A new “front door” opens Tuesday for Massachusetts residents seeking mental health care, promising fast access to what has been a near-impenetrable system.
Whether in crisis or just not sure where to turn, people will now be able to call or text the Behavioral Health Help Line – 833-773-BHHL – or walk into one of 25 designated centers. If all goes as planned, immediately a clinician will assess the situation and connect the person with help, regardless of the type of insurance they have.
The opening of the Help Line is the first big step in the outgoing Baker administration’s ambitious plan to overhaul the state’s fragmented, understaffed system for people with mental illness or addiction.
In addition to the Help Line, the “Roadmap for Behavioral Health Care Reform” establishes mobile teams ready to respond immediately to those in crisis and calls upon 25 Community Behavioral Health Centers to provide swift and flexible care in every city and town across Massachusetts. The hope is that fewer people will flock to hospital emergency departments, where they now spend days or weeks waiting for help.
“This road map is a game-changer. It’s truly transformative for our state,” said Rebekah Gewirtz, executive director of the National Association of Social Workers, Massachusetts chapter.
“Right now you call [a provider’s office] and you get a voicemail that says, ‘If this is an emergency, call 911,’” said Danna Mauch, CEO of the Massachusetts Association for Mental Health. With the new Help Line, a live voice will answer the phone. “That, to me, is a big change,” Mauch said.
But as the “door” swings open, questions remain for Mauch and others. Will people find out about the Help Line and understand the new system? Amid a severe shortage of health care workers, will there be enough clinicians to meet the needs? Will the front door open only to leave people stuck in the vestibule?
Even as they anticipate bumps in the road, advocates and providers say that doing nothing would be far worse.
“I feel like standing still isn’t an option,” said Mary McGeown, executive director of the Massachusetts Society for the Prevention of Cruelty to Children.
Today, hundreds of people, many of them children, are languishing in hospital emergency rooms while waiting for psychiatric beds. More than 2,000 Massachusetts residents die each year from opioid-related overdoses. Community mental health centers have waiting lists numbering in the thousands. And the majority of adults seeking behavioral health care in recent years were unable to get an appointment when they needed one.
McGeown says she often gets calls from family and friends who need help and don’t know where to turn. She does what she can for them. But the Help Line, she said, should find a pathway for anyone.
The Help Line will operate around the clock. The person answering the phone will be either a clinician or trained specialist who has personal experience with behavioral health issues.
Unlike with suicide hot lines, those picking up the phone are there not just to listen, but also to act. They will dispatch a crisis team to attend to the caller in person, if needed, or arrange an appointment with a clinician. They will stay on the line until the caller is connected with the next step and follow up days later to ensure the “hand-off” was successful.
For some, the next step might involve Riverside Community Care, one of the 25 community mental health centers selected to participate in the Roadmap. Now called Community Behavioral Health Centers, these organizations each received $750,000 in start-up funding. They must meet an array of performance standards, such as assessing patients within 24 hours of first contact, providing appointments for those in urgent need within 48 hours, and arranging follow-up appointments within two weeks.
In anticipation of the Roadmap, Riverside acquired and renovated a two-story brick building in Milford, investing $2.2 million in donated and borrowed money.
Less than two weeks before the Help Line was to open, leaders of the center proudly showed a visitor around their new digs, which features separate waiting rooms for children and adults, a hidden side door for privacy when people arrive by police or ambulance, and sunny alcoves filled with plants.
With the Roadmap, community-based mental health care will be adequately funded for the first time since the big mental institutions were shut down in the 1970s, said Julie Greiner-Ferris, senior director. “It’s offering something completely new that’s been necessary and underfunded for decades,” she said.
The state is providing enough money to offer competitive salaries — and its payment scheme allows new flexibility.
Traditionally, the centers receive reimbursement for each session with a licensed therapist. With the Roadmap, MassHealth, the state’s Medicaid program, will pay the 25 centers in “bundles” – a flat fee per day for each patient, to be spent in whatever way a care team thinks will help. This allows the centers to provide services that are not usually covered, which could include helping someone sign up for food assistance or find a place to live.
The bundled payment also allows — indeed, requires — the centers to employ two types of workers who previously could not collect reimbursement: people who have suffered from mental illness or addiction and are trained to help others in the same boat, and care coordinators who will help patients navigate the system. Each patient will have a team strategizing on the best way to meet their needs.
Eliza T. Williamson, deputy director of programs for NAMI Mass, which advocates for people with mental health conditions and their families, said such a system could have made a huge difference for her years ago when she repeatedly ended up in the hospital with her own mental health condition.
“I was able to do well when I was an inpatient, but then didn’t have the skills or the connections or the supports in the community to get any traction,” she said. “At no point did I meet anyone who said, ‘Hey, I was where you are. And now I’m not.’”
But, at least for now, the centers’ interdisciplinary teams will be available chiefly to members of MassHealth, which covers one in three state residents (and 70 percent of Riverside’s clientele), as well as 216,000 people who buy insurance through the Massachusetts Health Connector.
People with commercial insurance will have access to the Help Line, crisis services, and initial assessment. To continue their treatment, privately insured people won’t get the team-based care and will need to seek therapist appointments as in the past, although the Help Line will assist.
State officials and providers like Riverside hope that private insurers will eventually contract for the bundled services that MassHealth patients get. “Part of our job moving forward is to try to sell commercial insurers on this concept,” said Vicker V. DiGravio III, Riverside’s president.
Blue Cross Blue Shield of Massachusetts will consider supporting such coverage in the future, after watching how the program plays out with MassHealth patients, said Andrew Dreyfus, the insurer’s outgoing president.
Even with enhanced payments, there is still a finite – and inadequate – number of mental health professionals, and staff shortages remain a top concern. To encourage more people to enter the field, the state has invested millions in workforce development, including programs to re-pay student loans. But these programs will take years to bear fruit.
“We are not totally, fully staffed,” Riverside’s DiGravio acknowledged. “We’re still trying to hire folks. … We’re worried, but we’re always worried about that.” With peer specialists and care coordinators added to the mix, he expects nevertheless to be able to serve more people.
Marylou Sudders, the outgoing secretary of health and human services, said that despite the workforce challenges, she and the centers “feel sufficiently ready” to move forward with an urgently needed program.
“If I waited until we have every possible person to staff it, I would still be planning this time next year,” she said.
Gewirtz, of the social workers association, shares the worries about the “strained system” but expressed excitement about the Roadmap’s promise. “Let’s work together and make this work,” she said.