Robin Wallace thought her years of working as a counselor in addiction treatment gave her a decent understanding of the system. She has worked in private and state programs in Massachusetts and with people who were involuntarily committed to treatment.
So in 2017, as her 33-year-old son, Sean Wallace, continued to struggle with heroin use — after years of coping with mental health issues and substance use — she thought she was making the right choice in forcing him into treatment.
"His behavior was erratic," Robin says. "I think he had some mental health issues that were worsened by his use."
Now she worries that her decision contributed to Sean's taking his own life.
The law known as Section 35
Robin had become one of several thousand Massachusetts residents each year who ask the courts to force a loved one into addiction treatment under a state law known as Section 35.
The law allows a family member, physician or police officer to ask the courts to involuntarily commit someone to substance use treatment. Dozens of states have civil commitment laws, but Massachusetts is believed to use it more aggressively than most states.
In the last fiscal year, more than 6,500 Massachusetts residents were ordered into treatment this way.
After a court clinician in Hyannis, Mass., reviewed Robin's request, a judge agreed that Sean's substance use was dangerous and ordered him committed to up to 90 days of residential treatment.
Sean had begged his mother in court that day not to go that route. He was being sent to a program, he told her, where he would be locked up and not allowed to continue taking the medication that was helping him with his addiction — methadone.
"I thought he misunderstood," says Robin. "Because I couldn't conceive that there would be an opioid treatment program that would not provide medication-assisted treatment."
It turns out Sean was right. Although many providers say medication is the gold standard in addiction treatment, Sean was sent to a program in a state prison in Plymouth, Mass., that does not provide the medicine.
When we spoke with Sean in 2017 — shortly after he'd spent about a month committed, he said that the conditions were inhumane and that he was often placed in segregation, or "the hole" — though he had not committed any crime.
"I was punished for not eating," Sean told us. "That's how I ended up in the hole. If you refuse your tray, they consider it a behavioral issue. I didn't know that — I was just sick."
He spiraled to suicide
Sean also said in that interview that he was having trouble adjusting to life after his time in the Plymouth prison.
"I just feel different," he said. "I have a lot more anxiety. I feel scared. I feel like I'm going to wake up and be back there."
Less than a year after that interview, Sean killed himself. His mother says that after that stint in civil commitment, Sean could no longer hold a job. He ended up in a psychiatric hospital and was later jailed on charges of trying to break into a house. Robin believes being locked up for addiction treatment contributed to his suicide.
"I think that his trauma was very much triggered by him being in the cell" at the local jail, she says. "And he just felt like he couldn't take it anymore."
The sheriff wouldn't comment, but documents at the local jail confirm that Sean tried to take his own life there; he later died from those injuries.
Sean's longtime partner, Heather McDermott, says he was never the same after his civil commitment.
"He was like a big, sad, depressed tumor that I was trying to bring back to life," McDermott says. "We had a home. I can't even believe we got here, and then — then he died."
Massachusetts is one of a few states that use prisons and jails to involuntarily commit men to addiction treatment — and Massachusetts uses the approach more than most states do.
In an emailed statement, the Massachusetts Department of Correction said that its mission is to promote public safety by providing a secure treatment environment. And there is so much demand for involuntary treatment for addiction in Massachusetts that 100 more beds opened in another jail last year.
Hampden County Sheriff Nick Cocchi says that many traditional treatment centers aren't willing to take patients who don't want to be there and that, with a declining inmate population, jails have room for these men.
"This is a very dangerous, acutely sick and — I would say — not so well-behaved population," Cocchi says.
Many states are going down the same road as Massachusetts — strengthening their civil commitment laws to hold people against their will so they will get treatment. And some researchers, such as Leo Beletsky of Northeastern University, say more families are choosing to have loved ones locked up because it's the only way to get immediate help.
"Limiting someone's civil rights should be the last resort and only reserved for those cases that are truly dire," he says.
Denise Bohan believes involuntary commitment saved her 33-year-old son's life. Families are desperate, she says, and can't reason with a loved one in the throes of addiction.
"This is a last resort," Bohan says. "It's not something you do, like, just on a whim. This is a desperate act of just trying to save your child's life."
Several Massachusetts officials are signaling that the law may change so that correctional facilities will not be used for men committed to involuntary addiction treatment — primarily because addiction is now widely considered a disease that requires medical treatment.
Already, a class action lawsuit against the state has been filed, charging gender discrimination — because Massachusetts stopped sending involuntarily committed women to prisons in 2016, in response to a different lawsuit.
A longer version of this story originally appeared in WBUR's CommonHealth. Deborah Becker is a senior correspondent and host at WBUR. Her reporting focuses on mental health, criminal justice and education.