What We Do

Advancing the rights and opportunities of persons with mental health challenges through quality legal advocacy and education in Massachusetts

MHLAC’s Mission Statement

by Phillip Kassel, MHLAC’s Executive Director

MHLAC provides legal and policy advocacy for people with mental health challenges throughout the Commonwealth of Massachusetts. A State agency, its central priority is to address those concerns that are most closely related to clients’ ability to live full and independent lives. Like other legal services offices, this includes combating poverty, which is often characterized as a “social determinant” of mental illness. When clients are put in institutional settings, MHLAC seeks to protect them from abusive treatment that can often wreak permanent damage.

MHLAC discharges its mission by attempting to influence the systems that negatively affect our clients, and also by helping individuals cope with these systems. In the latter category, MHLAC accepts nearly 2,500 requests for assistance annually. It provides at least information, advice, and referral to all who call, while reserving more intensive representation for low-income persons. MHLAC maintains an extensive Online Library of specialized legal rights information for the benefit of clients, professionals, and the public. It also holds training events to educate attorneys and judges, legislators, social service providers, and the general public on mental health issues that MHLAC staffers identify as client priorities.

MHLAC’s advocacy is guided by these principles:

Address systemic problems:To achieve the maximum impact from limited resources, we focus on addressing systemic issues that affect significant numbers of low-income clients in common;
Prioritize issues affecting people disadvantaged for multiple reasons: MHLAC places special emphasis on the intersection of problems faced by people with multiple characteristics that expose them to bias (e.g. persons of color with mental illness);
Issue driven advocacy: The approach MHLAC takes to resolving client problems is dictated by an open-minded analysis of what tactic will most likely succeed in achieving relief. We employ a wide variety of methods, including class and targeted individual litigation, as well as legislative, administrative, and public advocacy; alone or in combination.

SELECTED MHLAC INITIATIVES

ACCESS TO JUSTICE

MHLAC advocates for courts to provide reasonable accommodations necessary for clients and court users to access and participate fully in judicial proceedings. We are working with court administrators to determine standards and uniform procedures governing such requests so as to ensure an equitable process for anyone using the courts.

EDUCATION

Every study or statistical analysis ever done demonstrates that students[ with disabilities and of color are disproportionately suspended, expelled, and arrested, compared with white and non-disabled students charged with the same offenses. The research clearly connects punitive discipline, which is most often for petty and subjective offenses (e.g. “disrespect;” “disturbing a school assembly”), with dropping out of school. Youth who drop out of school typically live their lives in poverty, suffering stressors that can bring mental illnesses to the fore that might otherwise have remained latent. MHLAC’s education advocacy, therefore, focuses on keeping youth with mental health disabilities in school[ .

Individual advocacy:

MHLAC represents students subject to school exclusion in due process and special education proceedings. These cases often disclose systemic concerns that can be addressed for other students in the same school or district.

Class-based litigation:

Springfield disciplinary due process:Pending litigation challenges the Springfield school system’s failure to comply with State statute and afford due process in disciplinary proceedings. Plaintiffs are emotionally challenged students who allege that they suffered long-term school exclusion after a hearing that failed to honor the most fundamental elements of procedural fairness.

Holyoke language access and language services for special needs students:With attorneys from Massachusetts Law Reform and Holland and Knight LLP, MHLAC filed suit in federal district court on behalf of limited English proficient parents of Holyoke students with disabilities who are routinely denied adequate translation and interpretation services and, effectively, their right to participate in their children’s’ education.

Legislative advocacy:

MHLAC leads the Coalition for Smart Responses to Student Behavior, which waged a long-term campaign to reduce the number of students arrested in schools, often for minor misbehaviors that were once typically handled by school staff. As with school discipline, students with emotional concerns and those of color are disproportionately arrested. The Coalition lobbied successfully for two important provisions of the recently enacted Criminal Justice Reform Act designed to curb this practice. One abolishes for juveniles the “crime” of “disturbing a school assembly.” The other requires school districts with police stationed in schools to enter into a memorandum with police departments that forbids, among other things, police enforcement of school rules. We are working with the Coalition to monitor compliance with the new law.

EMPLOYMENT

MHLAC litigates cases and otherwise assists clients with disabilities who suffer bias in the workplace in the form of denials of reasonable accommodation or outright bigotry, which can cause or exacerbate mental health issues. These cases seek relief from wrongful terminations, demotions, or the denial of health and disability benefits coverage. Advocacy prioritizes low-wage workers whose damages are generally not sufficient to retain private counsel.

FAMILY LAW

Individual representation:

MHLAC represents parents in child custody and parenting time cases when a parent’s mental illness is being weaponized against them. The FLP team strives to ensure that the focus in these cases is on actual parenting strengths and abilities, and decisions are not based on diagnosis, assumptions or stigma around mental health or psychiatric history.

Legislative advocacy:

MHLAC leads an effort to pass parenting anti-discrimination legislation to protect parents with disabilities from discrimination in child custody decisions. Parents with disabilities, especially psychiatric and intellectual disabilities, inappropriately lose custody or parenting time at alarming rates due to disability discrimination. This legislation would require Courts to determine if a parent’s disability causes actual harm to a child based on evidence, not assumptions, and to assess whether there are supportive services that could be put in place to alleviate any perceived harm.

