On a recent weeknight, mental health clinicians Nokson Ugah and Madalena Andrade sat in front of computers and phones in the call center of a community behavioral health center in East Boston. They were gearing up for a long night. The call center is open 24/7, and their goal when staffing it is to help people in the midst of mental health crises.
“We have had people who are having their first psychosis break, and they are frightened,” said Ugah,”hallucinating and seeing things that they never saw before.”
When a call like this comes in, the center dispatches another clinician from the mobile crisis team to evaluate the caller in person. The meeting can happen at a home, school, subway station or coffee shop, or anywhere else the person feels comfortable. It usually takes place within an hour of the call.
The crisis interventions are one one of several levels of care Massachusetts community behavioral health centers, or CBHCs, are required to offer. They also have to provide urgent care for mental health needs that aren’t quite a crisis, routine ongoing care, and voluntary overnight care in what are known as community crisis stabilization units, which can be separate from the centers’ outpatient facilities.
CBHCs rolled out across the state at the beginning of 2023, as part of an initiative launched by former Gov. Charlie Baker’s administration to increase access to mental health care. There are now 26 such centers.
More services, on demand
Kate Moore directs crisis programs for North Suffolk Community Services, which runs the East Boston center. She said the center is able to provide appointments quickly, for a variety of services.
“In a day and age where we like everything on Amazon or one click, now we have one click here,” Moore said. “Your psychiatry, your therapy, your substance use treatment — whatever you need, we can do it in one place.”
The full range of care includes assistance from people who have personal experience with mental illness, known as peer support specialists. It can also include wellness assessments with nurses and help from case managers to address housing and food needs. All of the centers’ services are completely covered for clients on most versions of the state’s Medicaid program, MassHealth.
The main lobby of the North Suffolk Community Services CBHC in East Boston.
Rebecca Higgins has been a client at North Suffolk’s CBHC for nine months. Before that, she said, she struggled with addiction for 20 years. She also has depression. Last May, she decided her life was going to change.
“I walked in here and I asked for services, and I got in immediately,” the Medford resident said. “I saw somebody at the desk. I said I needed help with substance abuse. They guided me.”
Higgins said she quickly got an appointment for therapy. Then, she entered a five-day-a-week intensive outpatient program at the CBHC. The program included group therapy and visits with a recovery coach.
More access, more demand
North Suffolk has offered mental health care in East Boston for more than 60 years. But it had to bring all of its outpatient services together under one roof and expand its hours to become a community behavioral health center.
The centers are required to open for routine and urgent appointments until 8 p.m. on weekdays and until 5 p.m. on weekends. They must provide crisis intervention services 24 hours a day.
Demand for the East Boston center’s services exploded after it became a CBHC, according to Samantha Green-Atchley, a clinical social worker who directs the center.
“The number of diagnostic evaluations that we’ve done to admit people to services has increased — doubled, if not more — for almost every month since the opening of the CBHC,” Green-Atchley said.
She compiled data that shows the jump in demand was particularly striking in one age group: children. In April 2023, the staff saw a 450% increase in children entering services as compared to April of 2022. Last May, child intakes spiked 840% compared to the same month a year earlier.
Green-Atchley attributes the higher numbers of people receiving care to a few factors: the increase in mental health challenges for kids during the COVID-19 pandemic; pent-up demand among other mental health care providers which led to wait lists and referrals to the CBHCs once they opened; and people being referred for care after receiving crisis evaluations from the center’s mobile team.
At first, CBHC leaders had a hard time staffing their facilities to meet the demand. State data shows they’re doing better now overall. Center officials said they can offer competitive salaries because they receive enhanced reimbursements from MassHealth.
In East Boston, center leaders said they’ve run out of space to accommodate all of the additional clinicians and other workers needed to serve their growing client list. This has led to concerns about their ability to provide quality care for such a large population.
“We do very well in terms of getting people in,” said Green-Atchley. “But in terms of meeting everybody’s needs about how often they want to be seen for follow-up care, where they want to be seen for follow-up care, do they want to be on telehealth, do they want to be in person, all of that is challenging.”
An alternative to emergency rooms
Last year, as more people got help at CBHCs, another important metric dropped. State data showed a 32% decrease in people waiting in hospital emergency departments for inpatient psychiatric beds from January 2023 through the end of November — the most recent month for which data was available. Among MassHealth members the phenomenon, known as boarding, plummeted almost 60% in 2023.
One of state officials’ goals in spearheading the creation of CBHCs was to reduce emergency room visits for mental health care that doesn’t require emergency medical attention.
Riverside Community Care’s CBHC in Milford is another part of that effort. Sunlight streamed through the large windows of the newly renovated building as the center’s director, Julie Greiner-Ferris, pointed out ways the staff has tried to cultivate a welcoming environment.
There are clusters of lush plants, some of them brought in by clients. Photographs of the area and paintings by kids who use the center decorate the walls.
“We really wanted to bring the community into this building,” Greiner-Ferris said, “to make this a space that doesn’t feel blocked off or dreary or hidden from anybody.”
That same day, about 170 people were seen at the Milford center for various kinds of sessions, treatments and interventions. During one crisis intervention, staff helped family members of a person experiencing a mental health crisis resolve a disagreement over next steps in the person’s care.
“My hope is that this place is somewhere that people know that they can come when they need some kind of support and feel comfortable asking for it, feel responded to … and feel respected,” Greiner-Ferris said.
Limits on private insurance coverage
While the Riverside Community Care center’s services are in demand, its leaders said they’re concerned about people who can’t access all of the care available because their insurance plans don’t cover it.
Unlike MassHealth, which pays higher reimbursements to CBHCs than to some other mental health care providers because the centers are part of a state initiative, many private insurers don’t cover the full menu of CBHC services.
Kim Fisher, a vice president at Riverside Community Care, said the organization’s CBHCs in Milford and Norwood are hearing from privately insured people who are upset to find out they aren’t covered for everything.
“It feels very uncomfortable for providers,” Fisher said. “It’s almost as if we’re denying care to a segment of the population, and we feel really — uneasy would be, I think, the least [serious] word I could use in that particular circumstance. It feels not right and not even ethical to us.”
Some CBHCs provide privately-insured patients only those services covered under their health plans. Crisis interventions are fully covered for everyone. If an insurance plan doesn’t cover them, the state pays. In East Boston, North Suffolk officials said the CBHC foots the bill when someone is uninsured or underinsured, but they worry that is unsustainable.
A spokesperson for Blue Cross Blue Shield of Massachusetts — the state’s largest private health insurer — said the company is exploring additional coverage for CBHC services, along the lines of what MassHealth provides. Point32Health, which runs Harvard Pilgrim Health Care and Tufts Health Plan, said it reimburses CBHCs using the a traditional “fee-for-service” model, meaning it doesn’t provide the higher payments that fund the centers’ extra programs. The company said despite the limitations on coverage, its members are having a positive experience at the centers and are having fewer admissions to inpatient mental health units.
Rebecca Higgins is on MassHealth, so she’s covered for the full array of services at the East Boston center. She recently completed her treatment program and said she doesn’t know what she would have done without all the support she received.
“Being able to talk to somebody, being able to call somebody … with my depression, just to be able to open up,” Higgins said. “I can ask for anything here.”
Resources: If you need help for your mental health, including information on the community behavioral health center that covers your region, you can call or text the Massachusetts Behavioral Health Help Line at 833-773-2445. If you’re feeling suicidal or are experiencing another mental health crisis, call or text the national Suicide & Crisis Lifeline at 988.
This article was originally published on WBUR.org.
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