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

MHLAC’s Mission Statement

What We Do

by MHLAC Executive Director Phillip Kassel

MHLAC provides legal and policy advocacy for people with mental health challenges throughout the Commonwealth of Massachusetts. A state agency of the judiciary, MHLAC’s central priority is to ensure that clients can live full and independent lives in their communities. MHLAC also seeks to protect its clients in institutional settings from abusive treatment that can wreak permanent psychological damage.

MHLAC’s advocacy is guided by these principles:

  • Address systemic problems: To achieve the maximum impact from limited resources, we focus on issues that affect significant numbers of clients in common.
  • Prioritize issues affecting people who are disadvantaged for multiple reasons: MHLAC places special emphasis on addressing challenges faced by people with several characteristics that expose them to bias (e.g., persons of color with mental health challenges).
  • Issue driven advocacy: The approach MHLAC takes to resolving client challenges is dictated by an open-minded analysis of what tactic(s) 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.

In addition to its systemic efforts, MHLAC helps people one by one. In accordance with established priorities designed, in part, to conform to our systemic advocacy, persons who call for assistance, irrespective of income, receive a range of responses. Some are referred to Massachusetts legal services providers and hotlines, or are directed to legal rights information maintained in our extensive Online Library (which also serves to educate and inform professionals and the general public). We talk to nearly 600 persons annually who are confined in hospital emergency rooms or mental health inpatient facilities. They are informed of their legal rights and, when appropriate, referred to the Committee for Public Counsel services for representation in advance of any initial court appearance.  

More intensive legal representation is reserved for low-income people, particularly those adversely affected by issues we’ve decided to pursue as “projects.” We launch projects when we believe that a viable strategy can generate a tangible positive impact for substantial numbers of clients. Below is a sampling of current work. Elsewhere on our website you’ll find additional information on our litigation and legislative advocacy. Ongoing investigations regarding systemic concerns arising in education, child welfare, imprisonment, and the provision of contracted mental health services are not reflected in this summary.

MHLAC ADVOCACY

(ordered alphabetically)

CONFINEMENT OF ADULTS WITH MENTAL HEALTH CONDITIONS

Estimates are that between a third and a half of all imprisoned persons have mental health conditions. In fact, jails and prisons confine more adults with such concerns than do mental hospitals. Many advocates believe that prisons and jails are inherently abusive beyond remedy. These advocates work toward a future in which imprisonment is rarely employed, focusing advocacy on keeping people out of carceral settings or limiting their time incarcerated. But advocates also are compelled to mitigate the harm suffered in inherently violent and inevitably damaging prison environments. Persons with existent mental health issues are particularly vulnerable. They are disproportionately held in tortuous long-term solitary confinement and denied both appropriate mental health care and minimal programing to address underlying socio-emotional determinants.

MHLAC’s prison advocacy is propelled by both theories. Its work is designed to limit clients’ time confined but also strives to preserve the potential that imprisoned persons can live healthy and happy lives following their release. MHLAC also works to limit abusive practices in other institutional settings, such as DMH group homes and hospitals.

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Class action litigation:

MHLAC co-counsels, along with lawyers from Prisoners’ Legal Services and the Disability Law Center, litigation against the Parole Board challenging its failure to offer reasonable accommodations to parole-eligible persons with mental health related or cognitive disabilities who need assistance in seeking and preparing for parole. The parties agreed to attempt settlement without extensive litigation and are negotiating a formal agreement. See media coverage on the case at WBUR Disability Discrimination Suit Massachusetts Parole Board and WGBH Prisoners with Mental Disabilities Claim Discrimination by Massachusetts Parole Board.

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 committed suicide at a rate three times the state average for jails. The complaint alleged 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 for minor violations of rules without considering the impact of mental illness; and do not provide adequate care to prisoners whose mental health is deteriorating in solitary confinement. The case settled favorably. Advocates are now engaged in monitoring and enforcement efforts.

