Nobody wants to go to the emergency room.
Often, however, this is not a choice.
Motor vehicle accidents, household accidents or the sudden onset of a medical condition means the flashing lights and wailing siren of an ambulance and a speedy journey through the hands of qualified experts trained and equipped to handle it all. what goes through the doors.
But what if the emergency is not physical?
Patients with behavioral health problems — whether brought on by conditions such as clinical depression, extreme anxiety, or compounded by substance abuse — can also end up in hospital emergency rooms. And sometimes that’s where they stay because they have nowhere to go.
Hospitals large and small in Massachusetts have faced an ongoing problem with a phenomenon sometimes known as psychiatric residency, where patients in need of mental health care end up in emergency departments or hospital medical units while waiting – sometimes for days or even longer – for a place in a facility capable of treating them.
“There is insufficient funding for the lower levels of care of basic community clinics, intensive outpatient programs, community crisis stabilization units and respite services,” according to a July report by the Commission. Joint, a national nonprofit organization that accredits more than 22,000 U.S. health care organizations and programs.
Last month, Governor Charlie Baker signed legislation to make it easier for patients in crisis to access mental health services.
The law, known as the “Mental Health ABC Act: Addressing Barriers to Care,” creates online portals that provide access to data on youth and adults seeking mental health and addictions services and includes a feature search engine that allows healthcare providers to easily search and find open beds. It demands that the State Health Policy Commission prepare and publish a report every three years on the state of pediatric behavioral health, as the youth boarding school crisis is particularly acute; require the Center for Health Information and Analysis to report on behavioral health needs; updates the expedited psychiatric inpatient admission protocol and creates an expedited assessment and stabilization process for patients under the age of 18.
“This legislation is a step change, dramatically improving access to mental and behavioral health services and addressing some of the most challenging aspects of delivering this essential health care to everyone,” State Representative Hannah Kane said. , R-Shrewsbury, in August. bill signing ceremony. “Far too many families have seen loved ones suffer and unable to access the short and long term care they need to recover and be well, including my family. I am grateful for the work of the speakers and the leadership of the Legislative Assembly.
Leigh Simons Youmans, the association’s senior director of health policy, said in a statement: ‘The MHA and our members are deeply grateful for the steps taken by state officials to address the health crisis. behavior in our hospitals. Investments to stimulate health personnel to reimburse extended stays in boarding schools are measures that will make a difference for patients, families and caregivers.
She added: “We know there is still work to be done. Hospitals are working around the clock with state leaders to build an even more accessible, equitable and sustainable behavioral health system.
“Administratively, our outlook is hopeful,” Dr. Ron Van Ness-Otunnu, chief of emergency medicine at Sturdy Memorial Hospital in Attleboro, said in an email to the Sun Chronicle. “It has not been long since the ABC Act was passed, so we do not yet see the full benefits that this legislation will bring. That said, we think positively of the forward movement that the new reforms will bring to address to the behavioral health crisis once they are fully launched.
And while the intent of the law is laudable, it hasn’t necessarily increased the supply of psychiatric beds in the area, though the state is holding a series of briefings through December to craft regulations. to implement the new law.
But, while the number of beds has increased, nearly 20% of those in the state are not being used because there are not enough workers to staff them, according to a new survey from MHA and Massachusetts. Association of Behavioral Health Systems (MABHS).
According to the August survey of 56 facilities representing 2,858 licensed psychiatric inpatient beds, 568 of those beds (19.9%) are offline due to staffing needs, the report said. “This figure has been steadily increasing, rising from 9% and 14% in February and October 2021, respectively,” according to the report.
The highest number of vacancies are found among mental health workers at the bachelor’s level (504), registered nurses (472) and social workers.
“Between February 2021 and now, the number of full-time equivalent workers needed to staff offline beds in the Commonwealth has doubled or more across nearly every category of worker, from RNs to social workers, nannies and attendants to personal care,” MHA’s Youmans said of the report.
