Joint Committee on Mental Health, Substance Use & Recovery
The Massachusetts Health & Hospital Association (MHA), on behalf of its member hospitals and health systems, physician organizations and allied health care providers, appreciates this opportunity to offer its comments in regards to legislation addressing mental health and substance use disorder treatment.
MHA supports HB1709 / SB1137 as it would help to alleviate access barriers to medically necessary inpatient mental health services. With the current shortage of psychiatrists, the expanded scope of authority for other licensed providers to evaluate and determine the need for inpatient level services will help to relieve this strain on the system. It will also decrease delays in patients accessing care if they no longer have to wait for an evaluation from a psychiatrist, and instead could be appropriately evaluated by a physician assistant pursuant to HB1709 / SB1137. MHA similarly supports the provisions HB1724 that would allow certified nurse practitioners or psychiatric clinical nurse specialists to appropriately evaluate patients.
MHA strongly supports HB1729 / SB1146, which provides for a streamlined review process for forensic or court-ordered commitment hearings to ensure that administrative delays in scheduling cases do not cause undue harm or delays in care for patients. Due to the significant shortage of resources in the judicial system as well as the lack of available Department of Mental Health (DMH) state beds, many courts are hampered by the inability to conduct timely on-site reviews of patient commitment hearings in addition to finding locations to place a patient, thereby increasing the number of “stuck” patients waiting for appropriate inpatient placements. Current law also allows open-ended delays in the review of cases, providing an additional barrier to care and requiring the boarding of patients in hospital emergency departments while awaiting a hearing to initiate treatment. Such administrative delays are not in the best interest of any patient, add unnecessary costs to the overall healthcare system, and should be streamlined in the manner outlined in HB1729 / SB1146. This bill also seeks to develop an expedited process for the appropriate regulatory agencies within the Child Advocate’s Office and the Department of Children and Families to determine the timeframe for administering certain antipsychotic medications to youth hospitalized in inpatient mental health facilities. The proposed facilitated process for reviewing these patient cases will best allow for the timely treatment and care.
MHA supports the principles outlined in HB1741, which requires DMH to develop a process for ensuring that patients who are in need of mental health services are able to access community-based services, as clinically appropriate. Many patients who could be safely managed in a lower level of care often have to go through inpatient level treatment, as they are not safe to themselves or others and are unable to be discharged to their home without having a detailed treatment plan overseen by a community-based or inpatient level provider. Allowing the courts to move patients directly to outpatient settings would reduce unnecessary use of acute level services and ensure that inpatient level care is accessible to patients in the system that need it.
MHA also supports HB1746, which would create the Massachusetts Rehabilitation Oversight Committee to gather data on substance use and treatment in the Massachusetts criminal justice system. MHA was part of the coalition in support of the administration of medication for addiction treatment, including medication for opioid use disorder, in correctional facilities under Chapter 208 of the Acts of 2018. Individuals with a history of incarceration are significantly more likely to die of an opioid related overdose. Having additional information and data about substance use and treatment in correctional facilities will help to inform further efforts to address the opioid overdose crisis.
With regards to HB1711, HB1726, and SB1138 that address involuntary inpatient treatment for substance use disorders, MHA was a member of the Section 35 commission established by section 104 of Chapter 208 of the Acts of 2018. MHA supported the commission’s recommendations and looks forward to their implementation. We would be happy to meet with legislators and staff to further discuss the recommendations.
Thank you for the opportunity to offer comments on this important matter. If you have any questions or concerns or require further information, please contact Michael Sroczynski, MHA’s Senior Vice President of Government Advocacy, at (781) 262-6055 or firstname.lastname@example.org