Jesse: Alright, let's do the intro thing.
Michelle: This is Committable. This is…
Jesse: Perfect!
Michelle: Oh, okay. I nailed it the first time?
Jesse: Nailed it, we are ready for the interview.
Michelle: Alright, well, I bought a ticket for this train.
Jesse: Wait, the Committable train? Is that what we're calling it now?
Michelle: Uh, I'm on it and I'm having the time of my life.
(intro music from Reasonable by Christopher G. Brown)
Jesse: This is Committable, a podcast about involuntary commitments. I’m Jesse Mangan and I'm here with Committable producer Michelle Stockman.
Michelle: Hello.
Jesse: This season we're going state by state to better understand mental health laws throughout the US and for this episode we're looking at mental health laws in Massachusetts. We have actually looked at Massachusetts before, in season one we made several episodes discussing section 12s. So, Michelle, do you wanna give a quick recap on what we learned about section 12s?
Michelle: I do, but I wanna preface it by stating that I still get confused and lose track of what is what, and we've been studying this, so it really does feel overwhelming if after this amount of research it's still something that's difficult to wrap my head around. But that being said, my recollection for Massachusetts is we're going with the section 12s in this case, and I believe that they're broken into different 12s. I believe there's a 12a and a 12b, and I think they bring you to the hospital for treatment where you're gonna be evaluated. And when you're evaluated, depending on the results of said evaluation, you may or may not be committed from there. But I think that if you do get committed, whether it be voluntary or involuntary, that's a new section.
Jesse: Yeah, basically a 12a is an emergency detention that gets you involuntarily transported to a facility, most likely a hospital, probably in ER. And you're being transported there for evaluation. And a 12b is essentially the evaluation part that can result in you then being put on a 72 hour hold in a psychiatric facility. And I think what your response illustrates really well is that, yeah, we have been discussing section 12s for over two years and they can still be really confusing. So imagine what it's like to be a person who is encountering this system for the first time?
Imagine trying to break down the complexity of these laws while simultaneously being detained, maybe handcuffed, maybe strapped to a gurney, held in an ER, before being sent to a locked ward for a 72 hour hold. Imagine trying to figure out all of that and then discovering that there is another section to these laws, a section 8. A section 8 is a civil commitment, and that's what we're discussing today, section 8. More specifically, section 8b, and to learn more about section 8b, what it is and what it means, I spoke to Nancy Murphy.
Nancy Murphy: I'm Nancy Murphy. I'm the managing attorney of the intake Unit at Disability Law Center. I primarily do work for individuals with mental health needs or brain injuries, but we're part of the Protection and Advocacy system across the country. We're an independent nonprofit and we have federal and state funding to protect and advocate for the rights of people with disabilities throughout the Commonwealth. And that's wherever they are. if they're in a facility, if they're on the job, if they're in their home. And that's individual advocacy, could be litigation, could be investigations and monitoring, legislative works, and kind of ensure that people are listening, right? I mean, most of the clients that I represent, or facilities that I go to, people don't have the financial resources to have anybody representing them or stepping in. And we're there to really bear witness to what's going on and be able to report out on it in a way that other people aren't. So, while other legal service organizations or private attorneys or advocates may be able to help individuals or advocate in particular issues, we can go in on a systemic level and we have the authority to actually go onsite into facilities and spend time on inpatient units, talking with people and reviewing medical records and really getting to know a place more like what it would be if you were living there. Go off hours, go on the weekends, go early, early in the morning before a change of shift when an administrator is not there and it's not neat like it might be for a scheduled attorney visit.
Jesse: So there are a lot of ways in Massachusetts where a Section 12 can bring someone to a facility where they're being evaluated. But there's something else that can happen in that facility, which is a Section 8. What is a Section eight?
Nancy Murphy: A section 8 is what happens when a facility decides someone is going to stay. And they may have, usually they do, but they may have said, look, you can either sign yourself in or we're going for commitment. I mean, that's what happens, and there's all sorts of coercion involved in that. And yet that's really what the law says. The law says it should be least restrictive environment. And if somebody is capable or competent of signing themselves in, then it should be voluntary, of course it's never totally voluntary because you can't just walk out if you want to. So if someone decides not to do that and the facility says, well, we think that you need to stay, then they can go for involuntary civil commitment.
