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MNA's Bill Requiring That Forensic Patients Entering DMH Facilities Be Put in a Designated Forensic

Updated: Nov 1, 2023

Senate Bill 1258, which would require that certain patient populations admitted to Mass. Department of Mental Health (DMH) continuing care facilities first be placed in a designated forensic unit, will be heard by the Joint Committee on Mental Health, Substance Use, and Recovery on Monday, October 30.


What:Hearing of Senate Bill 1258, An Act Providing Appropriate Care for Certain PopulationsWhere:Statehouse, Room B-1; livestream under the Hearings & Events section of the legislative website.When:Monday, October 30 at 12 p.m.Who:MNA nurses and healthcare professionals working in DMH continuing care facilities across the Commonwealth


This bill specifically targets admission of certain categories of patients (forensic patients) to DMH continuing care facilities and it would require that these patients — upon admission to the facility — be put into a designated forensic unit. Such a unit would provide the appropriate care and environment for this patient population until such time as any redetermination can be made.


SB 1258 was filed by the Massachusetts Nurses Association (MNA) with Sen. Robyn K. Kennedy (D-Worcester) as the lead sponsor.


The Necessity of This Bill

Admitting forensic patients to continuing care units mixes them with other patient populations, which is problematic and dangerous for everyone involved: continuing care patients, forensic patients, staff, and visitors. Forensic patients are a specialized population requiring specialized care, and many of these patients arrive at DMH facilities highly unstable, not stabilized on medication, and floridly psychotic.


Forensic patients in Massachusetts are being admitted to DMH continuing care facilities with increasing frequency. A 2019 report from the Worcester Recovery Center and Hospital (WRCH), for example, showed 40% of patients at the facility were forensic, with WRCH staff reporting this statistic has continued to rise over the last four years.


While continuing care patients have treatment plans designed to ultimately transition them to the community, that is not the case with forensic patients. Instead, forensic patients being sent to DMH facilities are typically undergoing a court-ordered evaluation or are in the middle of serving a sentence but cannot be cared for appropriately in the penile system. Others have been found not mentally fit to stand trial.


"We are failing all of our patients under the current system," said Kate Murphy, RN and president of the MNA. "Designating these patients to specialized forensic units upon entry will allow time for evaluation and stabilization. From there, patients who are able to transition to regular continuing-care floors can do so."


"This bill will provide every patient — no matter their designation — with the best environment possible for getting the quality of care they need and deserve," added Murphy. "SB 1258 needs to move forward for the health and safety of all involved: patients, staff, and visitors."


Overview of Proposed Categories for Admission to the Forensic Units Under SB 1258:

  1. A criminal court may require a period of examination and observation at a mental health facility to determine whether a client/patient is competent to stand trial and/or is criminally responsible for the crimes with which they are charged. To make this determination, the court may order the client hospitalized for 20 days, and for an additional 20 days if needed.

  2. If a client/patient is found guilty of criminal charges, the criminal court may require an evaluation at a mental health facility for up to 40 days as an aid in sentencing. During this period of observation, the hospital may petition the court for the client/patient's involuntary commitment.

  3. If the criminal court finds a client/patient incompetent to stand trial or not guilty by reason of mental illness, it may order the client/patient hospitalized for examination and observation at a mental health facility. This hospitalization may last up to 40 days. However, total hospitalization under secs. may not exceed 50 days.

  4. If a client/patient is found incompetent to stand trial or not criminally responsible, the hospital or the district attorney may petition the criminal court for their involuntary commitment. The hospital or district attorney must act either during the period of observation described or within 60 days after the client/patient is found incompetent or not criminally responsible.

  5. If the court commits a client/patient to a mental health facility, it may restrict their movements to the buildings and grounds of the facility. If the superintendent of the facility believes the client/patient no longer needs to be restricted, they must inform the court that ordered the commitment. If the court fails to respond within 14 days, the restrictions must be removed.

  6. If the head of a correctional facility believes that a client/patient, as a prisoner, is in need of hospitalization by reason of mental illness, they may have the client/patient evaluated. A copy of the report will be sent to the court. The court may then order them to be evaluated at a mental health facility or Bridgewater for up to 30 days

Currently, patients like those described above are admitted to non-specialized floors and mixed with other patient populations, and this has happened as the overall percentage of forensic patients cared for in DMH continuing care facilities has increased. Under SB 1258, all such patients would be evaluated and cared for in designated forensic units where the care is specialized.


Addressing Workplace Violence

Caring for forensic patients in designated forensic units first, as opposed to admitting them directly to a DMH continuing care facility, also addresses another issue that is plaguing the healthcare sector: workplace violence against healthcare workers. According to the MNA's 2023 "State of Nursing Survey":

  • Twenty-four percent of nurses said they do not feel safe in their workplace, an increase from 9% of nurses in 2019 and 17% in 2021.

  • Sixty-three percent of nurses said workplace violence and abuse is a serious problem, up from 42% in 2021.

  • Seventy-six percent of nurses in direct care at a teaching hospital said workplace violence and abuse is a serious problem.

  • Seventy-nine percent of nurses in direct care at a community hospital said workplace violence and abuse is a serious problem.

  • In addition, according to the U.S. Bureau of Labor Statistics, healthcare workers experience the most nonfatal workplace violence as compared to other professions, accounting for nearly 70% of all non-fatal workplace assaults.

"So much needs to be done in order to address the entirety of workplace violence in the healthcare sector," added Murphy. "But this would be one step in the right direction."

The Massachusetts Nurses Association represents more than 1,300 nurses and healthcare professionals who are employed by the Commonwealth, including those working at the state's various continuing care DMH facilities.

Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and lobbying the Legislature and regulatory agencies on healthcare issues affecting nurses and the public.

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