Victoria Buckley has seen the human toll of our broken mental health system. A psychiatric occupational therapist and chair of Lexington’s Commission on Disability, Buckley has witnessed people in the throes of mental health crises languishing for weeks in hospital emergency rooms without appropriate care. She can tell you about the Lexington woman, not yet 30, who has exhausted her lifetime allotment of Medicare coverage for psychiatric hospitalization. She can describe how hard it is to get mental health help if you are a person with developmental delays or autism. And she knows the consequences of the unconscionable wait times for outpatient psychiatric attention: people “start fooling around with their meds, or they’re prescribed something from the emergency room as a stop-gap and then they can’t get any more meds until they see a psychiatrist,” she says. It’s a recipe for disaster.
Around a third of Massachusetts adults and children experience mental health issues, a situation that worsened with the COVID-19 pandemic. Some half of them can’t get the care they need because there is a serious shortage of mental health care providers — here in Massachusetts, and across the country.
But there’s cause for hope. Last fall, Massachusetts passed a sweeping new law known as the Mental Health ABC Act: Addressing Barriers to Care. The law makes it easier to access mental health and substance use care, and establishes new requirements for schools to support the mental health of children. Its success will depend on whether Massachusetts can reverse the dire shortage of psychiatrists, psychiatric nurse practitioners, therapists, and other mental health clinicians and paraprofessionals (collectively known as the behavioral health care workforce), and on whether the Commonwealth’s commitment to improvement will endure.
The new law breathed life into the Baker administration’s Roadmap for Behavioral Health Reform by creating the Massachusetts Behavioral Health Help Line (BHHL) and a statewide system of Community Behavioral Health Centers (CBHCs). These initiatives are meant to serve as portals for people to get the care they need, when they need it. “The big-picture theory is that we will have fewer people degrading to the point where they don’t have any choice but to call 911 and have the police take them to the emergency department,” says Lori Krinsky, president of the National Alliance of Mental Health (NAMI) Central Middlesex chapter.
The BHHL, according to the state’s website, is staffed by clinicians who assess callers’ needs and connect them to outpatient, urgent, or crisis care. No insurance is needed. Anyone in Massachusetts can call or text the BHHL 24/7 at 833-773-2445, or chat online at masshelpline.com. The line accommodates more than 200 languages. (The national 988 Suicide and Crisis Lifeline can also help people reach the BHHL.)
The CBHCs are a network of twenty-five facilities across the Commonwealth that are intended as “one-stop shops” for behavioral health care. The CBHCs that serve Lexington are located in Waltham and Framingham, and are run by Advocates, a human services agency. “CBHCs provide routine, urgent, and crisis care for mental health and substance use challenges,” Advocates’ vice president of integrated clinical services Danielle Dunn explained in an email. “We serve children and adults of all ages, and we offer services from peer support and counseling to care coordination and medication services.”
CBHCs’ 24/7 crisis services are intended as alternatives to hospital emergency departments, and are available to anyone in Massachusetts, regardless of insurance. People can get crisis help by calling, walking in, or requesting a mobile crisis intervention team of trained professionals to meet them at home, work, or other location. Non-crisis CBHC services may be covered by private insurance, depending on the plan. MassHealth clients can access all CBHC services for free.
The new law also places a variety of requirements on schools. Schoolchildren with complex needs who receive services through more than one state agency are sometimes left in limbo when the agencies disagree about the services they should get. The new law requires the agencies to convene a review team to resolve the matter — within deadlines. And in the case of school discipline, the new law seeks to keep kids connected to their school communities by imposing requirements intended to reduce the use of suspensions and expulsions.
Lexington Public Schools (LPS) has been working on reducing suspensions and expulsions for several years now, since long before the new law. The impetus was the recognition by administrators that these practices were being disproportionately imposed on Black students and students with disabilities. A recent LPS report suggests progress: in academic year 2017-2018, there were 88 students, pre-K through 12, who were suspended or expelled from school. Last year, that number had dropped to 28. As of January 29, 2023, 16 LPS students have been expelled or suspended.
LPS, a school system known for high levels of student stress, employs guidance counselors, social workers, and psychologists who can help families navigate the mental health system. “Every school has those individuals who are behavioral health specialists to help assess different situations and crises,” says School Superintendent Julie Hackett. Lexington is fortunate; not every Massachusetts school is this well-staffed with mental health workers. “It’s typical in an urban setting, just as an example, to have one counselor in an entire building for 600, 700 students,” Hackett says. “I think that’s changing now, but the resources are so limited that often that’s the place where schools don’t get the help they need.” Hackett also reports that LPS staff has been trained to recognize and appropriately respond to students experiencing self-harm or suicidal ideation.
Maria Bertram, who with Jessica Quattrocchi chairs LexSEPAC/SEPTA, an organization of Lexington parents of children with special needs, says that she hears from families that have moved to Lexington that the mental health services here are better than most other towns. But Bertram sees room for improvement. “I have found personally through the IEP process that those concerns about mental health are taken seriously,” she says, referring to the system through which children get special education services. But, she says, “I think that the service delivery becomes a lot less flexible in middle school and high school.” The upshot, she believes, is that, compared to elementary school, mental health can get less attention in the upper grades.
