Minutes from 3/5/21 Meeting

Commissioners Present: 

Commissioners Absent: 

  • Senator Ryan Fattman 
  • Emi Joy 
  • Appointee of the Secretary of Administration and Finance 
  • Francesca Spina 

Representative Day called the meeting to order shortly after 1pm and requested legislative staff member, Caitlin Long, to call the roll.  

Representative Day inquired as to whether there were any objections to the draft minutes from 2/5/21. No objections were raised and a roll call was taken. With the exception of those absent, the Commission unanimously approved the draft minutes. Representative Day recognized Stephen Amos and Mike Jackson from the NIC.  

Stephen Amos introduced Dr. Karen Albert.  Dr. Albert is the President of Practical Solutions for Public Safety, she has over 40 years of experience in the field. 

Dr. Albert explained the goal of her study process, which will result in a staffing analysis document. The four participating agencies are aware of the compressed timeline and are committed to the process. 

No questions were raised to Karen Albert  

Rep. Day recognized Carrie Hill of the Massachusetts Sheriffs Association. 

Carrie Hill presented a PowerPoint that laid out the standards and guidelines for correctional facilities for mental health and substance use disorder.  There are many overlapping state and national standards, as well as program and healthcare guidelines.  Similarly, there are several overlapping standards relating to restrictive housing, serious mental illness, gender identity and further restrictive housing standards.   

Medication Assisted Treatment (MAT) standards set forth requirements for MAT programs. A program must have a qualified addiction specialist on staff.  The standards determine when individuals can start a program, how it is performed, and prohibit forced participation.  There are additional reporting requirements.  The Commonwealth’s MAT pilot was reviewed.  The programming  needs to provide behavioral health counseling, and participation must be voluntary.  There are extensive reporting requirements relating to MAT.  We are almost 2 years into the pilot.  There are significant costs but there have been significant impacts on people’s lives.  Denying access to MAT has been challenged as a violation of the Eighth Amendment , a violation of the ADA, and of the Rehabilitation Act.    

Ms. Hill then detailed the mental health and substance use work being done in each Sheriff’s Department.  This concluded the presentation.  

Representative Day thanked Ms. Hill for her work.  He restated that the presentation will be put on the public website. The costs mentioned in the presentation will be included in the work being done by the Sheriffs and Tom Preston.  

Representative Day reviewed the charge: an analysis of what constitutes an appropriate level of funding is a complex one as there are lots of overlapping regulations and standards. The issue of grant funding further complicates this issue.   

Senator Brownsberger: There are a diversity of standards and also a diversity of needs in different counties.  The notion that the commission will be able to say the appropriate spending for mental health and substance abuse is not realistic and we have to articulate that as this particular part of the charge isn’t something that we will be able to do, as there are judgment calls that we cannot make and there is lack of substance for these specific tools.  The question of what can we do that is instructive, is really the question we have before the commission.  

Thomas Preston agreed and thanked Carrie Hill for her presentation. Every facility is following a certain set of guidelines and polices must be implement in each facility. It is hard to say how much funding is appropriate. 

Representative Whelan reflected on Carrie Hill’s presentation through a lens of someone who started their career in corrections several years ago.  Seeing the work in mental health and substance abuse to get those sentenced healthy again versus what used to be available, where a prisoner would be lucky to meet with a counselor once a week.  The facility he started in had 1,100 inmates and the only re-entry program was work-release with 45 slots. Correctional facilities are more humane than they were before, seeing the volume of work now, he is incredibly impressed and reiterated his thanks.   

Sheriff Ashe reflected and echoed Representative Whelan’s comments and thanked Carrie Hill for that fantastic presentation.  We can look back to back the era where each Sheriff was off doing their own thing and there was very little corrections.  He was impressed to see how far the sheriffs have come and to see how much work they do. He acknowledged the work of the co-chairmen want to acknowledge their leadership and the sense of caring and the vision of wanting to acknowledge the two big areas of mental health and substance abuse.   

Senator Brownsberger made a motion that the Commission find that the element of its charge that requires it to determine the appropriate level of spending on mental health and substance abuse disorder services is not an element that it can meet in any precise way, but the commission pursue to an understanding of actual spending on mental health and substance abuse disorder by each branch and each institution and that we ask Carrie Hill and the MSA to come back with a recommended matrix in which we can analyze actual spending for our next meeting.  

Kate Cook offered to second the motion but suggested that the one thing she thought the commission is capable of is looking at is best practices.   It seems like because each facility does not provide the same services, we could look at certain services and say that that is the best practice and ideally that each facility could provide the same service.  

 Senator Brownsberger agreed, we cannot make the finding of actual appropriate funding but we can break it down to go more in depth as each institution is doing.  We may find that we should be spending more on all of these things.    

Gerard Horgan proposed the commission look at this at a national level.  It is important to get a national perspective. If we are looking at the MAT programs happening in MA, lets take a look at costs in staffing and compare it to the other states.   

Senator Brownsberger believes  we will have a hard enough time getting the data for our own state, not to mention trying to get data from other states.  

Gerard Horgan clarified that perhaps NIC could incorporate some national perspective in the report.   

Senator Brownsberger agreed, if the data is available we are happy to see it.   

Tom Preston agreed, if data is there happy to see it, especially to see if MA is actually leading the way.   

Sheriff Coppinger responded to what Kate Cook said: if you look at the programs by county you really need to look at the demographics and geographic as each county is different, some are more affluent than others and some are more rural, eastern communities tend to have more issues with substance abuse compared to western communities.  

Representative Day agreed.  We need to get to a base level to ask who is doing what, and who is not doing it and why not?  

Jim Morton posed a question for the sheriffs: is lack of services in some cases due to lack of vendors, or what the access is to certain vendors in certain counties.    

Sheriff Coppinger commended Commissioner Morton’s question and agreed that the commission has to look at that too.  

Sheriff Hodgson stated that some sheriff’s offices may not have access to programs, or MAT.  Some sheriffs offices may not have a program, but that doesn’t mean they don’t want it.  They may be in the midst of waiting for access to the program or seeing results from other sheriffs offices before implementing it.  

Senator Brownsberger revisited his motion.   

Representative Day said that we will not get to an appropriate level of funding because corrections is too diverse, happy to entertain the motion.   

Senator Brownsberger renewed the motion and Kate Cook seconded the motion.  

Ben Forman explained that on the data side, there has been great help from the sheriffs on how they categorize their medical expenses but if some really expensive care is being done on the hospital side, we are missing theses costs and we want to be sure we get the numbers right.   

Senator Brownsberger believes Commissioner Forman’s comment goes beyond this narrow motion.   

Roll call taken; no objections were heard. Rep. Whelan stepped away and Mike Widmer left the meeting.  

Representative Day thanked Senator Brownsberger for the motion.  He thanked Carrie Hill once again.  As she continues to work to pull the cost matrix together, it will help with Ben Forman and Emi Joy’s work, which is a more objective exercise. 

Senator Brownsberger wanted to make it clear on the record that we have two different matrixes here: the Chapter 69 matrix and now a matrix on actual spending of mental health and substance abuse spending.  Is it fair to review these matrixes at our next meeting?  

Carrie Hill: Yes, the other matrix is completed after meeting with Commissioners Preston and Horgan and the results should be ready by the next meeting they may not be fully completed but enough to review at the next meeting.  

Representative Day looked ahead to the next meeting date, April 9th or April 16th?  

Senator Brownsberger recommended the 9th.   

Representative Day agreed, and scheduled the next meeting for April 9th at 11am.  

The Commission then opened the floor for public testimony.