Mental Health Clinics

‘Like any other kind of health issue’: Advocates see Gov. Charlie Baker’s bill as step forward for mental health services in Massachusetts

When Fran Hutchinson last testified about mental health and insurance at the State House, people walked up to her and said she was brave for sharing details about her treatment.

It wasn’t brave, Hutchinson said. She said her mental health treatment — and the struggle to get adequate services — seemed as normal as discussing treatment for her diabetes or high blood pressure.

As the New Bedford woman testified on Tuesday, she told lawmakers on the Joint Committee on Health Care Financing that the provisions increasing spending and services for behavioral health marked a step toward reducing the lingering stigma of mental illness and behavioral health services.

“I’d like to see a day where we don’t need to be courageous any more,” said Hutchinson, president of the Bristol County chapter of the Massachusetts Senior Action Council, “when it’s no different than talking about my diabetes or my blood pressure, and nobody needs to be courages about it.”

Gov. Charlie Baker’s health care bill calls for increased spending on primary and behavioral health care, restrictions on certain drug price increases, making urgent care clinics offer behavioral health services and making tele-health coverable by insurance, among other provisions that aim to boost mental health resources.

Gov. Charlie Baker greets members of the Massachusetts Senior Action Council before a hearing by the Joint Committee on Health Care Financing. Baker testified in favor of his bill that would boost spending on primary and behavioral health care.

Between 2013 and 2017, about 232,000 people age 18 or older in Massachusetts experienced serious thoughts of suicide each year, according to a 2017 report on behavioral health by the Substance Abuse and Mental Health Services Administration.

Residents of all ages have sought mental health treatment within the state only to find that insurance companies do not have accurate lists of providers, many psychologists and psychiatrists either are no longer accepting new patients or do not accept insurance and appointments over the phone aren’t being covered by some insurance plans.

While health care spending grew 3.1% from 2017 to 2018, even those with insurance are paying more in copays and premiums than they used to.

If the bill is enacted, Hutchinson said she would be able to afford psychiatric appointments over the phone with her doctor on the Cape. Her last insurance provider covered the service, but her current one does not.

“It was like being in the same room,” Hutchinson told lawmakers Tuesday afternoon. “There was no difference at all in treatment.”

Baker noted on Tuesday that telehealth was developed in Massachusetts decades earlier, but the state is one of last to embrace the practice.

“The fact that we’re not particularly aggressive about incorporating it or progressing it is bizarre,” said Baker, who testified alongside Health and Human Services Secretary MaryLou Sudders. “This is a really significant opportunity to do something that would increase access and probably reduce cost too for a lot of services.”

The bill also calls for rate increases for insurers to pay behavioral health providers. About half of mental health providers in the region do not accept insurance, with many citing problems with insurance companies retroactively denying claims after paying the practitioner, a process known as a “clawback.”

At the center of Baker’s health care bill is the requirement that insurers and providers increased their spending on primary and behavioral health care by 30% over three years.

That increase is a share of the existing 3.6% health care cost growth benchmark set by the state’s Health Policy Commission, meaning the overall spending increase comes out to under 2% over three years.

The insurers and providers would have to report their progress every year to state health policy agencies and, if they fail to meet their targets, face performance improvement plans.

Sen. Julian Cyr, a Truro Democrat, asked Baker and Sudders how they would increase cultural competency in the workforce. Cyr, an openly gay senator, said having an LGBTQ mental health provider has made a big difference for him.

Sudders said she believes the first step is better investing in primary and behavioral health care to draw a larger, more diverse pool of providers.

“In order for that to happen, we have to say it’s a value to us in the commonwealth," Sudders said, “because who’s going into a profession that’s not valued?”

Lori Pellegrini, president of the Massachusetts Association of Health Plans, praised the bill’s measures to prohibit “surprise” medical fees and facility fees, tackle certain drug price increases and invest in primary and behavioral health care.

“The effort to really focus on primary care and behavioral health is really important as we think both of those professions and both of the services they provide are really the backbone of the health care system,” Pellegrini said.

The Republican governor’s bill received favorable responses from Democrats on the committee, including Rep. and ER doctor Jon Santiago, Cyr and Sen. Harriette Chandler.

“I commend you for your sensitivity. I don’t think I’ve ever spoken like this at a health care financing hearing,” said Chandler, vice chair of the committee and the former House chair of the committee when she was a state representative.

Baker took the response as a sign that the health care bill has a strong chance of landing on his desk later this year.

“I came out of that feeling like we have a pretty good chance of seeing something happen before the end of the session,” he told reporters after he testified alongside Sudders.

Not everyone was satisfied with the legislation. Sen. Barry Finegold, an Andover Democrat, later testified saying he wouldn’t support the bill if the funding doesn’t help community hospitals, according to the State House News Service.

“This is just not about finances, it’s about economic and racial justice...and while we’re debating many solutions, I want to be on record saying that a pot of money is not acceptable. To address this problem, we need a steady stream of funding -- either a floor for commercial reimbursement rates, or an increase of Medicaid reimbursements,” Finegold said.

Hutchinson, who supports the bill, told MassLive she’s been seeking mental health services for three decades. Sometimes, she said, that meant sifting through outdated lists of providers. When she called them, she learned most weren’t accepting new patients, contrary to what the online list says, and some had even moved or retired.

