The current level of psychiatric inpatient youth services at the Cambridge Health Alliance (CHA) will survive for another year, at least, but the organization’s struggles to keep this program alive underscore a major problem in Massachusetts.
On April 3, the CHA announced a drastic reduction in psychiatric inpatient services for children and teens, cutting the number of available beds from 27 to 16 and eliminating care for children under the age of eight. The proposed change, primarily a cost-cutting measure, involved the merger of two inpatient units, one for adolescents age 12-19 and another for children as young as three.
Following a public review, which was required by Massachusetts law, as well as emotional outcries from citizens and state organizations, the decision was rescinded less than two months later. Federal funding was secured, allowing the two units to maintain status quo until the end of the fiscal year (June 2014).
“There was a tremendous range of people who expressed their feelings about the importance of child mental health services,” says Jay Burke, M.D., M.P.H., chairman and chief of the department of psychiatry at CHA. “That was an outpouring of support, both for services in general across the state and also for the two units that we have.”
Among those supporting youth services at the CHA were three state senators – Sal DiDomenico (D-Everett), Anthony Petruccelli (D-East Boston) and Patricia Jehlen (D-Somerville) – who co-sponsored an amendment that provided approximately $2 million worth of funding, enabling the two units to continue operations.
The new funding is just a short-term fix, however. “We were delighted when they announced that they can’t close these services,” says Laurie Martinelli, executive director of the National Alliance for Mental Illness of Massachusetts. “But it’s a temporary victory, very temporary.”
The problem, which is rampant throughout Massachusetts, is the lack of adequate reimbursement from insurance companies and other sources. It’s particularly critical for children’s services, which generally require highly-structured, staff-intensive programs that tend to be costly.
“[It’s been a] longstanding issue that psychiatric services in this state are not adequately reimbursed,” Martinelli says. “Cambridge Health Alliance does not have enough money to provide these services. The state of Massachusetts has a serious, serious problem and this is not a new problem.”
Meanwhile, the CHA is working on a long-term solution to keep the two units intact while also bolstering its current youth programs. “We’re having real discussions with various payers and policymakers about how to support services like this,” says Burke. “Our staff has been investing themselves in re-examining everything we do, thinking of how we can make it even better.”
Toward that end, the CHA has been making an effort to provide services in local school-based clinics. “We’re also working with agencies like the Cambridge Police Department to find a way to support adolescents who have been identified as having potential problems,” Burke says. “We want to keep them out of the criminal justice system and find them in treatment.”
Burke also notes that the Alliance is working closely with The Guidance Center in Cambridge and developing liaisons with local pediatric practices. “We’re trying to be engaged in much better coordinated care between psychiatry and primary care,” he says.
By Howard Newman