HEALTH CARE

Various entities of government and special commissions are focused on restructuring health care delivery to reduce costs. This process raises special issues in the context of mental health care (e.g. continuity of care is particularly important when a client has developed a strong relationship with a psychotherapist). Working in coalitions or on commissions created by statute, MHLAC seeks to ensure that the needs of people with mental health concerns are adequately factored in these deliberations, targeting financial incentives that negatively influence quality of care and undue emphasis on psychiatric medication to the exclusion of alternative treatment modalities (e.g. peer respite).

Certain priority issues focus advocacy in this area on the impact of implicit bias on persons with mental health concerns. Research shows that physicians are often unconsciously influenced by bias toward persons with psychiatric histories and therefore fail to adequately diagnose physical problems, while, instead, characterizing symptoms as somatic. As a remedy, MHLAC advocates for the division of mental and physical health records so clients can authorize release separately. MHLAC also promotes the employment of persons with lived experience of mental illness in service delivery and the use of “Open Notes” (doctors’ notes posted on line and available to patients) to promote transparency and flush biased thinking.

INSTITUTIONAL ABUSES

According to some estimates, more than a quarter of all prisoners have mental illness. In fact, jails and prisons confine more adults with mental illness than mental hospitals. Particularly in adult correctional facilities, care is almost always inadequate, and staff may employ dangerous controls, including the disproportionate imposition of long-term and even permanently damaging solitary confinement. MHLAC tries to preserve the potential that imprisoned persons can restore healthy and happy lives following their release.

Class-based litigation:

Bridgewater State Hospital: MHLAC joined in an action that successfully challenged the extraordinarily abusive use of restraints and seclusion against persons confined in the state’s forensic hospital, one of only two such facilities in the nation run by a state correctional agency. After many years of unfulfilled promises and dashed hopes for reform, litigation and concerted administrative and legislative advocacy by MHLAC and others resulted in key reforms, including the exclusion of prison guards from housing units, a new mental health provider that is taking a genuinely therapeutic approach, and a drastic reduction in the use of restraints and seclusion. MHLAC continues efforts to ensure that the facility provides therapeutic care and respects patient rights.

The Bristol County House of Correction: With Prisoners’ Legal Services, MHLAC sued Sheriff Thomas Hodgson and others to challenge the excessive use of solitary confinement of prisoners with mental illness in the Bristol County House of Correction, where prisoners commit suicide at a rate three times the State average for jails. The complaint alleges that jail administrators fail to identify prisoners with mental illness (who are most vulnerable to the psychologically devastating impact of prolonged solitary confinement); routinely punish our clients, often for minor violations of rules, without consideration of their mental illness; and do not provide adequate care to prisoners whose mental health is deteriorating in solitary confinement. Defendants’ motion to dismiss was denied and the case is in formal discovery.

Coalition work/administrative advocacy:

MHLAC monitors and addresses the use of potentially dangerous physical and chemical restraints across the Commonwealth. It sits on the Interagency Restraint Reduction Task Force, comprised of agency representatives, service providers, and advocates. The Task Force advocates for changes in law and policy regarding the use of restraints in various state-regulated settings serving youth, as well as for changes in treatment approaches to avoid the use of restraints entirely. MHLAC also comments on changes in regulations governing restraints and supports legislation designed to curb their use.

Legislative advocacy:

MHLAC’s opposition to the use of solitary confinement in prisons is also expressed in legislative work. MHLAC worked in coalition with other groups to achieve the limits set on the use of solitary confinement in the recently-passed Criminal Justice Reform Act.

MHLAC championed legislation either strengthening or establishing five “fundamental” human rights of patients in mental hospitals, including access to telephone, mail and visitation. More recently, MHLAC led lobbying resulting in a sixth right, the right to daily outdoor access, or “fresh air,” as well as Department of Mental Health regulations enforcing this right. Monitoring of hospital compliance is ongoing.

INSTITUTIONAL ABUSES

Consistent with keeping our clients independent, MHLAC works to fulfill the promise of Olmstead v. L.C., 527 U.S. 581 (1999), which held that unjustified segregation of persons with disabilities constitutes discrimination in violation of Title II of the Americans with Disabilities Act. The decision obliges public entities to provide services to people with disabilities in the most integrated setting possible.

Individual advocacy:

MHLAC accepts for review appeals of denials of eligibility for Department of Mental Health services. We also advocate for services from State agencies when eligible clients are dissatisfied with the agency’s efforts.

Policy advocacy:

MHLAC joined in the long and successful fight to keep Massachusetts from enacting, as have many other states, an “outpatient commitment” law. Such a law would allow courts to force mental health treatment, mostly in the form of medication, on people living in the community, while diverting already insufficient resources into adjudication and enforcement instead of treatment. MHLAC also works to educate a public that blames peoples’ troubled behavior on a failure to “take their meds,” when medications are not necessarily the only or best form of mental health treatment.

Appellate advocacy:

MHLAC leads or assists in the production of amicus briefs, typically filed in the Massachusetts Supreme Judicial Court. Several briefs have addressed due process procedures in civil commitment proceedings cases. MHLAC argues in these briefs for stringent protections against the arbitrary imposition of what high courts have deemed a “massive” deprivation of freedom.