Now it's really interesting because in Massachusetts we're really good on the law on some of these things. The practice is a little different and how it plays out, but we're really good on the law. So that means that you should have notice, you should have due process, you should have counsel appointed to you, and you should be able to see a judge. You can get an independent evaluation and there'll be a hearing. So that's how you get civilly committed, and the standard is supposed to be, it's a civil process but the standard is supposed to be a criminal standard. That this is beyond a reasonable doubt, that there's a mental illness, there's a likelihood of harm, and that there's no less restrictive alternative, and it's supposed to go in those steps.
Now, going back to where I started when I said Massachusetts we’re really good on the law, I wanna point out that there are other states where if two psychiatrists agree, for example, you are committed. There is no hearing, there is no due process, there's no judge, there's no lawyer, there's nothing, you're just in. So I might nitpick today about Massachusetts, but I do wanna point out that in my legal opinion, we're ahead of the curve with some of these things. Although I think that there's much left to be done in practice, and also some development of the law. The one thing I'll say is there's a bizarre piece in Massachusetts about civil commitment, and that's if you are a man, and if there's a decision that you need strict security, you may go to Bridgewater State Hospital. There is no equivalent for a woman, it's only for men, and there is no legal statute or definition of what strict security is, it's kind of, they'll know it when they see it or something like that. This is an absolutely terrifying notion to me.
Many, many times none of this is planned, and so someone will wind up sectioned with absolutely no warning. Could be a pet at home, could be a child at home, life doesn't stop because this is happening, it's not planned. So they're just plucked out of their life and put in a hospital with no idea of how long they're gonna be there, when they're gonna get out, what their rights are. So if you add to that, that this could turn into a civil commitment, without an idea of if that's gonna be a full six months or if it's gonna go longer. And then you add to that the idea that you may, if you're a man, meet this strict security standard. Now you're in a whole other ball game, because now you're not in a DMH licensed psychiatric unit. Now you're at Bridgewater State Hospital, which for all intents and purposes is not a hospital, it is a correctional facility, literally, it is under the direction and operation of the Department of Corrections. It looks like a correctional facility, it acts like a correctional facility, and while there have been some developments in the mental health services and some changes in the security there, it is a correctional facility and you do not need to have criminal involvement to meet that strict security standard and go to Bridgewater, or stay at Bridgewater.
Michelle: I love that she really does paint the picture of putting us in the headspace of a day in the life of, you might have pets at home, you might have a kid at home, you are plucked from this life. Because to me that was some of the biggest takeaways from both your story in season one and Cassidy's story in season two, and listening to her talk about this, you know, she's saying things that you think should bring you comfort, like least restrictive option. You know, you have to have exhausted all of these other things first, and those things just don't happen, they aren't checking these things, they really aren't. Or if they are, it's very minimally.
Jesse: Yeah. I think this goes back to what she said about Massachusetts being good on the law because a neutral reading of the law, without any awareness of what actually happens to people going through these systems, a theoretical reading of the law could give the impression that this all makes sense. That there are clear checks and balances, and this process is only initiated when absolutely necessary. But if you take a moment and think about something like Section 8B, a legal mechanism that can take someone involved in a civil commitment and put them in a correctional facility, not necessarily because of criminal activity, but because of a belief that there is a security risk, but what qualifies as a security risk doesn't seem to be defined anywhere. So how do you have a law like that that hinges on this concept without defining it? How do you justify taking someone from a hospital after they have been told that they need to be detained for necessary treatment, and then detaining that person in a correctional facility without even an allegation that they have committed a crime?
