Christine Macbeth: How we can address the crisis in behavioral health care access | Columnists


For the last few years, I’ve written in these pages about a workforce shortage at the Brien Center that is threatening access to behavioral health care. In fact, I’ve called it a crisis — the worst I’ve ever seen in my career.

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In December, in the Project Paycheck series, Eagle reporter Larry Parnass took a deep dive into our agency, writing that the Brien Center was down 100 employees at the time, including many licensed clinician positions. Our workforce crisis had inevitably led to an access-to-care crisis, with everyone except those experiencing dire emergencies placed on long waiting lists.

Now, we have the results of a statewide survey of community-based behavioral health providers like the Brien Center, which documents the full extent of both crises and the impact they are having on people in urgent need of mental health and addiction services.

It’s even worse than we thought.

The survey was conducted by the Association for Behavioral Healthcare, a statewide nonprofit representing 80 agencies in Massachusetts including the Brien Center. Among its many sobering findings is this one: At a time when COVID-19 has greatly increased the need for care — and the need was already very high — state agencies served 11 percent fewer adults and children in 2021 than we did in 2019.

Here are more statistics gleaned from the ABH survey:

• Nearly 14,000 individuals across the state are on waitlists to receive outpatient services.

• Children and adolescents spend an average of 15 weeks on a waitlist before starting ongoing therapy.

Why is this happening? Primarily, it all boils down to reimbursement for behavioral health services and salaries for our caregivers. The state sets the rate of reimbursement for care, and in most cases, that amount is less than the cost of providing high-quality services.

That gap is most profound when it comes to paying licensed clinicians. On average, state-funded agencies like the Brien Center are forced to pay significantly less in salary to a licensed clinician than our local hospitals can pay or what the clinician could earn in private practice. Thus, where to work becomes a much easier decision when one is facing large bills left over from years of education. Where would you choose to work? According to the ABH survey, it now takes nine months or more to fill a psychiatrist position.

Brien Center President and CEO M. Christine Macbeth welcomes Baker proposal to support behavioral health

This entire scenario is shameful and unsustainable. However, there is reason to be hopeful. Earlier this year, Gov. Charlie Baker’s administration announced a 10 percent rate increase for outpatient behavioral health services. And just this week, he submitted a new proposal that would require providers and insurers to increase spending on primary and behavioral healthcare by 30 percent by 2025. If approved by the Legislature, the new spending would add $1.4 billion to the system over the next three years.

ABH is also calling for state and federal governments to expand student loan repayment programs to help solve our recruitment and retention problems, among other good proposals.

I am also hopeful that mental illness and addiction will someday soon reach the same level of awareness and funding as other illnesses — and we have the pandemic to thank for this. Gov. Baker summed it up well in his news conference this week: “The pandemic has only underscored the need to treat behavioral health care services the same way we treat other health care services, both in terms of people’s ability to access those services — but more importantly, to put them on a level playing field with respect to how and what we pay for them,” he said.

At long last, state and federal leaders appear to understand the magnitude of our problems and many have resolved to address the inequity. For individuals and families who depend on us, help can’t come soon enough.

M. Christine Macbeth, ACSW, LICSW, is president and CEO of the Brien Center.


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