Updates 2/17.
Torture (no access to outdoors): my Human Rights Complaint
The DMH directory for January 2025 says that Jeanne Crespi is the Person in Charge for Corrigan. I emailed my Human Rights Complaint to her. She also is not acknowledging receipt of my email. When I don't get a reply, I try someone else. So far, the people who have received copies of the complaint include: Jose Alfonso, Maxwell I. Mayer, Startrese Sims, the DMH ombudsman, and Lawrence Weiner. Will anything happen? I assume nothing will happen. Someone will, based on clearly faulty reasoning, put it in a file for things that don't get attention. The patients will continue not to be able to access the outdoors. C'est la vie.
Corrigan History.
It was originally called the Fall River Mental Health Center. I believe it was opened in the 1960s.
At one point, it had 40 beds.
There was some controversy about Brown University allegedly getting paid for research it didn't do.
There was a larger-than-life psychiatrist there, Kennard C. Kobrin, who had lots of legal charges against him (pressuring female patients for sex, medicare fraud, running a pill-mill. I hoped to speak to him, but, unfortunately, he died in 2020. It seems he was largely vindicated.
Another public persona who is important in the Corrigan story is David B. Sullivan who is still alive. I have reached out to him to see if he could tell us about Corrigan and his career. The outline is that he started out as a social worker at Corrigan. He then became a state representative and in that role worked to save Corrigan when it was threatened to be axed. After his stint on Beacon Hill, he went to work in Fall River city government. In the Housing Authority or something like that. He eventually retired from that, and I do not know what he is currently doing. I looked up some email addresses for him and asked if we could ask him about his experience. Probably nothing will come of it though. [Sigh]
In 2010, there were attempts to shut Corrigan down for budget reasons, and he protected it. Incidentally, in press reports, it was said that Corrigan would lose 16 beds. So the reduction to 16 beds occurred prior to 2010.
Here is a good article about the fresh air law and when it was implemented. https://www.nepsy.com/articles/leading-stories/mass-dmh-releases-fresh-air-regulations/ The "fresh air" law was passed in January 2015, and the regulations I have been referring to went into effect in July 2016. The article mentions that MGH applied for a waiver of these rules. Back in October 2024, when I first became alarmed about the white, white skin of some of the Corrigan patients (how they never went outside), I assumed that Corrigan had a waiver. Specifically, I assumed it had developed a Plan which would detail why they couldn't provide outdoor access. That is exactly what I asked Larry Weiner for. And it is what I asked Public Records for. Why do they not want to present this Plan? I have no idea.
Currently, the DMH is trying again to make progress on getting out of the inpatient psych business. But Corrigan MHC appears to have escaped the axe. The plan is to cut another MHC, one in Pocasset.
My best interpretation of what is going on here: the way Corrigan is run is the way DMH is run. The ethic is one of CYA. They pick a very small number of measurable outcomes they are interested in. For example, for Corrigan, the goals are (a) don't discharge to the street or to a homeless shelter; (b) pass accreditation, (c) no elopements, and (d) no suicides on unit. When it comes to something like providing outdoor access, it simply falls by the wayside. Likewise, therapy. Social workers don't spend much time at all actually talking to the patients. The fear, I guess, is that if they pay attention to other goals such as outdoor access, they will take their eyes off the CYA goals. For example, outdoor access could lead to elopements.
Another example of this reduction to least common denominator is the new focus on falls. You don't want falls, because that will make you look bad. Why provide outdoor access when it will increase the likelihood of a fall?
Philosophically, this is the essence of modernity. One wants to eradicate "higher" goals. (Charles Taylor, 1995).
