Years ago, the Brien Center opened a critical stabilization unit for children and adolescents here in Berkshire County because kids experiencing a severe mental health crisis were placed in treatment facilities far from their families. We believed at the time — and we still believe — that providing care close to home is the very best way to treat children and everyone who comes to us for care.
In the last few years of operation, the Brien Center’s CSU was rarely fully utilized and lost thousands of dollars each year. The same scenario happened in many other communities across the state which had offered similar units. Gradually, a number of them were forced to close.
No agency could afford to lose hundreds of thousands of dollars annually when, overall, state reimbursements already failed to meet the cost of care. Also, insurance companies were denying 24-hour psychiatric care, including the state’s Medicaid program.
When the pandemic struck, the remaining beds for children in crisis were cut in half because they were no longer able to share a room. Thus, an inadequate number of beds decreased even more, leading to greater heartache for parents and delayed care for their children. As recently reported in The Berkshire Eagle, kids languish in Emergency Departments, sometimes for days, while staff frantically try to locate a placement for care. An uptick in the need for mental health services during the pandemic brought this very serious situation into sharper focus.
But there is much more to this story. Over the last several years, an ever-increasing number of adults and children are seeking behavioral health care, and the level of their illness is more acute. This is a phenomenon that is happening in the Berkshires and everywhere in the U.S. At the same time, there are not enough licensed clinicians to meet the need. In fact, I am struggling with a workforce crisis that is the worst that I’ve seen in my long career. The same is true for all of my colleagues leading nonprofit behavioral health agencies in Massachusetts.
Making matters even worse, the Brien Center has experienced a decade of reimbursements from the state that do not cover the cost of delivering high-quality services. As a result, we are not able to pay our clinicians as much as they could earn in schools, hospitals or in private practice. A 2019 Gallagher Survey found that behavioral health clinicians were paid 18.3% more in hospitals than in community-based agencies like the Brien Center. Our situation is dire: Not only are there not enough clinicians to meet existing need, the Brien Center cannot offer salaries that would enable us to stand out from the competition. Below-market salaries are driving unacceptably high vacancy and turnover rates in outpatient clinics, diminishing access to care for the most vulnerable people in our community.
The Brien Center has talented and dedicated behavioral health providers who have saved lives and helped thousands of our friends and neighbors get better and get back to productive lives. There just aren’t enough of them.
As the state reconsiders its obligations in light of lessons learned from the pandemic, behavioral health care must become a higher priority. If we want to attract and retain clinical and nonclinical staff to community-based settings, we have to pay what these valued employees would earn in a hospital.No one should be denied access to mental health care in a crisis because there isn’t a bed nearby, or a well-trained and compassionate caregiver to offer help.