Nancy Murphy: So overwhelmingly, when someone gets to Bridgewater for the first time there was some type of criminal involvement, but that's not all the time. And so an example might be that someone is in a DMH facility, DMH licensed unit, and let's say there is some type of harm to others, some type of behavior where there is actual harm, let's say to a staff person or something like that. That facility might say, we can't manage this person, this is not an appropriate placement for this person. We think they meet strict security and they can transfer that person to Bridgewater State Hospital. In that instance, there does not need to be judge oversight, that's in the law. It could be that they would get to Bridgewater and because of that action somebody might then file criminal charges against them, and so kind of the action to transfer to Bridgewater would happen first, and then the criminal charges would come next. What you see more often is people that have some sort of criminal involvement, maybe arrested, wind up in a county jail. County jail recognizes some type of behavior or symptomatic mental health issue and says, we don't have the resources to deal with this person, we don't know what to do with them. We don't know if they're gonna hurt themselves, or maybe they've had an attempt at self-harm or some type of harm to others. And they say, we're gonna send 'em to Bridgewater, you figure it out, and they go to Bridgewater and then Bridgewater will do an evaluation. There's a lot of people that spend less than 60 days at Bridgewater to have an evaluation, either for competency to stand trial, feedback on sentencing, things like that, or to just figure out if they need to be committed to Bridgewater.
Now, let's say someone meets the standard for commitment and they're committed to Bridgewater and they're there six months, a year, a year and a half, two and a half years, and finally Bridgewater says, Hey, we think you're back on your feet, we think you're stable, you're at your baseline, you're gonna be discharged. Where do they go? They go back to county jail, because they're in the system, they're still serving a sentence or awaiting a trial. So there's this double-edged sword within the system and some people refer to it as sort of getting pushed off a cliff because you're in the criminal justice system, you have this heightened hospitalization with really tailored mental health treatment, and then, you know, as a bonus for sort of graduating, you get sent to a county jail with little to no resources. Or iif you're in the state correctional, you would go to Bridgewater units at Old Colony Correctional and then get sent back to the state correctional. It's a little bit of whiplash for people that are in the system because the county jails are not set up to be an appropriate step down, and they're not set up to be able to follow through on a discharge plan. It could be something as simple as sometimes somebody could be on a very serious medication that requires regular blood draws and really close monitoring, and then they get sent to county jail and county jail says, Hey, that's not on our formulary, and just stopped. And if you're talking about a really intense medication for mental health needs that has psychological and physical effects too, to just stop a medication, so it's a complicated system and navigating how somebody gets there and what happens to them when they're gone is an ongoing mission and advocacy of Disability Law Center. We've been onsite, I've personally spent years and years monitoring onsite at Bridgewater State Hospital. For many, many years two full days a week I was just walking around and just part of the structure of Bridgewater. It's really interesting, after years on site one person that was living there said to me, you know, I think you're really the crazy one because you choose to keep coming back. And I said, well, I have the luxury of leaving. You know, and the idea to me of just leaving people behind that, it's not that they don't have a voice, it's that nobody's listening, that's the bigger problem. And so as the Protection and Advocacy it's part of our mission to not just give a voice to people that don't have it, but really rather make sure somebody's listening. It's not always the voice that's the problem, it's the ear, there’s nobody there to hear it.
Jesse: If I'm understanding correctly, once you reach Bridgewater State Hospital, because it's a different system that might mean different regulations or policies around medication. But if a person's being prescribed medication that their physician believes is necessary, and they're voluntarily taking it and they believe it's helpful, they could be transferred to a facility that says you no longer have access to the medication which you and your physician believe are necessary?