It is the same with DMH. I don't know enough to be able to say what their CYA goals are. Avoiding lawsuits? Avoiding negative press? Avoiding the closure of facilities (i.e., empire defense)? But whatever the least-common-denominator or CYA goals are, they seem to be disciplined at ignoring all goals based on principle. Thus, if you look at the walls of any mental hospital, it will have significant space devoted to telling people that if they have the right to file a Human Rights Complaint. The descriptions make it sound like a big deal. Like you are really going to be able to have your voice heard. But in reality, the Person in Charge is just someone who works there, and the Human Rights Officer too. They are people who are not incentivized to actually listen to and treat seriously any complaints.
Two other examples are the ombudsman and public records. If you look at the ombudsman's page, it sounds like they are really going to listen to you. (They say they will get back to you in 48 hours!). In reality, this is a higher goal which gets ignored. Or we could say iby ignoring it, they justify the law itself, but not any particular application of it.
For public records, they say they will get back to you, but they don't. Transparency? They don't even acknowledge receipt of emails. This is not a matter of individual agression. It is, I assume, strategic and organized. I don't know (because they won't talk to me) but one hypothesis is that the upper staff tell the lower staff that issue X has become a legal matter. Once it has that label, then everyone is supposed to ignore it and the attorneys will deal with it. It serves the "don't lose in court" goal, which is a CYA goal, at the expense of "higher" goals such as transparency and accountability. Or so I suspect.
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Two updates since I posted this audio. Specifically, I sent two emails to Corrigan or DMH staff. In the first, I asked for the plan again--this time I asked two other people in addition to LW. I also expanded the request to include prior years. In the second, I decided to go ahead and make an official Human Rights Complaint. You are supposed to make a complaint to the Person in Charge. I sent it to three people who, if they aren't that person, would certainly know who was. Needless to say, I don't expect any of them to even confirm receipt of the email!!!
Here are the two emails:
substantive part of first email--asking for plan
Dear Ms. H, Mr. W, and Mr. G,
I hereby request both the current version and all available prior versions of the written plan specified and required under 104
CMR §27.13(6)(f)5 for the inpatient unit at Corrigan Mental Health Center. I hereby also request any and all documents and records pertaining to the DMH determination of reasonable justification referenced referenced in 104
CMR §27.13(6)(f)(5)(c)(ii). substantive part of second email--human rights complaint
Dear Mr. W, Dr. M, and Dr. A,
I intend this email to constitute a complaint under 104 CMR, § 32. My complaint relates to a longstanding condition at the Acute Inpatient Unit (IPU) at Corrigan Mental Health Center ("Corrigan"). I believe this condition is either dangerous, illegal, or inhumane.
The condition relates to all Corrigan IPU patients other than those who are young, physically fit, and relatively social (the "Youthful" patients). For example, it relates to those patients who are catatonic, obese, elderly, or who suffer from a physical handicap or a mental disorder such as social anxiety or claustrophobia (the "Compromised" patients).
Corrigan staff represent that the patients have four times that they get to go outside. But there seems to be little or no concern or recognition that only the Youthful patients take part in these breaks. The Compromised Patients can spend days, weeks, and even years without ever accessing the outdoors.
[Consider, e.g.,] patient D, who was an elderly man with significant social anxiety. In speaking with him, his favorite moments were the times he would take walks with his sister and look at flowers. Yet as a resident at Corrigan IPU, he was too socially anxious to go to lunch, much less to go with the group for outdoors. [Yet if someone dedicated themself to taking him outside, he greatly enjoyed and benefited from it.]
[But for a staff member's taking it on themselves to encourage him to access the outdoors] however, he would never have gone outside. For practical purposes, for this patient to go outside, it is not sufficient to simply post outdoors times. Given his complex condition, and given the physical plant at Corrigan, for practical purposes, he would not have gone outside at all during his time there but for a person encouraging him and following through.
Patient P has been a resident for perhaps two years. [Again, a special effort is required to take P outdoors, and staff is highly resentful and obstructinist when someone takes the effort. Staff would rather use the outdoors break as their own outdoors break, without having Compromised patients interfering. Once, it was impossible to take P down, and staff purposively blocked her participation. Yet there were three staff outside, and only two (Youthful) patients. Nevertheless, the explanation was that P could not access the outdoors due to ... "we don't have the staff"].
