Massachusetts is among several states using involuntary commitment to force someone into addiction treatment if they have an alcohol or substance abuse problem and pose a risk of serious harm. But it's the only state to provide that treatment in a correctional facility, and critics say that's no place for those battling addiction who haven't been criminally charged. Hari Sreenivasan reports.
Few states have been hit harder by the opioid epidemic than Massachusetts. Last year alone, about 2,000 people there died of opioid-related overdoses.
For friends and family looking to help their loved ones on the road to recovery, the state has a law that sends men, in particular, to be treated while living in jail.Some call that old-fashioned incarceration. Others say it's the lifeline the men need to fight their addiction. NewsHour Weekend's Hari Sreenivasan has more.
Past the secure gates of the Hampden County jail in Western Massachusetts, Sheriff Nick Cocchi is taking us to meet incarcerated men who haven't necessarily committed a crime.
Sheriff Nick Cocchi:
These are all people that are at a point in their life where forced treatment and necessary and immediate treatment was called for. The sheriff runs a program for men who have been civilly committed for substance abuse treatment under a Massachusetts law called section 35.
Here, for the first four or five weeks, you can't go anywhere, you're here.
Our first stop is a daily mindfulness meditation class.
Someone watching this they're literally going to hear the new age music and they're going to see guys on floor mats deep breathing and they're gonna say what's going on with the sheriff? He's supposed to be making sure…
A tough guy…
Yeah, well I've always said this, a fair county sheriff is giving them the resources and the tools to address those issues and to go back into the community and be successful. We're saying there's a better life and we're saying can help you get there.
Under section 35 a family member, police officer, or doctor can petition a court to commit an individual — that is, hold them involuntarily –– if that person has an alcohol or substance abuse problem and is a risk of serious harm to themselves or others.
Similar to involuntary commitment for mental illness, after an evaluation by a clinician, a judge can "section" a person, as the process is known, for up to 90 days. For women, that means receiving treatment in a civil facility. But for most men, it means getting treatment in a jail.
It's a tool to be used as a last resort. We would love for people to put their hand up and say I have an addiction issue and I need help and I'm willing to go get that help but that's not the case all the time. So it's important that the family members have an option that they can help bring their loved one in, actually get them the help that they need whether they're ready for it prepared for it or want it or not.
The law has been on the books since 1970, but the number of people committed has gone up nearly 66 percent in the past ten years thanks to the opioid crisis.
The noise level is down, there's not a lot of commotion.
In Cocchi's program the men are housed in a unit that's isolated from those who are criminally incarcerated.
The men are called clients rather than inmates or prisoners. There's 24/7 medical treatment available, including drugs like methadone, buprenorphine, and naltrexone, all of which are FDA approved to treat opioid addiction. And there's access to addiction counselors and daily group therapy.
The rooms are jail cells, but Sheriff Cocchi says the doors are not locked and the men here aren't confined to them.
So the days are very structured but they're not structured to where we force anyone to do anything. You have to voluntarily get up and go to class.
There are even therapy dogs.
How you feel?
Nervous, but good. I'm ready.
Was it worthwhile to be here?
After several weeks at the unit in the jail, many men quote "step down" to a facility about 20 minutes away in Springfield. Located in a renovated nursing home, it has fewer restrictions and is more like a dorm.
The emphasis remains on recovery.
It's getting in touch with your inner peace. The way we were hitting the drums, we have to find that because it's not the drink and the drug, it's enjoying life without it.
39-year-old Antoine Diaz has struggled with addiction for more than a decade. He lost his brother to a heroin overdose last year.
This time when I relapsed my twin brother was dead. And that's when it's, it's easier to die. It really is. People are not really suicidal but just the pain and the suffering becomes overbearing that they just want to shoot it away. And next you know it could be a bad batch and you're gone. And I experienced that this time. I was dead for three and a half minutes. No heartbeat, no nothing.
After being revived, Diaz was "sectioned" by his family.
Then they came and said you're getting sectioned, I flipped out. I hated my wife, I hated everybody but she was right. I needed to be removed. That's what a section is. You need to be removed from society.
Since the program began last May, more than a thousand people have gone through the section 35 program in Hampden County, and the sheriff's department says fewer than five percent have been sectioned again.
But it doesn't track relapses that don't result in another civil commitment.
We're not telling you that we have a magic wand and we can wave it and we can cure people because there is no cure. We're engaged every day trying to be part of the solution in taking another chunk out of this ravaging ugly disease of opioid addiction.
Antoine Diaz credits the approach of the Hampden County sheriff with helping him get to this point.
I'm going to be honest with you, I didn't, I didn't like Cocchi, right the sheriff. I had another guy I liked but I swear to God to you, I swear to you his message and his way for recovery is passionate, real, the programming everything it's progressive, like it's different.
Over here we have another classroom area.
To pay for the program's first year, Cocchi reallocated nearly three million dollars from the existing sheriff's department budget. And in july, the Massachusetts legislature earmarked an additional million dollars for the program.
