Three teenagers who lived on the Lower Cape died by suicide in February. In the fall, Adam Howe, a man with a long history of mental health problems, killed his mother, Susan Howe, in Truro, then took his own life while in custody at the Ash Street Jail in New Bedford.
The crisis in mental health care came painfully into view here in 2022.
Theoretically, Howe should have been placed in custody at Bridgewater State Hospital, the state prison for the mentally ill who are deemed dangerous. The reasons Howe landed in a Bristol County jail instead were troubling.
Because he was having trouble breathing, and with his long history of mental health and addiction problems, local police took Howe to Cape Cod Hospital after they arrested him. Cape and Islands District Attorney Michael O’Keefe said he called Bridgewater and was told Howe would first need to be put in a general population jail before being transferred to that facility. “I’ve never heard that one before,” O’Keefe said.
But no one answered the phone at the Barnstable County jail, said O’Keefe. Later, Barnstable County Sheriff James Cummings said his jail no longer takes anyone pre-arraignment, especially those who are suicidal, sick, or detoxing because, he said, “it screws up our staffing.”
That’s why Howe was taken to Ash Street. The New England Center for Investigative Reporting found in 2018 that at least 16 people had died by suicide between 2006 and 2017 while in custody in Bristol County — accounting for more than a quarter of all the suicides in the state’s county jails, though Bristol had just 13 percent of the inmate population.
Amid these tragedies, both O’Keefe and Cummings announced their retirements. Both are Republicans who have been in leadership roles for more than two decades.
Their replacements, District Attorney-elect Rob Galibois and Sheriff-elect Donna Buckley, are Democrats who have promised to prioritize compassionate mental health and addiction treatment for people who fall into the criminal justice system.
Galibois has promised to establish a mental health court that would divert nonviolent criminals with mental health problems into treatment rather than jails. Buckley said she wants to make addiction and mental health services strong features of the county jail.
“We need to make sure our sheriff’s office is focused on correction, rehabilitation, and treatment, providing inmates with opportunities to rebuild their lives, experience the power of recovery, and try to live a life that will allow them to be productive,” Buckley said on the campaign trail. “Otherwise, we are not safe.”
It remains to be seen how much political muscle Buckley and Galibois can exert. But the calls for reform of mental health systems seem to grow louder each year.
State Sen. Julian Cyr, a Truro native, helped pass the Mental Health ABC Act, which Gov. Charlie Baker signed in August. The law proposes ways to address youth suicide and improve access to emergency crisis care. It also provides better tools to enforce parity complaints — that is, complaints about private insurance refusals to cover mental health and addiction services in the same way it covers physical ailments.
The law also grants loan forgiveness for those entering the fields of social work, psychiatry, and addiction services.
Meanwhile, in response to the three youth suicides, the Cape & Islands Suicide Prevention Coalition held a series of public forums. At the one in Truro in March, parents and educators listed their worries about the extreme lack of care for adolescents experiencing mental health crises.
There are no inpatient beds on Cape Cod for people under 18.
Beth Cook, the nurse at Truro Central School, told forum attendees that three years earlier her daughter spent six days waiting in the emergency room at Cape Cod Hospital for a psychiatric treatment bed to open. Cook eventually gave up and drove her daughter daily to an outpatient program in Pembroke, 80 miles away.
In the summer of 2022, the Massachusetts Health & Hospital Association polled hospitals and found that “on any given day, more than 600 behavioral health patients are boarding in Massachusetts hospital emergency departments and medical/surgical units as they await a specialized inpatient bed.”
Nauset Regional High School Guidance Director Dee Smith said at the March forum that the high school had abandoned its Signs of Suicide curriculum several years earlier. In its place, Outer Cape Health Services had placed a health care navigator at the high school to help teens and families connect to services.
But it is unclear what services are available and at what cost. Physician assistant Gretchen Eckel, who treats children and adolescents at Outer Cape Health Services, asked the panel of social workers and nonprofit organizers at the forum if they knew any ways to get private insurance to pay for care.
“I know it is a system issue — it is bigger than us in this room,” Eckel said. “But besides making calls for legislative change, how do we get more services covered by key providers?”
The answers were not encouraging. Meghan Robitaille, program director at the Justice Resource Institute, said insurance coverage “is the worst problem I have. I hate it. This is not how it should be. If someone needs help, they should get help.”