Essentially, there is a great deal of resistance to taking [Compromised] patients outside. [Social worker D.K. is in a position of authority but is highly resentful of any efforts to change practices. She seems to believe that because of her managerial position, she is beholden to defend the status quo. She does not have the experience or magnanimity for her job and appears to have been promoted too early.]
Patient L, who was catatonic, probably never accessed the outdoors [although when asked, SW D.K. blithely asserted that he gets outside often. Just because you are management does not mean you have to lie or dissemble for the sake of the official version.]
Accessing the outdoors is a human right for all detainees. Under Massachusetts law, access to the outdoors has to be either individual or group access. I do not believe that Corrigan offers individual access. Other psychiatric hospitals, such as Southcoast Behavioral, are built so that it is easy to access the outdoors. With Corrigan, it has to be done in a group and down two dark, steep staircases. It is a forbidding prospect [for Compromised patients]. I understand that that is a physical plant issue, but if outdoor access is not provided, it is necessary that Corrigan have a plan for why this is not possible, and that plan has to be approved by DMH.
In October, I asked Mr. W. for a copy of this plan. I offered to help him revisit it. I never heard back from him, and DK provided no support for my initiative. [She is reckless and causes significant harm to actual people in apparently supporting what she believes are "rules" but often appear to be simply what-we've-always-done. As we know from Hannah Arendt, evil is not flashy; in practice in the world, evil is banal. And in America, served with a complacent smile.]
I hope that this Complaint will serve to alert staff to the problem of outdoors access. Not being able to access the outdoors is considered a form of torture. There are important efforts to ensure that penitentiaries provide outdoor time to their inmates. The law--and common humanity--requires the same opportunity be provided to residents of psychiatric IPUs.
Original post:
The first time I encountered the de facto policy that DMH employees don't respond to emails, was on Halloween 2024. I wrote an email to the "Human Rights Officer" [LW] at Corrigan asking whether I could help by bringing a fresh eye to the facility's outdoors policy. I received zero reply.
I have reprinted my email below. It refers to the CMR (Mass. code of regulations). So let's first get oriented to that.
That Halloween email is quoted below. In that email, I quote some from the Massachusetts Code of Regulations (CMR). So let's consider the CMR first.
The first five sections of the CMR are:
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES 102 CMR - OFFICE OF CHILD CARE SERVICES 103 CMR - DEPARTMENT OF CORRECTION 104 CMR - DEPARTMENT OF MENTAL HEALTH 105 CMR - DEPARTMENT OF PUBLIC HEALTH
We are interested in 104. Within 104, the first five sections are:
104 CMR 25.00 - Authority, Mission, And Definitions (§ 25.01 to 25.04) 104 CMR 26.00 - Organizational Structure and Citizen Participation (§ 26.01 to 26.03) 104 CMR 27.00 - LICENSING AND OPERATIONAL STANDARDS FOR MENTAL HEALTH FACILITIES (Subpart A to D) 104 CMR 28.00 - Licensing and Operational Standards for Community Services (§ 28.01) 104 CMR 29.00 - Application for DMH services, referral, service planning and appeals (§ 29.01 to 29.16)
We are interested in 27. Within 27, there are four subparts:
SUBPART A: SCOPE AND DEFINITIONS SUBPART B: LICENSING SUBPART C: OPERATIONAL STANDARDS FOR MENTAL HEALTH FACILITIES SUBPART D: OPERATIONAL STANDARDS FOR SUBSTANCE USE DISORDER TREATMENT FACILITIES
We are interested in Subpart C, which has 13 subsections, including:
§ 27.11 - Periodic Review § 27.13 - Human Rights § 27.14 - Human Rights Officer; Human Rights Committee § 27.15 - Absence without Authorization
We'll be looking here at 27.13 and specifically sub-section (6)(f) which states: "A patient of a facility ... shall have reasonable daily access to the outdoors.""
