Fund behavioral health clinics to avoid the emergency accommodation crisis

The only thing everyone can agree on is that the emergency department is the wrong place for long-term treatment of patients with acute behavioral health needs. On a typical day last fall, there were 716 “stuck” patients across the country. While these patients wait day after day, they often receive little or no care for their illness, and their personal lives and dignity are compromised; sometimes these patients are taken out into the corridor because the emergency department is dealing with surges. The state must do better than letting patients move like that.

Some help is on the way. The Baker administration has announced that MassHealth, the state-run Medicaid agency, will make additional payments to hospitals that are dealing with the behavioral health crisis. This is an important step, as well as the development of a long-term plan for the creation of adequate stationary capacity. He also announced that new regional behavioral health centers in the community are expected to open in 2023 and the urgent expansion of care is increasing. These are important steps, but these centers alone cannot meet the necessary tsunami.

Many patients first seek care in a community behavioral health clinic. This is not only the most suitable environment for people with mild needs, but also costs the state much less than a hospital bed.

In Massachusetts, the incidence of acute readmission in hospital has almost doubled among patients with concomitant behavioral health conditions, and hospital stays are on average nearly one-third longer. Re-admission and long stays are as bad for patients as they are expensive for our system.

The challenge is that where there was once enough capacity for people to be served on an outpatient basis, this is no longer the case. A study published by our organization earlier this year found that for every 10 clinicians who go to work in a mental health clinic, 13 leave. This unsustainable trend must be reversed now. Our association estimates that about 25,000 people in need are left without services.

Compensation is at the top of the list of reasons cited by clinicians to explain their departure. Salaries are lower than in other conditions, such as hospitals and municipal health centers, because the insurance refund rates are too low. To stabilize – and, hopefully, expand – the workforce, commercial health insurance plans and MassHealth will have to pay higher rates for the services provided by behavioral health clinics. Leaving clinicians also cite the growing administrative burden – the proverbial mountain of documents – and the crushing educational debt as contributing to the decision to leave their jobs.

The practical result of these challenges for the workforce is that people wait too long to receive care. For example, the average wait for a child or adolescent to start therapy is almost four months. In this long distinction between identifying the need for care and the fact that care actually begins, behavioral health conditions can go from manageable to urgent to urgent.

The behavioral health care system needs to be put in order, both outpatient and inpatient. The Massachusetts Chamber and Senate have upcoming bills to improve access, and our association strongly supports them. A critical next step will be to further increase MassHealth’s cost recovery rates. Commercial health plans must also raise rates, and employers who pay insurance premiums must require real-time access to outpatient care for their employees.

If the British community can fix the front door of our behavioral health system by adding capacity to mental health clinics, it will reduce or eliminate the problem of people being taken to hospital emergency departments.

Lydia Conley is the President and CEO of Behavioral Health Associationwhich represents 80 community-based mental health and addiction treatment organizations in Massachusetts.

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