MAMH Applauds Senate Passage of the Mental Health ABC Act 2.0: Addressing Barriers to Care

Significant barriers to care and disparities in access existed prior to the pandemic, but these issues have been exacerbated over the last 18 months. For example, about 4 in 10 adults in the U.S. reported having anxiety or depression during the pandemic, as compared to 1 in 10 adults prior to the pandemic. The impact on children and adolescents has been similarly significant, with emergency department (ED) visits by adolescent girls related to thoughts of suicide or suicide attempts increasing by 50 percent.

The Mental Health ABC Act 2.0 builds on previous mental health reforms to tackle some of these difficult challenges. These include insurance company policies that make it hard to access care, a lack of providers across the Commonwealth but especially in communities of color, and care that too often is fragmented and siloed. A summary of the bill's major provisions can be found here.

Although mental health parity laws already are in place at the federal and state levels, people trying to access services quickly learn that pre-authorization requirements, inadequate provider networks, and other barriers to mental health treatment still exist. This bill takes important steps to more effectively investigate and resolve parity complaints, including greater reporting and oversight of insurance companies’ policies for mental health coverage.

The bill also takes several steps to address ED “boarding” – the long waits that adults and especially children may encounter when they seek help in a psychiatric crisis. Some of the most important provisions focus on preventing the need for ED visits in the first place. For example, the bill would require commercial insurance to cover Emergency Service Programs (ESPs), which are community-based and recovery-oriented programs providing behavioral health crisis assessment, intervention, and stabilization services.

In addition, the bill also would require health plans to cover care offered through a collaborative care model -- a model which includes behavioral health providers as members of a person's primary care team. The collaborative care model has been proven to be more effective, less costly, and less stigmatizing than a model in which primary care and behavioral care remain separate.

Despite these critical provisions, some people may still require inpatient care. The ABC Act 2.0 would create an online portal with real-time data to allow health care providers to easily search and find open inpatient mental health beds when needed.

The Senate also passed important amendments, including these:

• Mental Health Watch (Sen. Eldridge): This amendment allows prisoners who are on mental health watch or presenting a risk of serious and imminent self-harm to petition the court for a transfer to a DMH licensed or operated inpatient facility or to Bridgewater State Hospital for treatment.
• 988 Crisis Hotline (Sen. Moran): This amendment helps prepares Massachusetts to implement the 988 crisis hotline by the go-live deadline of July 2022, and to operationalize 988 in a way that leverages the opportunity to improve and better coordinate a system of crisis behavioral health services. This will help to divert people in crisis away from unnecessary hospitalization and toward community-based, effective treatment and support. The provision also helps to incorporate 988 into the new “front door” to the behavioral health system envisioned in the Roadmap for Behavioral Health Ambulatory Care Redesign released by the Baker Administration earlier this year and currently being implemented.
• 911 Response for Behavioral Health Emergencies (Sen. Creem): This amendment is a first step in helping 911 emergency response systems to better identify individuals in behavioral health crisis and triage those calls to an appropriate, effective, and non-traumatizing response.

MAMH is grateful for the leadership of Senate President Karen Spilka and Senators Julian Cyr, Cindy Friedman, Michael Rodrigues in drafting and securing passage of the bill. We also thank Senators Jamie Eldridge, Susan Moran, and Cynthia Creem for shepherding critical improvements to strengthen the bill. The bill now goes to the MA House of Representatives for consideration.