There are six subsections to § 27.13(6)(f) which elaborate on this reasonable daily access. Three are relevant here (sub sections 1, 2, and 5).
Sub section 1 says what is meant by "reasonable daily access." We are told it means "supervised or unsupervised daily access to the outdoors, individually or in groups." The word "individually" piqued my interest because Corrigan does not provide individual access. In addition, this section says that facilities can establish designated times for access, "as long as each patient has a reasonable opportunity to access the outdoors on a daily basis ... during one or more of" those schedule times.
Subsection 2 is about how to construe "outdoors." Specifically, "outdoors" means "a space or area outside of a building, which may include a porch, courtyard, roof deck or open space surrounded by a building." Subsection 5 is about how the facility needs to have a plan.
My Halloween email to LW was pretty tame. I simply noted that it doesn't seem like the Corrigan IPU patients have access to the outdoors. And I asked to see the plan. I assumed that would answer all my questions. Here is the email:
---Beginning of Halloween 2024 email to Human Rights Officer LW regarding outside air and outside light.----------------
"I am writing to ask if I could help assist you / your office in conducting a fresh-eyed review of Corrigan Inpatient's compliance under 104 CMR, §27.13(6)(f) (reasonable daily access to the outdoors).
Although Corrigan Inpatient does schedule Recreation breaks (at 8am, 1pm, 4pm, and 8pm), it is my understanding and belief that some patients, especially elderly patients or largely bedridden patients, do not in fact take advantage of these breaks. ...
On three occasions, I prompted elderly patients to go to on one of these outside breaks. On two of those occasions, my efforts were successful, and I believe the patients greatly benefited. [Yet to my understanding, this trip outside was rare for these individuals,] causing me to wonder whether some patients would *like* to take advantage of the outside but are intimidated by the current structures of these breaks.
For example, note that under 104 CMR, §27.13(6)(f)(1), "reasonable daily access ... mean[s] daily access to the outdoors, individually or in groups" [my emphasis]. I do not believe that Corrigan Inpatient offers individual access. Yet, for many IPU patients [e.g., those with paranoia, social anxiety, obesity, or catatonia], the only way they could reasonably be expected to access the outdoors would be via individual access].
Admittedly, it may not be possible or feasible to offer individual access, but my aim is to help assist you and Corrigan Inpatient in taking a fresh look at this issue. ...
To start, could you please provide to me (or point me towards) the written plan described in 104 CMR 27.13(6)(f)5? That may answer all my questions. I look forward to working with you on this important issue.
The Association for the Prevention of Torture, for example, recommends a minimum of one hour outdoor exercise for any detainee [https://www.apt.ch/knowledge-hub/dfd/outdoor-exercise]. The benefits of exercise and sunlight for mental health are very well established.
I would be happy to discuss these issues in person at at any point.
-------End of Halloween email
No response. Zip. Not even acknoweldgment of receipt. I did, however, re-send this email to LW yesterday (February 7, 2025). Note that despite being significantly over-staffed, the answer to the question, "Why don't you provide individual access?" will probably be: "we don't have the staff for that."
It will also be pointed out that the building is old, and it is not feasible to provide secure access: partly due to the unreliable elevators and partly due to the fact that to access the outdoors from the unit, it is necessary to walk down a long and narrow stairway. That is certainly understandable.
Nevertheless, the CMR specifies that if the facility cannot provide access, they simply need to document it in the plan. Here is the code regarding that plan. Section c is the part saying that if staffing or the physical plant preclude satisfying the requirements, then you simply add that to the plan.
