Survey: Children in states with difficulty accessing behavioral health care

It’s the perfect storm after the pandemic: an increase in children needing behavioral health care and a decrease in available clinicians.

A survey conducted by the Association for Behavioral Healthcare found that children in the state are waiting longer for behavioral health services. For example, there is an average wait of 20.5 weeks for families seeking in-home therapy with MassHealth (the state Medicaid program), and those with private health insurance must wait longer with an average of 26.5 weeks for to those types of services.

The survey said clinician shortages hinder children’s ability to receive behavioral health help.

Massachusetts has an impressive system of home- and community-based mental health services for families with public and commercial health coverage, but that system is only on paper, says a report released in December which describes the results of the survey. Children are suffering because we have failed to invest in services and labor.

The Association for Behavioral Healthcare is an organization representing more than 80 community-based mental health and addiction treatment organizations. Its survey, which it conducted in July, was answered by 30 organizations operating 208 sites across Massachusetts and found that as many as 3,300 families are waiting to receive services by the end of Fiscal Year 2022.

Lydia Conley, president and CEO of the Association for Behavioral Healthcare, explained that if children are not given resources when they first need them, children’s needs can become acute while waiting for care.

In response to the federal litigation Rosie D. v. Romney, the state created the Childrens Behavioral Health Initiative for children with MassHealth to provide services such as in-home therapy and behavioral health services.

In 2019, a similar standard of services is required for those with private insurance, called Behavioral Health for Children and Adolescents. The survey by the Association for Behavioral Healthcare states that because of unclear guidelines from private insurance companies, there is less incentive for families to accept commercial insurance, creating a two-tier system of who gets -access and receive CBHI services within the Commonwealth.

Meanwhile, the number of children treated by the system has yet to return to pre-pandemic levels, the survey found.

To date, the use of these services has not been repeated, due to the reduced capacity of the provider. … By the end of May 2023, respondents reported approximately 32% fewer children and families than pre-pandemic levels received these same services, the report said.

Wages for clinicians are a factor, the survey says. Many of the services provided by the Childrens Behavioral Health Initiative are based in an in-home setting to involve family members and caregivers. These appointments are often conducted in the evenings and on weekends and present more complexity than office appointments, but the wages paid are significantly lower than the wages of in-office or remote clinicians.

As of August 2023, state officials have invested $70 million in the initiative, but Conley said, not raising salaries enough to attract and retain staff.

As a result, approximately 756 staff positions sat vacant, and difficulties in finding financing and staff led to the closure of the program. Between the 2019 to 2023 fiscal years, the report said, six in-home behavioral services programs, 15 therapeutic mentoring programs and 17 in-home therapy programs closed.

In addition to the state’s Roadmap for Behavioral Health Reform, the Association for Behavioral Healthcare has provided specific recommendations to meet the needs of families in communities. It proposed providing sustainable rates for clinicians, paying rate differentials for non-English services, eliminating provider referrals, investing in outpatient services, implementing loan repayment awards and scholars to attract and retain clinicians and reduce unnecessary administrative work for clinicians.

Katherine Mague, senior vice president of the Behavioral Health Network, confirmed that as one of the organizations that reported on the survey by the Association for Behavioral Healthcares and provides services to youth in both Hampden and Hampshire counties, the findings seen

There has been an exodus of staff during the pandemic and hiring back has been difficult, Mague said. Children come in with more severe conditions now than ever before. It’s a real mental health crisis and it’s harder now to do the work that so many more need it.

If you or someone you know is looking for help, call or text the Behavioral Health Help Line at 833-773-2445.

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