Lack of long-term mental health beds is harming patients
Acute care psychiatric hospitals are meant for short-term care, to stabilize someone with a mental health emergency. But in November, the state’s psychiatric hospitals had 110 patients who were ready to be discharged but who couldn’t be. That’s because the patients needed long-term inpatient care and the Department of Mental Health, the sole provider of such continuing care, didn’t have enough available beds.
Shockingly, 62 of these patients had been waiting more than 100 days, including 24 who had been waiting more than a year, according to a survey by the Massachusetts Health & Hospital Association and the Massachusetts Association of Behavioral Health Systems. The average wait for these patients — who the Department of Mental Health agreed were eligible for care — was 197 days.
That six-month average wait time means patients who are severely, chronically mentally ill aren’t getting the long-term therapy they need. And if a patient is taking up a psychiatric hospital bed unnecessarily, the bed isn’t available for a patient who needs acute services — worsening the problem of psychiatric patients waiting for days in hospital emergency rooms.
“This type of backup is happening at every transition point in the system,” said former Department of Mental Health commissioner Marcia Fowler, who is now CEO of Bournewood Health Systems, which operates an inpatient psychiatric facility in Brookline. “It’s happening across the system, and it’s really a reflection of decades and decades of underfunding of the behavioral health system.”
The lack of state-financed continuing care beds is only one part of the mental health system that needs fixing. The inpatient problem is exacerbated by a lack of outpatient services that leads to more hospitalizations and makes it harder to discharge patients.
But it is an issue private hospitals and the Department of Mental Health must resolve. The state’s first attempt at finding an organization to open more beds failed when no organizations bid on the contract. Figuring out why and what needs to be changed should be the next step.
The Department of Mental Health provides services to people with severe, long-term mental illness. This includes community-based programs and a handful of state-run inpatient hospitals that provide long-term care, the largest of which are Worcester Recovery Center and Hospital and Tewksbury Hospital.
The problem is that the hospitals are full. The department’s latest report from January 2023 on hospital admissions found that there were 664 operational beds among all the hospitals and they were over capacity, serving 678 patients.
The Department of Mental Health is required to prioritize court-related admissions, when someone is civilly committed because they pose a danger to themselves or others or when someone accused of a crime is sent for a psychiatric evaluation. Those court-related admissions fill almost all available beds.
The January report showed the Department of Mental Health admitting 91 people from the courts and two from inpatient hospitals. In the first year the department was legislatively required to produce these reports, starting in December 2021, 1,042 admissions came from the courts and 43 from hospital psychiatric care, according to data compiled by the Massachusetts Association of Behavioral Health Systems.
David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents private psychiatric hospitals, said it is unsafe for hospitals to discharge these patients because their chronic mental illness requires inpatient care. But, he said, “They wait and wait and wait because DMH doesn’t have the beds.” MassHealth generally pays for the hospital stay.
The Department of Mental Health acknowledges that it has seen continued high levels of demand for inpatient and outpatient services throughout the pandemic and its capacity to provide inpatient care has not increased.
Fowler says the problem is funding, since the Department of Mental Health can only operate as many beds as the Legislature pays for. She added that as in much of health care, there is also a staffing shortage and mental health clinicians are often paid less than other clinicians because insurance pays less, despite laws requiring payment parity between physical and mental health care.
But there is now money available. The Department of Mental Health recently sought to contract for another 65 continuing care beds. Governor Maura Healey, in her fiscal 2024 budget proposal, allocates $23 million to operate these beds for the year. Department officials believe this would reduce average wait times for psychiatric hospital patients by over 100 days. But no hopsitals bid on the contract, and the department is continuing to search for bids, with an added financial incentive.
Danna Mauch, president and CEO of the Massachusetts Association for Mental Health, an advocacy coalition representing mental health patients, families, and providers, said there are likely several reasons no hospital bid. The reimbursement rate offered by the state may have been too low to make it financially viable. Hospitals may not have money or space to build a continuing care unit. Private providers focused on acute medical needs may not be competent to provide the rehabilitation and recovery services required at a longer-term facility.
But if more beds are not created, the pain will continue to be felt by people like Joanna Mann, a 54-yearold Newton resident who has suffered since childhood with severe depression and delusions. She has gone to different local hospitals several times with suicidal thoughts. Each time, she says, she has had long waits — in a locked basement room, in an emergency room chair, in an emergency department room with no human contact other than a security guard. She was seeking a safe place and was instead “left on my own experiencing scary delusions,” Mann said. Mann needed a psychiatric hospital, but there were no open beds.
If psychiatric hospitals had somewhere to discharge some of those 110 patients who no longer need
be there, more people in crisis could be treated.