Hutchinson found her current psychiatrist after calling five providers who appeared active. He was the only one who called her back.

“The bad news is he’s retiring in May, so I start all over again,” she testified. Hutchinson praised the provision of authorizing psychiatric nurses to prescribe medication, noting it would create more treatment options for patients like her.

If the bill becomes law, Hutchinson told MassLive she hopes that behavioral health services will not only become more accessible, but that they will be treated as normal and important, just like other forms of medical care.

“He’s treating it more like any other kind of health issue than something all on its own,” she said of Baker. “I want to see the day come when nobody needs to be considered courageous for talking about something that’s no different than talking about blood pressure or diabetes.”

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As the mental health crisis grows, Puerto Ricans need long-term care

 © Getty Images As the mental health crisis grows, Puerto Ricans need long-term care

I remember distinctly one of my summer visits to Puerto Rico with my family when I was a teenager. We were sitting at the dining room table having lunch, and in mid-bite, I felt the ground rumble.

I thought it was the subway, forgetting for a moment that I was in Puerto Rico and not New York City. Everyone ran out the door, and as my uncle quickly returned to pull me outside, I saw the terror in his face.

I recall that terror as I think about my family and friends in Puerto Rico now. Still stricken by the recent earthquake and its aftershocks, more than 8,000 residents are reportedly living in 40 shelters; neighborhoods and a school were destroyed, and thousands are sleeping in tents or inside cars.

For all these reasons, Puerto Ricans are at risk for mental trauma and PTSD. Two years ago, after Hurricane Maria, I witnessed firsthand the devastating impact a natural disaster can have on mental health.

I spent two weeks in Puerto Rico with a team from the Health Department as part of New York City's hurricane relief missions. I remember the painful stories of children who fearfully clung to their parents when the sky grew cloudy, of Puerto Rican veterans who were reminded of war upon hearing helicopters surveying the damage.

Puerto Rico's connection to New York City is so profound. We will always be ready to support the Island.

Today, New York City First Lady Chirlane McCray announced the City is sending nine mental health experts to Puerto Rico to provide crisis counseling, emotional support, connections to mental health services, and help with coping with stressful events. This is in addition to the staff already on the ground, which includes health professionals, building inspectors, engineers, and emergency managers to support the cities with the worst damage. Governor Cuomo also pledged to send extra mental health experts to Puerto Rico as part of the State's emergency response.

But we need consistent support from the federal government. Pressured by Democratic leaders last week, the Trump administration declared that "a major disaster exists" in Puerto Rico, and finally approved the $8.2 billion already owed in aid, plus an additional $8.3 billion funding notice. On Monday, Senator Chuck Schumer also rightly called for Health and Human Services to release millions more in aid specifically for mental health providers and outpatient services.

The emergency aid will provide vital support, but temporary assistance is not nearly enough. To address this unprecedented mental health crisis, Puerto Rico needs a stronger Medicaid program.

Approximately 1.4 million low-income Puerto Ricans depend on Medicaid, and it is the largest payer for mental health services in the United States. Medicaid covers inpatient and outpatient mental health services, counseling, case management, supportive housing, and prescription medications.

A key part of the problem is that Puerto Rico receives only a fixed block grant of funding for Medicaid each year that is grossly inadequate to cover the cost of health care for its enrollees.

Last month, Republican and Democratic members of Congress unveiled a massive budget deal, which included $12 billion in Medicaid for Puerto Rico over four years - enough to cover the Island's expenses. But in a devastating blow, President Trump intervened and reportedly demanded it is slashed to $5.7 billion over two years.

With another funding cliff looming in two years under the new agreement, Puerto Rico may continue to lack the certainty it needs to commit to long-term investment in Medicaid. Ultimately Congress should agree on a steady infusion of Medicaid funding for Puerto Rico to be on par with the mainland states.

No matter what the federal government does, New Yorkers will do everything possible to support Puerto Rico during this mental health crisis, so those remaining on the Island-either by choice or lack thereof - have the same opportunity and security as we do.

Oxiris Barbot is New York City's Health commissioner.

Terri White out as head of Oklahoma Department of Mental Health and Substance Abuse Services

OKLHAOMA CITY — Terri White is resigning as head of the Oklahoma Department of Mental Health and Substance Abuse Services, it was announced Tuesday.

Her last day is Saturday.

She led the agency for 13 years. She joined the agency in 2001, holding various roles before being named commissioner in 2007.

White is the longest-serving current commissioner of mental health in the nation.

She also served as Oklahoma secretary of health from 2009 to 2011 under former Gov. Brad Henry.

The Edmond native holds master’s and bachelor’s degrees in social work, both from the University of Oklahoma.

Carrie Slatton-Hodges, the agency’s deputy commissioner for treatment and recovery services, will serve as interim commissioner.

Under legislation passed last session, Gov. Kevin Stitt will appoint White’s replacement.

“We appreciate the leadership Terri White has provided in addressing and promoting mental health across Oklahoma and wish her the best as she enters this new chapter,” Stitt said.

“I have requested for Carrie to immediately step in as the interim commissioner to ensure consistency and stability in delivering the vital mission of the Oklahoma Department of Mental Health and Substance Abuse Services.”