In so doing Lynn metaphorically walked through the state’s new “front door” to mental health care — and experienced its potential and its pitfalls.
The Help Line — 833-773-BHHL — is a key aspect of a broader overhaul of mental health services in Massachusetts launched on Jan. 1 by the Department of Health and Human Services. Providers and advocates say the overall project — which includes urgent care centers, short-term “crisis stabilization” beds, and a team-based approach to ongoing care — is showing promise but remains very much a work in progress amid severe staffing challenges.
The Help Line, in the eyes of many, is a bright spot — “beautifully managed,” as one advocate put it.
When Lynn called, a woman answered immediately and spoke in a voice Lynn described as soothing and kind. The Help Line is intended for anyone seeking mental health care, whether they are facing a crisis like Lynn’s daughter or just looking for help.
Lynn, who asked to be identified by her middle name to protect her daughter’s privacy, explained the situation to the trained specialist on the phone. The woman connected her with the local mobile crisis team; such teams, which can include nurses, social workers, and other types of mental health providers, are situated around the state to visit people who need immediate attention, assess their condition, and guide them in the next steps.
In the past, the crisis team was available only to people covered by MassHealth, the state’s Medicaid program, and Lynn has commercial insurance. But now, she learned that the Roadmap had made mobile crisis teams available to everyone.
Unfortunately, on this night, the local crisis team was not especially mobile. They did not have enough staff to visit her daughter at home.
It’s not clear how often this happens, but finding enough workers remains a challenge throughout health care, including behavioral health.
Officials at three mental health agencies interviewed by The Boston Globe said their mobile crisis teams are fully staffed and usually able to make home visits within an hour.
But Pam Sager, executive director of the Parent/Professional Advocacy League, which works for improved access to mental health services for children, youth and their families, said some of the 25 mobile crisis teams “are struggling.” They’re finding it difficult to recruit staff willing to visit people’s homes, and parents sometimes wait hours for someone to arrive, Sager said.
In Lynn’s case, the crisis team offered to speak with her daughter by phone or video. The girl declined. They invited Lynn and her daughter to walk into the team’s office and speak with a clinician in person, but the teenager refused to get in the car.
Meanwhile, the Help Line specialist, who was on hold while Lynn spoke with the crisis team, got back on the phone and chatted some more. “They asked about me — ‘We’re here for you too,’” Lynn said. “We talked a little and she was super nice, and just very helpful.”
Lynn estimates the entire interaction with the Help Line and mobile team took about 45 minutes.
That is not unusual. According to state data, during the first quarter of the year, the average weekly “handle time” for the Help Line ranged from 13 to 19 minutes. The Help Line received 8,575 calls in the first three months of this year and answered on average within 13 seconds. Additionally, staff exchanged 2,620 texts or online chats with people seeking help, and these tended to last about 25 minutes.
“I was pleased and surprised with the ease of dealing with it,” Lynn said of the Help Line, which she’d heard about at work (the state ran a media campaign). She decided not to go to a hospital emergency department, as they’d done in the past.
The Help Line and mobile team “did the same assessment and the same sort of risk stratification the ER would have done,” Lynn said. She and her daughter avoided the stress of a long wait in a frenetic environment that would likely have not resulted in any additional care.
Providing an alternative to ER visits is one of the key goals of the state’s program, called the “Roadmap for Behavioral Health Care Reform.” Today, in emergency rooms throughout the state, hundreds of patients in crisis — many of them children — “board” for weeks or days awaiting a psychiatric bed.
Emily Bailey, chief of behavioral health at MassHealth, said the state had seen a decline in ER boarding among MassHealth members since the beginning of the year.
But data from the Massachusetts Health & Hospital Association show little change in the number of hospital “boarders,” with 548 in the week ending July 17, about the same as a year ago.
“We still view these as early days for the Roadmap’s implementation, but we do believe that its components will make a major difference once they have had time to fully take hold,” a spokesman said in an e-mail. He noted that many people still don’t receive care for mental health conditions until they become emergencies, and there remains a tendency to “instinctively” head to the ER with any problem.
A new employee orientation class was held at Clinical and Support Options in Northampton, one of the Community Behavioral Health Centers established under the state’s overhaul of mental health services.Suzanne Kreiter/Globe Staff
The Roadmap involves much more than the Help Line and crisis teams. The state has contracted with providers who formed 25 new Community Behavioral Health Centers — CBHCs — to provide an array of services, including urgent care centers where patients can walk in, receive an assessment, and walk out with a connection to someone who will help.
Instead of being paid for each encounter with a licensed clinician, the centers receive a flat fee per day for each patient. That frees them to employ workers whose services aren’t normally reimbursed: trained “peer specialists” who have personal experience with mental illness or addiction, and care coordinators who will help patients navigate the system. It also makes it easier to work in teams focused on providing whatever the patient needs, even if it’s not a medical service, such as help finding a place to live.
“We’re finally able to provide care in the way we wanted to do for years and have never been able to do,” said Vicker V. DiGravio III, president of Riverside Community Care, a Dedham agency that runs centers in Milford and Norwood.
The centers received 90,000 visits in their first three months of this year, while mobile crisis teams provided 13,000 visits on-site and in schools, homes, and group living environments, about 20 percent more than the previous year.
The centers are currently serving primarily MassHealth patients, one-third of the state’s population. But if commercial insurers were to contract with these centers, their services would be available to privately insured people as well. So far, few have. State officials say a major goal in the coming months is to persuade more private insurers to sign on.
Meanwhile, people with private insurance like Lynn continue to get care as in the past, through outpatient providers, which often involves long waits. Lynn said her daughter was seeing her regular therapist and seemed to have stabilized after a medication change.
Even within the CBHC system, people may have to wait for treatment, especially if they want individual therapy, rather than group therapy or meeting with peer specialists.
Karin Jeffers, president and CEO of Clinical and Support Options.Suzanne Kreiter/Globe Staff
But Karin Jeffers, president and chief executive of Clinic and Support Options, which operates four centers in Western Massachusetts, said everybody seeking care “has the ability to get at least something.”
Under the Roadmap, MassHealth is paying higher rates to the centers than it pays for mental health services in other parts of the system. That has enabled Jeffers to increase salaries by more than 25 percent, which helped with both retention and recruitment in the CBHCs. But some said the higher salaries have meant that centers are cannibalizing the rest of the mental health system by drawing providers away from other programs. State officials said MassHealth is planning rate increases for certain services starting in August, to try to address this problem.
Assessing the Roadmap rollout so far, Danna Mauch, president and chief executive of the Massachusetts Association for Mental Health, said, “Given the fact that this was implemented in the context of a workforce crisis, it is going better than many of us predicted.”
Jeffers agreed. “It’s actually really impressive to see what has been accomplished by both the state and the providers,” she said. But she noted the demand continues to outstrip the supply of providers.
“Everyone wants it to be at its full potential now. The reality is we still have work to do.”
Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.
