Massachusetts mental health care system in flux

By Chris Lisinski

When the head of the largest behavioral health provider in western Massachusetts woke up Thursday, there were 39 people continuing to wait in emergency departments around greater Springfield in need of psychiatric treatment beds.

That figure is not unusual, according to Behavioral Health Network President and CEO Steven Winn. At times, the number of people in the area stuck boarding in emergency departments due to a lack of available mental health beds “can swell into the 50s or 60s, easily,” Winn said.

While policymakers and insurers pursue reforms to improve mental health care access, Winn warned on Thursday that the staffing shortages plaguing many providers cause downstream effects that exacerbate the emergency department boarding crisis.

“There are multiple clinics throughout western Massachusetts. BHN operates 11 outpatient clinics where people can come in and get treatment for a mental health or substance use problem. We have traditionally struggled to hire staff and retain them, and that’s been about the funding,” Winn said during a virtual panel discussion on Thursday.

“The thing we’re most excited about is having the resources come into the community behavioral health centers that will allow us to offer decent wages to people and hopefully reduce the turnover,” he added. “Turnover results in waitlists, and that sort of follows on down the road. When people can’t get into the care that they need in the community, their needs become more acute, and that’s when they end up in the EDs needing more intensive care.”

As a result of a shorthanded workforce, patients have long struggled to secure quick access to community behavioral health services, Winn said. And since the COVID-19 pandemic began, waitlists have “mushroomed.”

Tania Barber, president and CEO of Caring Health Center in Springfield, said access to mental health care remains one of the most imposing challenges for communities in the western part of the state amid a shortage of specialized beds and a payment model that “long devalued” behavioral services.

“As the expression goes, services below the neck have been reimbursed more than those above,” Barber said.

People have been seeking behavioral health services at a significantly higher rate in recent years, fueled both by the strain of the COVID-19 pandemic and by a shift toward telehealth. Blue Cross Blue Shield of Massachusetts reported Wednesday that it saw 8 million in-person and virtual behavioral health visits in the third quarter of 2022, up from 4 million in 2019.

While speakers at Thursday’s western Massachusetts-focused event highlighted persistent industry challenges, they also said they are optimistic that a suite of recent steps from the Baker administration and the Legislature will begin to turn the tide.

Gov. Charlie Baker and his deputies in 2021 rolled out a “roadmap for behavioral health reform,” which the administration dubbed a “multi-year blueprint” for shifting how Bay Staters access care and boosting the stature of community-based services.

Lawmakers and Baker also agreed this summer to a sweeping mental health care law that eliminated a prior authorization requirement for mental health acute treatment, required insurers to cover annual mental health wellness exams and emergency service programs, and sought a rate floor for evaluation and management to ensure primary and mental health providers are reimbursed equitably.

Tranches of funding are available, too. Blue Cross Blue Shield of Massachusetts Foundation President and CEO Audrey Shelto said the American Rescue Plan Act made more than $400 million in federal aid available for Massachusetts behavioral health services.

“We have what I haven’t experienced before in my professional career: an incredible degree of alignment across the executive and legislative branches on both the needs, the challenges and the strategies and, as I said before, I kind of hesitate to say it, but a really huge amount of money to smartly spend and invest in our behavioral health system,” Shelto said.

Applications will open this month for health care workers to seek between $12,500 and $300,000 worth of educational loan repayment from the state under a $130 million program the Baker administration announced in November.

Many behavioral and mental health care providers, including social workers, psychiatrists, substance use recovery workers and those who work in community health centers, are eligible to seek the aid, which the state will offer with the help of the Massachusetts League of Community Health Centers.

Western Massachusetts behavioral health care leaders said during Thursday’s panel that the loan repayment will be a major boost, describing success with similar past efforts at getting providers to remain in community settings.

“It will definitely help, especially with retention and the recruitment efforts,” Barber said. “This is a huge component that, with the other residency programs that we had for nurse practitioners or providers, this piece for behavioral health is really essential … I think it’s an excellent opportunity that is certainly going to help move the needle further than where we’ve been.”