Nancy Murphy: That's right, and there's a lot of advocacy around this but it's a huge problem with people that need mental health services being in any sort of correctional system, including the county jails. That there will be someone who is stable at Bridgewater, they've been doing great, participating in treatment, they're really excited about their recovery, feeling really good. Of course, then they get pushed off the cliff, right? And just, oh, well you're all better, you don't need services anymore. So we can send you back to county jail. And their discharge plan will say like, Clozpine, you know, or it's like a heavy, really intense medication. And they go to county jail and the county jail says, Hmm. No, we don't do that. Let's put you on this one instead. And that transition is so jarring, you know, you have somebody that has been doing really well and stable and then they're taken off it, there's a whole process to see what might work. They've dropped off the cliff in terms of they're no longer in a “hospital", like Bridgewater, and they're just back in county jail. Maybe in general populations seeing a therapist once a week, once a month, it could be completely different. And so what's gonna happen? A lot of times things don't go well, and they might act out, they may decompensate, they might get really, really sick, either mentally or physically because of the medication withdrawal or the changes, and so they wind up back at Bridgewater. And then you say, what is happening in this system? And then each time that happens to someone, that cycle, their baseline and the work it takes to get back to where they were gets more and more challenging.
And so you see in this system this revolving door of people at Bridgewater, and each time they come back it's a little bit rougher than the time before, and it can take longer than the time before. And having been a monitor there for eight years I can look at the roster of admissions and discharges and I, I mean these are names that are all familiar to me just by being there. That process is something that Disability Law Center, both as the Protection and Advocacy and as this additional authority by the state legislature, we're looking at that issue of continuity of care post-discharge at Bridgewater. What happens when people leave? Where are they going? What services are they getting? And what shape are they in when they get back? If they get back. And it is common that once you've been at Bridgewater, if you have another commitment or you have any involvement with the criminal justice system there's a good chance you're gonna wind up back at Bridgewater too.
Michelle: I want to highlight trans lives in this instance. because she very specifically said this is a law that applies to men and not women. However, even though I know some people passionately disagree, gender is not associated with biology, and there are many people who are going there that identify as women. And I really can't imagine in this scenario if you are being put into a detention center specifically set for men, and getting treatment as a man, I can't imagine that's gonna be great for your mental health. I do think it's a lot of trans lives that get caught up in this as there is an association between, you know, likelihood of being kicked out of your house, being on the street, being in situations in which you probably will be arrested or perceived as having some kind of episode that someone needs to step in and commit you essentially. And this civil commitment process seems just uniquely horrifyingly, specifically tailored to fuck over trans lives…to “flook” over trans lives.
Jesse: It's our podcast Michelle, you can swear.
Michelle: Great, cuz I just did.
Jesse: And I think this emphasizes some of the serious flaws in the overall process because policymakers create laws, the Department of Mental Health interprets those laws one way, the Department of Corrections might interpret those laws a different way. You have those two institutions, those two different sets of treatment and detention guidelines, and you have the person being passed from one to the other, probably just trying to find a baseline, just trying to survive. And then you have a vendor, Wellpath Incorporated, who the Department of Corrections brings in to run aspects of their facilities. So now it's not just the DMH interpreting things one way, then the DOC interpreting things another way, now you have Bridgewater State Hospital essentially being run by this vendor who may be interpreting things a different way. And so I don't really understand why these state institutions would hand over something as important as interpreting patients rights to an outside vendor.
Nancy Murphy: Let me backup a second. In April, 2017, this was a monumental shift for Bridgewater State Hospital, before April, 2017 all of the security at Bridgewater State Hospital was by correction officers throughout the facility. So we call this the pre-transition. So there was a vendor that did mental health services but on every unit, everywhere, all the security was done by uniformed correction officers. Then there was a transition where on a date in early April, 2017, all of the correction officers walked out and a new mental health vendor came in and took over both the security and the mental health. This was a huge step forward for Bridgewater. It meant no more uniformed correction officers, it meant now both the mental health and the security piece were run by a mental health vendor. And even though to get into Bridgewater, there are still correction officers that sort of man that first trap. I mean, it's a trap because the trap, like the doors in a correctional facility, but once you're in there aren't uniformed correction officers.
That transition carried over, the mental health vendor took the DOC policies on security and services and kind of recodified them into their own. So they didn't just pick their own, they went based on what DOC had, but they don't comport to the Department of Mental Health, and that's the big issue. So, to me, it's not just that there's a vendor that's in charge, it's that there's no uniformity for mental health services in the state.
