Mental Health Care in Massachusetts: Needs Rise While Spending Falls

What happens when society decides it will reimburse tens of thousands of dollars (or even hundreds of thousands) for a surgery that may offer only incremental improvements to a person’s health or longevity, but won’t spend thousands to help that person’s mental health?

You get a second-class system of care. In America, we call this the mental health system, which is a separate and completely unequal player in the U.S. healthcare system. In fact, it is so dysfunctional and underfunded that American mental health care resembles some third-world countries.

The Boston Globe continues its examination into the Massachusetts mental health care system. And what they find is hardly surprising.

A lot of people think of Massachusetts as a liberal state, home to world-class renowned, very rich universities such as Harvard and MIT. They believe that because it’s a blue, liberal state with a lot of wealth living within its borders, it must offer some of the best social services in the nation.

However, nothing could be further from the truth.

Funding Budgets on the Back of People with Mental Illness

The sad reality is that Massachusetts continually funds its budget deficits by cutting the barebones social services it does offer, slashing those services to its most vulnerable citizens — those who are poor with serious mental health concerns. While mental health outpatient spending per capita has stagnated over the past decade, spending on inpatient services has been cut in half.

Much-needed inpatient beds have been cut as the state has closed all but two of its public hospitals for those with psychiatric problems. While it did open a state-of-the-art facility during that time — the Worcester Recovery Center and Hospital — the facility only serves a tiny portion of those who need inpatient services. In short, the state apparently doesn’t believe such services are needed much any longer.

Meanwhile, the state’s role overseeing mental health care shrunk steadily, and work once done by state employees, such as tracking down patients who missed appointments, was increasingly left undone. […]

The result, the Legislature’s Mental Health Advisory Committee concluded in 2014, is a system in which accountability for the care of the most severely ill people is often “lost or nonexistent.” They bounce from hospital to hospital, caregiver to caregiver, until, with some frequency, something awful happens.

Still, governors have continued closing psychiatric hospitals. Under Mitt Romney, the state shut down Medfield State Hospital in 2003, and, crucially, shuttered a specialized unit at Taunton State Hospital for men with severe mental illness who were prone to violence but not necessarily criminals.[…]

A few years later, the Patrick administration shut Westborough State Hospital earlier than expected to erase a $13 million hole in the Department of Mental Health budget.

Private Health Insurance is No Better

Most Americans carry health insurance now, and it’s been mandated in Massachusetts long before the nation’s Affordable Care Act became law.¹ So maybe it’s not so bad in the mental health care market most of us access…

But the underfunding of mental health care also affects people who rely on private insurers for their treatment. One in six mental health clinicians in private practice say they no longer even accept insurance because repayment rates are so low, according to a 2015 study by CliniciansUNITED, a union-affiliated group. […]

One Brookline social worker said she stopped accepting United Behavioral Health insurance because its payment rates were so low that her take-home pay came to well under $35 an hour.

“Rates have remained flat. My cost of living has gone up significantly,” said the social worker, who asked that her name not be used. “It’s embarrassing how poorly we get paid.”

But it’s far worse than that. I hear stories every week about people looking for a new psychiatrist in their community. They’ll call every psychiatrist listed on their insurance company’s directory, and count themselves lucky if they get a single call back within a week. The earliest appointment available? It can vary from 1 to 5 months out. You claim people don’t wait for healthcare in the U.S.? Millions waiting for mental health care will tell you differently.

One of the biggest problems is that apparently we’re not willing to pay mental health professionals what they’re worth. Pay and reimbursement rates for outpatient services has stagnated and barely budged in the past decade for most therapists, psychologists, and, to a lesser extent, psychiatrists.

Meanwhile, physician pay in general healthcare continues to increase year after year. In 2010, a general surgeon earned a median salary of $343,958, according to the Bureau of Labor Statistics. In 2015, that rose to $395,456, a 15 percent increase. Compare that to clinical psychologists, who earned an average of $66,810 in 2010. In 2015, that rose to $70,580 — a meager 4.6 percent increase (which barely keeps pace with the annual inflation rate of 1-2 percent).

In many health plans, rates have actually been cut, driving professionals to stop accepting health insurance from some of the biggest providers. As a career, entering into the mental health field makes less and less sense as a way to make a living that will grow along with your experience.

Credit: Suzanne Kreiter/Globe Staff

 

Solutions for Mental Health Care in America

There are no easy answers to the growing problem of people’s increasing lack of access to mental health care. Things are actually going to get far worse before they get better, since nothing is even in the pipeline for discussion. The latest U.S. Congressional bill to help address the mental health needs of the nation is stagnating in a Senate committee (and didn’t really increase funding for mental health care at the levels needed to make any kind of meaningful difference).

Many states in the country are facing significant problems of opioid overdose among their citizens, resulting in 78 Americans dying every day due to overdoses. Despite this public health crisis, Congress could only muster a bill that encourages people to get treatment but doesn’t actually increase any funding or resources to help combat the crisis. This is what passes for “action” in Washington, D.C.

In short, if you’re an American and don’t want to (or can’t afford to) pay cash to your professional, you’re getting some of the worst care in developed countries for any kind of mental health problem. And that’s unlikely to change anytime soon.

 

Read the Boston Globe article: Spotlight: The Broken Covenant

 

Editor’s Note

While I admire and respect the Boston Globe’s venerable Spotlight team for this series of articles highlighting the poor mental health care in Massachusetts, I’m also completely put off by their focus on violence in people with mental illness. Time and time again, they illustrate their argument for needing more mental health care resources in the state by sharing stories of violence. I guess they only motivating factor that might move the needle in the public’s mind is fear. This, despite the overwhelming evidence demonstrating people with mental illness are far more likely to be victims of violence than its perpetrator. It’s a disappointing slant that only goes to reinforce the mistaken prejudice that people with mental illness are prone to violence, allowing people to feel free to discriminate against them.

Footnotes:

1. The Affordable Care Act was modeled on legislation passed in Massachusetts mandating every citizen carry health insurance.

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