Legislative advocacy:

Like its other work, MHLAC’s Statehouse advocacy is designed to limit time in confinement and protect against institutional abuses. Its staff promotes legislation to render the parole process more accessible and fair. MHLAC worked in coalition with other groups to enact the Criminal Justice Reform Act of 2018, which set limits on the use of solitary confinement, and works with legislators to address ongoing circumvention of this statute in prisons. MHLAC also supports legislation that would shift control of the Bridgewater State Hospital from the Department of Correction to the Department of Mental Health.

MHLAC’s legislative efforts also encompass mental hospitals. It championed legislation codifying “fundamental” human rights of patients in mental hospitals, including access to telephone, mail and visitation. More recently, MHLAC-led lobbying resulted in a statutory amendment setting out a right to daily outdoor access, or “fresh air.” Monitoring of hospital compliance is ongoing.

Coalition work/administrative advocacy:

MHLAC monitors and addresses the use of potentially dangerous physical and chemical restraints across the Commonwealth. Staff members participate in the Interagency Restraint and Seclusion Prevention Initiative, comprised of agency representatives, service providers, and advocates who advocate for changes in law and policy in order to minimize or eliminate the use of restraints in various state-regulated settings serving youth. MHLAC also comments on changes in regulations governing restraints and supports legislation designed to curb their use.


EDUCATION

Studies overwhelmingly demonstrate that students with disabilities, particularly those of color, are disproportionately excluded from school. The research clearly connects punitive discipline, which is most often for low-level, subjective offenses like “disrespect,” with graduation failure. Youth who do not obtain high school diplomas typically experience poverty as adults and suffer stressors that can bring mental illness to the fore. MHLAC’s education advocacy, therefore, focuses on keeping youth with mental health concerns in school.

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Class Action litigation:

Special education for jailed school-aged students: MHLAC, in cooperation with the EdLaw Project of the Youth Advocacy Division of the Committee for Public Counsel Services and Latham & Watkins LLP, leads pending litigation that challenges the failure of the Massachusetts Department of Elementary and Secondary Education to abide by a clear statutory mandate to identify and provide special education to eligible young adults confined in county houses of correction.

Holyoke language access and language services for special needs students: With attorneys from the Massachusetts Law Reform Institute and Holland & Knight LLP, MHLAC filed suit in federal district court on behalf of limited English proficient parents of Holyoke students with disabilities who were denied adequate translation and interpretation services and, effectively, their right under special education law to participate in educational planning. A negotiated settlement establishes appropriate standards governing communication between parents of limited English proficiency and school staff. MHLAC staff began an eight-year monitoring period in 2020. Compliance is significantly improved by virtue of the monitoring team’s dogged efforts.

Legislative advocacy:

In cooperation with Citizens for Juvenile Justice and a group of advocates from partner organizations, MHLAC led the Coalition for Smart Responses to Student Behavior in a long-term campaign to reduce the number of students arrested in schools, often for minor misbehaviors that were once typically addressed by school staff. The Coalition lobbied successfully for two Massachusetts’ statutes designed to curb this practice. One forbids punishing juveniles for “disturbing a school assembly,” a vague criminal offense often imposed for merely talking back to school police that accounted for as many as half of all student arrests in some schools and school districts. The other statutory reform requires districts with police stationed in schools to enter into a memorandum of understanding with local police departments. MOUs must forbid, among other things, police enforcement of school rules. Subsequent to the enactment of these provisions, court filings of criminal complaints against students for public order offenses dropped by almost 70%. More recently, MHLAC and its partners successfully advocated for a statutory change eliminating the requirement that police officers, dubbed school resource officers, be assigned to each school district.  This allows districts to decide for themselves how best to keep schools safe.

Recent advocacy efforts focus on the MOU requirement and enforcing widely ignored school arrest reporting. In 2021, the Legislature appointed MHLAC to a commission charged with drafting a mandatory MOU for school districts and police. MHLAC helped craft a strong document providing clear guidance to school police and administrators to avoid undue arrests. It continues to work with school advocates, students, and parents on implementation and compliance. Additionally, pending legislation would reinforce school arrest reporting and also establish a grant program for schools and districts wanting to reduce reliance on police without compromising school safety.

