CommonWealth Beacon, November 25, 2023... We need approval of legislation to fairly fund our clinic system
Every day at nonprofit mental health clinics across Massachusetts, clinicians provide treatment to children and adults for a variety of conditions in response to the behavioral health needs of their communities. These clinicians gain experience over time, starting right after graduation, spending intensive hours under supervision to gain their license, and then in some cases staying for years in the same clinic that served as their training ground.
But that career path is slowly crumbling.
More and more often, administrators are seeing their well-trained clinicians recruited away by the private sector, with higher compensation often the deciding factor in the departures. The clinics are unable to compete with the salaries being offered because state reimbursement rates do not enable outpatient clinics to be competitive in employee hiring and retention.
The mental health clinics have historically taken on the unfunded responsibility of training new clinicians, investing time and resources that helped create a pipeline of passionate professionals who often joined their teams and eventually helped train the next generation of clinicians. That is how the clinic system is able to maintain, and expand, access to their much-needed services.
In recent years, as reimbursement rates fell further behind, outpatient clinics lost staff to acute and psychiatric hospitals, primary care practices, schools, and state agencies. These settings can offer significantly better salaries, benefits, and work-life balance. They have become the proverbial greener pastures that not everyone can afford to resist.
Clinics have also seen a troubling number of master’s-level and licensed staff choosing to join group and private practices, many of which are transitioning to out-of-pocket pay models to avoid the lower rates and paperwork burdens that come with insurance reimbursement. A study last year found that for every 10 clinicians entering the mental health clinic workforce, 13 clinicians exit.
The net result of this trend is a smaller pool of available behavioral health staff and greater disparities in care access for the state’s most vulnerable residents. Children in need of regular therapy waited an average of 15 weeks before care became available, while adults languished for an average of 13 weeks, according to the study. This is unacceptable.
To be fair, the state has spent time and money on the behavioral health crisis. Our leaders recognized and responded to the fact that more people need mental health and substance use disorder treatment, following the enormous social challenges we all experienced in the pandemic.
The centerpiece solution was the creation of Community Behavioral Health Centers, a new community-based treatment and bundled payment model that many in need have taken advantage of since the 26 centers launched earlier this year. However, Massachusetts still needs a broad and robust network of hundreds of licensed outpatient clinics to supplement the work of the few dozen centers spread out regionally. The need out there is just too great.
Unfortunately, many outpatient clinic providers have shuttered sites after struggling for years with staggering financial deficits – some sites are in the red by as much as $300,000 annually. Clinician job vacancies continue to climb, at some sites as high as 58 percent.
That means more and more patients are not receiving critical behavioral health care. Worsening patient conditions often lead to crisis situations that overload hospital emergency departments, where patients “board” in large numbers because hospital beds are in short supply.
We need to change this darkening financial picture before it gets any worse, by passing pending legislation that will increase reimbursement rates for mental health outpatient services by 5 percent and ensure that rates paid to clinics, which offer varied and comprehensive services, remain 20 percent higher than independent practice settings. These are not random figures; this is how to fairly fund our clinic system.
Only a positive outcome on Beacon Hill will help reduce clinician vacancies, support the vital training ground for tomorrow’s clinicians, and ease the long waitlists that have forced patients and their families to face desperate times.
Lydia Conley is the president & CEO of the Association for Behavioral Healthcare, which represents more than 80 community-based mental health and addiction treatment provider organizations.
This article originally appeared on CommonWealth Beacon on November 25, 2023.
