COMMENTARY BY REP. LIZ MALIA and SEN. JOHN F. KEENAN —
In May, three people were brought into the Quincy Medical Center emergency room. One had suffered a brain hematoma, the second a heart attack, the third a severely fractured ankle.
Each patient was stabilized, and then, due to the severity of the injuries, transferred to a partnering Boston hospital. All three had private insurance, but no phone calls to insurance companies were required. The average length of their emergency room stay was between two and three hours.
During that same time period, three people suffering from acute mental health conditions were brought into the same emergency room. Two had attempted suicide; the third was in the midst of a psychotic episode.
Those patients spent 70, 108, and 78 hours, respectively, on an emergency room gurney while doctors and emergency mental health service providers negotiated with insurance companies and then struggled to find a bed in an appropriate mental health facility.
The suicidal patient who had waited the longest eventually was just discharged straight from the hospital, with no follow-up care scheduled.
These incidents do not represent the typical experience of an emergency room patient at Quincy Medical Center, or any other community hospital.
But the boarding of mental health patients within hospital emergency rooms for 24, 48, and even 72 hours or more is a growing problem.
At a hearing on this issue held by the Joint Committee on Mental Health and Substance Abuse, emergency room physicians and hospital executives testified about the growing amount of time and resources mental health patients consume during their stays in emergency rooms.
A survey conducted by the Massachusetts College of Emergency Physicians on April 11 found 180 mental health patients being boarded in emergency rooms across the state. Of those patients, 40 percent had been waiting for services for more than 24 hours. Five of those patients had been waiting five days for treatment.
It’s becoming clear that, despite state and federal statutes to the contrary, there remains a stark difference between how physically ill and mentally ill patients receive treatment in Massachusetts. Or as Dr. Luis Lobón, of the Cambridge Health Alliance, put it during his testimony: mental health parity does not exist in Massachusetts.
There is no one reason for this failure.
We agree with Marylou Sudders, the well-respected former Massachusetts Department of Mental Health commissioner that the boarding problem was caused by the failure of the system as a whole.
The Commonwealth does bear some responsibility, as budget cuts have forced the closure of 200 state hospital beds, which then creates backups elsewhere in the system. However, of greater concern is the apparent failure of our state’s public and private insurance plans to meet their new obligations under federal and state parity laws.
Diabetic patients aren’t kept on gurneys in hallways over a weekend because the hospital can’t get authorization for treatment from insurance companies that turn off the lights Friday at 5 p.m. And oncology units aren’t closing because they’re losing money. But these are the realities for mental health services.
Failure to properly treat mental illness comes with a staggering financial cost. As a society, we pay for it through increased demands on our police, our courts, and our jails.
Insurance companies may balk at the upfront costs, but they pay in the end, as studies have consistently shown that consumers with mental illnesses also have higher average medical costs. In addition, hospitals recover from health insurance companies the money they lose through boarding mental health patients for days at a time by shifting costs elsewhere.
Efforts are ongoing to reconstruct our state’s health care system under a global payments model. It is important that this new model also include revamping our state’s mental health system. Individuals who are suicidal, schizophrenic, psychotic, or even homicidal need and deserve proper medical treatment, just like someone suffering from a heart attack, stroke, or broken hip. We need to make mental health parity a reality.
Rep. Liz Malia, and Sen. John F. Keenan, co-chairs, Joint Committee on Mental Health and Substance Abuse
Each patient was stabilized, and then, due to the severity of the injuries, transferred to a partnering Boston hospital. All three had private insurance, but no phone calls to insurance companies were required. The average length of their emergency room stay was between two and three hours.
During that same time period, three people suffering from acute mental health conditions were brought into the same emergency room. Two had attempted suicide; the third was in the midst of a psychotic episode.
Those patients spent 70, 108, and 78 hours, respectively, on an emergency room gurney while doctors and emergency mental health service providers negotiated with insurance companies and then struggled to find a bed in an appropriate mental health facility.
The suicidal patient who had waited the longest eventually was just discharged straight from the hospital, with no follow-up care scheduled.
These incidents do not represent the typical experience of an emergency room patient at Quincy Medical Center, or any other community hospital.
But the boarding of mental health patients within hospital emergency rooms for 24, 48, and even 72 hours or more is a growing problem.
At a hearing on this issue held by the Joint Committee on Mental Health and Substance Abuse, emergency room physicians and hospital executives testified about the growing amount of time and resources mental health patients consume during their stays in emergency rooms.
A survey conducted by the Massachusetts College of Emergency Physicians on April 11 found 180 mental health patients being boarded in emergency rooms across the state. Of those patients, 40 percent had been waiting for services for more than 24 hours. Five of those patients had been waiting five days for treatment.
It’s becoming clear that, despite state and federal statutes to the contrary, there remains a stark difference between how physically ill and mentally ill patients receive treatment in Massachusetts. Or as Dr. Luis Lobón, of the Cambridge Health Alliance, put it during his testimony: mental health parity does not exist in Massachusetts.
There is no one reason for this failure.
We agree with Marylou Sudders, the well-respected former Massachusetts Department of Mental Health commissioner that the boarding problem was caused by the failure of the system as a whole.
The Commonwealth does bear some responsibility, as budget cuts have forced the closure of 200 state hospital beds, which then creates backups elsewhere in the system. However, of greater concern is the apparent failure of our state’s public and private insurance plans to meet their new obligations under federal and state parity laws.
Diabetic patients aren’t kept on gurneys in hallways over a weekend because the hospital can’t get authorization for treatment from insurance companies that turn off the lights Friday at 5 p.m. And oncology units aren’t closing because they’re losing money. But these are the realities for mental health services.
Failure to properly treat mental illness comes with a staggering financial cost. As a society, we pay for it through increased demands on our police, our courts, and our jails.
Insurance companies may balk at the upfront costs, but they pay in the end, as studies have consistently shown that consumers with mental illnesses also have higher average medical costs. In addition, hospitals recover from health insurance companies the money they lose through boarding mental health patients for days at a time by shifting costs elsewhere.
Efforts are ongoing to reconstruct our state’s health care system under a global payments model. It is important that this new model also include revamping our state’s mental health system. Individuals who are suicidal, schizophrenic, psychotic, or even homicidal need and deserve proper medical treatment, just like someone suffering from a heart attack, stroke, or broken hip. We need to make mental health parity a reality.
Rep. Liz Malia, and Sen. John F. Keenan, co-chairs, Joint Committee on Mental Health and Substance Abuse
