Executive Order  No. 422: Services for mentally ill individuals under age 19

WHEREAS, it is the policy and intent of this Administration to promote the provision of appropriate services to all mentally ill individuals in the Commonwealth;

WHEREAS, it is the policy and intent of this Administration that services for mentally ill or emotionally disturbed children and adolescents be, to the greatest extent possible, delivered in age-appropriate settings;

WHEREAS, inpatient psychiatric units operated by the Department of Mental Health that primarily serve mentally ill adults are generally inappropriate to meet the needs of mentally ill adolescents;

WHEREAS, since the issuance of Executive Order 244, the Department of Mental Health has developed an extensive network of age-appropriate treatment settings, including: three adolescent continuing care hospital units; a unit for younger children; five Intensive Residential Treatment Programs for adolescents who require longer term treatment in a secure setting; and three Clinically Intensive Residential Treatment Programs for younger children;

WHEREAS, in recent years there has been an increase in the number of adolescents referred to Department of Mental Health facilities by the court system for evaluation and treatment, a small number of whom have histories of extreme violence or of victimizing other, especially younger, adolescents; have previous or pending criminal charges involving a high degree of violence or victimization; and/or who are being tried or sentenced as adults because they are over seventeen years old, or pursuant to the Youthful Offenders Act;

WHEREAS, there are a number of adolescents committed to the Department of Youth Services, with similar backgrounds to those described above, who require inpatient psychiatric treatment under the auspices of the Department of Mental Health;

WHEREAS, placement of such adolescents on adolescent units is inappropriate either because they create a likelihood of serious harm to themselves or others, or because they require stricter security than is available on adolescent units; and

WHEREAS, the Department of Mental Health also has developed specialty units, such as the Deaf Unit at Westborough State Hospital, and a specialized research and evaluation unit, presently at the Erich Lindemann Mental Health Center, which may, under certain circumstances, be appropriate placements for persons under nineteen years of age;

NOW, THEREFORE, I, Argeo Paul Cellucci, Governor of the Commonwealth of Massachusetts, by virtue of the authority vested in me as Supreme Executive Magistrate, do hereby revoke Executive Order 244, and issue this order as a necessary step to ensure the continued development of appropriate mental health services for individuals under age nineteen, and to provide for safer evaluation and treatment of those adolescents described above, as follows:

Section 1. The Department of Mental Health is hereby directed to continue its efforts to address the special treatment needs of mentally ill persons under the age of nineteen.

Section 2. The Department of Mental Health shall continue to prohibit admission of persons under the age of nineteen to adult inpatient psychiatric units operated by said Department, except under the following circumstances:

a) The Department of Mental Health may place a 17 or 18 year old person on an adult inpatient unit of a state-operated hospital or mental health center where a judge of a juvenile, district or superior court has issued an order for the commitment of the person to a mental health facility pursuant to the provisions of Massachusetts General Laws chapter 123, sections 15, 16, 17 or 18, or where the person has been committed to the Department of Youth Services, and the Department of Mental Health has made a determination that one or both of the following factors exist:

(i) placement of the person on an adolescent mental health unit would create a likelihood of serious harm to the person or others; or

(ii) the person is in need of stricter security than is available on an adolescent mental health unit. In making such a determination, the Department of Mental Health shall apply criteria set forth in its regulations.

b) The Department of Mental Health also may place individuals under the age of nineteen on specialty units designated by the Commissioner of Mental Health, provided that appropriate physical space and programmatic services are provided, as approved by said Commissioner.

Section 3. The Department of Mental Health is hereby directed to continue to utilize special education resources provided for individuals who are eligible under Chapter 71B of the General Laws as in effect from time to time.