Study: Children in state struggle to access behavioral health care

It’s the perfect post-pandemic storm: more children needing behavioral health care and fewer doctors available.

According to a study by the Behavioral Health Association, children in the state are waiting longer for behavioral health services. For example, families applying for MassHealth (the state Medicaid program) have an average wait of 20.5 weeks for home care, and those with private health insurance have to wait even longer, averaging 26.5 weeks for these types of services.

According to the study, the lack of clinicians hinders children’s ability to receive behavioral health care.

Massachusetts has an impressive system of home and community-based mental health services for families with public and commercial health care, but that system is only on paper, said a report outlining research findings released in December. Children suffer because we are unable to invest in services and workforce.

The Association for Behavioral Healthcare is an organization that represents more than 80 community mental health and addiction treatment organizations. Its July survey of 30 organizations with 208 locations across Massachusetts found that as many as 3,300 families were waiting for services at the end of the 2022 fiscal year.

Lydia Conley, CEO of the Association for Behavioral Healthcare, explained that if children are not given resources when they need them in the first place, children’s needs can escalate while waiting for treatment.

In response to the federal lawsuit Rosie D. v. Romney, the state created the Children’s Behavioral Health Initiative for children on MassHealth to provide services such as home care and behavioral health services.

In 2019, those with private insurance were required to have a similar level of service called Child and Adolescent Behavioral Health. The Association for Behavioral Healthcare study finds that because of unclear guidelines from private insurers, there is less incentive to accept families with commercial insurance, creating a two-tiered system for who uses and receives CBHI services within the Commonwealth.

At the same time, the number of children cared for by the system has not returned to the pre-pandemic level, according to the report.

So far, the use of these services has not recovered due to reduced service provider capacity. … By the end of May 2023, respondents reported that about 32 percent fewer children and families were receiving the same services as before the pandemic, according to the report.

According to the study, clinician salaries are one factor. Many of the services provided by the Childrens Behavioral Health Initiative are based in the home environment, according to family members and caregivers. These appointments are often held in the evenings and on weekends and are more complex than office visits, but the salaries paid are significantly lower than office or teleclinic salaries.

Through August 2023, state officials have invested $70 million in the initiative, but Conley said raising wages is not enough to attract and retain staff.

As a result, approximately 756 clerical positions are open, and funding and staffing difficulties have resulted in program closures. According to the report, between fiscal years 2019 and 2023, six home behavior service programs, 15 therapeutic mentoring programs, and 17 home therapy programs have been closed.

In addition to the states’ roadmap for behavioral health reform, the Association for Behavioral Healthcare made specific recommendations for meeting the needs of families in communities. It proposed offering sustainable prices to clinicians, paying the difference in prices for non-English speaking services, eliminating provider referrals, investing in outpatient services, implementing loan reduction rewards and scholarships to attract and retain clinicians, and reducing unnecessary administrative work for clinicians.

Katherine Mague, senior vice president of the Behavioral Health Network, confirmed that as one organization that reports to the Association for Behavioral Healthcares study and provides services to youth in both Hampden and Hampshire counties, the findings are spot on.

During the pandemic, staff left, and hiring back has been difficult, Mague said. Children now come to much more acute facilities than before. This is a real mental health crisis and it’s harder to work now when so many need it.

If you or someone you know is looking for help, call or text the Behavioral Health Help Line at 833-773-2445.

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