On Purpose: Supporting Children and Families Before a Crisis Occurs

Message from MAMH President and CEO Danna Mauch:

Recent news stories have highlighted growing concerns about children and adolescents “boarding” in Emergency Departments – waiting days and sometimes weeks for help in response to a mental health crisis. A weekly survey by the MA Health & Hospitals Association found that on a single day last month 115 individuals under age 18 were in Emergency Departments waiting for an inpatient psychiatric bed to become available. The problem is especially critical for children with autism or intellectual or developmental disabilities, who are more likely than their neurotypical peers to visit an Emergency Department for psychiatric concerns and have longer wait times.

Providing real solutions to Emergency Department boarding means understanding and addressing the root causes of the problem. One part of the problem, of course, is that there are an insufficient number of inpatient psychiatric beds for children in the Commonwealth. Recent efforts by the state to expand the number of beds and provide real-time access to information about their availability will help to address this. But most families, providers, and others would agree that hospitalization should be a last resort. The real challenge facing us is to support children and their families before a crisis occurs.

For children with new or emerging mental health conditions, access to timely services and treatment in their own communities may mean the difference between short-term management of a treatable condition and a psychiatric crisis requiring emergency intervention. Unfortunately, a significant gap exists between the number of children and families who want services and the timely availability of affordable treatment. A 2022 survey of Massachusetts provider agencies by the Association for Behavioral Healthcare found that the average wait time for outpatient therapy for children and adolescents is more than 15 weeks.

These longs waits for outpatient services for children often lead to worsening conditions, additional stress, and crisis situations. And although Emergency Departments are not well suited to support children in psychiatric crisis, for too many families they have become the only available option.

For more than four years, MAMH has worked with the Children’s Mental Health Campaign and other stakeholders to research, build consensus on, and develop insurance coverage for more effective, reliable options. With financial support from the Miller Innovation Fund, the C.F. Adams Charitable Trust, and the Peter & Elizabeth Tower Foundation, we collaborated to develop and promote adoption of a model of “pediatric behavioral health urgent care” – a community-based intervention to provide children and families with the help they need for an emerging mental health concern before it becomes a crisis.

With the leadership of the Executive Office of Health and Human Services (EOHHS), pediatric and adult urgent behavioral health care was adopted as part of the Roadmap for Ambulatory Behavioral Health Reform and a reimbursement rate was set for designated CBHC and attestation Clinic providers.

Last month, with funding provided by Mass General Brigham (MGB), MAMH launched a pilot project with five Community Behavioral Health Centers. Each grantee partnered with a school or school district to facilitate student access to urgent care services, including mental health services at school and streamlined access to community resources and referrals. MGB and the C.F. Adams Charitable Trust are supporting an independent evaluation of the grant to determine whether the intervention is effective in reducing Emergency Department visits by students for behavioral health reasons, 911 calls and police intervention at schools, and student suspensions and expulsions.

Emergency Departments and inpatient psychiatric services have an important role to play in the continuum of services for children and their families – and that role is as a service of last resort. To end Emergency Department boarding we need to provide children and families with the help they need when they need it, and pediatric behavioral health urgent care is an important part of that solution.