Demand for mental health services spike in jails, sheriffs report

The inmate population in state and county correctional facilities has been on the decline for several years, but some sheriffs said Monday that the demand for substance use and mental health treatment in county jails has been spiking, putting a strain on jail resources and staff.

Hampden Sheriff Nick Cocchi, the vice president of the Massachusetts Sheriffs Associations, estimated that 75 percent of the inmate population incarcerated in county jails now require addiction and mental health services.

Cocchi said treating those conditions is essential to the mission of sheriffs to prepare inmates for successful reentry to Massachusetts communities and the prevention of recidivism to break the cycle of incarceration that has harmed many families and communities for generations.

"Our population coming to jail, as much as it's being reduced, the acute mental health and heath care issues are posing a significant strain on the budgets of sheriffs' offices," Cocchi testified before the Joint Committee on Ways and Means.

The House and Senate budget committees heard testimony Monday on Gov. Charlie Baker's proposed investments in the judiciary and public safety, including $689 million for the 14 county sheriffs. Cocchi said the governor's budget is essentially a maintenance budget, with increases going to cover the cost of cost-of-living raises for correctional staff.

Middlesex Sheriff Peter Koutoujian said in his county in January 2019 about 11 percent of inmates in custody had a diagnosed mental health disorder. Today that figure stands at 53 percent. The number of inmates in need of mental health treatments for everything from sleep disorders to anxiety has also spiked over the same period from 51 percent to 75 percent.

Koutoujian said he added six full-time mental health clinicians in 2019, two more in 2020 and just posted an opening for another clinician last Friday.

"You shouldn't have to come to jail to get good treatment but we're asked to fill a gap that shouldn't exist in the community," Koutoujian said.

One way sheriffs are looking to meet the need is by expanding the medication assisted treatment pilot program currently operating in seven counties — Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk and Suffolk — to all sheriffs' offices. This would require an increase in funding from the $15 million in Baker's budget to $22.5 million, Cocchi said.

The program, which provides inmates with access to Suboxone as a treatment for opioid addiction, is also expanding with state-run Department of Correction facilities, though the effort had been hampered by a shortage of nurses and other medically trained professionals to administer the medications.

While medication assisted treatment is currently available in some state prison facilities, Assistant Deputy Commissioner of Correction Mitzi Peterson said the goal of the Department of Correction is to add MAT services to one new minimum security facility on April 18, a new medium security facility on May 2 and have it available throughout the prison system by June 1.

"It is all hinging on staffing," Peterson said.

The sheriffs also support the Baker administration's efforts to get permission from the Centers for Medicare & Medicaid Services, as part of the state's 1115 waiver request, to expand MassHealth coverage to many ineligible inmates and others in state custody, including young people in the custody of the Department of Youth Services, adults with chronic mental health needs, and those released from jails and prisons for up to a year after reentry.

The Joint Ways and Means Committee took hours of testimony Monday from a numbers of state agencies, including the Executive Office of Public Safety and Homeland Security.

Other groups who testified included district attorneys, public defenders, the Ethics Commission, the Office of Campaign and Political Finance, Massachusetts Legal Assistance Corporation, Massachusetts Commission Against Discrimination, victims and witness assistance advocates and the Disabled Persons Protection Commission.

Public Safety Secretary Terrence Reidy said the governor's $1.4 billion in proposed funding across all public safety agencies would support a variety of reentry and rehabilitation services, finance two new State Police cadet academies to replenish a diminished police force due to attrition and retirements, and boost funding for police training in use-of-force and de-escalation tactics in line with the 2019 policing reform law.

Reidy said the $775.6 million proposed for the Department of Correction would mark a $30.2 million increase driven by payroll and other "maintenance increases," though he noted that since 2012 the percentage of DOC funding going into benefit programs and client services has increased from 18 percent in fiscal year 2012 to 28 percent in fiscal 2023, while the amount going toward payroll has declined from 69 percent to 58 percent.

Attorney General Maura Healey, who choked up as she talked about her staff, also testified for the final time as the state's top law enforcement official, though as the Democrat runs for governor in 2022 many lawmakers on the committee said they hoped to continue working with her for years to come.

"I know we're going to continue to work with you in your capacity as attorney general and probably into the future," said Rep. Ann-Margaret Ferrante, the vice chair of House Ways and Means.

Healey focused on the work her office has done in areas like consumer protection, wage theft, unlawful debt collection and human trafficking, and her office's role as a revenue generator returning $332 million to the state General Fund over the last seven years through enforcement actions, including $42 million in fiscal 2021.

She said the number of seizures of fentanyl and heroin recorded by the New England Fentanyl Strikeforce has doubled, making it important to continue to focus on drug trafficking, and she told Rep. Bud Williams of Springfield that addressing street violence requires investments in law enforcement and youth programming, like summer jobs.

"I'm a big believer in bringing the support for our young people while we work collaboratively to do the enforcement work to get guns off the street," Healey said.

The attorney general requested a budget of $63 million in fiscal year 2023, which represents a small increase from fiscal year 2022 and the same level recommended by Baker.