Baystate mental health consolidation stirs anxiety

Closing smaller units, partnering with for-profit US Healthvest

ON THE FACE OF IT, Baystate Health’s plan for a new mental health facility in Holyoke seems like a boon for the region.

The proposed new facility will have approximately 130 beds, increasing the total number in the region by 30 percent. The new facility also offers mental health beds for geriatric and pediatric patients, as well as those who are disruptive or have a substance abuse problem. Right now, many of these hard-to-place patients “board” for days if not weeks in emergency rooms waiting for inpatient care.

“Because of the increase in bed capacity and an improved environment of care, we envision that we will be able to treat a broader spectrum of patients in the new facility, including patients who have historically needed to be sent to the Boston area for care,” said Dr. Barry Sarvet, chair of psychiatry at Baystate Health.

But as it opens the new facility, Baystate plans to close smaller mental health units at three of its community hospitals in Westfield, Palmer, and Greenfield. According to mental health patients, providers, and advocates in these smaller communities, that’s not a fair trade.

Each of the smaller hospital-based units slated to close are deeply rooted in the communities they serve.  Patients and service providers rely on them as part of a web of supports that help

people with serious mental health conditions stay in their communities. In contrast, the new facility is relatively far away in a region with spotty and circuitous bus service.

The new facility will also be operated as a private entity, which has stoked the concerns of advocates and patients who wonder whether the focus will be on profits instead of patient care.  Baystate will be a minority partner (33 percent) in the project with US Healthvest, a behavioral health services company based in New York that runs half a dozen behavioral health for-profit companies around the nation. US Healthvest is also opening a 120-bed facility in Worcester this year.

Donna Stern, a nurse on the Baystate Franklin mental health unit in Greenfield and a local leader of the Massachusetts Nurses Association, said closing community hospital beds and investing as a minority partner in a private company means Baystate Health is “essentially washing their hands clean of mental health.”

As a for-profit, she said, the new facility will have no requirement to admit people who are uninsured, and will accept a smaller percentage of people covered by Medicaid, the health insurance program operated by the state and federal government. “We take people every day who do not have insurance,” she said. “We are the last safety net for these folks.”

As baby boomers age, she said, they are living longer and getting sicker and sicker in their later years. “If you’re looking at this as a business model, you’d take the ones with good insurance, no medical problems, and higher reimbursement rates,” she said.

According to Stern, profit margins are higher still when patients are discharged as quickly as possible, in what she calls “spin-cycle admissions.”  She said people with serious mental illness often need more time in an inpatient programs in order for their condition to stabilize before discharge into the community.  Sometimes they can’t be stabilized and must wait for a longer term placement.

“We will keep people for weeks and weeks, waiting for a long-term bed.  We’ll keep them for 100 days or more,” she said. “You’ve got high recidivism with many of these people because it’s a chronic illness. We keep them safe. Why can we do that? Because we are not about making money.”

Sarvet disputes the notion the new facility will be less accessible to poorer people. “As in all of our current Baystate psychiatric facilities, decisions to accept and admit patients will be on the basis of clinical need and regardless of financial means,” he said. “We anticipate that the proportion of patients with public and private insurance will be similar to our current facilities.”

Over the past decade, dozens of hospitals across the state have closed units or eliminated services that have a high cost relative to insurance reimbursement ratios. Frequently, these hospitals then open or expand services such as surgery or neurology with better reimbursement ratios. According to Stern, hospitals closing services often promise to compensate for loss of essential services by admitting more indigent patients or providing transportation, but don’t follow through.

Sarvet said the transportation needs of patients, and how to address them, are currently being discussed.

The Nurses Association is pushing a bill on Beacon Hill that would prohibit hospitals from opening or expanding new services for three years after shutting units or services the Department of Public Health deems essential to the community.

Last month, Baystate Health announced plans to close intensive care units at Baystate Noble in Westfield and Baystate Wing in Palmer, converting them to medical surgical beds. In addition, Baystate plans to close six pediatric beds in Westfield, reducing the inpatient capacity.

“Giving Baystate the benefit of the doubt, I can understand their decision to centralize intensive care services,” said Judith Shindul- Rothschild, associate professor of nursing at Boston College. She said there is evidence that medical teams in larger intensive care units deliver better patient care as they see and learn to handle a broader range of illnesses and complications. However, the equivalent does not hold true for mental health units, where care delivered within a patient’s local community and support network can greatly benefit their recovery, she said.

“I don’t understand why Baystate, which is sitting on buckets of cash, is closing down these community hospital mental health units,” she said. “They have the second-highest margin of all hospitals in the state.”

Cindy Spirito, who was a patient in the Westfield unit eight years ago, said the recent news of the unit’s planned closure has triggered anxiety among her friends.  “People with mental health don’t like change. They’re already stressing right now hearing that the unit is going to close. That stress is going to trigger more problems for people out here,” she said.

Tammy Brigande, the director of the Westfield State University Counseling Center, said her program has developed a collaborative relationship with mental health staff at Baystate Nobel in Westfield that helps expedite treatment, and eases student transitions back to campus. “If we have a student who’s dealing with depression, we can get the student in, get them treated before things snowball and they get too far behind in the semester,” she said.

When the unit at Nobel closes, she said, it will be much less likely that a student’s friends would visit them during their hospital stay as many do not have access to a car. “The importance of community and social support are huge. Taking people out of their community is not a helpful approach,” she says.

A few years ago, unable to see a path out of his depression, Fran Huidekoper drank some antifreeze, hoping to kill himself. He ended up in the hospital instead where he got the intensive support he needed to get better. Now living in Westfield, Huidekoper is alarmed by news that Baystate wants to close the mental health unit in his local hospital and centralize services in a new facility in Holyoke about 15 miles away.  For people without a car or good insurance, he said, it may as well be on the moon.

Meet the Author
“Public transportation in this area sucks,” he said, noting that that a bus from Westfield to Holyoke runs only once a day.  Bus service from Greenfield to Holyoke is equally sparse. While an ambulance will take someone suffering a mental health crises from the emergency room to Holyoke, Huidekoper said the fear of getting stuck in an unfamiliar town might discourage some people from seeking help in the first place.

“They might call a friend who has a car or they might not get help at all.  They might commit suicide, that’s how serious this is,” he said.