Jesse: I wanted to clarify the process with the vendor, which is that the person is going from a DMH facility to a Department of Corrections facility, which is run by a vendor. And so one of the issues there is not necessarily the intent of the vendor, but the vendor is answering to the Department of Corrections, so the vendor may or may not have awareness of what DMH policies are and may or may not have any obligation to follow all DMH policies. So it's really, by the time you reach the facility run by the vendor, it's sort of like a game of telephone and you don't know how they're interpreting a different system that you're now entering.
Nancy Murphy: That is exactly accurate, and that's compounded by the fact that some of the leadership at Bridgewater State Hospital who have been there for well before the transition, are still in leadership roles and have never worked outside of Bridgewater. So they only know mental health treatment and forensic evaluations, or risk assessments, referential to Bridgewater and the correctional system. As opposed to someone in the Department of Mental Health world who may come from a community background or a psychiatric unit background, their point of reference is recovery/least restrictive. Bridgewater's point of reference is stabilization and back to county jail. Nobody, unless it's really unexpected of a judge saying, no, this person doesn't meet commitment and there are no criminal charges pending, which is incredibly rare, nobody just walks out of Bridgewater State Hospital. You either go to a DMH facility as a step down or you go to county jail. So there is no thought to discharge planning, the community, continuing on with your life and recovery, it's just moving people along the spectrum so that they can either face criminal charges or things like that. So I think that you're exactly right, the paradigm of it being under Department of Corrections doesn't have people trying to say, what would it be like at Department of Mental Health? It is like a game of telephone where each version, it changes just a little bit more, and by the time you get to Bridgewater, you're like, what is happening here? I don't understand what's happening here.
Michelle: We're saying the word vendor a lot, but we are likely talking about Wellpath Inc. In the last decade they have been sued in federal court over 1300 times. The organization, a local Massachusetts organization called Deeper Than Water, sent out surveys to a lot of inmates in a bunch of correctional facilities. So, you know, this is DOC run places that I'm talking about right now, not specifically Bridgewater State, but it's the same company providing medical and mental health services to all of these. Most of the surveys that have come back are just egregious instances of human rights violations and negligence, and a lot of what I just heard her talk about a lot of, I had this problem and I had it completely managed with this medication and then I got here and they'll forget my medication, they will withhold it as punishment if they do not feel that I'm complying appropriately, or they will withhold it because it's cheaper, it's cheaper to just have me suddenly die than it is to give me medication. Because a lot of these people are here for life, and because they're also in for life a lot of them can actually speak to before Wellpath and after Wellpath. And many say that this is the worst treatment that they have ever received.
And in a lot of responses to a question, you know, what are things that could be done differently now? So many answers were, I could be maybe treated like a human being, that could be a good first move to help things be better. So this is the vendor we are referring to. And another thing that I wanna highlight, that's the amount of inmates that repeatedly have to say, I promise I have evidence, I promise I have proof, I promise if you'll just listen to me, if you'll just believe me for a second, I can back it up. I just think it's so significant, you know? So many of these issues, like people experiencing distress, mental health distress who are committed, people who are incarcerated, I mean really anyone who's had their rights stripped and told by an expert or authority that this person needs to have their rights stripped for the good of themselves and the community. It doesn't matter if it happened to them illegally or through all of this shady coercion. Once that stigma is on them, it doesn't matter anymore, no one is listening and no one is caring and no one is believing them. And it's really deeply, I find deeply, deeply upsetting. Because I don't think that by virtue of incarceration or commitment you are a liar, or you don't have an understanding of what's going on, and you don't have an understanding of what's happening to you or that you're not capable of if given some level of compassion for a little while coming out of whatever distress you're in. It's just deeply, deeply upsetting.