Lexington has a Mental Health Task Force that brings together staff from the schools and the municipal side of town government to stay on top of issues. The town offers a free-of-charge Mental Health Referral Service to help Lexington residents and schoolchildren find therapists, and has hired a mental health clinician dedicated to Lexington residents with American Rescue Plan Act (ARPA) funds. The town’s Human Services Department director, Melissa Interess, reports that the clinician has a full caseload.
For the last half dozen years or so, the Lexington Police Department has participated in a grant-funded, multi-community jail diversionary program, in which mental health clinicians work alongside police. In its latest iteration, the program has two full-time clinicians sharing work among six police departments. One of them, Katelyn Fisher, a social worker, has been embedded since January with the police departments of Lexington, Bedford, and Lincoln. Fisher accompanies the police when they respond to situations involving mental health, substance use, confused elders, or “Section Twelves” (emergencies where people with mental illness pose a risk to themselves or others). She assesses people’s needs and support networks, connects people to help, and follows-up with phone calls. “In Lexington, I see maybe ten to fifteen calls a week; that’s including follow-ups,” Fisher says. “I’ve seen kiddos as young as eleven all the way up to an elderly person who may have dementia or some paranoia, schizophrenia, anything like that.”
Having a clinician working with police, says Lexington Police Chief Michael McLean, is “another way for us to make sure that we are properly dealing with a call and to get another resource in there so that the community member who’s in crisis can get they help they need.”
The success of all these programs, and the prospect of future progress, depends on tackling the behavioral health workforce shortage — a longstanding problem that worsened with the pandemic and is especially dire for people in marginalized communities. Low reimbursement rates for mental health services are considered a primary cause of the shortage. “Low reimbursement rates correlate to people’s compensation, what they’re able to take home to pay off their student loans, to pay their rent or their mortgage,” says Lydia Conley, president and CEO of the Association for Behavioral Healthcare. “In many instances, delivering mental health treatment services does not afford you a family-sustaining lifestyle.”
In the discussion of mental health reimbursement rates, the word “parity” comes up a lot. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that coverage, treatment limits, co-payments, and insurance company rules for mental health and substance use disorder services must be comparable to those offered for medical and surgical services, but even today, parity in health care is not the reality for many Americans. The new mental health law strengthens Massachusetts’ parity laws — but enforcement requires the development of agency regulations, and these have yet to be written. The responsible agency is the Department of Insurance (DOI), which handles not only health insurance, but auto, life, home, long-term care, and workers compensation insurance as well. State Senator Cindy Friedman, who represents parts of Lexington and is an architect of the new mental health law, is concerned that the DOI is over-extended. “Healthcare really needs its own commission and commissioner and staff,” she says. She anticipates that the legislature will address this in the next fiscal year.
The state is also trying to encourage more people to choose careers in mental health. Last year, Massachusetts put $122 million of ARPA funds toward repaying the education loans of mental health providers who promised to work for underserved communities. “We’re pushing to fund that again in this budget,” Friedman says. She says that there are efforts afoot to make community college free for people going into mental health fields, and to look at educational programs across the Commonwealth to get a fuller sense of what is available, who attends, and who graduates. “It’s going to take time because the system that we’re trying to shore up is a system that has really been ignored for many years,” Friedman says.
These promising changes are already making a difference. But the mental health system still hurts. Significant numbers of Massachusetts residents still suffer from unacceptable delays in getting care, still languish in emergency rooms, still attend under-resourced schools, still can’t get appropriate care for their complex needs.
At the same time, this moment feels pivotal. Senator Friedman, who has spent years working to reform the mental health system, credits leaders like Senate President Karen Spilka and the Baker administration’s Secretary of Health and Human Services Marylou Sudders for propelling things forward. “You just cannot underestimate the power of having a leadership who’s willing to believe in what you’re trying to do and really puts their power behind it,” she says.
988 Suicide & Crisis Lifeline: call, text or chat 988.
Veterans Crisis Line: Call 988 and press 1, or text 838255, or use the Veterans Crisis Chat.
Behavioral Health Help Line: call or text 833-773-2445; chat at masshelpline.com/chat. If deaf or hard of hearing, use a TTY to contact Massrelay at 711, or call through video relay service at 833-773-2445.
Community Behavioral Health Centers — walk-in or call for routine, urgent, and crisis care for mental health and substance use challenges.
Advocates CBHC Framingham, 1094 Worcester Rd., Framingham, MA 01702; 800-640-5432
Advocates CBHC Waltham, 675 Main St., Waltham, MA 02452; 800-640-5432
Mobile Crisis Intervention — Lexington area: 800-540-5806
Lexington Public Schools Mental Health Resources
Lexington Mental Health Referral Service
For Complaints and Problem-Solving:
Lexington Commission on Disability
Lexington Human Rights Committee
Check out the legislative priorities of the Massachusetts chapter of the National Alliance on Mental Illness, and ask your state legislators to co-sponsor the bills you support.
Eliot House in Concord and Lexington.
Edinburg Center in Bedford are also excellent sources for help for people with Mental Health Issues.
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