THE VOICE

Closure of two Steward hospitals may mean the loss of 70 inpatient psychiatric beds

The key to addressing the delayed movement between crisis, inpatient, and continuing care is investment in community services.

The following op-ed piece by Vinfen President & CEO Jean Yang was published on September 3, 2024, in the Opinion section of The Boston Globe.

Steward Health Care’s closure of Carney Hospital and Nashoba Valley Medical Center last week hurts local patients, who will have to travel longer distances for care. The closures will also negatively impact people in need of mental health services.

Steward operates 5 percent of the state’s inpatient psychiatric beds. Carney alone had 50 beds while Nashoba operated 20. While that may not sound like much, in a system already under-resourced, every bed is essential. Hospital-based services are part of a larger mental health system, a service continuum, where shortages at one service level lead to disruptions and access problems at others.

Strengthening the mental health safety net has been a focus of state leaders in recent years. In 2023, Massachusetts opened 25 Community Behavioral Health Centers across the state operated by nonprofit mental health organizations, including Vinfen. These centers offer a standard set of services including outpatient mental health, crisis intervention, and short-term crisis stabilization beds in a single location. This model has proved successful in preventing mental health cases from escalating and in diverting patients from hospital emergency departments.

Additional state investments have increased the number of inpatient psychiatric beds. Yet in July, there was a weekly average of 300 individuals experiencing a mental health crisis who were “boarding” in emergency departments across the state—meaning that individuals at one of the lowest points in their lives, desperately seeking care and safety, were stuck, waiting, often alone, in hallways or hospital rooms.

Although the number of boarders is half what it was three years ago, it is still too high. The closures of beds at Carney and Nashoba Valley hospitals takes the state in the wrong direction and will certainly make the boarding problem worse. Before the end of the legislative session, the House passed its version of a health care oversight bill that would have given the state additional powers to determine the impact of bed closures before closures were approved. This bill unfortunately died in conference committee as it could not be reconciled before the end of formal session.

Emergency departments are not the only places where boarders are waiting for services. On any given day, there are around 200 patients in acute or long-term psychiatric hospitals who are approved for discharge but unable to leave because they are waiting for an opening in the community-based service system. Although Community Behavioral Health Centers have been an important front door to the mental health system, those living with serious mental health conditions require a coordinated, comprehensive set of housing and recovery support services.

Comprehensive community services, such as Adult Community Clinical Services and Program of Assertive Community Treatment, do exist. These are 24/7 services provided by nonprofit organizations that employ multidisciplinary teams of licensed mental health clinicians, nurses, peer specialists, housing coordinators, and substance use counselors. The teams provide clinical interventions, encourage peer and family support to facilitate engagement, support functioning, and maximize symptom self-management.

Serving around 24,000 adults in Massachusetts, these programs have demonstrated that, with appropriate support, people can recover, strengthen family connections, find jobs, and pursue education, all while learning to manage their mental health conditions. They are also less likely to return to the hospital with a relapse of severe mental health symptoms. Finally, these programs are significantly less costly than psychiatric hospitalization.

The key to addressing the delayed movement between crisis, inpatient, and continuing care is investment in community services. This investment will provide the relief needed to the boarding crisis and costly inpatient discharge delays. The Commonwealth needs to direct more resources to community-based services. This is where the demand is highest, the waitlists are the longest, and where workers are paid the least — significantly less than their hospital counterparts and often 30 percent less than their state employee counterparts working in similar programs. The result is that the nonprofit organizations that provide these services experience staffing vacancies that threaten the effectiveness of the services and put staff at risk.

The Commonwealth has made important strides in recent years, and we commend Governor Maura Healey and state leaders for their efforts to keep five Steward hospitals open. Adequately financing and expanding these community-based treatment and recovery support services are the keys to alleviating the backup in hospitals and in emergency departments: Doing so will allow patients in hospitals to be safely discharged to supportive services and will allow those waiting in emergency departments to move to inpatient services. This suite of services has proven highly effective at supporting individuals in their own communities, which is a far more humane and cost-effective way of providing care for those with serious mental health conditions.

Vinfen CEO Joins Local Business Leaders for Legislative Talk 

Vinfen President/CEO Jean Yang joined members of The New England Council in attending a fireside chat with Congresswoman Lori Trahan at Boston’s Hampshire House on September 5. The Council's Capitol Hill Report breakfast event gathered around 130 attendees, all members of the regional business association, to engage with Congresswoman Lori Trahan in a crucial discussion on pressing legislative matters. As part of an ongoing series, this event allowed members to stay informed on issues in Congress that are likely to impact the New England region.  

The conversation between Congresswoman Trahan and Ira Golden of Lantheus, the event's sponsor, offered insights into the congressional agenda leading up to the election. Topics such as telehealth, housing, and higher education were highlighted as key focus areas, and the event underscored the collaborative spirit of the New England Council, facilitating direct dialogue between its members and influential legislators.