Last year, the Baker administration allocated $31 million in American Rescue Plan Act funding to address the behavioral health workforce crisis. Hospitals have used the temporary funds to increase salaries and signing bonuses to incentivize and retain bedside workers, and to hire temporary staff to keep current beds in line.
A COVID-19 recovery bill that the Legislature passed in late 2021 and Baker signed into law contained $111 million for behavioral health staff loan relief. This forgiveness program is currently being designed. The legislation also contained $198.6 million for a behavioral health trust fund that has yet to be allocated.
The problem, hospitals say, is getting insurers to reimburse behavioral health services more equitably, expand loan repayment programs and other workforce development programs, and create support for the employee wellness to minimize major work-related strains in the behavioral health sector, the report says.
Meanwhile, the number of people needing these beds “is pretty constant,” Van Ness-Otunnu said in a phone interview last week.
“Today we have seven boarding schools, one has been with us for 10 days. Sounds like a good day,” he said, adding that they may have up to two dozen people waiting for behavioral health care when the emergency room at Sturdy, a nonprofit community hospital, has of 32 regular emergency beds.
“It goes up and down,” he said, and it’s not always predictable.
MHA’s weekly Behavioral Health Boarding report for Sept. 19 found there were 597 total patients waiting in emergency departments statewide. That was down from 679 patients in the September 12 report. The organization said its Region 5, which includes Southeast Massachusetts, Cape Cod and the Islands, has 147 residents across 13 hospitals, one of which is Sturdy.
By its very nature, it is difficult to see an increase in the number of emergency patients coming. Van Ness-Otunnu said he saw as many as 186 patients with all kinds of health needs come through his department in one day, but “it was a bit of a crazy day.” But even at an average of around 130 people a day, having 30 additional people, for example, with behavioral health issues, he said, “is a challenge.”
Justine Zilliken, director of strategy at Sturdy, said the emergency department this year tends to provide care for around 49,000 patients with health needs of all kinds.
A quick snapshot earlier this month, provided by the Massachusetts Behavioral Health Access website, which tracks the availability of hospital care in the state, showed only about 9 psychiatric care beds in a 30 mile radius of Attleboro, with the closest at Brockton Hospital with five beds. The next closest site is at the Corrigan Mental Health Center in Fall River with two. Expanding the search to 50 miles, that available number was still less than 20 beds.
Sturdy does not have an on-site psychiatric ward, but he does have mental health professionals on call, Van Ness-Otunnu said, and behavioral health nurses on staff.
“They’re great at interacting with patients,” he said, especially those who may be restless and frustrated while waiting for treatment. “They are well trained in verbal de-escalation.”
The hospital may also consult with psychiatrists who can make recommendations on medications.
Older patients may present their own challenges.
As an accredited Level 2 geriatric emergency department, Sturdy has a particular focus on elderly patients who, Van Ness-Otunnu noted, “may have dementia issues and psychiatric issues secondary to their condition.” They may stay in the ER for an extended period of time but, he says, “we can get them to a better state.”
The shortage of psychiatric care beds, while still a problem, may soon ease, according to the Massachusetts Hospital & Health Association.
He notes that thanks to an incentive program launched by the Baker administration last year, about 300 new inpatient behavioral health beds are coming online.
The American Rescue Plan Act bill passed by the state legislature recently commits $400 million to expand access to mental and behavioral health services, including behavioral health workforce needs.
As part of this bill, the Legislature established a $198 million Behavioral Health Trust Fund to address behavioral health access services across the continuum of care.
The HCA says hospitals and health systems are advocating for the creation of a Behavioral Health Rates Task Force to assess ways to ensure the financial stability of behavioral health units and facilities and enable providers to behavioral health to pay their staff adequate salaries, prohibiting clinical refusals. due to an administrative or technical defect in a claim, and require coverage of all medically necessary mental health services and the resolution of administrative barriers for providers wishing to expand behavioral health services.
It can help community hospitals like Sturdy, Van Ness-Otunnu said. “We took the initiative to provide services.
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