The supply-demand mismatch in behavioral health frequently prevents patients across the country from getting the help they need. Oftentimes, there just aren’t enough providers to keep up with the demand.
Fixing that problem is easier said than done, but the state of Massachusetts is working on it with its Expedited Psychiatric Inpatient Admissions initiative (EPIA). While the program is a creative fix designed to improve the behavioral health care delivery process, providers say it’s only a small piece of a larger, nationwide puzzle, which needs to be solved sooner rather than later.
“The reason this program is even needed … is because we don’t have the ability to get people the care that they need when they need it,” Steve Winn — CEO of Massachusetts-based Behavioral Health Network (BHN) — recently told Behavioral Health Business. “The problem is we don’t have adequate resources in behavioral health.”
Developed by the Massachusetts Department of Mental Health (DMH) and first implemented in January 2018, EPIA was designed to help Massachusettsans with behavioral health issues access appropriate treatment quicker. Specifically, it’s targeted toward patients with significant behavioral health needs who end up in the emergency department (ED) for care.
That situation is more common than one might think: Nationwide, one in eight ED visits is related to a behavioral health issue, according to the Association of American Medical Colleges. Oftentimes, patients don’t know where else to go for behavioral health help — but EDs rarely have the specialized personnel to treat them.
As such, patients in need of inpatient behavioral health care often sit in the ED for days or even weeks waiting for behavioral beds to open up. But that’s no longer the case in Massachusetts thanks to EPIA.
The program created a standardized escalation protocol to help place patients in psychiatric beds faster. Essentially, the longer a patient waits in the ED for a psychiatric admission, the more people jump in to help with the bed search.
Among other rules, EPIA requires hospitals to expedite a patient’s psychiatric placement after they’ve been in the ED for 60 hours. At that point, they turn to the patient’s insurance carrier for help. If the patient still hasn’t been placed after 96 hours, DMH steps in to help.
Hallie-Beth Hollister, a counselor at BHN, has seen EPIA’s impact firsthand. She and a small group of her colleagues are responsible for helping find behavioral beds for psychiatric patients.
She likened EPIA’s escalation process to extra muscles. When insurers or the state get involved, the challenging bed-search process becomes a little bit easier, she said.
“It’s that extra push [after] we’ve already exhausted our regular workflow and our advocacy efforts,” Hollister told BHB.
Based in Western Massachusetts, BHN is a regional provider of comprehensive behavioral health treatment. Its services and programs include a small crisis arm, and, within that, BHN has an even smaller bed-search team, which is responsible for helping a handful of area emergency departments find timely placement for psychiatric patients.
Overall, BHN’s bed-search team works to avoid institutionalizing patients whenever possible, Hollister told BHB. However, they consider the option when community resources are unavailable or inappropriate.
While the number of patients BHN directs to behavioral hospitals is small, EPIA’s overall impact on the organization is significant, according to Hollister.
“There are times when DMH has flagged someone as appropriate for escalation and will step in with that little extra push to try to get someone placed,” she said.
In fact, when DMH gets involved — be it to help BHN or another bed-search team — it typically gets patients placed in an average of two days.
The program is necessary in part because of the nationwide shortage of behavioral health providers, which leads to frequent delays in care. Still, that’s not an acceptable excuse in Winn’s eyes.
“There are very few medical specialties where if you need something, you have to go to the ER and just sit there and wait for days and days and days before you can get a consult or the care you need,” Winn told BHB. “In part because we don’t have adequate resources in the community and in part because we don’t have enough of the acute inpatient [behavioral] beds that we need, we have people who go to the ED, we determine their needs, and then we can’t connect them with the care that they need.”
While Winn is thankful for the EPIA program, he called it a band-aid for a bigger problem: the lack of adequate resources in behavioral health.
“The real question is: Why do we keep getting these cuts so that we need a band-aid?” Winn said. “How do we stop the problem from happening before we need the band-aid?”
States and communities across the country are currently working to troubleshoot that problem. Take Massachusetts, where BHN is located, for example.
In addition to the EPIA, the state has improved funding for emergency services teams and is working with providers to brainstorm community resources that would prevent people from going to the ED for behavioral issues to begin with.
“Similarly, there are some hospitals locally that are building facilities to include more psychiatric beds, so that will also help,” Winn said. “So in Massachusetts, there’s a lot of movement.”
In the end, though, fixing the larger supply-demand mismatch in behavioral health will likely come down to providing more funding, federal attention and tools for behavioral health providers.
“The root of the problem is that we don’t have adequate resources in behavioral health to prevent people from getting to that point where they need inpatient care or to have the inpatient beds readily available when they need them,” Winn said.
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