Inpatient behavioral health facilities have been recently facing issues that David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, said are unlike anything he's seen in his 30 years of experience.
"Everything from workforce to acuity to emergency department boarding, you name it," he told lawmakers Tuesday.
Matteodo pitched the Health Care Financing Committee on bills (S 776, H 1291) from Sen. John Keenan and Rep. Liz Malia that he said would require MassHealth, the state's massive health insurance program, to ensure all of its contracted third-party firms and managed care organizations "provide comparable access to behavioral health services and medications."
"This is important because sometimes the different — we call them carveouts, the management firms for behavioral health — manage things differently and they can be too stringent or they can be really denying a lot of services that we think are necessary, so we think MassHealth should closely scrutinize and make sure those services are what the public clients in MassHealth deserve," he said.
Those two bills were among several pieces of legislation that drew testimony from behavioral health practitioners and advocates looking for solutions to challenges facing their field, and patients seeking care.
Dr. Patrick Aquino, chair of the psychiatry division at Lahey Hospital and medical director of integrated services for Beth Israel-Lahey Health, said Massachusetts is grappling with an "acute shortage of psychiatrists" at the same time that the COVID-19 pandemic has brought on "an ever-increasing need for mental health treatment."
He asked the committee to support a bill from its Senate chair, Sen. Cindy Friedman, as a way to increase access to care.
Friedman's bill (S 769) focuses on collaborative care, which Aquino said is a model that integrates primary and behavioral health care by bringing other services to patients in their primary care provider's office.
He gave the example of a patient identified as having depression during a regular primary care visit. Instead of being referred to a separate office for behavioral health treatment and waiting weeks for an appointment, that patient could start treatment right there, Aquino said.
"As a practicing psychiatrist myself, I see individuals in my office, one-on-one, and I practice as a consulting psychiatrist to several primary care practices," he said. "In the same amount of time it takes me to evaluate and treat one person in my office, through case review with the embedded behavioral health clinician as part of collaborative care, I can provide specialty psychiatric input to advance the care of six to seven individuals in primary care."
Association for Behavioral Healthcare President Lydia Conley and representatives from two of her group's members — Diane Gould of Advocates and Karin Jeffers of Clinical & Support Options — testified in support of bills (S 781, H 1302), filed by Keenan and and Rep. James O'Day, that would increase the rates MassHealth pays to licensed mental health clinics and community behavioral health centers.
"As we all know, we are in a mental health crisis," Conley said. "Emergency department boarding is at unprecedented heights, individuals who need behavioral health help are unable to find it, and robust, healthy clinics offer us two solutions to these problems."
Conley said clinics serve as a training ground for the behavioral health workforce and offer a multidisciplinary range of services that help keep people in the community for treatment and decrease eventual need for emergency department services.
Jeffers said Clinical & Support Options, which operates six mental health clinics in western and central Massachusetts and serves more than 19,000 MassHealth members, has "never seen such a significant workforce crisis, directly related to funding of mental health clinics."
She said that all of her clinical staff that have left over the past three months have decamped for higher-paying hospital or school-based jobs. From Sept. 1, 2020 to Sept. 1, 2021, Jeffers said her staff decreased from 661 people to 596, even as she hired 248 people in that time frame.
"It shows you just how many people are leaving this field, and it's specifically community behavioral health," she said.