State sees boom in number of psychiatric beds

A room sat waiting for clients in a new, as-yet unused unit in the TaraVista Behavioral Health Center.
Lane Turner/Globe Staff
A room sat waiting for clients in a new, as-yet unused unit in the TaraVista Behavioral Health Center.

As psychiatric patients struggle to get treatment, some of them waiting for days in emergency rooms, health care companies have seen an opportunity: Three gleaming new psychiatric hospitals have gone up in Massachusetts since 2015, and two more are in the works.

But it’s turning out to be harder than expected to fill them with patients.

At least one hospital has been forced to limit patient admissions because it hasn’t been able to recruit psychiatrists. Further, state mental health leaders and hospital owners are grappling with the fundamental question of whether these new facilities will be willing to treat the most challenging patients.


The problem is especially perplexing in Massachusetts, where the increasing number of psychiatric beds has bucked a trend. Nationally, the supply of psychiatric beds has been falling for years.

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“We understand it’s not acceptable to have people in the emergency room for days,’’ said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, a trade association. “It’s also not good policy to have hospitals accept patients they can’t handle. We are trying to find that balance.’’

TaraVista Behavioral Health Center in Devens, a new hospital built by Concord psychologist Michael Krupa and private investors, has opened just 30 of its 108 licensed beds since November. Krupa said he is struggling to hire doctors and has made do with two temporary psychiatrists, despite increasing salaries 20 percent and offering signing bonuses.

“It’s been an enormous challenge,’’ he said.

Psychiatric hospitals are supposed to stabilize patients who are suicidal or at risk of harming others, usually with medication adjustments, but are not meant to provide long-term treatment. Many patients in crisis end up going to an emergency room, where they wait for a hospital bed.


Mentally ill patients with complex needs tend to wait the longest in emergency rooms because psychiatric hospitals often don’t have enough staff, or the appropriately trained staff, to care for them.

The Department of Mental Health is pushing hospitals to take these hard-to-place patients, who include children and those with intellectual disabilities, a history of assault, significant medical problems, or addiction.

“They see all these beds being built,’’ Matteodo said. “They’re saying we don’t want hospitals just taking care of the easy patients.’’

The mental health department requires hospitals to describe in their license applications how they will “facilitate” admissions for these especially needy patients, officials said. But they stopped short of saying these services are required, and the agency is drafting new regulations.

The department is working “to establish an enforceable expectation that individuals who require inpatient hospital level of care will have access to the services they need,’’ a spokeswoman said in an e-mail.


Matteodo said hospitals want to accept needier patients but require better reimbursement rates from insurers and government health programs to be able to do so.

Even without higher rates, the cost of hundreds of new beds to the health care system will be enormous, said Danna Mauch, president of the Massachusetts Association for Mental Health, a nonprofit organization that advocates for people with mental illness. She worries the money will come at the expense of other needed services, like outpatient rehabilitation, transitional housing, and competitive salaries to attract skilled workers into the mental health field.

“People like to think beds are a panacea,’’ Mauch said. More beds “definitely will help some problems, but at the end of the day there are more fundamental issues.’’

Michael Krupa, chief executive of TaraVista Behavioral Health Center in Devens. His psychiatric hospital, which opened in November, is part of a boom in psychiatric hospitals in the state.
Lane Turner/Globe Staff
Michael Krupa, chief executive of TaraVista Behavioral Health Center in Devens. His psychiatric hospital, which opened in November, is part of a boom in psychiatric hospitals in the state.

The number of psychiatric beds in Massachusetts rose 14 percent in the last three years to 2,776.

The dramatic drop-off in psychiatric beds nationally has come amid the push to treat patients in outpatient settings and tighter controls by managed care insurance companies. Between 1998 and 2013, the number fell from 34 per 100,000 people to 22 — far lower than in most European countries, according to the National Association of Psychiatric Health Systems in Washington, D.C.

But the trend has started to reverse, in part because of new laws requiring parity in health insurance coverage for physical and mental illnesses, said the group’s president Mark Covall. Iowa officials just approved the first psychiatric hospital in the state, while hospitals are opening more beds in North Carolina, Ohio, Indiana, California, Texas, and Florida, he said.

The new hospitals in Massachusetts are going up in the central and southeastern regions of the state, where emergency rooms have regularly sent patients in crisis to psychiatric hospitals in metropolitan Boston.

As is required in some other states, companies seeking to open new psychiatric hospitals in Massachusetts do not have to submit a so-called determination of need application to regulators containing evidence that the service is necessary. This lack of regulation has attracted behavioral health businesses to the state as well, Covall said.

Two psychiatric hospitals opened in 2015 — High Point Hospital in Middleborough, with 72 beds, and Southcoast Behavioral Health in Dartmouth, which expects to eventually open 120 beds.

St. Luke’s Hospital in New Bedford closed its own small psychiatric unit and partnered with the for-profit Acadia Healthcare to open the Dartmouth facility. This model allows the acute-care hospital to use its space for more lucrative medical services, while relying on a company that specializes in psychiatric care for clinical and business expertise.

UMass Memorial Health Care in Worcester recently announced similar plans. The academic medical center will open a psychiatric hospital with about 1oo beds, partnering with the private for-profit company US HealthVest.

The California psychiatric company Signature Healthcare Services is planning to open a 152-bed hospital in Westborough. Chief executive Patrick Moallemian said in an e-mail he expects to open one of nine units in the next two months.

The supply of psychiatrists in the United States fell by 10 percent between 2003 and 2013, according to an article in the journal Health Affairs. Matteodo said many would rather work in private practice, where patients often pay directly, allowing doctors to avoid insurance paperwork — and discounted fees. And patients in private practices are generally healthier.

“It is tough duty working in a hospital,’’ Matteodo said.

Matteodo is urging the Board of Registration in Medicine to move more quickly to license psychiatrists coming into the state. He is also trying to persuade the state Medicaid program to improve reimbursement for hospitals that treat hard-to-place patients, who might require private rooms or more staff.

Renee Clark, chief operating officer of Southcoast Health Hospitals Group, said the new psychiatric hospital in Dartmouth treats adults and adolescents. But it does not admit patients with a history of assault.

“I know the state is concerned about lack of access to those types of bed,’’ she said, but we “are not equipped to do that.’’

Moallemian said his Westborough hospital intends to treat a “full array’’ of patients, including children.

“DMH is rightfully concerned about any potential gap areas in psychiatric services, and we have made a commitment upfront to be an active part of the provider community meeting those needs actively,’’ he said in an e-mail. He went on to say that he hopes the “financial aspects of our operations will also be a high priority.’’

Liz Kowalczyk can be reached at