THE MASSACHUSETTS HOUSE on Thursday plans to vote on a mental health bill that would improve access to mental health care, particularly for children, while ensuring that the health care system treats mental and physical health care equally.
The House bill builds on a major bill that the Senate passed in November and includes many similar provisions, addressing topics like emergency room boarding and insurance coverage for mental health care.
The two bills have to be reconciled before the session ends July 31 for anything to become law. But the fact that both bodies are passing omnibus mental health bills indicates that there is significant interest in addressing the state’s burgeoning mental health crisis.
Rep. Adrian Madaro, a Boston Democrat and the House chair of the Committee on Mental Health, Substance Use, and Recovery, said he is “optimistic” a bill will become law this session. “The fact that rather than scrap the entire Senate bill, we sought to build upon it and offer something that was complimentary, that’s a signal of the willingness of the House to roll up our sleeves and work with the Senate and get something over the finish line that really moves the needle for residents of the commonwealth,” Madaro said.
Senate President Karen Spilka, who has pushed hard for the passage of a mental health bill in the Senate, said she is grateful that the House released the bill. “If there is any silver lining to the COVID-19 pandemic, it’s that more people are willing to talk openly about their need for quality mental and behavioral health care,” Spilka said. “Yet our delivery system is broken, and people can’t easily get the care they need and deserve. With the release of this bill from the House Committee on Ways and Means, we are one step closer to transforming that delivery system.”
Amy Rosenthal, executive director of the consumer advocacy group Health Care For All, said the bill is badly needed. “While Massachusetts has made great strides in expanding health coverage, many families still face barriers to accessing the care they need,” Rosenthal said. “This is especially true for behavioral health, and the COVID-19 pandemic has exacerbated an already growing behavioral health crisis, especially among youth.” Rosenthal said the bill “includes language to specifically address the needs of children, adolescents, and families to help them thrive at home, in school, and in the community.”
While the state has always struggled to meet the needs of mental health patients, the situation worsened amid the COVID-19 pandemic as social isolation led to more patient demand while providers faced staffing woes.
One major focus in the House bill is on mental health care for children. The pandemic has seen an increase in the problem of boarding – mental health patients, often children, waiting for days in the emergency room for an inpatient psychiatric bed to open up. Reports have found that children are suffering high rates of depression and anxiety.
“Youth have been particularly hard hit by the effects of the pandemic, the isolation, the lack of socialization,” Madaro said. He said the House’s goal is to address boarding, but also provide more services in schools and communities to avoid teenagers ending up in the hospital.
The House bill would create online portals to give health care providers information about available beds, so providers could match boarders with beds. The portal for pediatric and adolescent boarders would include more information than the adult portal, so the state could collect better information. It requires hospitals to have a mental health clinician available any time the emergency room is open to evaluate and stabilize patients. It would establish new protocols to expedite psychiatric inpatient admissions for children under 18.
The bill would create an interagency team to manage complex pediatric cases, like when a child is getting services from multiple agencies. It would require children in foster care be screened for behavioral health conditions and referred to treatment. It would establish a new commission to report on pediatric mental health issues. It gives the child advocate more authority to help parents access behavioral health services for children.
The bill would create a new statewide program to help schools implement behavioral health services, with supports that include consultation for school staff, coaching, and technical assistance. Schools would be required to create plans for dealing with emergency behavioral health situations.
The bill would prohibit early education settings from expelling or suspending students except for “extraordinary circumstances” where the child poses a safety threat.
Another major focus of the bill is parity, ensuring that mental and physical health are treated the same way by providers and insurers. There are already parity laws, but the bill would provide additional enforcement.
“The problem is a lack of enforcement of decade-old federal laws,” Madaro said.
Hospitals would have to review policies to make sure they do not discriminate against patients with mental illness. The bill directs the insurance commissioner to take a more active role in monitoring compliance with parity laws, with the ability to fine insurers up to $1 million. It requires additional reporting and establishes a process for consumer complaints.
It also requires insurers to cover an annual “mental health wellness exam,” an idea that originated in the Senate.
There are several other mandates on insurers to ensure mental health care is covered. The bill would require insurers to cover a collaborative care model, where a psychiatric professional works with a primary care team, as well as emergency services. It would prohibit insurers from requiring pre-authorization for acute mental health treatment.
David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represent psychiatric hospitals, called the bill “a step forward for behavioral health.” Matteodo said the elimination of prior approval for acute care is particularly important to improve access and let patients, particularly those with MassHealth, be admitted to hospitals more quickly.
“It means behavioral health does not have to go through a lot of hoops that [medical-surgical] doesn’t have to go through,” Matteodo said.
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said the association supports many provisions of the bill including annual wellness exams, the expedited psychiatric admissions process, the expansion of school-based services, and provisions related to reporting and accountability on mental health parity. Pellegrini said she applauds the House “for their collaboration and leadership in seeking to improve access to behavioral health care services and treatment.”
The bill includes several other provisions:
It would set up new grant programs to address workforce challenges, including a scholarship fund and a fund to provide mental health supports to clinicians themselves. “It’s abundantly clear we need to enhance service and treatment options, but our efforts will be fruitless without a strong workforce,” Madaro said.
It directs UMass Medical School to develop a program for mental health professionals to learn about military service-related conditions.
It requires the state to contract with at least one crisis center to participate in the national 988 suicide hotline program, where someone can call and get crisis intervention services 24 hours a day, seven days a week. A commission would be established to set up a 988 suicide prevention hotline and intervention system. In the meantime, there are provisions to ensure people can access emergency mental health services by calling 911.
It initiates a public awareness campaign about the state’s “red flag” law, an infrequently used law that lets a judge confiscate someone’s guns if they pose a threat to themselves or others.
The Department of Justice in 2020 issued a scathing report about the lack of mental health care provided to Massachusetts inmates. The House bill would give prisoners who are at risk of harming themselves a right to petition a judge to transfer to a psychiatric facility.
Danna Mauch, president and CEO of the Massachusetts Association for Mental Health, called the bill “a very strong bill in support of a broad platform of reforms and improvements for behavioral health services to both adults and children.”