By 2024, there will be more mental health patients stuck waiting in hospital emergency departments than in 2022. But Massachusetts still has some of the longest waits in the nation, and behavioral health patients with unique needs — such as the elderly, pregnant women, or children with autism — too often can’t get the right care.
Ensuring care for people with mental health crises is a matter of parity – people who come to hospital with a stroke or a broken leg are less likely to wait days than people with schizophrenia or depression, according to Health Policy Commission data.
The problem of bottlenecks in the mental health system is also complicated, and the answer must be multifaceted: ensure patients can obtain timely care in nonhospital settings, ensure that insurers pay providers adequately for services for complex patients, and eliminate regulatory barriers, such as those that limit where an ambulance can take a mental health patient.
According to the Health Policy Commission, 37.5 percent of people who visit emergency departments for behavioral health reasons will be on board for more than 12 hours in 2024, down from 39.6 percent in 2022. (Fewer than 10 percent of patients with physical health problems are on board. Adults and 11 percent of children who need inpatient psychiatric care will wait more than 48 hours to receive that care in 2024, compared to 21 percent of adults and 22 percent of children two years earlier.
The main reason for the improvement is that the state began implementing its roadmap in 2023. MassHealth began reimbursing hospitals for evaluating and treating behavioral health patients in the emergency department, so hospitals can hire additional clinicians to quickly stabilize patients and potentially discharge them. The state created a diversion program where crisis intervention teams connect patients who are in the emergency department or at risk of going to community-based support.
The state contracted with a newly created community behavioral health center, which is essentially an emergency care center with 24/7 crisis support. The new mobile team can visit other people’s homes. Police officers have started transporting people to centers instead of hospitals. Recently, the center has begun admitting people directly to inpatient psychiatric hospitals, rather than requiring an emergency department evaluation.
There is still a need to increase awareness of community-based centers, ensure adequate services statewide, and simplify hospital admissions. But Meri Viano, associate director of the Professional Parent Advocacy League, a family network that supports children’s mental health, told the editorial board that just having 24/7 support is essential. “When a crisis happens, you need to intervene within an hour,” Viano said. “We don’t ask people who have heart attacks, why would you schedule it at 3:00?”
David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents psychiatric hospitals, said since January 2023, nearly 300 new psychiatric beds have been opened (even after counting closed beds). State officials also created an online system — replacing phone calls and faxes — to help hospital doctors find open psychiatric beds. The second phase of the project will soon allow hospitals to use the software to refer patients to community behavioral health centers.
But despite real improvements, the mental health system is still backed up. Matteodo said psychiatric hospitals may have problems discharging certain patients. “We have a lot of geriatric people in [psychiatric] hospital for a year or more because we can’t send them to the right nursing home that will take them,” said Matteodo. The report of the Health Policy Commission states that emergency departments can struggle to remove patients who are homeless or who lack transportation for follow-up care.
Viano said emergency departments often can’t find placements for children with complex needs, such as those with medical conditions like diabetes or epilepsy, developmental conditions like autism, or severe mental health conditions that cause aggression. It suggests that there may need to be higher insurance reimbursement for patients with multiple needs.
Leigh Simons, vice president of policy and regulatory affairs at the Massachusetts Health and Hospital Association, said patients who need long-term residential care through the Department of Mental Health often can’t get beds because the program is full of court-referred patients.
In addition, seemingly relatively minor issues, such as transportation, can become problematic. Today, ambulances are required to take mental health patients to the nearest emergency department, even if the hospital has no psychiatric beds. Another ambulance may be needed to transport them to a psychiatric facility – so the person must wait for a psychiatric bed to open and for transport. Regulatory changes could allow ambulances to take patients to the nearest hospital with a psychiatric bed or to a community behavioral health center. Some hospitals are trying to use special SUVs to transport behavioral health patients.
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Editorials reflect the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
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