Lack of mental health beds means long ER waits

Four years ago, a Pittsfield woman named Christine told MassLive about her experience waiting with her young son in the hospital emergency room for three days until the hospital could find an inpatient psychiatric bed for him.

In 2015, research from the Health Policy Commission found that 28 percent of people who showed up at an emergency room with a behavioral health diagnosis, around 50,000 people, spent more than 12 hours there. Boarding – spending more than 12 hours in a hospital ER waiting for a psychiatric bed – has been a major problem in Massachusetts since a landmark 2001 lawsuit, Rosie D v. Romney, which argued that a lack of home-based mental health services contributed to ER boarding.

The problem stems partly from difficulties accessing mental health treatment due to long waits for appointments and providers who do not accept insurance. There is also a scarcity of inpatient psychiatric beds, particularly for children.

What’s changed since then, amid a global pandemic that is threatening people’s mental health?

According to a report released Wednesday by the Health Policy Commission, emergency room boarding is only getting worse.

In 2019, 27 percent of behavioral health emergency department visits resulted in boarding. By September 2020, 31 percent of people who visited the emergency department for a behavioral health emergency boarded. In some regions of the state, like the Norwood/Attleboro area, the number exceeded 40 percent.

As in previous years, the percentage of pediatric patients who had to board was higher than the number of adult patients – 39 percent compared to 28 percent from March through September 2020. In fact, 878 pediatric patients had to wait in the emergency room for more than 48 hours before they could get a psychiatric bed.

According to the report, a major reason for the shortage is the state has lost 270 psychiatric beds since 2019. Providence Behavioral Health Hospital in Holyoke closed. Norwood Hospital closed after flooding in June 2020 and has not yet reopened. Other hospitals reduced capacity to allow space for quarantining and social distancing due to COVID-19.

The Executive Office of Health and Human Services has laid out a roadmap for improving the behavioral health system, and some recommendations may help prevent emergency room boarding. The system envisions a “front door” that someone could call to be connected with mental health treatment before they reach crisis. There would be community behavioral health centers offering same-day evaluations and referrals to treatment, with evening and weekend hours. There would be stronger community-based options providing urgent mental health care and crisis intervention. The report also flags the need for expanded inpatient psychiatric bed capacity.

Whether the plan will be implemented and how long it will take – the state is envisioning a four-year rollout – remains to be seen. Lives may depend on it.

SHIRA SCHOENBERG

FROM COMMONWEALTH

Despite the pandemic, House leaders released a budget proposal that ups spending without relying on the enormous influx of federal dollars that are expected to flow into Massachusetts from the American Rescue Plan, which President Biden signed in March. The strategy avoids baking a lot of one-time revenue into the operating budget, which creates a structural deficit once the money runs out in later years. “We have a long road to travel until this crisis is behind us, and using federal dollars, we can think about what the new normal will look like,” said House Ways and Means chair Aaron Michlewitz of Boston. Read more.

House budget chief Aaron Michlewitz served on a commission that reviewed the effectiveness of some of the state’s tax breaks, but he indicated on Wednesday that he has no intention of pushing legislation to eliminate or modify some of the more egregious “tax expenditures” identified by the panel. Read more.

The House budget proposal calls for publicizing a law that allowed women to obtain a 12-month prescription for birth control. The law, which passed in 2017, fell through the cracks and most women, pharmacists, and health care providers didn’t know it existed. Read more.

The Health Policy Commission traces the racial impacts of COVID-19 and also hints that sterner action may be needed to deal with health providers that fail to rein in their spending. Read more

Opinion

The state’s new climate law is “a major step toward reducing emissions—but it only addresses half of our climate change problem,” writes Kate Dineen of A Better City, who argues that we must also invest in climate resiliency. Read more

 

FROM AROUND THE WEB

 

MUNICIPAL MATTERS  

A new poll indicates more than three-quarters of Boston residents support rent control to rein in the high cost of housing. (WBUR)

The Pittsfield School Committee votes 4-3 to hire as superintendent Joe Curtis, who was serving as the interim superintendent. Dennis Powell, a member of the committee, resigned in protest after the vote. (Berkshire Eagle)

A Methuen Water Department worker sues the city alleging sexual harassment by her supervisor. (Eagle-Tribune)

Springfield City Councilor Sean Curran wants the Baker administration to relocate an agency or department headquarters to Springfield. (MassLive)

The Boston Public Library system will no longer charge late fines on overdue books. (Boston Globe

HEALTH/HEALTH CARE

US officials continue the pause of the Johnson & Johnson vaccine. (NPR) Gov. Charlie Baker, who has called the J&J vaccine a potential game-changer for the state, says the pause will cause minimal disruption to the vaccine rollout. (GBH)

WASHINGTON/NATIONAL/INTERNATIONAL

The US will announce economic sanctions today against Russia because of its cyberattacks attempting to influence the US presidential election. 

ELECTIONS

With acting Mayor Kim Janey and City Councilor Michelle Wu way out in front in the first poll of the Boston mayor’s race, some consultants and political observers say the other contenders need to move quickly to establish themselves in the race, including with early TV advertising. (Boston Herald) Wu vows to form a “children’s cabinet” if elected. (Boston Herald

BUSINESS/ECONOMY

Experts say employers can require their employees to get vaccinated against COVID. (Telegram & Gazette)

A former executive at Middleborough-base Alden Shoe Co. has pleaded guilty to stealing nearly $30 million from the company. (Boston Herald

EDUCATION

UMass freezes its in-state tuition for the second year in a row. (Salem News)

Asian American families are opting not to return to in-person instruction in Boston public schools at a rate much higher than for any other group. (Boston Globe

A BU School of Public Health survey indicates 9 of 10 professors believe student mental health has deteriorated during COVID. (GBH)

ARTS/CULTURE

The Leominster mayor is seeking to identify a sword that was mailed to his office that may have been stolen 50 years ago. (Leominster Champion)

CRIMINAL JUSTICE/COURTS

The state rescinded medical parole that was granted to two men who were seriously ill with COVID-19 and have now recovered. (WBUR)

Police are stepping up enforcement of the state’s ban on the use of handheld cell phones while driving. (Telegram & Gazette)

The procession honoring slain US Capitol Police Officer William Evans will start in Connecticut and end in his hometown of North Adams. (Berkshire Eagle

PASSINGS

 Bernie Madoff, who orchestrated the largest Ponzi scheme in history, dies in prison at 82. (USA Today)