Massachusetts has spent the last year and a half implementing what’s called a Behavioral Health Roadmap, and one health care foundation is reporting the results are mixed but promising.
The roadmap was developed during Governor Charlie Baker’s tenure, and launched just as Maura Healy’s administration took over in January 2023.
The plan has focused on shoring up community services for mental health crises. A key component is the creation of 27 new community behavioral health centers (CBHCs) around the state.
CBHCs in western Massachusetts include those run by River Valley Counseling Center, Gandara Center, Behavioral Health Network, Clinical and Support Options, the Center for Human Development, the Brien Center in Pittsfeld, and Valley Human Services in Ware.
“These sites have extended hours for care that really enable people … to seek services in the community, rather than presenting at an emergency department, which was one of the key goals of the roadmap,” said Kaitlyn Kenney Walsh with the Blue Cross Blue Shield of Massachusetts Foundation, which recently assessed the state’s progress in a report.
But Walsh said the rollout of the new behavioral health centers has included some “hiccups.” For instance, some private insurers do not cover all the services offered at CBHCs.
“So navigating through that has been complicated for people, particularly people who may not have mass health coverage, which was the initial system upon which this was based,” she said.
And she said there’s still confusion over whether ambulances can legally drop off patients at the community health centers (as they can for emergency departments) which creates transportation dilemmas for some potential patients.
The Massachusetts Department of Public Health declined an interview to discuss the roadmap’s progress but sent a statement saying that emergency room use is down by 59 percent for mental health crises, which they attribute to the community health centers. It added that officials would still like to see more people, especially youth, use newly-created stabilization services.
“It’s typical to see a period of ramp up when new services are made available to the community,” the statement read. “MassHealth is continuing to work closely with community organizations, healthcare providers, police departments and other partners to ensure all residents of the Commonwealth are aware of and have access to this service.”
The Blue Cross report also found one unintended consequence of the CBHCs: Since these community behavioral health centers are able to pay higher rates than the industry standard, there is concern they could pull staff from other places.
Walsh says this speaks to a longstanding scarcity in — and lack of diversity among — behavioral health providers .
“The CBDCs are a new care model that did include some new payment approaches, including bundled payment rates and certain per diem rates that really enabled these sites to attract new workforce or existing workforce to stay at their locations,” Walsh said. ”And given that the underlying behavioral health workforce is already fragile, shifting of providers from one location to another does create some concern that this could exacerbate shortages at other sites.”
For instance, one worry is that mental health clinicians who are working at primary care practices might switch to CBHCs, she said. “I think that there's still some open questions around what the shift will look like, but certainly many of the stakeholders that we spoke to as part of this indicated that this is a more attractive work environment and salary than many of the alternative options could provide.”
One of the most successful aspects of the roadmap so far, according to the Blue Cross report, is a new Behavioral Health Help Line, which is staffed 24/7. Walsh said the help line fielded 42-thousand calls and 13-thousand texts or chats in its first year. However, around the same time, a national suicide prevention helpline launched - as did a state substance abuse hotline.
“So naturally, there was some initial confusion in terms of awareness around when to use what line,” Walsh said. “But in general, what we've heard is that people are aware of this line, they’re using it for the right reasons, and it's been helpful in getting people to the services that they need in a more timely way.”
The roadmap also created new mental health urgent care centers and eventually aims to integrate primary care with behavioral health, although Walsh said that integration is likely to take longer than the other components.