Individual representation:

MHLAC represents students subject to school exclusion in due process and special education proceedings. These issues tend to merge, since school discipline claims typically implicate violations of students’ rights under special education and disability discrimination laws. Cases often seek remedies for bad practices affecting students other than the clients.

In 2012, Massachusetts revised its discipline laws to ensure that school exclusion be used only as a last resort. Unfortunately, the law is persistently ignored. To address this problem, MHLAC brings damages actions against school districts on behalf of students who were unlawfully excluded, while encouraging other Massachusetts education advocates to do the same by offering form pleadings and technical assistance.  The strategy is intended to deter violations by administrators who wish to avoid being sued.

Community and coalition work:

MHLAC works with a Holyoke student-run advocacy organization in a mutually beneficial partnership. Pa’Lante helps MHLAC identify issues of concern, as well as individual students affected by negative school practices like unfair discipline. MHLAC lawyers and paralegals help students know their rights and self-advocate.

Additionally, MHLAC organized and leads a coalition of advocates in Western Mass that meets regularly to share information about systemic trends affecting clients and to devise collective remedial strategies. The focus is on educational issues but might also involve related child welfare matters.


FAMILY LAW AND CHILD WELFARE

MHLAC clients with children face unfair treatment from the court and child welfare systems. Those with psychiatric histories and intellectual challenges lose custody of and parenting time with their children at alarming rates because their disabilities are often weaponized against them in court. Such parents are also subjected to child welfare interventions driven by bias and misconceptions that result in prolonged system involvements and lasting trauma. They are investigated and separated from their children at far higher rates than nondisabled parents and often denied reasonable accommodations necessary to address perceived parenting deficits linked to their disabilities, as required by the Americans with Disabilities Act. MHLAC advocates individually and systemically to address these issues. 

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Individual representation

MHLAC advocates work to ensure that the focus in family law cases is on actual parenting strengths and abilities, and that decisions are not based on stereotypes about people with psychiatric histories. MHLAC also advocates for the provision of reasonable accommodations to address alleged parenting concerns when the Department of Children and Families denies them. Advocates also offer training to parents’ court appointed lawyers on spotting issues and making adequate records in court proceedings involving disability issues arising in child welfare cases. 

Legislative advocacy:

MHLAC leads an effort to pass legislation to protect parents with disabilities from discrimination in child custody decisions. 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. MHLAC also supports legislation that would address unnecessary family interventions by amending the Child Requiring Services statute to reduce school referrals based on attendance and behavioral issues that are often connected to unmet special needs.  

Coalition work:

MHLAC leads a statewide coalition of advocates who strive collectively to combat discriminatory and unfair family policing. The coalition meets regularly to share information, respond to policy and regulatory changes, and to coordinate advocacy in support of legislative initiatives, including current efforts to establish a bill of rights for children in foster care, pass a comprehensive child welfare omnibus bill, and establish “Miranda rights” for parents facing DCF involvement. MHLAC also maintains strong ties with the broader disability community, ensuring that cross-disciplinary perspectives from across the Commonwealth inform coalition efforts to mitigate harms arising from systemic failures. 


HEALTH CARE

In recent years, Massachusetts instituted reforms that have great potential to aid people with mental health conditions. These include the Roadmap for Behavioral Health Reform, which would enhance access to mental health care, and the Mental Health Omnibus Law, which addresses a broad range of behavioral health issues. Much stands in the way of full implementation of these reforms. The mental health service system faces many challenges, including those arising from the lingering effects of the COVID-19 pandemic, behavioral health wage stagnation and workforce shortages, lack of community placements, increases in the numbers of, and intolerance towards, people who are homeless, and recent threats to our nation’s Medicaid program

MHLAC works with other advocates to expand the range of services and supports available to people with mental health issues and ensure that rights are preserved for those in the service system. Legislative and policy initiatives MHLAC supports include efforts to:

