Involuntary Treatment Laws in Massachusetts: What Do They Mean?

Getting help for yourself or a loved one isn’t always easy, even when it’s what they need most. In some cases, someone can be involuntarily admitted for treatment when they pose a danger to themselves or others or meet other criteria for Involuntary Treatment Laws in Massachusetts.

What Are Involuntary Treatment Laws?

An involuntary treatment law is a legal avenue that admits someone to substance use disorder, mental health treatment, or hospitalization without their consent. In many cases, their condition is severe, and they are deemed unfit to care for themselves or others or are unable to make healthy, safe decisions on their own.

For some patients, there may be a history of refusal to seek treatment or official to remain in treatment in the past. The purpose of involuntary admission is to help the patient achieve a baseline of stability and safety so they can begin building a safe and healthy life if they’re unable or unwilling to do this for themselves. [1] Involuntary commitment is a last resort for someone in dire need and applies only to limited circumstances to promote autonomy and prevent abuse.

What Are The Involuntary Treatment Laws in Massachusetts?

There are laws regarding involuntary mental health commitment in the state, both for emergency intervention and for long-term treatment. They all fall under Chapter 123 of Massachusetts General Laws, the chapter regarding mental health issues, including substance use. [2]

Section 35: Involuntary Commitment For Substance Use Disorder

In Massachusetts, Section 35 is a legal avenue for qualified petitioners to seek the involuntary commitment of those who suffer from alcohol or substance use disorder.[3] This law states that “Any police officer, physician, spouse, blood relative, guardian, or court official may petition…for an order of commitment of a person whom he has reason to believe has an alcohol or substance use disorder.”

The petition will be filed, and a hearing will be scheduled before a judge. If the patient does not make an appearance, a warrant may be issued for their arrest, though the circumstances of the arrest are limited. The patient will always have the right to legal representation during this process.

This individual must be believed to be at substantial risk of physical harm, specifically due to alcohol or substance use. If that’s the case, the court may order involuntary commitment at a psychiatric facility or treatment program for up to 90 days.[4] After their release, the patient may receive up to 1 year of case management services provided by the Mass. Department of Public Health.

Is Section 35 a good first treatment option?

No. Involuntary treatment should never be presented as the first-line intervention for alcohol or substance use disorder. Entering treatment voluntarily is the preferable approach and may improve treatment outcomes.[5] To qualify for civil commitment, the individual must present a high likelihood of serious harm

‌What is section 21 in Massachusetts?

Section 21 is under the same chapter as Section 35, Chapter 123, and refers to the transportation component of involuntary treatment. If the patient poses a very substantial risk to themselves, has a history of suicide attempts, or is exhibiting extreme violence, physical restraint may be necessary during transport for everyone’s safety.[6]

What is the Baker Act in Massachusetts?

The Baker Act was submitted into law on October 18, 2019, by its namesake, Massachusetts Governor Charlie Baker. It’s an article in the legislature labeled “An Act to Improve Health Care by Investing in Value.” 

The Baker Act was designed to help eliminate barriers to behavioral health treatment by establishing a new system that would incentivize care providers, hospitals, and health plans to focus more funds on primary care and behavioral health.[7] This greatly influenced the development of Senate Bill 2519, An Act Addressing Barriers to Care in Mental Health, which was also passed into law.

Section 12: Massachusetts Emergency Civil Commitment

In Massachusetts, a “Section 12” commitment is for emergency restraint and hospitalization due to a high potential for harm due to mental illness.[8] This emergency order is for a 3-day window where the patient will receive psychiatric care at a pre-authorized public or private facility. The purpose of a Section 12 emergency petition is for psychiatric evaluation to determine if further treatment is needed.

What Is An Emergency Petition?

An emergency petition or emergency hold (also known as a 72-hour hold, involuntary hold, psychiatric hold, or psych hold) is a temporary detention in which someone may be in crisis and need assistance now. However, it may or may not meet all of the criteria for 90-day involuntary treatment.

Who Can Request an Emergency Petition?

Section 12 of Massachusetts General Laws outlines who can seek an emergency order of commitment and under what circumstances. It cannot be only family members who believe the patient needs help; it must be an informed mental health professional or other invested authority. Approved parties include: [9]

• Physician
• Qualified psychologist
• Advanced practice registered nurse
• Licensed independent clinical social worker (LCSW)
• Police officer

They must believe that failing to hospitalize the patient due to mental health concerns could lead to serious harm. In certain circumstances, friends or family members can request hospitalization from approved professionals. However, they must still evaluate the patient, either in person or based on the evidence presented, before it goes before a judge. The process may take a few days; ultimately, the court will determine the best action.

How Do I File a Section 12 in Massachusetts?

An approved provider or professional must file an Application For Authorization of Temporary Involuntary Hospitalization with the Commonwealth of Massachusetts, The Department of Mental Health.[10] This may be filed directly with the court or with the emergency department at a hospital.

What Does Involuntary Treatment Look Like?

Each patient’s treatment plan will be individualized based on their unique needs, as set forth by the court hearing. Involuntary treatment can range from detox and withdrawal management or inpatient rehab to partial hospitalization or other outpatient levels of care. After formal treatment has ended, usually 90 days, ongoing case management may be implemented, as well as other

less restrictive alternative treatment programs.

What Is Assisted Outpatient Treatment (AOT)?

Assisted Outpatient Treatment is court-ordered mental health or substance use treatment that is an alternative to inpatient hospitalization. This may be more appropriate for those who are not in immediate crisis but may not otherwise commit to treatment. AOT is still a contested matter of legislature, and as of early 2024, Massachusetts does not have the provisions for this mental health law.[11]

What Are The Criteria For Imposing Involuntary Treatment Laws In Massachusetts?

The official criteria for involuntary treatment in Massachusetts are provided for under Section 35 of Chapter 123 general law, and applications must be submitted by an authorized petitioner (police officer, physician, spouse, blood relative, guardian, or court official):[12]

1. Individuals present habitual consumption of harmful substances to the point of injury or significantly impaired social and economic functioning.
2. An inability to control substance or alcohol use.
3. Presents a high likelihood of serious harm due to alcohol or substance use.
4. This person is in immediate danger to their physical well-being.

The criteria for Section 12 are slightly different and for emergent, immediate intervention. This law focuses more on mental illness rather than substance or alcohol use. The criteria to apply for a 3-day, Section 12 emergency psychiatric hold include :[13]

• Individuals must have a significant risk of serious harm because of mental illness.
• A failure to hospitalize would create or increase the likelihood of serious harm.

What Are The Patient’s Rights?

Despite the involuntary nature of civil commitment and an order of commitment, patients always have rights. The Massachusetts Mental Health Legal Advisors Committee has prepared a resource outlining these rights in “Your Rights Regarding Admission To And Discharge From A Hospital Under Massachusetts Mental Health Law,” which shares: [14]

• You have the right to legal counsel
• You may seek review by a judge through an emergency hearing
• You must be allowed to commit to treatment on a conditional voluntary status
• The treating hospital must share your Section 12 status with you
• After 72 hours, you may be discharged unless the hospital appeals for an extension
• At any time, you can submit written intent to leave treatment
• You may request an independent psychiatric evaluation
• You may testify on your behalf in court and cross-examine witnesses
• An involuntary commitment that has been extended to 6 months requires a new petition filing

Get The Help You Need

If you or a loved one are struggling with mental health or substance use disorder challenges to the point of significant risk to physical well-being, seek emergency services right away. If you’d like to learn more about the treatment process and recovery solutions available, reach out today.