Jesse: Yeah, it seems like the ideal circumstances would be that if you are encountering someone in distress, you get that person somewhere that can give them the help that they need. But here are the laws saying that if a clinician believes that you are displaying symptoms of a mental illness, symptoms that put you in some sort of risk of imminent danger, then we need to detain you in a psychiatric facility. If while being detained in that psych facility someone believes that you pose a security risk, whatever that means, then we need to send you to Bridgewater State Hospital, which is essentially a corrections facility. If this whole process was initiated under the belief that this person was in some sort of imminent risk of danger then why would you start by detaining them in a facility that isn't equipped to manage a security risk? Whatever distress got you into that system, whatever that initial justification for detention was, now all of that seems to become secondary, or tertiary, to this other type of detention that is not about treatment. And this person is being passed between these institutions, each one exposing the person to different ways in which they could experience serious trauma. A legal process like that seems so obviously problematic that it seems like the law is openly acknowledging that they have conflicting priorities and that the law is deeply flawed.
Nancy Murphy: I think that's what the system is saying. I think the law pretty clearly says this should be least restrictive, you should always be doing least restrictive. I think in practice people say, well, we don't know what else to do with this person, so this is the least restrictive. But that's not what the law says. The law doesn't say it's least restrictive because you've completely botched community services or response or you know, you've done such a terrible job deescalating people, and so now that that event has escalated to this point now you're least restrictive. That's not really what the law contemplates, but I think that's what happens. So I agree with everything that you said, but I would say that's what happens in practice. So many mistakes happen along the way that this is the best way that they can figure out how to navigate what to do with people. But that's because of the failures in treatment along the way. The failures in response and the failures in treatment along the way are what typically leads somebody to an involuntary commitment, whether it's at a DMH unit or Bridgewater.
It's the worst paradigm that you can imagine, you have somebody that you want to be engaged in treatment, and you want to be participating in treatment, and in the very introduction to that treatment you are stripping away all of their rights and taking away any coping mechanisms from a support network, to their home, to their pet, their iPhone, whatever people use, it's really hard to imagine. And then it's a real question of what are you doing with them now that you have them? Because people don't live in these places forever. And so if you put somebody in a Bridgewater and lock them up for three years, five years, and then their criminal charges are resolved and they're done, and you step them down to a DMH unit and they spend a year, or two years, in a DMH unit, what resources do they have when they are discharged? How can they make it in society to either live independently or live with supports? And what unbelievable resentment and trauma have they xperienced because of that path that you put them on?
Jesse: If there's awareness that there are patterns, that people who are brought into Bridgewater State hospital are not unlikely to go back to Bridgewater State Hospital if they're released. Like, accepting that that pattern exists, if you do get released in a situation where whatever's happened, you've had some interaction with police or correctional facilities, you've been brought into a psych facility, you've been brought into Bridgewater Site Hospital, all of that has a risk of trauma. All of that is very likely to increase the stress, and then eventually you're released, I guess, what then?
Nancy Murphy: I don't know, I think that's the issue, I don't think there's a good answer, it's all cumulative. And I think if there's a chance that somebody can navigate all of this on their own, which given what brought them into the system is an uphill battle to begin with, right? If somebody could navigate this all on their own, what they're gonna be like at the other end is gonna be a shadow of what they started with because each step of the way is additional trauma. And I'll give you an example, you know, before the transition at Bridgewater there was a unit dedicated to restraint and seclusion. So if you were going to be restrained or you were gonna be secluded at Bridgewater you went to the intensive treatment unit called the ITU. And the only thing that that unit did was seclude people, or four point restrained them. What brought Disability Law Center to Bridgewater was an investigation of that unit and their use of restraint and seclusion. In 2014, we made findings, we issued a report to the governor, we had a settlement agreement with the state. At the time, there was also a lawsuit and we became the court monitor to that lawsuit. And this all started around the use of restraints and seclusion at Bridgewater and that ITU. On day one of the transition in April, 2017, that unit closed. So restraints and seclusion at Bridgewater dropped drastically simply because they took away that simple tool to just lug someone to the ITU and put them in the restraints or seclusion. The system changed at Bridgewater, some of the culture changed at Bridgewater.