Now one million dollars is a drop in the hat. But it was a major move in the right direction especially with all the people that are criticizing the program.
Why would you have a system where instead of using health care settings to treat a disease you put that money into prisons?
Bonnie Tenneriello is one of those critics. She's a staff attorney at Prisoners' Legal Services of Massachusetts, a nonprofit group that represents incarcerated people.
It may be a nicer environment than an ordinary prison setting but it's still a prison and you're still telling people you belong in jail. There is already enough stigma around addiction that for us to say it's OK to put people with addiction in jail just furthers that stigma, furthers a belief in our communities that these people are bad. And that's going to stop people from getting treatment.
Tenneriello is suing the state to end the use of jails for treatment on behalf of ten men who have been "sectioned" at a facility in Plymouth called the Massachusetts Alcohol and Substance Abuse Center, or MASAC.
The suit alleges abusive behavior by corrections officers, minimal substance abuse treatment, and overall, a traumatizing experience for people "sectioned" there.
You put people in jail they're gonna to act like they're in jail and a lot of people did.
37-year-old Joel Kergaravat is not one of the plaintiffs in the lawsuit, but he spent several weeks in MASAC. He was sectioned by his family last June after struggling with opioid addiction.
The Department of Corrections is equipped to handle prisoners. They're not equipped to handle mentally ill or sick people. That was evidenced by the fact that they would refer to us as junkies and, you know, pieces of shit and, it's not, it's not their arena.
Kergaravat has been sober for about a year, but he says that's in spite of his experience at masac, not because of it.
There's no treatment. Nothing I would consider treatment there. It felt like having gone to jail for, for a period of time for a crime I didn't commit.
Citing the pending litigation, the Massachusetts Department of Correction, which operates MASAC, declined an interview with PBS NewsHour Weekend. But in court filing the state denied the suit's allegations, and "strongly reject[s], as both a factual matter and a legal matter, the suggestion that the commitment of section 35 patients to [its] facilities…is equivalent to 'incarceration' or 'imprisonment.'
The Hampden County sheriff's department is not specifically named as a defendant, but Bonnie Tenneriello says the lawsuit aims to end the use of jails for all section 35 commitments across the state.
She says that would simply put men and women in the state on equal ground. Remember, women who are "sectioned" are treated only in civil settings. That's because in 2016 the Massachusetts legislature explicitly changed the law.
And there's now pending legislation that would do the same for men.
In September, a joint committee of state legislators held a hearing on this issue
Rep. Ruth Balser:
We are the only state in the nation that sends people with addiction for involuntary treatment in a prison facility. This is what we need to change and what we want to change.
And in July, a state commission also recommended that Massachusetts end the practice.
When people point at us and say it shouldn't happen there. Well where else is it gonna happen? There was not one bed for these type of men in western Massachusetts. We opened this program a year ago and now they tell me but you shouldn't be doing it. Hey, how about a phone call. Say thank you. I'll take those calls all day long.
Antione Diaz says the setting in a criminal justice facility is not what makes being sectioned hard.
It's not jail. You're civil. It doesn't matter where they house you at. In reality being here, people don't want to be left alone. Being here is hard for me. You know why? Because like I have to be left with me and I'm the problem. And it's uncomfortable. But it teaches me how to grow. You know, it did not feel like jail and I did a jail bit.
Instead of taking shots at us come on down and see it for yourself…
Sheriff Cocchi says he's open to having his program regulated by civil agencies in the state, including the Department of Public Health. But in the meantime, he says the stakes couldn't be higher.
Take my hundred and twenty beds away. Then what? How many funerals we going to? How many family members have got to bury a loved one? I'm not going to be on that side of the coin.
But that's a false choice you have. You need a civilian setting for these people. We're not saying take the treatment away. What we want is a commitment to fund and make available treatment in health care settings where it belongs
Tenneriello supports the pending state legislation to make that happen.
But Sheriff Cocchi argues that his program should be allowed to continue, even if others in the state are not.
I would ask, don't throw the baby out with the bathwater, please. If we're doing it right, acknowledge that. Carve us out. Allow us to do what we're doing."
For now, the sheriff will continue doing exactly that. But opposition to providing treatment for civilly-committed men behind these gates remains.
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Hari Sreenivasan joined the PBS NewsHour in 2009. He is the Anchor of PBS NewsHour Weekend and a Senior Correspondent for the nightly program.
Sam Weber has covered everything from living on minimum wage to consumer finance as a shooter/producer for PBS NewsHour Weekend. Prior joining NH Weekend, he previously worked for Need to Know on PBS and in public radio. He’s an avid cyclist and Chicago Bulls fan.
Connie Kargbo has been working in the media field since 2007 producing content for television, radio, and the web. As a field producer at PBS NewsHour Weekend, she is involved in all aspects of the news production process from pitching story ideas to organizing field shoots to scripting feature pieces. Before joining the weekend edition of PBS Newshour, Connie was a Peace Corps volunteer in Thailand where she trained Thai English teachers.
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