisons for Section 35 commitments.

Three years ago, a state commission tasked with reviewing Section 35 released a set of recommendations, which included taking forced treatment out of carceral settings and providing data on its effectiveness. Commission member and Northeastern University professor Leo Beletsky said those recommendations went nowhere.

"The state chose to essentially ghost the recommendations."

Leo Beletsky

"The state chose to essentially ghost the recommendations," Beletsky said. "They ignored the recommendations, and the system has proceeded as it did before with very little transparency, very little oversight."

Many families affected by a loved one's substance use disorder said they hope the state will use some of the money from legal settlements with opioid manufacturers to create new treatment settings for those civilly committed. But many argued Section 35 should stay, even if it means putting someone in a carceral setting for treatment.

"I've used Section 35 myself," said Joanne Peterson, founder of the family addiction support group, Learn 2 Cope. "I've seen many people find recovery afterwards. Does that happen for everyone? No, definitely not. But some families are living in fear: car accidents, fires, serious situations where a person was in imminent danger. If we no longer had Section 35 for them, then they would just die."

Jesse Harvey's legacy

Catherine Nash said she knows firsthand how desperate families can become. While she believes that sometimes forced treatment can help, she thinks Section 35 needs to change.

"If what they claim to do really worked, if they did it properly, I think it would be helpful to people and keep people alive," Nash said. "As it is, I think it contributes to their death."

Sitting in her Holden living room beside a small shrine in memory of her son, Jesse Harvey, Nash said she takes comfort in his legacy. The Church of Safe Injection now operates in nine states.

And earlier this month, Southern Maine University posthumously awarded him a master's degree in policy, planning and management. Graduation speakers highlighted Harvey's work in harm reduction and addiction.

"It was awarded May 6, but he should have gotten it two years before," Nash said.

"It was so wonderful. I was so proud of him."