Addiction treatment agencies in Massachusetts are struggling to hire and train enough people to care for their patients.
These providers also are having difficulty finding the ancillary services — such as housing and transportation — that patients need to sustain their recovery after leaving.
Those are among the key findings of a survey of addiction treatment providers released last week by the office of US Senator Elizabeth Warren.
The survey points to the many challenges that remain as the state struggles to cope with the surge in opioid overdose deaths, a public health calamity that claimed some 2,000 lives last year.
“It’s not for lack of attention or lack of effort on the part of the commonwealth,” said Vic DiGravio, president and chief executive of the Association for Behavioral Healthcare. “It’s that these issues are so big and overwhelming . . . There are so many fronts that we need to be fighting on.”
The association, a trade group for Massachusetts treatment providers, helped Warren’s staff develop the survey questions.
The Massachusetts senator’s office sent the 33-question survey to more than 80 organizations that provide prevention, treatment, and recovery services for people with substance use disorders.
The recipients were members of the Association for Behavioral Healthcare and the Massachusetts League of Community Health Centers, and some providers who asked to participate.
Warren received replies from 51.
The survey yielded some positive findings: Respondents said that lack of health insurance was rarely an obstacle to care, and the additional coverage provided under the federal Affordable Care Act has further helped provide a range of services.
Three-quarters of respondents reported that they were able to provide affordable, high-quality care as a result. Many said that the majority of their patients are enrolled in MassHealth, the state’s Medicaid program.
But the workforce shortage highlighted in the survey is longstanding and worsening, despite receiving less attention than the need for treatment beds.
“Our members are still struggling to meet the demand for treatment, and a huge part of that is workforce,” DiGravio said. “Their ability to serve their patients is compromised by a lack of qualified workers.”
DiGravio called for programs to help repay the educational loans of health care professionals to encourage more to enter the field. But, especially in a state with a high cost of living, higher wages are needed to attract people -- and DiGravio said providers are not paid to enough to support a robust workforce.
In 2010, according to statistics cited in the Warren report, there were fewer than 50 psychiatrists, psychologists, counselors, and social workers available to care for every 1,000 people in Massachusetts. The demand has only risen since then, yet low reimbursements perpetuate the problem.
Nationally, the median wage for behavioral health disorder counselors was $41,070 in 2016, and 10 percent made only $27,210. Social workers in the field make $42,700.
A growing number of psychiatrists decline to participate in insurance networks, the survey report stated.
Even when patients get treatment, they often cannot sustain their sobriety. The survey report cited a recent analysis that found that 30 to 40 percent of patients in Massachusetts do not complete inpatient addiction treatment -- and among those who do complete treatment, one in eight come back within a month.
Part of the problem is that patients leave treatment without the basics needed for a productive life. Treatment providers said they have trouble referring patients to services that help with housing, career counseling, and transportation.
“That’s probably even a bigger challenge than the workforce issue,” DiGravio said. “For people to people to achieve and sustain long-term recovery, the two biggest things they need are employment and stable living.”
Another issue facing providers is insurers’ policies. Although nearly everyone in Massachusetts has insurance, survey respondents said that doesn’t always amount to having access to care. Some said that they cannot obtain reimbursement for certain types of services, particularly outpatient.
Despite federal and state “parity laws” requiring insurers to cover behavioral health disorders at the same level as physical problems, providers said that low reimbursements for behavioral health care result in less access.
Warren has introduced a bill that would require health plans to document and disclose the steps they have taken to ensure they are complying with parity laws.
Enforcing parity laws would also help with the workforce issues, Warren spokeswoman Lacey Rose said in an e-mail. But “substantially boosting funding and resources to these providers is also essential,” she said.
Although some 600 new treatment beds have been added in recent months, survey respondents said that waiting lists remain commonplace. More than half had waiting lists for inpatient care, some as longs three weeks. The problem is even worse for the longer-term care needed after inpatient stays, with 90 percent of residential recovery homes reporting waiting lists. Patients can wait for as long as 90 days for a bed in a recovery home.
Respondents pointed to two underlying problems -- a shortage of beds, and inadequate access to services, such as medication treatment, that can prevent relapse.
The survey also emphasized the importance of federal funding in addiction treatment. More than 60 percent of respondents reported relying on federal grants from the Department of Health and Human Services, the Department of Housing and Urban Development, the Department of Justice, and other agencies.
“No matter how they are using these grants, the vast majority of respondents stated they could not do their work without federal support,” the survey report said.
In a statement, Warren said, “The opioid epidemic is an ongoing crisis, and it demands an all-hands-on-deck response. Addiction treatment centers and community health centers are on the front lines of this fight, and this survey helps us better understand the important work they do.”