On a recent weekday evening, mental health clinicians Noxon Wooger and Madalena Andrade sat in front of their computers and phones in the call center of a community behavioral health center in East Boston. They were preparing for a long night. The call center is open 24 hours a day, seven days a week, and the goal when staffing it is to help people facing a mental health crisis.
“There are people who are experiencing psychosis for the first time, and they’re scared, they’re hallucinating, they’re seeing things they’ve never seen before,” Ugar said.
When such calls come in, the center dispatches another clinician from its mobile crisis management team to directly assess the caller. Meetings can take place anywhere the person feels comfortable: at home, school, subway station, coffee shop, etc. This typically occurs within an hour of the call.
Crisis intervention is one of several levels of care that Massachusetts Community Behavioral Health Centers (CBHCs) are required to provide. It must also provide non-crisis mental health emergency care, regular continuing care, and voluntary overnight care known as a community crisis stabilization unit separate from the center’s outpatient facilities.
CBHCs were rolled out across the state in early 2023 as part of an initiative launched by former Gov. Charlie Baker’s administration to increase access to mental health care. There are currently 26 such centers.
More services on demand
Kate Moore directs the crisis program for North Suffolk Community Services, which operates the East Boston Center. She said the center can quickly provide appointments for a variety of services.
“In an age where you could buy anything on Amazon with one click, it’s now just one click here,” Moore said. “Psychiatry, therapy, substance use treatment, whatever he needs, we can do it in one place.”
All care includes the assistance of people with personal experience with mental illness, known as peer support specialists. It may also include a health evaluation by a nurse and assistance from a case manager to address housing and dietary needs. All of the center’s services are fully covered for customers in most versions of MassHealth, the state’s Medicaid program.
Rebecca Higgins has been a customer of North Suffolk CBHC for nine months. Before that, she said, she had been battling addiction for 20 years. She also suffers from depression. In May of her last year, she decided to change her life.
“I walked in here and asked for service and they came right away,” the Medford resident said. “There was someone at the desk and I said I needed help with substance abuse and they coached me.”
Higgins said she immediately made an appointment for treatment. She then attended an intensive outpatient program five days a week at her CBHC. The program included group therapy and visits from a recovery coach.
As access increases, so does demand.
North Suffolk has been providing mental health care in East Boston for over 60 years. But to become a community behavioral health center, he needed to bring all outpatient services under one roof and expand hours.
Centers must be open until 8pm on weekdays and 5pm on weekends for routine and emergency appointments. They must provide him with crisis intervention services around the clock.
Demand for East Boston Center’s services has exploded since it became a CBHC, said Samantha Green Atchley, a clinical social worker who directs the center.
“The number of diagnostic evaluations we do to admit people to services has doubled, if not more, almost every month since the CBHC opened,” Green-Achley said.
She compiled data showing that the surge in demand is especially pronounced among certain age groups: children. In April 2023, staff saw a 450% increase in children attending services compared to April 2022. In May last year, the number of children admitted jumped 840% compared to the same month last year.
Green-Achley attributes the increase in people receiving care to several factors. Pent-up demand among other mental health providers resulted in waiting lists and referrals to CBHCs after opening. and those who are referred for care after receiving a crisis assessment from the center’s mobile team.
Initially, CBHC leaders struggled to staff their facilities to meet demand. State data shows improvements across the board. Center officials said they are able to offer competitive salaries because they receive generous reimbursement from MassHealth.
East Boston lacks space to accommodate the additional clinicians and other staff needed to serve its growing client list, center leaders said. This raises concerns about the ability to provide quality care to so many people.
“We’re doing very well in terms of talent acquisition,” Green-Achley said. “But everyone has different options, including how often they want to be seen for follow-up care, where they want to be seen for follow-up care, whether they prefer telemedicine or whether they want to be seen in person. All of which are challenging in terms of meeting the needs of
Alternatives to Emergency Rooms
Another important metric declined last year as more people received assistance at CBHCs. From January 2023 to the end of November, the most recent month for which data is available, the number of people waiting for inpatient psychiatric beds in hospital emergency departments fell by 32%, according to state data. The phenomenon known as boarding among MassHealth members plummeted by nearly 60% in 2023.
One of the goals of state officials who spearheaded the creation of CBHCs was to reduce emergency department visits for non-urgent mental health care.
Riverside Community Care’s CBHC in Milford is part of that effort. The newly renovated building’s large windows let in sunlight, and center director Julie Greiner Ferris pointed out the ways the staff strives to foster a comfortable environment.
It is filled with lush plants, including some brought in by customers. The walls are decorated with local photographs and drawings by children who use the center.
“We wanted to bring the community into this building and make it a space that didn’t feel closed-in, gloomy or hidden from everyone,” Greiner-Ferris said.
On the same day, approximately 170 people visited the Milford Center for various types of sessions, treatments and interventions. During one crisis intervention, staff helped the family of a person experiencing a mental health crisis resolve disagreements about next steps in the person’s care.
“My hope is that this is a place where people know that if they need any kind of support, they can feel free to ask for help, feel answered, and feel respected. That’s true,” Greiner-Ferris said.
Private insurance coverage limits
While Riverside Community Care Center’s services are in demand, its leaders said they are concerned about people not being able to take advantage of all available care because their insurance plans don’t cover it.
Unlike MassHealth, which pays higher reimbursements for CBHCs than some other mental health providers because the centers are part of state initiatives, many private insurance companies do not cover the full menu of CBHC services. Not covered.
Kim Fisher, vice president of Riverside Community Care, said the organization’s CBHCs in Milford and Norwood have heard from privately insured members who are upset about not having all their coverage covered. He said he was listening.
“It’s very unpleasant for providers,” Fisher said. “It’s almost as if we’re denying care to some people, and we really feel that way – I think the anxiety is minimal. [serious] Words that can be used in that particular situation. That doesn’t feel right or ethical to us. ”
Some CBHCs provide privately insured patients only with services covered by their health plan. Crisis intervention is fully covered for everyone. If your insurance plan doesn’t cover it, the state will pay. In East Boston, North Suffolk officials said the CBHC would foot the bill if someone is uninsured or underinsured, but they fear that is unsustainable.
A spokesperson for Blue Cross Blue Shield of Massachusetts, the state’s largest private health insurer, said the company is considering additional coverage for CBHC services in line with those offered by MassHealth. Ta. Point32 Health, which operates Harvard Pilgrim Healthcare and Tufts Health Plan, said it reimburses CBHCs using a traditional “fee-for-service” model. That means it doesn’t offer larger payments to fund additional programs at the center. The company said that despite coverage limitations, members have had a positive experience at the center and admissions to mental health units have been reduced.
Rebecca Higgins has MassHealth, so she has access to all of the services at East Boston Center. Although she recently completed her treatment program, she said she doesn’t know what she would have done without all the help she received.
“Being able to talk to someone, call someone… just being able to open up when I was depressed,” Higgins said. “You can ask anything here.”
Resources: If you need mental health support, including information about community behavioral health centers in your area, you can call or text the Massachusetts Behavioral Health Help Line at 833-773-2445. If you are feeling suicidal or facing an emerging mental health crisis, call or text the National Suicide and Crisis Lifeline at 988.
