Long list of causes of emergency overcrowding with behavioral health patients

For those people who want to use health insurance, their insurance companies make it as difficult as possible to get care.

One thing insurers do is ask for time-consuming pre-authorizations for psychiatric admissions — a requirement almost entirely unique to psychiatry — in the hopes of discouraging clinicians from trying to facilitate access to these services. in study Several years ago, my colleagues and I found that doctors at Hasbro Children’s Hospital in Providence spend an average of 60 minutes on the phone with insurance representatives in order to hospitalize depressed and suicidal patients.

Another way insurers make it difficult to get care is by not keeping accurate lists of providers in their network and accepting new patients. I’ve done quite a few “mystery shopper” studies where my Harvard colleagues and I found many false numbers and full practices in insurance databases as well as practitioners who never answered phone calls.

Is it no wonder our emergency departments are overcrowded with patients waiting for hospital beds? Add the pain, suffering, and isolation caused by the pandemic, and the grim reality is that an already broken system is out of reach for many.

Dr. J. Wesley Boyd

Belair, Texas

The writer is a lecturer (part-time) in the Department of Global Health and Social Medicine at Harvard Medical School and Professor of Psychiatry and Medical Ethics at Baylor College of Medicine.

The key role of Physician Assistants should be recognized by the state

The behavioral health crisis is the second ongoing epidemic in our state. Policymakers should listen to the Massachusetts Health and Hospital Association, which found employment issues played a major role in the crisis.

There are more than 4,000 Physician Assistants practicing in all medical settings, including psychiatric settings, throughout Massachusetts. They have thousands of hours of behavioral health training and are often the first provider to assess a patient in crisis. However, currently protected areas cannot authorize the acceptance of healthy behaviour, restraint, and isolation.

Governor Baker acknowledged the key role PAs play in behavioral health care when he and the state Department of Mental Health issued a… Bulletin No. 22-02 in January 2022, which gives qualified protected areas the same authority as other qualified health care professionals to provide services under Massachusetts laws regulating mental health assessments and involuntary restraint. Previously this would have required a second examination by another physician or nurse practitioner, adding to the provider’s burden.

We call on the legislature to allow us to practice at the top of our licenses and help address the behavioral health crisis by ensuring that this emergency order does not fall into law.

Joshua Merson

legislative chair

Massachusetts Association of Physician Assistants

West Ford

The dominant medical model for diagnosis and medication fails a lot

I read Jesica Bartlett’s article on the front page with a mixture of anger and frustration, and I’m not even the parent of a child who desperately needs nurturing and is instead being stowed away. Instead, I am a clinical, psychoanalytic, family, and systems psychiatrist. I have watched, over the course of more than 30 years in practice, as mainstream mental health care has become increasingly dominated by a medical model for diagnosing and treating mental health distress as if it were suddenly descending on the brain of a child or adolescent, out of the historical context of complex experiences and relationships with important people in their lives.

Oftentimes, parents of young adults now waiting in emergency rooms have been seeking adequate help for their children for years. Treatment has increasingly focused on calculating the symptoms, with the goal of finding the right medication for the child, even children under 4 years of age. Meanwhile, commercial insurers have lowered reimbursement rates for mental health providers and forced them to jump bureaucratic hoops to get paid at all. As a result, many practitioners have decided to only take private paying patients, resulting in a tragic inequality in access to mental health care that has been growing for years in this state.

Since the beginning of the pandemic, commercial insurers have lowered reimbursement rates for family and couples therapy. Family and home interventions are critical to treating complex emotional distress in children and their families before it reaches a crisis point. The lack of community care is one of the driving forces behind the increasing need for psychiatric care at the hospital level. This crisis will require major investments and, perhaps most importantly, a major paradigm shift for pre-Prozac models of mental health care if things are to change.

Susan H Phillips


The writer has a private practice, holds a Ph.D. and is co-chair of the Psychodynamic Couple and Family Institute Program in New England.

Lawmakers must take action before them

Action before the legislature of Addressing barriers to mental health care He deals with some of the issues in Jessica Bartlett’s detailed article, such as getting into the emergency room. This law was also the subject of a November 2021, Boston Globe Editorial.

The Senate bill would use U.S. bailout funds for an online portal to facilitate the identification of health care professionals for psychiatric beds. This same money will also be used to hire and train behavioral health care professionals. The bill would require that a behavioral health professional be available during emergency room opening hours.

If there’s anything this pandemic has taught us, it’s the importance of quality health care at the right time, and that includes those who need mental health care. Passing bills like this would represent a fundamental improvement in meeting the mental health care needs of those who need it.

Helen Zazulac


In the face of high discounts and onerous rules, it sees few patients for free

Health insurance presents barriers to care for many families and physicians alike.

Many working families with private insurance enjoy a high deductible that requires thousands of dollars to be paid out of pocket before insurance pays for treatment. This prohibits some families struggling with the costs of housing, food and other basic needs from constantly seeking or receiving care.

MassHealth, the state’s Medicaid program, requires physicians to complete a Certification of Children’s and Teens’ Needs and Strengths every two years in order to file bills, another burdensome hurdle for mental health providers.

As an essentially retired physician, I have chosen to offer free treatment to a few teens who probably will not receive consistent care because their families cannot afford the deductible and the current CANS re-accreditation process is not acceptable.

Perhaps insurance providers should be required to eliminate high deductibles for mental health care and CANS re-accreditation should be extended every four years. Addressing these barriers can increase access to mental health care for young people at risk.

Sally Cheek

Jamaica Plain

The author is a licensed independent clinical social worker.