The following op-ed was published in The Republican newspaper of Springfield on February 23, 2023.
By Jalil A. Johnson & Lindsay Morin Ciepiela | CHD
For too long, in Massachusetts and across America, our system of responding to an individual or family crisis in behavioral health has been a crisis in itself. People experiencing crisis most often faced two highly undesirable options: Being stuck in a hospital emergency room for hours, days or — appallingly — weeks; or being deemed “not sick enough” to require inpatient hospitalization, and usually returned to the community with the mental-health equivalent of a Band Aid.
The stubbornness of the problem was not for lack of effort or ability on the part of those trying to solve it. But like most complex problems, resources available for solutions didn’t line up perfectly with the need, and as a result, too many people and too many lives slipped through the cracks.
A little more than a month ago, we were part of a team that launched the new Community Behavioral Health Center model in Massachusetts, one that we call “Gateway” here at the Center for Human Development (CHD), and one of only two in the commonwealth that opened all its doors on schedule. We’re thrilled to say that — so far — the new model of crisis and supportive services is working. People we’ve served and staff, as well as hospitals, police departments and schools, have raved about the quality of care and excellent access to treatment people are receiving. In the decades we’ve spent working in healthcare, in various settings, we haven’t experienced anything like this before. It is one of the greatest shifts we’ve seen towards improving quality and access.
This good news is long overdue. It’s no secret that there is great demand for these services everywhere: Providers have been stretched for years, and people and families have struggled to get care as a result. Meanwhile, crisis services have borne the brunt of community frustration–many prescribers, clinicians and community partners lost most or all of their confidence in crisis response. For many of us, the guideline became: “If you want quality care for your patients in crisis, take care of them yourself if you can, and avoid using crisis services when possible.”
Our experience was that people seeking help for a behavioral health crisis in the old system would usually end up into one of two categories: severe enough to require hospitalization, or not severe enough to require hospitalization. Those deemed “not sick enough” would return to the community, ostensibly to wait until they became severe. There really was no accessible, in-between level of care – somewhere between the hospital and the Band Aid.
Far too many cases ended up in emergency rooms for lack of a better alternative. Community-based crisis teams weren’t typically resourced to triage and treat certain problems, like substance dependence or psychosis, while ERs were full of people who were either experiencing severe symptoms of mental illness, or did not need to be there at all.
The new system is a breath of fresh air. It offers providers a menu of options to effectively treat adults and children in the community. Mobile crisis services meet people where they are, outside the clinical setting; crisis stabilization provides up to seven days of high-level care in a comfortable, home-like environment; and an outpatient clinic provides urgent care and even same-day access to psychiatry, therapists, case management, and wide-ranging care for substance-misuse disorders.
We’ve finally equipped our outpatient crisis teams to triage and often treat more complex issues in the community. One of our hospital partners expressed thanks, telling us that in the first two weeks, every person that our program had sent to the emergency room truly needed that inpatient level of care. Because of strong collaboration and tools to maintain stability in the community, we are able to bridge gaps in the system and keep people out of ERs and hospitals who don’t need to be there.
Consolidating this spectrum of services (mostly) under one roof has paid big dividends for quality of care and staff satisfaction. Same-day, close-at-hand access to counseling, prescribers, and residential level care is relatively unheard-of in behavioral health. In practice, this means clinical staff can focus on what they do best: care for people at the highest level of their licensure. The program is still young, only 5 weeks old, but we foresee this leading to less burnout and better staff retention.
And caregivers want to be part of the new model: to join in the work putting this important change into action. Experienced providers and new grads alike are feeling the exhilaration of test-piloting a sophisticated new system, and we feel lucky to be on the cutting edge. People are elated to finally be able to take care of people in the way we were trained to do.
The greatest rewards are responses from families of kids we’re helping, including one mom who hugged our staff, saying: “Thank you for just giving us somewhere to go.” Families who have struggled for years to access services are seeing near-immediate changes—lights are going on and doors are opening. We’re also able to link people with the broader spectrum of our services, helping them find their way to longer-term change.
Jalil A. Johnson is vice president of medical services at the Center for Human Development; Lindsay Morin Ciepiela is vice president of clinical services at the Center for Human Development. They led the design and implementation of CHD’s Gateway Community Behavioral Health Center in Chicopee.