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Massachusetts mental-health crisis: No beds for young psychiatric patients

WBUR reports an 8-year-old from Jamaica Plain with PTSD has spent more than a month basically warehoused at Children's Hospital because there are no free beds anywhere in the state.

"Basically, he's just sitting in a room playing with Legos all day and watching TV and playing video games," she added.




It was necessary to dismantle the deplorable state run mental health facilities in the Commonwealth, but it was also necessary to replace them, for there was still a need for the services they were supposed to have been providing.

If we don't have the capacity to treat children in crisis now, we're going to have to start building even more facilities to serve them as adults soon.

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This has been an issue for a very long time. Even partial hospitalizations and CBATs are hard to come by for children.

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As an MSW candidate I did internship at Columbia Presbyterian NY State Psychiatric Institute, and moved home to Boston to practice. One week in at on at Shattuck prominent Dr. head of said to me, "this is very disappointing isn't it?"

The State of MASS has the funding but the services are not there, what good is money if you can't buy anything with it?

Poor Child I wish them the best.

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I know a lot of folks who could not find help during their kids teen years unless said teen needed to be hospitalized. Nothing short of that was possible. People confronted 'in-network" lists that had zero doctors taking patients after calling 50 people - or doctors retired, left practice, etc.

And even if they could find a therapist, the kids would have the same problem that many adults encounter: the health insurance would change subcontractors every year, and the hunt and the development of relationships would have to start anew (if care could be found).

It was abysmal ten years ago.

It has to be much worse now.

Once again, the pandemic has laid bare the degree to which our society has been stripped of resources for supports that would save money and lives in the long run, all for the greed of corporations to continue hoarding money.

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Than being left at an arbor care facility. At least the people who say they are doctors at Children’s really are. And he’s less likely to die there.

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The situation for adults is 48 -64 hours in an emergency room waiting for a place to go for adults never mind children. Gah. As someone with mental illness, I would go to the emergency room on last resort.

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As other commenters have pointed out, It's punishing to try to access mental health services for children, and even if you finally break through, the quality of the services can be awful. Many families know that in seeking help, they will drain the family's financial and emotional resources even further and will likely end up in an unhelpful situation even if they do prevail, so they don't even try. There is a lot more demand for good mental health services than is even apparent from this article.

Pediatricians and other medical providers (including those in hospitals, health centers, and large networks) like to pass the buck on children with mental health challenges to the family by breezily recommending they seek out a good therapist, but won't refer the child to anyone specific as they would for any other therapist or doctor, like an OT or Orthopedist. When pressed they'll tell you to look in Psychology today. This is like telling a family in crisis to go find a unicorn and make a blanket out of its rainbow mane.

There is so much dishonesty about child mental health in MA.

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...but it's irresponsible of WBUR and this parent to share this much of this child's story. A child cannot consent to this.

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Yes, I was shocked to see a photo of the child in his hospital room as part of the WBUR story.

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I work in this system, and the pediatric boarding is the number one reason why I want out. Massachusetts has one of the highest per-capita rates of mental health professionals, but I presume that they're all taking private-pay "worried well" clients in Back Bay offices, because there sure aren't enough to treat the kids who are in the system today - and I do mean TODAY.

I had a long talk with a DMH representative the other day, and I'm satisfied that it's not a lack of that agency's efforts; the treatment beds just aren't there, and when they are, the insurance companies don't pay enough to have even one bed empty and allow the inpatient units to be sustainable. Community mental health agencies are all on shoestring budgets and trying to balance quality of care with the fact that they can only hire brand new (mostly unlicensed) clinical staff. All of this adds up to many children receiving care that doesn't match their needs, and causes them to come back through the system again and again, and into their adulthood.

The legislature passed a major bill recently that mandates that private insurance pay for Children's Behavioral Health Initiative services, but they didn't mandate that they pay a fair rate, or that they contract with any providers - and now people with secondary MassHealth coverage can't get the services at all because "well, the private insurance is supposed to cover that."

This is a legislative problem. The legislature needs to take it seriously. One of the wealthiest states in the country should not be having these problems. Instead, we have gag laws that forbid private practice clinicians from discussing their insurance reimbursement rates, and so the insurance companies are allowed to run the show. Healthcare reform only works as long as a legislative body owns the results as much as they own the number of people who are "covered."

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I also work in the system, and have spoken to DMH about what they and other EOHHS agencies are doing about the boarding problem. I agree that state is trying to do a lot - trying to be creative to solve the child and adult boarding problem right now, including some solutions that are short term (like more mobile respite) and some long term (like more beds).

Boarding is a complicated issue, made much worse by COVID. There are some bills to address various pieces of the problem - I think there are 3 different ER boarding bills. The legislative session is new, so we'll see where these go.

There is also an Expediated Inpatient Policy that puts some onus on insurance companies - that was showing some effectiveness before COVID upended things.

The truth is that inpatient psych beds (and CBATs, ICBATs, and CCS beds) are NOT the solution. Good support in the community is.

Anyone who has been inpatient themselves or has had a close family member inpatient knows that there is a limit to how helpful they can be. These supports are meant to help people through the immediate crisis - not through the underlying struggles (or traumas) that are fueling the crisis.

Unfortunately it's hard to get good outpatient care, and that's also made much worse by COVID - in part because a lot of people are struggling right now, and trying to access care. And this is adding to the inpatient bed strain.

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Inpatient beds, particularly for peds, are full of youth who don't need to be there. Several of the hospital systems use a triage system that recommends hospitalization well above and beyond what the APA and APA recommend.

They're also used as a holding tank for youth in DCF custody. Most DCF involvement is unnecessary and could be prevented with community supports and DCF reform that relies on evidence-based child welfare practice rather than "take children just in case" practices that do nothing but clog up the system and make it harder to find and assist families really in need of intervention.

It's fascinating when I attend national trauma or child welfare conferences. I hear people from our well-funded states talking about massive DCF overreach and unnecessary hospitalizations, and all the liability-driven problems in our state. Then I hear people from poor states talking about how there just isn't anything available, and they pretty much can't get seen in an ER or get anyone on the phone at DCF.

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So, one of the issues with MassHealth is that they make it impossible for individual clinicians to take it. I am a seasoned clinician who is certified to do a number of types of evaluations that are in high demand. I specialize in systems-involved families and am not as familiar with counseling the populations who go to these Back Bay boutique practices. I would love to take MassHealth. However, they do not let independent clinicians contract with them. They only issue licenses as a mental health clinic, which requires one's own 24/7 on-call service and one's own physician/medical director, as well as physical office space. These things are not feasible for those of us who don't run a clinic. (I have always done a lot of telehealth and I did evaluations at schools, homes, group homes, etc., as well as support groups at various agencies pre-COVID. I don't have ongoing clients who rely on me as their primary therapist.)

Other insurances don't require this and do allow independent clinicians with my type of setup to contract with them. MassHealth allows other types of independent providers (SLP, OT, physician, etc.) to contract independently, and all of those folks do see people who might at times have a mental health crisis, and MassHealth does allow those folks to direct people in crisis to call an ambulance or the local crisis team in the absence of in-house services.

I was at a panel on mental health reform, at which the Secretary of Health and Human Services was present, and I brought up this issue. She jumped in and told me, "No, that's not true; independent therapists can certainly contract with MassHealth. Just go on the website." She would not listen to me, or the other clinicians on the panel, who were telling her that we are not in fact one of the types of clinicians who can contract independently.

We need legislation that all insurances pay the same rate, and we need to create something like one portal where any licensed clinician can easily register and bill whatever insurance the person has. I would love it if they required us all to take insurance, and required the insurance to take us.

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