--------BEGIN EXCERPT FROM CODE REGARDING THE PLAN THE FACILITY MUST KEEP-----------
a. The plan shall include the following: i. procedures, including staffing and other safety requirements, to allow for access to nonsecure outdoor space for patients who have been assessed as clinically appropriate and safe to exercise this option; and ii. procedures, including staffing and other safety requirements, to allow for access to secure outdoor space, if available, for patients who have been assessed as clinically appropriate and safe to exercise this option.
b. Reasonable efforts to safely provide access to outdoor space may include, but shall not be limited to: i. reasonable capital expenditures to develop, construct or otherwise acquire outdoor space; ii. reasonable modifications of staffing patterns to permit staff escorts; or iii. reasonable modificationsto building access policies to permit patient access to common areas of the facility or proximate to the facility not normally dedicated as patient areas.
c. If the facility determines that it cannot safely provide secure outdoor access due to staffing or physical plant limitations, it shall: i. identify and document such limitations in the plan; and ii. identify what actions the facility will take to address these limitations and the time frame for the actions. If the facility determines that the limitations cannot be reasonably remedied, the facility shall identify the reasons for such determination. Such reasons shall be documented with sufficient detail to enable the Department to determine whether they constitute reasonable justification.
d. Upon request of the Department, but no less frequently than in its application for licensure or license renewal, the facility shall demonstrate to the Department’s satisfaction that its plan is current and that it has identified, considered and implemented all reasonable actions to safely provide access to outdoor space.
--------END EXCERPT FROM CODE REGARDING THE PLAN THE FACILITY MUST KEEP ------------
That was 27.13. The next section is also relevant. It's about how the Human Rights (including the right of access to the outdoors) is (supposedly) enforced. It doesn't look promising, but here it is:
27.14: Human Rights Officer; Human Rights Committee
(1) Human Rights Officer. Each facility shall have a person or person employed by or affiliated with the facility appointed to serve as the human rights officer and to undertake the following responsibilities: (a) To participate in training programs for human rights officers offered by the Department; (b) To inform, train and assist patients in the exercise of their rights; (c) To assist patients in obtaining legal information, advice and representation through appropriate means, including referral to attorneys or legal advocates when appropriate; and (d) In the case of Department facilities, to serve as staff to the facility’s human rights committee. The human rights officer must have no day-to-day duties that are in conflict with his or her responsibilities as a human rights officer, including carrying out fact-finding activities under 104 CMR 32.00: Investigation and Reporting Responsibilities.
2) Human Rights Committee. For each facility operated by, or under contract to the Department, the Commissioner or designee shall establish, impanel and empower a human rights committee in accordance with the provisions of 104 CMR 27.14. Such a human rights committee may be established jointly with other programs in an Area; provided however, that the number, geographical separateness or programmatic diversity of the programs is not so great as to limit the effectiveness of the committee in meeting the requirements of 104 CMR 27.14. (3) The majority of members of each human rights committee shall be current or former consumers of mental health services, family members of consumers, or advocates; provided however, that a member who has any direct or indirect financial or administrative interest in the facility or the Department shall notify the facility director or Commissioner, as applicable, in writing. (4) The general responsibility of each such human rights committee shall be to monitor the activities of the facility with regard to the human rights of the patients in the facility. The specific duties of the committee shall include: (a) Reviewing and making inquiry into complaints and allegations of patient mistreatment, harm or violation of patient’s rights and referral of such complaints for investigation in accordance with the requirements of 104 CMR 32.00: Investigation and Reporting Responsibilities; (b) Reviewing and monitoring the use of restraint, seclusion and other physical limitations on movement; (c) Reviewing and monitoring the methods utilized by the facility to inform patients and staff of the patient’s rights, to train patients served by the program in the exercise of their rights, and to provide patients with opportunities to exercise their rights to the fullest extent of their capabilities and interests; (d) Making recommendations to the facility to improve the degree to which the human rights of patients served by the facility are understood and enforced; and (e) Visiting the facility with prior notice or without prior notice provided good cause exists.
(5) Each such human rights committee shall meet as often as necessary upon call of the chairpersons, or upon request of any two members, but no less often than quarterly. Minutes of all committee meetings shall be kept and shall be available for inspection by the Department upon request. The committee shall develop operating rules and procedures, as necessary.