Lawmakers in Massachusetts are debating bills that seek to reduce boarding of behavioral health patients in hospital emergency departments and to keep them from being housed in correctional facilities.
Those measures and a few others were discussed at a joint Senate-House of Representatives hearing Monday.
Two proposals stem from the recommendations offered in a report from a Mental Health Advisory Committee (PDF) created by the Massachusetts Legislature in 2012, which then expanded its scope in 2013.
That year, Gov. Deval Patrick closed 124 of the 169 beds at Taunton (Mass.) State Hospital. The administration then said it was to reinvest in community-based mental health services.
Massachusetts Nurses Association spokesman David Schildmeier said the move aggravated an ongoing mental health crisis in the state.
“There's been a crisis in mental healthcare in Massachusetts with people waiting for days and months for a bed,” Schildmeier said.
He added that the MNA supports both bills recommended in the report.
These include one measure that calls for a two-year pilot program to create a special temporary facility at the Taunton hospital where patients being boarded in an ED can remain until a behavioral health bed can be found.
The number of psychiatric patients using ED services has grown in recent years as state and city budgets slash community and public mental health clinics.
“This is a national problem and this could be a model for the rest of the country if it works,” Schildmeier said. “Instead of boarding them in an ED where they get no care and draw attention from other patients, they would get care at a specialized facility and have their condition addressed until a bed becomes available.”
The other bill calls for the state department of mental health to create two units for “difficult to manage” patients.
While most patients undergoing treatment for behavioral issues are not violent, Schildmeier said a minority are, and they are frequently “shifted from facility to facility, wreaking havoc wherever they go.”
The MNA noted in a news release that these patients often end being “housed in the corrections system where their conditions go untreated or are exacerbated.”
Ellen Farley, a nurse at Taunton and a member of the MNA board, testified at the hearing (PDF) that her colleagues have suffered broken collar bones, “whiplash injury” from being pulled by the hair with great force, bruised ribs and a broken jaw. One was punched in the face after narrowly avoiding being hit in the head with a chair.
“While we believe individuals with severe behavioral health needs deserve the best possible care, the fact remains that there are people who fall outside the usual parameters of recovery,” Farley testified. “Despite the best efforts of treatment, these individuals pose a risk to others due to highly assaultive and violent behaviors.”
Despite being promised the “support they need,” Farley said staff has been cut and she represents a “workforce that no longer feels safe in our work environment.”
Schildmeier thought the prospect for passing the bills in the Massachusetts general assembly looked good because of the high-profile legislative leaders on the advisory panel and the broad base of stakeholders it included.
Among the committee members were representatives from behavioral health professions, emergency physicians, the Massachusetts Hospital Association, union leaders, nurses, psychiatrists and the insurance industry.
The advisory panel reported last year that some 3,500 behavioral health patients each month are boarded for longer than 12 hours.