During Covid Bridgewater opened up the ITU again and called it the Containment Unit, so that when guys would come to Bridgewater upon admission, if they needed to be quarantined, they quarantined them in that same physical space that used to be the ITU. So now you have people that maybe five years earlier were secluded for weeks or months on end in this unit cycling back through. And even though the correction officers are gone, and even though it's not called the ITU anymore, they're being secluded in a containment unit because of a pandemic, possibly even in the same cell that they were in five years earlier. It feels and looks exactly the same. Now you can say, we're not secluding them, that's Covid, that's the pandemic. Now, trauma doesn't know the logic behind that, it's the same exact experience and so triggering in all of those ways. Those are the things in the system that are missing, especially with Department of Correction overseeing it, that focus on trauma informed care and individuals, and the overall experience and the continuity of care. What happened to somebody before they were admitted? Where are they going when they're discharged? It's all missing at Bridgewater, and those are the types of things we're looking at and the stories that we're trying to tell. To like I said, not give a voice, but be an ear and then see if we can repackage it in a way that somebody's gonna listen.
Jesse: One thing that resonated with me at the end was if you make it through this system, any of these systems, you can become a shadow of your former self. That has felt like where I've been for over 20 years. There are still people in my life who knew me before being committed and know me after. Sometimes it seems like they're comparing me to the potential they believe I had before to what they see now. I was forced into treatment for anorexia, but I only maintained the criteria for that diagnosis for about five years, but I've had PTSD from that forced treatment and maintained the symptoms of that PTSD for over 20 years. What does that mean for a system that claims it was designed to help people in distress if it creates this other problem?
Because who knows what I could have been if I'd never gone through this.
Michelle: Yeah, and I see how you navigate the world, and also I think of how others in similar positions would have to make some of the same constant decisions that you have to make. Job applications ask for you to report mental health, in some cases, housing applications do the same thing. When you go see a doctor and they ask you about, you know, your past experiences to help inform care, you know, every single one of these things ends up being this decision where you take a huge risk in choosing how much to divulge, how little to divulge, and also then puts you in the position of maybe making moral decisions you wouldn't like. For instance, well, don't really wanna lie, but this could save my life, so I guess I'm going to be a liar now. Not just for you, but for anyone who's been in this position of, you know, what happens if I get into an accident? What kind of paperwork out there exists about me. It paints a very specific picture that's going to immediately change how someone engages with me, how they treat me, how I get help. It's almost horrifying enough that you asked for help one time and this happened, but now asking for help has exponentially increased terror associated with it. I mean, if you broke your leg, I don't know what you would do. You'd probably just duct tape it and move on.
Jesse: I think this connects to what Nancy said about Massachusetts being good on the law, but not necessarily on the practice because all of my commitments happened in Massachusetts, so there's that record. And now I am in New York, I've been in New York for several years and for many of those years I didn't have health insurance. Partly because of cost, but largely because I was worried that if I had health insurance it would give an incentive for someone to commit me again if I ever ended up in a hospital for any reason. But then I got married and being married I'm now on my spouse's health insurance, and I have to wrestle with this question of, in New York simply having that past commitment, that is all they need to authorize detention and a psychiatric hold. In Massachusetts there would have to be an additional finding, you couldn't simply look at my history and say, this is sufficient to authorize a psychiatric hold. So as horrific as going through the Massachusetts system was for me, I am now in a situation where everything that happened in Massachusetts could now be used to justify someone doing it to me again in the state that I'm in. And I don't know what to do about that. I sincerely don't know what I would do if I broke my leg.
Michelle: I mean, duct tape's, not out of the question…
(laughter from Jesse)
Michelle: I do feel like this is why it is so important and valuable that we are going state by state because this is where we're at with some of these systems. We're talking about one of the good states right now, that's scary. And I think that that is worth highlighting to people that what will only 80% traumatize you in one state could 120% traumatize you in another? I mean, it's just, I'm glad we're talking about it.
Jesse: Me too, and I'm glad we're continuing to talk about it because next time on Committable, we'll be talking about West Virginia.
(closing music from Reasonable by Christopher G. Brown)
Jesse: Committable is produced by Jim McQuaid, Michelle Stockman, and me, Jesse Mangan. All music is from the Song Reasonable by Christopher G. Brown.