As of 2024, there will be fewer mentally ill patients waiting in hospital emergency departments than in 2022. However, Massachusetts still has some of the longest wait times in the nation, and behavioral health patients with unique needs, such as the elderly, pregnant women, and children with autism, are too often unable to receive timely treatment.
Ensuring treatment for people with mental health crises is an issue of equality. 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 data from the Health Policy Commission.
The issue of mental health system bottlenecks is also complex, and the answer needs to be multifaceted. These include ensuring that patients receive timely care outside of the hospital setting, ensuring that insurance companies adequately pay providers for services to complex patients, and removing regulatory barriers that limit where ambulances can transport mental health patients.
According to the Health Policy Commission, 37.5% of emergency department visits for behavioral health reasons in 2024 were boarded for more than 12 hours, down from a high of 39.6% in 2022 (less than 10% of patients boarded with a physical health problem). That means 4,500 fewer behavioral health patients boarded flights in 2024 compared to 2022. By 2024, 13% of adults and 11% of children needing inpatient psychiatric care will have waited more than 48 hours to receive that care, compared to 21% of adults and 22% of children two years ago.
The main reason for the improvement is that the state began implementing the roadmap in 2023. MassHealth has begun reimbursing hospitals for evaluating and treating behavioral health patients in emergency departments so that they can hire additional clinicians to quickly stabilize and potentially release patients. The state created a diversion program in which crisis intervention teams connect patients in the emergency room or at risk of going to the emergency room with community-based supports.
The state contracted with the newly created Community Behavioral Health Center, which is essentially an urgent care center with 24/7 crisis response. The new mobile team can visit someone’s home. Police officers began transporting people to centers rather than hospitals. Recently, the center began admitting psychiatric inpatients directly, without requiring an emergency department evaluation.
There is still a need to increase awareness of community-based centers, ensure adequate services across the state, and simplify hospital admissions. But Meri Viano, associate director of the Parent Professional Advocacy League, a network of families that support children’s mental health, told the editorial board that it’s important to have support 24/7. “When a crisis occurs, intervention is required within an hour,” Viano said. “I don’t ask people who are having a heart attack. Can you make an appointment for 3 o’clock?”
david Mateod, executive director of the Massachusetts Association of Behavioral Health Systems, which represents psychiatric hospitals, said nearly 300 new psychiatric beds have opened since January 2023 (even accounting for closed beds). State officials also created an online system to replace phone calls and faxes to help hospital clinicians find available psychiatric beds. The second phase of the project will allow hospitals to use the software to refer patients to local behavioral health centers.
But despite substantial improvements, the mental health system remains backed up. Mateod said psychiatric hospitals may have difficulty discharging certain patients. “We have a lot of elderly people in our hospital. [psychiatric] The Health Policy Commission report said emergency departments may struggle to safely discharge homeless patients or those without transportation to follow-up care.
Viano said emergency departments often struggle to accommodate children with complex needs, such as those with medical conditions such as diabetes or epilepsy, developmental disorders such as autism, or severe mental illnesses that cause aggression. This suggests that higher reimbursement may be required for patients with multiple needs.
Lee Simmons, vice president of policy and regulation for the Massachusetts Health and Hospital Association, said patients who need long-term inpatient treatment from the Department of Mental Health often don’t have beds because the program is full of court-referred patients.
Additionally, seemingly relatively minor issues, such as transportation, may become important. Ambulances are now required to transport mentally ill patients to the nearest emergency department, even if the hospital does not have a psychiatric bed. A separate ambulance may be required to transport the patient to a psychiatric facility, so the patient must wait until a psychiatric bed becomes available. The regulatory change could allow ambulances to transport patients to the nearest hospital or community behavioral health center with a psychiatric bed. Some hospitals are experimenting with using specialized SUVs to transport behaviorally disordered patients.
Government efforts have improved the boarding crisis, but new data reveals that the problem remains and these efforts need to continue.
Editorials represent the views of the Boston Globe Editorial Board. follow us @GlobeOpinion.
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