Mental illness costs Massachusetts hundreds of millions of dollars for intervention and treatment and billions more in lost work and economic benefits.
But now the state, which has been both castigated and praised for its treatment of mental illness and behavioral disorders, is looking to move forward with newly adopted reforms designed to integrate mental health with other forms of treatment, reduce stigma and return patients to productive lives.
An $83 million spending package would implement a number of policy reforms, including a redesigned Adult Community Clinical Services Program to deliver treatment and support options for people suffering from behavioral problems.
“It’s really a breakthrough,” said Cheri Andes, executive director of the National Association for Mental Health’s Massachusetts affiliate.
The new direction would also include a mandate to coordinate the overall health care of those with serious mental health disorders.
And the initiative, which would be married to MassHealth, would also include $62 million to support community mental health programs.
By considering mental and physical health care as part of a whole and placing more emphasis on community-based programs, Andes said the new direction could ultimately lessen the need for institutional care and with it the stigma that often comes with treatment for mental illness.
“It could also ease the stigma that people place on themselves internally,” Andes said.
Nearly 20 percent of the U.S. population is thought to suffer from some form of mental illness, according to some estimates. And it could be getting worse. The rate of depression among young people rose from 5.9 percent to 8.2 percent in 2015, according to Mental Health America.
The state’s Department of Mental Health budget rings in at nearly $800 million in 2018, and total hospitalization costs for mental illness in the Bay State exceed $250 million annually, according to the Healthcare Cost and Utilization Project.
But that’s nothing compared to the cost of mental illness in the form of lost productivity and absenteeism, according to studies. Serious mental illness is responsible for $193 billion in lost earnings nationally each year, according to estimates from the National Alliance on Mental Illness.
In Massachusetts alone, the economic impact of mental illness is thought to approach $3 billion per year. And that’s in a state that ranks high in some national surveys when it comes to mental health care.
The Bay State is ranked first in the U.S. overall by Mental Health America, based on 15 measures including mental illness prevalence and access to care.
It has 49 mental health providers for every 10,000 residents, well above the national average of 19.9 per 10,000, according to a study by the Robert Wood Johnson Foundation.
But there are also serious problems that need to be addressed, say many observers. A health care system that has long prioritized curing physical ailments over mental ones is a major issue, they say.
“If you walked into an emergency room and discovered that you had cancer, it wouldn’t be long before you were admitted to Dana Farber or Brigham and Women’s,” said Phil Shea, president of Community Counseling of Bristol County. “If you presented with a serious mental illness, you might sit hours, days, even weeks before a bed opened up.”
Shortages of inpatient beds and psychiatrists, as well as the number of practitioners exiting the field or limiting their practice to cash-only customers, have made quality care harder to find.
A prizewinning Boston Globe Spotlight Team series last year called attention to violence and murders involving the mentally ill in Massachusetts and highlighted San Antonio, Texas’s innovative mental health care model.
Money has also long been a problem for Massachusetts mental health care.
Until recently, a long progression of of state budget cuts threatened to undermine mental health care in the state to the point where per-capita spending on mental health fell well below the national average. Under the fiscal 2019 budget, mental health funding will increase by about $90 million, its first raise of that magnitude in years.
“The years 2009-2014 were years of reduction in the state budget that decreased mental health funding,” said Danna Mauch, president of the Massachusetts Association for Mental Health. “The increases this year will fill in the gaps and intensify services that had been watered down in previous years.”
That injection of funds likely will create new opportunities for workers in all phases of mental health care, Mauch said.
“The challenge will be filling all those positions,” she said.
One program that stands to benefit from the new funding will be Shea’s CCBC, which will increase from 10 to 20 the clinical staff of a program it administers for the Department of Mental Health.
But the agency will also take on the task of coordinating mental and physical health care for about 1,200 patients under the ACCS initiative.
Advocates say utilization also needs to be looked at.
Hospital stays for serious mental illness tend to be substantially longer for Massachusetts patients than the national average. The average hospital stay for a patient with schizophrenia in 2014 was nearly a third longer for Massachusetts patients compared with other states, a review by the Healthcare Cost Utilization Project found.
The average cost of that hospitalization was $15,000 compared with less than the $10,000 average for all states.
Adding to the state’s mental health care costs was the bill rung up by state prison inmates previously diagnosed with serious mental illness. That came to another $323 million in 2015.
Another chronic problem, say mental health advocates, are long waits for care experienced by many patients and the number of patients lacking insurance coverage for mental health issues.
“Despite a greater per capita supply of mental health providers and a lower rate of uninsured adults and children in Massachusetts relative to other states, individuals and providers across Massachusetts report delays and wait lists associated with accessing outpatient mental health services,” according to a study completed last year for Blue Cross of Massachusetts.
Waiting was longest for patients with the state’s MassHealth insurance plan, in some cases as long as 6-9 months.
The report cited insufficient reimbursement rates and red tape for frustrating providers and prompting some to opt out of the plan.
Recommendations cited by stakeholders include reforming payment systems, reducing administrative burdens attached to insurance coverage and overhauling intake assessments.