As mental health crisis worsens, record-setting investment languishes
“We were successful in getting an appropriation, yes. It’s on paper. But has it helped yet? No,” said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems.
The wide-ranging mental health care crisis has many causes, stemming from a shortage of clinicians to a lack of places people can go in a crisis that aren’t the emergency room, to higher numbers of people seeking help.
Lawmakers have tried to address it, ultimately agreeing in December to a Senate proposal to allocate $400 million from the federal American Rescue Plan Act spending bill — an amount advocates said was one of the largest funding amounts to be put toward the behavioral health crisis in decades.
Governor Charlie Baker signed off on half of the plan, including $110 million for a loan repayment assistance program for mental health professionals who agreed to work in community health centers, mental health centers, and inpatient psychiatric facilities. Another $15 million would go for primary care workforce development at community health centers, and $11.6 million would be put toward a mental health nurse practitioner fellowship program. Millions more was allocated for behavioral health services at multiple locations, workforce development programs, an online portal that would allow emergency room clinicians to view available behavioral health beds across the state and public awareness campaigns.
But the sides began to squabble over who would get to allocate $198 million put in a newly created behavioral health trust fund, for more thoughtful fixes of the state’s mental health problem.
Lawmakers wanted an advisory committee to make recommendations to the Legislature no later than March 1, so they could appropriate the funds.
But in a Dec. 13 memo, Baker rejected that idea, calling it “a lengthy, bureaucratic process that will unnecessarily delay the delivery of critical funding.” Baker instead said the advisory committee should solely advise where the money might go, and allow Health and Human Services Secretary Marylou Sudders discretion to appropriate the funds.
Despite Baker continually referencing the quick need for the funding, the sides volleyed the legislation back and forth for the next 5½ months. The bill stalled in the House twice, once after Baker punted it back to the Legislature with an amendment, and again after he vetoed the language entirely in mid-April. The House ultimately voted to override the veto on May 26, with the Senate concurring the same day.
Matteodo, who is an appointee to the envisioned advisory committee, said he has not yet heard when the group will meet.
“The House was disappointed to see the governor’s amendment, then veto, when it could’ve been signed in December,” said Ana Vivas, a spokesperson for House Speaker Ron Mariano.
Representative Aaron Michlewitz, chairman of the House Ways and Means Committee, said the House was busy in its budget process while discussing the funding. Lawmakers also considered holding the behavioral health trust fund bill and incorporating it into a larger mental health care bill. Ultimately the House decided not to push the timeline for the funding further out, Michlewitz said.
“I view it as wanting to make sure we’re getting this as right as possible, recognizing the timeline and necessity of it,” he said.
Though much of the delay was because the House waited so long to take up Baker’s amendment and override his veto, Senator Cindy Friedman placed the blame with the governor for vetoing the bill to begin with.
The legislative delays on the ARPA funding mirror the larger debate of how to reform the state’s mental health care system. Senators have twice passed mental health care reform legislation. While the latest bill is wide-ranging, Friedman said a major piece of it would directly address emergency room boarding, such as by moving children into care even before payment details have been worked out.
Vivas said the House would take up the mental health legislation on Thursday.
Meanwhile, Baker set forth his own health care legislation in March that would increase investments in primary and behavioral health care. A hearing on the bill was held in April.
Advocates are quick to point out that the state has been working to solve the behavioral health crisis, and has dispersed millions in other funding for both short- and long-term solutions.
In February 2021, the Executive Office of Health and Human Services released a plan to reform the state’s behavioral health network, proposing a centralized service for people who wanted to find mental health or addiction treatment, a type of urgent care for behavioral health issues, and expanded inpatient psychiatric bed capacity.
As part of the reform, the state allocated $40 million in fiscal 2021 and $84 million in fiscal year 2022.
Danna Mauch, CEO of the Massachusetts Association for Mental Health, said other pieces of the road map are underway, including the designation of community behavioral health centers, which will become a statewide network of providers to help people in crisis, as an alternative to the emergency department. The state has also put out bids for a vendor that will oversee a behavioral health help line, set to go live in January, where people can access clinicians who can direct them to care.
Additionally, the Baker administration allocated $31 million as part of an initial $186 million round of ARPA funding awarded in July 2021. The money was intended to give inpatient psychiatric facilities temporary supplemental payments to recruit clinical and direct care staff.
MassHealth too has invested heavily in mental health reforms, providing supplemental reimbursements to support services emergency rooms give to patients waiting for a psychiatric bed.
In January, the administration announced that MassHealth’s temporary pandemic 10 percent rate increase for outpatient behavioral health would be permanent.MassHealth also launched a new behavioral health urgent care program in February, which incentivizes mental health centers that serve MassHealth members to extend hours for those with urgent behavioral health needs.
A hospital diversion program to help discharge patients from emergency departments was additionally expanded by the administration from an initial pilot of 12 hospitals to 45 hospitals. As of late May, the program had assisted 448 adults and 275 youths.
“Obviously we’re concerned. There are urgent needs,” Mauch said. “That said, I’m the eternal optimist, they have been using some federal funds . . . and other ARPA funds to begin to implement some of this stuff even while this dispute is being worked out.”
Matteodo also said the $31 million funding “saved” the state’s psychiatric hospitals, which would have lost even more staff without it, and he said MassHealth and the governor’s administration had stepped up to find solutions to the crisis.
Despite those gains, many recognized that more was needed.
“We have a fundamental, systematic problem that we have not addressed fully,” Friedman said. “There is a lot more to do.”