By 2024, fewer mental health patients will be waiting in hospital emergency departments than in 2022. But Massachusetts still has some of the nation’s longest waits, and behavioral health patients with special needs — such as the elderly, pregnant women, or children with autism — often can’t get treatment in time.
Ensuring treatment for people with mental health crises is an equity issue – according to data from the Health Policy Commission, someone who comes to hospital with a stroke or a broken leg is less likely to wait days than someone with schizophrenia or anxiety.
The problem of barriers in the mental health system is also complex, and the answer must be multifaceted: ensuring that patients can receive care in a timely manner in a non-hospital setting, ensuring that insurers pay adequately for services for complex patients, and eliminating regulatory barriers, such as restrictions on where an ambulance can transport a mental health patient.
According to the Health Policy Commission, 37.5 percent of people who went to an emergency department for a behavioral health reason were admitted for more than 12 hours in 2024, up from 39.6 percent in 2022. 2022. Thirteen percent of adults and 11 percent of children who needed inpatient psychiatric treatment waited more than 48 hours to receive that care in 2024, compared with 21 percent of adults and 22 percent of children two years earlier.
A major reason for the progress is that the government has started implementing its road map in 2023. MassHealth began paying hospitals to evaluate and treat behavioral health patients in the emergency department, so hospitals could hire additional doctors to quickly stabilize patients and potentially release them. The state has established a diversion program where crisis intervention teams connect patients who are in the emergency department or at risk of moving to community-based support.
The state has contracted with the newly established Community Behavioral Health Centers, which are essential care centers with 24/7 crisis support. New mobile teams can go to someone’s home. Police officers have started taking people to centers instead of hospitals. Recently, centers have begun admitting people directly to psychiatric hospitals instead of requiring an emergency department evaluation.
There is still a need to increase community-based awareness, ensure adequate services across the country, and facilitate hospital admissions. But Mary Viano, president of the Association of Parent Professional Advocates, a network of families advocating for children’s mental health, told the editorial board that simply having 24/7 support is critical. “When a crisis happens, you need to intervene within an hour,” Viano said. “We don’t ask someone who has a heart attack, would you have scheduled it at 3:00 in the afternoon?”
David Mattiodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents psychiatric hospitals, said that since January 2023, nearly 300 new psychiatric beds have opened (even after accounting for closed beds). State officials have also created an online system — replacing phone calls and faxes — to help hospitalists 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 the real improvements, the mental health system is still supported. Mathiodo said psychiatric hospitals can have trouble discharging some patients. “We have a lot of genetic people in it [psychiatric] Hospitals for a year or more because we can’t discharge them to an appropriate nursing home that will take them. “Emergency departments can struggle to safely discharge patients who are homeless or those who lack transportation to follow-up care,” Matudu said. The Health Policy Commission report says.
Emergency departments often cannot accommodate children with complex needs, such as those with a medical condition such as diabetes or epilepsy, a developmental condition such as autism, or a serious mental health condition that causes aggression, Viano said. This suggests that higher insurance payments may be required for patients with greater needs.
Lee Simmons, vice president of policy and regulatory affairs at the Massachusetts Health and Hospital Association, said patients who need long-term residential care through the mental health department often can’t get beds because the programs are full with court-referred patients.
Additionally, issues that seem relatively minor, such as transportation, can become important. Today, ambulances are required to transport mental health patients to the nearest emergency department, even if that hospital does not have psychiatric beds. Another ambulance may be needed to transport them to a psychiatric facility – so the person must wait for a psychiatric bed to become available and transport. Organizational changes could allow ambulances to transport patients to a nearby hospital or community behavioral health center with psychiatric beds. Some hospitals are experimenting with using special SUVs to transport behavioral health patients.
Government efforts have ameliorated the boarding crisis – but new data make clear that problems still persist and these efforts must continue.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
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