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Cambridge Health Alliance latest to cut beds for children with mental illness

Cambridge Health Alliance said Wednesday it will eliminate 11 of its 27 beds for treating children and teens with acute mental illness and will end inpatient care for its youngest children as it grapples with financial losses.

The hospital system has two highly regarded inpatient units — one serving adolescents ages 12 to 19 and another for children as young as 3. The two units will be combined into one smaller unit serving patients ages 8 to 18, said Dr. Jay Burke, chief of psychiatry, and the hospital will focus more on providing community-based services.

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“It’s been a place that we’ve been very proud of, and we hope to continue that, just at a somewhat smaller scale,” Burke said.

While several other hospitals have psychiatry units that serve children of all ages, Cambridge Health Alliance’s Child Assessment Unit accounts for nearly one-third of the hospital beds in Massachusetts designated specifically for the younger age group, typically under 12.

The hospital notified the state Department of Public Health of its plans on Wednesday. An agency spokesman told the Globe it had determined that the bed reduction warrants a public hearing under a law requiring review of changes to “essential” medical services. A hearing date has not been set.

The cuts are most likely to affect children who live outside of the communities north of Boston served by Cambridge Health Alliance’s network. Three-quarters of patients served by the shrinking units live outside of the hospital system’s service area of Cambridge, Somerville, Revere, Everett, Chelsea, Malden, and Winthrop — reflecting the psychiatric program’s reputation and the shortage of inpatient beds elsewhere.

A spokeswoman for the state Department of Mental Health said there are 252 inpatient psychiatric beds for children and teens in the state.

That number represents a steady decline over the past five years, from about 310 in 2008, said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, a trade group for psychiatric hospitals.

The decline has been offset somewhat by an increase in community services, such as in-home therapy, launched in 2007 after a federal judge ordered expanded programs in response to a class action lawsuit alleging inadequate care for low-income children with mental illness.

Hospitals say demand for beds fluctuates, typically peaking during the spring and dropping when school is out, and it places a financial strain on them to maintain enough beds year-round.

“From the parent point of view, you don’t want to hear that when you’re sitting in the emergency room for two days with your child” waiting for a vacant bed, said Lisa Lambert,director of the Parent/Professional Advocacy League.

“There is a terrible shortage of beds,” said Dr. Joseph Gold, clinical director of child and adolescent programs at McLean Hospital.

McLean and its parent system, Partners HealthCare, have increased inpatient beds for children and teens over the past decade, including working with Franciscan Hospital for Children to expand services there.

The Brighton facility has 20 psychiatric beds for adolescents and 12 for children. The unit for the youngest patients is in high demand, Gold said.

“We will try to make up the difference” from the cuts at Cambridge Hospital, said Gold, who lauded the quality of care there. “But it’s a challenge.”

Several other hospitals, including MetroWest Medical Center and Westwood Lodge, also serve children as young as age 4, Cambridge Health Alliance noted in its letter to the state.

The hospital system will close the adolescent unit in the Cahill Building on the Cambridge campus for renovations in early July and reopen the smaller combined unit in October, said Burke, the psychiatry chief.

He said the younger children are the most expensive to treat because they require more staff members to care for them. Those under age 8 make up about 9 percent of all children and teens served in the last fiscal year.

Tom Breslin,a spokesman for the Massachusetts Nurses Association, which represents nurses on the units, said the decision to eliminate beds for that group was especially problematic “because not only are we seeing a broad reduction of services in both the public and private sector, here’s yet another group who are not going to have access to even a reduced unit.”

Kerrie McAllister of Framingham, a nurse who has worked on the Child Assessment Unit for 19 years, said she is concerned about the loss of services for the younger kids and the mixing of 8- and 9-year-olds with troubled teens.

As the nation is reflecting on how to better help children and young adults with mental illness, in the aftermath of the Newtown, Conn., school shootings and other tragedies, she said, “We need more access and more services, not less access and less services.”

About 70 people work on the child and adolescent units. Burke said there could be layoffs as a result of the consolidation, but the hospital will work to place people in new jobs when possible.

In the fiscal year ending in June 2012, Cambridge Health Alliance had an overall loss of $28.5 million, according to a state filing. Another recent report showed that the system is among the lowest-paid teaching hospitals in the state.

“We, like other health care systems, are assessing all services and programs to determine how we can best serve our patients in the face of declining reimbursements, funding cuts, and payment reform,” spokesman David Cecere said in an e-mail. “As a safety net institution with very limited resources, these challenges are amplified.”

Burke said the hospital is focusing more on efforts that can keep children out of the hospital, including services in schools and placing psychiatrists in pediatricians’ offices.

Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.
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