FOUR YEARS AGO, a Pittsfield woman named Christine told MassLive about her experience waiting with her young son in the hospital emergency room for three days until the hospital could find an inpatient psychiatric bed for him.
In 2015, research from the Health Policy Commission found that 28 percent of people who showed up at an emergency room with a behavioral health diagnosis, around 50,000 people, spent more than 12 hours there. Boarding – spending more than 12 hours in a hospital ER waiting for a psychiatric bed – has been a major problem in Massachusetts since a landmark 2001 lawsuit, Rosie D v. Romney, which argued that a lack of home-based mental health services contributed to ER boarding.
The problem stems partly from difficulties accessing mental health treatment due to long waits for appointments and providers who do not accept insurance. There is also a scarcity of inpatient psychiatric beds, particularly for children.
What’s changed since then, amid a global pandemic that is threatening people’s mental health?
According to a report released Wednesday by the Health Policy Commission, emergency room boarding is only getting worse.
In 2019, 27 percent of behavioral health emergency department visits resulted in boarding. By September 2020, 31 percent of people who visited the emergency department for a behavioral health emergency boarded. In some regions of the state, like the Norwood/Attleboro area, the number exceeded 40 percent.
As in previous years, the percentage of pediatric patients who had to board was higher than the number of adult patients – 39 percent compared to 28 percent from March through September 2020. In fact, 878 pediatric patients had to wait in the emergency room for more than 48 hours before they could get a psychiatric bed.
According to the report, a major reason for the shortage is the state has lost 270 psychiatric beds since 2019. Providence Behavioral Health Hospital in Holyoke closed. Norwood Hospital closed after flooding in June 2020 and has not yet reopened. Other hospitals reduced capacity to allow space for quarantining and social distancing due to COVID-19.
The Executive Office of Health and Human Services has laid out a roadmap for improving the behavioral health system, and some recommendations may help prevent emergency room boarding. The system envisions a “front door” that someone could call to be connected with mental health treatment before they reach crisis. There would be community behavioral health centers offering same-day evaluations and referrals to treatment, with evening and weekend hours. There would be stronger community-based options providing urgent mental health care and crisis intervention. The report also flags the need for expanded inpatient psychiatric bed capacity.
Whether the plan will be implemented and how long it will take – the state is envisioning a four-year rollout – remains to be seen. Lives may depend on it.