On Friday, the Massachusetts Department of Mental Health issued new “Fresh Air” rules for psychiatric patients in the state. The rules require hospitals to grant mental health patients daily outdoor access (depending on factors like weather, and the patient’s medical condition, legal status, or risk of running away).
But according to Stat News, up to 20 Massachusetts hospitals—about one-third of the psychiatric facilities in the state—plan to seek waivers to the new rules. The hospitals cite concerns about “safety, staffing, space, and liability.” Some private hospitals are also saying that because the average length of psychiatric stay in Massachusetts is “only” nine days, access to fresh air doesn’t matter.
Jonathan Dosick, who has experienced inpatient treatment for depression and anxiety,founded the “Fresh Air Rights” campaign in Massachusetts in 2003. He told Stat News that access to fresh air is a basic right: “Prison inmates are allowed outside by law. Even organic livestock, they have laws protecting them. What does that say about people with psychiatric conditions?”
And, as Harvard professor Dr. Ken Mandl tweeted: “What does it say about shrinks if they must be legally compelled to send patients into sunshine?”
The Massachusetts’ “Fresh Air” bill went into effect in April 6, 2015. The law added “reasonable daily access to the outdoors” as a sixth fundamental right for mental health patients—along with the existing rights to make confidential phone calls, send and receive mail, see visitors, stay in humane living quarters, and communicate with an attorney or advocate. But it didn’t offer practical guidelines on how hospitals were supposed to implement the rule. A year of wrangling over requirements and exceptions followed before the state finally issued the regulations last Friday.
According to Lauren Roy, an attorney with the Massachusetts-based Mental Health Legal Advisors Committee, which advocates for mental health patients’ rights, at least 17 other states already have similar laws.
The new Massachusetts rules require hospitals to make “reasonable” efforts to allow patients outside, including making staffing changes or building an outdoor space. But they don’t outline any penalty for not complying. So, according to Roy, the next step will be for patients to sue or file complaints with the Department of Mental Health if they are denied outdoor access.
Multiple studies have pointed to the mental health benefits of access to outdoors (especially trees and green space). It’s ironic that a place supposedly dedicated to improving the mental health of its residents wouldn’t prioritize access to a free treatment (fresh air and sunlight).
This attempt to make psychiatric institutions less like prisons comes at a time when, ironically, prisons have become increasingly like de facto psychiatric institutions. Last Thursday, the White house announced a new “Data-Driven Justice Initiative” intended to “disrupt the cycle of incarceration,” stating that “In local jails, 64 percent of people suffer from mental illness, 68 percent have a substance abuse disorder, and 44 percent suffer from chronic health problems.”
Though many prisoners are regularly denied their rights, even the UN and the American Correctional Association technically require prisoners to be allowed at least one hour daily of physical exercise outdoors when weather permits.
Matt Roberts, who was hospitalized at Beth Israel Deaconess Medical Center following a suicide attempt in 2006, believed that fresh air would have helped his recovery, but saysthat staff denied his pleas.
“All I wanted to do was get up, maybe get a little sunlight,” Roberts recalls. “I remember saying this, ‘I’ll put leg shackles on. I don’t care. You can tie me to another staff member. Just let me go outside.’”