Section 35: When addiction calls for drastic action

The difficult process of placing an addict into involuntary rehab comes with additional hurdles for Islanders.

Photo by Susan Safford

This is the fifth installment in a continuing look at opiate abuse and its effect on the Island community. The series began on Jan. 2 “Opiate addiction hits home,” and was followed on Jan. 22 “Martha’s Vineyard police and physicians confront opiate abuse,” on Feb. 12 “Opiates, a love story,” and on May 7 “Battling Addiction on Martha’s Vineyard.”

The Section 35 commitment is the final stand in the battle against addiction. When voluntary rehab, reasoning, begging and pleading have failed, and an addict’s family, doctor, or local law enforcement officer believe that there’s an imminent threat of serious harm to the addict or to others, Section 35 enables them to request that the court put the addict into involuntary inpatient rehabilitation for up to 90 days.

“Section 35 is the last resort,” said Dr. Charles Silberstein, resident psychiatrist and addiction specialist at Martha’s Vineyard Hospital. ”For a lot of people it feels cruel to say ‘you can’t live with me anymore’ for worry that it will backfire. But it’s reasonable to say, from a place of compassion, ‘I can’t tolerate this anymore. I worry I am enabling you and I can’t bear it.’ The problem is when people say it and don’t mean it and it becomes meaningless, or worse, it tacitly says ‘I’m powerless and I’m going to continue tolerating your addiction.’”

On the rise

Due to the increase of opiate and heroin addiction, Section 35 commitments have been rising steadily in Massachusetts. According to the Massachusetts Department of Public Health (DPH) there has been a 67 percent increase in the number of Section 35 commitments since 2006. A total of 4,982 Section 35 commitments were made in fiscal year 2013 (FY 13), which began on July 1, 2012. The numbers were particularly grim for the Cape and Islands in FY 13. According to the office of state senator Jennifer Flanagan, there were 975 Section 35 commitments in the Cape and Islands region, which is by far the most in the state. The MetroWest region was a distant second with 597 commitments; there were 218 in Boston, which has a population of roughly three times the Cape and Islands.

An Islander who wants to initiate a Section 35 petition must go to Edgartown District Court and file an application with clerk magistrate Liza Williamson, who will guide them through the process.

“It’s very difficult for loved ones to file a Section 35,” Ms. Williamson said in an interview with The Times. “Our judges, the police, every department here is very sensitive about it.”

Although the  judges are only in Edgartown district court on Monday, Thursday, and Friday, Ms. Williamson said the petition can also be handled via fax.

“We find a way to make it work, no matter what day of the week it is,” she said. Ms. Williamson said the local chapter of the National Alliance on Mental Illness (NAMI) is an excellent resource for family members who are considering petitioning for a Section 35.

It’s not uncommon for police to file a Section 35 petition.

“When I review police reports, if I see we have a lot of interaction with that person and it’s clear that substance abuse is a problem, we can fill out the [Section 35] paperwork,” Edgartown Det. Sgt. Chris Dolby said. He added that the definition of family member is blood relative or spouse.

Live-in companions, even if they have children together, cannot file a petition for commitment under current Massachusetts law.

An Edgartown District Court judge reviews the petition and decides it has merit, a warrant of apprehension will be issued, which enables the police to take the person into custody and transport them to the Duke’s county courthouse. Before a judge can issue a commitment the individual must be examined by a Department of Mental Health (DMH) approved physician. This is where the Island complications arise. There is no DMH approved physician on the Vineyard. Consequently, commitments are handled in Falmouth District Court.

“If the judge decides to issue a warrant, it’s only good for the close of that court day,” Mr. Dolby said. He said he must get the individual on the boat to Falmouth, hope the doctor is available in court, and hope he or she can see the person before 4 pm. “If not, the person walks,” he said. “I had a recent case where the person, who clearly needed help, walked off the boat because time ran out.”

Getting an early start is important. “They’re called sunset warrants,” Ms. Williamson said. “I advise people to file as early in the day as possible. Getting someone off Island is a time-sensitive puzzle with a lot of moving parts. The sheriff’s department makes every attempt to get people transported in timely fashion. The Steamship Authority is as helpful as they can be. Dr. [Jeffrey] Zack and the emergency department at the hospital do a great job coordinating their efforts. But if you get the person to Falmouth and there’s no doctor there, it doesn’t matter,” she said, highlighting a major Island complication.

Island exigencies

“Unfortunately, in order to commit, you need an evaluation from a department of mental health (DMH) designated forensic psychologist, and we don’t have one on Martha’s Vineyard,” Ms. Williamson said. “There’s one DMH doctor, Donna Maynard, who does evaluations for the entire region. That covers from New Bedford to the Cape and Islands. Donna does a great job but there’s only so much one person can do. When I get a Section 35 I’ll call her and ask, “Can you help today, yes or no?”

Ms. Williamson works on the Committee for Public Counseling Services with the goal of finding on-Island DMH doctors and psychiatrists. “I’ve reached out to several psychologists and psychiatrists to ask them about getting DMH designated certified,” she said. “But it’s difficult when you already have a very busy private practice. The mental health system on the Island is extremely overburdened.”

If the Islander is seen by the appropriate doctor in Falmouth and committed before the sun sets on the warrant, the judge will order him or her to a licensed inpatient substance abuse treatment facility, such as the Women’s Addiction Treatment Center (WATC) in New Bedford, or the Men’s Addiction Treatment Center (MATC) in Brockton. If no beds are available, which is often the case, men are sent to the Bridgewater Correctional Complex and women are sent to the Framingham Correctional Institution, state-run prisons, where they are kept separate from the criminal population.

“It’s frustrating because there are so few beds available,” Ms. Williamson said. “Sometimes the only beds are at Bridgewater or Framingham. It can be traumatic for someone to go to one of these places but when you get to a Section 35, you’re out of options. You’re trying to save that person’s life.”

Mr. Dolby, a member of the Vineyard drug task force, was sharply critical about the support system that currently exists on the Island. “We’re up against it. We’re in a tough situation,” he said. “There’s no rehabilitation on this Island. It’s ridiculous that someone has to go to Falmouth to be evaluated. Addiction is a huge problem here. I see how frustrating it is for the addicts and the families of addicts. New Paths and Vineyard House do good work, but they’re just putting a finger in the dike.”