  • Enact legislation that would require equal treatment of physical and mental health coverage in disability insurance policies;
  • Ensure that the Division of Insurance enforces parity laws and to expand insurance coverage for services delivered in Community Behavioral Health Centers; 
  • Increase pay rates of behavioral health workers and support incentives to attract workers to the field;
  • Divert people in psychiatric crisis from emergency department admissions;
  • Promote delivery of competency evaluations and restoration in the community;
  • Eliminate the delivery of addiction services in carceral settings;
  • Promote Housing First and supportive housing models of community care;
  • Challenge unnecessary use of police in crisis response;
  • Promote expansion of reentry services for those leaving carceral settings;
  • Protect Medicaid coverage and, more generally, preserve programs as Medicaid cuts threaten funding for community health care, supportive housing, and related services.

INDIVIDUAL LIBERTIES/PRIVACY/FREEDOM FROM CONSTRAINT AND VIOLENCE

Consistent with its goal of helping our clients enjoy independent lives in the community, MHLAC works to fulfill the promise of Olmstead v. L.C., 527 U.S. 581 (1999), which held that the unjustified segregation of persons with disabilities constitutes discrimination in violation of Title II of the Americans with Disabilities Act. The Supreme Court’s decision obliges public entities to provide services to people with disabilities in the most integrated settings possible. This impetus propelled class action litigation brought by MHLAC during the height of the pandemic, when persons were maintained in congregate care facilities in close quarters for inadequate reasons.

MHLAC works to protect clients’ independence and liberties in a variety of other ways. It fights undue disclosure of psychiatric histories by state agencies that are “holders” of this information. Other advocacy is intended to promote appropriate, non-punitive, responses to mental health crises.

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Class action litigation:

MHLAC filed a class action against the Secretary of Administration and Finance and the Division of Administrative Law Appeals, which is an agency of the Commonwealth under A&F that adjudicates administrative appeals of actions taken against public employees. The complaint alleges that DALA publishes embarrassing and damaging personal details in unredacted decisions that are readily found online. Plaintiffs assert that this practice violates statutory privacy protections and adversely affects the lives of plaintiff class members (e.g., by limiting employment prospects). Plaintiffs recently moved for Summary Judgment and to certify a class.

Appellate advocacy:

MHLAC leads or assists in the production of amicus briefs, typically filed in the Massachusetts Supreme Judicial Court. Briefs often address due process procedures in civil commitment proceedings and argue for stringent protections against undue deprivations of freedom.

Legislative advocacy:

MHLAC has long been part of, and now facilitates, a coalition of advocates that lobbies annually (successfully to date) against the enactment of a counterproductive involuntary outpatient commitment law that would authorize courts to force mental health treatment, typically consisting of psychiatric medication, on community members, and absorb resources for enforcement of orders instead of implementation of planned positive initiatives. As a viable alternative to coercive efforts to force acceptance of treatment, MHLAC lobbies administratively and legislatively for the expansion of peer respites, which are small-scale, home-like supportive environments that offer voluntary short-term stays to people in crisis.

Administrative Advocacy

MHLAC successfully reached agreement with the Civil Service Commission on a policy requiring redaction of identifying information from published state workers’ appeal decisions that contain embarrassing and potentially damaging facts. We monitor decisions as they issue and are published to ensure that they sufficiently protect litigants’ privacy.

MHLAC also sits on the “988 Commission,” which studies and issues policy recommendations on how to promote proper utilization of the Massachusetts 988 Suicide and Crisis Lifeline, which refers people facing a mental health crisis for personalized and immediate responses when calling 911 for police is not appropriate.

Individual advocacy:

MHLAC advocates for services from state agencies when eligible clients are dissatisfied with the agency’s efforts, which includes representation of clients whose rights are violated by DMH-contracted service providers. It also advises clients subject to civil commitment for mental health treatment on their rights and connects them with attorneys from the state mental health public defender agency when appropriate.