On October 22, 2018, the U.S. Department of Justice (DOJ) Civil Rights Division notified the Massachusetts Department of Corrections (MDOC) that it would investigate the statewide prison system pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997(b). The DOJ was joined by the Special Litigation Section of the DOJ Civil Rights Division and the U.S. Attorney’s Office for the District of Massachusetts.

The investigation focused on whether MDOC violated the constitutional rights of its prisoners by placing prisoners with serious mental illness in restrictive housing and failing to provide geriatric and palliative care prisoners with adequate medical care. The DOJ later closed the investigation of these initial questions without issuing a notice of constitutional violations.

Between April 2019 and November 2019, the DOJ conducted site visits. On November 21, 2019, the DOJ added two more questions to investigate, looking at whether MDOC provided prisoners in mental health crises with adequate mental health care and with adequate supervision to protect from self-harm.

Prisoners with serious mental illness comprised approximately 24% of the Massachusetts prison population. When a prisoner experience a mental health crisis, MDOC placed them on a "mental health watch." This consisted of removing the prisoner from their housing unit and putting them in a suicide resistant mental health watch cell that was, on average, 93 square feet. Correctional officers then observed the prisoner either constantly or at 15-minute intervals. The prisoner received, at most, a daily 10-15 minute assessment by a mental health professional. Between July 2018 and August 2019, prisoners engaged in self harm 688 times while on mental health watch, and 103 of those incidents were so severe that the prisoner needed an outside trip to the hospital. During that same 13-month period, all of the prisons with mental health watch cells except one put a prisoner on mental health watch for 90 consecutive days; half of the prisons also put at least one prisoner on mental health watch for over 180 consecutive days.

On November 17, 2020, the DOJ published its findings letter on MDOC's treatment of prisoners in mental health crises.

The DOJ found that MDOC's use of mental health watches for prisoners in mental health crises violated the Eighth Amendment of the U.S. Constitution in three ways: (1) lack of adequate supervision, (2) lack of adequate mental health care, and (3) prolonged mental health watches in restrictive housing conditions. MDOC did not meaningfully increase therapeutic interventions or individually tailor restrictive conditions, and correctional officers acted with deliberate indifference when failing to take preventative actions for the prisoners' safety, such as taking away instruments of self harm. MDOC also knew of the serious risk of harm, yet did not provide adequate protection and supervision. Correctional officers received no special training regarding mental health watches, and often junior officers with less experience would be assigned because it was considered an undesirable assignment. As a result, MDOC's mental health watches led to self harm and suicide.

The DOJ acknowledged that MDOC did begin implementing some reforms as a result of the investigation. Starting in September 2019, MDOC held biweekly meetings to discuss prisoners with histories of self harm. Later that year, MDOC provided additional training to its staff, including officers in mental health housing units and interacting with prisoners in crises. MDOC also investigated other methods of making mental health watch safer.

Although MDOC had started making improvements, the DOJ provided a list of recommended remedial measures to address the three areas in which MDOC had violated prisoners' constitutional rights:

1. Supervision of prisoners
   1. Prevent prisoners from accessing instruments of self harm.
   2. Develop clear and consistent policy and training for correctional officers and mental health clinicians.
   3. Create strict disciplinary measures for officers that fail to comply with policies, such as officers who asleep while supervising a mental health watch.
   4. Ensure communication and coordination between mental health and security staff.
   5. Increase security staffing.
2. Mental health care
   1. Conduct daily mental health assessments. Offer them at different times of day, and record when and why a prisoner requests or refuses an assessment.
   2. Ensure prisoners receive meaningful therapeutic interventions.
   3. Hire more mental health clinicians.
   4. Develop individualized crisis treatment plans for prisoners who engage in repeated self harm.
   5. Instead of putting prisoners on a prolonged mental health watch, transfer them to inpatient psychiatric care.
   6. Develop policy and procedure for prisoners being released from mental health watch.
   7. Report and review data connecting mental health watches to incidents of self harm, and take appropriate corrective action.
3. Restrictive housing
   1. Ensure policies don't violate the Constitution.
   2. Minimize isolation.
   3. Reduce the unnecessarily harsh nature by, when possible, avoiding measures such as removing clothing and canceling showers.

The DOJ is currently in negotiations to resolve its findings.

Lauren Yu - 07/21/2021


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