May 8, 2023
State commission releases recommendations to bolster behavioral health
$192 million to benefit behavioral health workforce and youth services
BOSTON – The Behavioral Health Advisory Commission tasked with investigating and assessing the state of behavioral health care in the Commonwealth and recommending how to spend tens of millions in federal relief dollars earmarked for mental health has completed its work. Co-chaired by Senator Julian Cyr (D-Truro) and Representative Adrian Madaro (D-East Boston), the Commission finalized its report last week outlining unanimous recommendations to the Legislature on how to distribute $192 million in federal COVID-19 recovery funds.
“The recommendations presented by the Behavioral Health Advisory Commission encompass an unprecedented level of funding for loan repayment programs and tens of millions of dollars for scholarships, paid internships, and clinical supervision to recruit and retain a new generation of health care providers,” said Commission co-chair Senator Julian Cyr. “We are anxious to put these funds to work to address the myriad of obstacles for residents to access behavioral health care. As the Legislature continues its work to invest in and transform the behavioral health care system in Massachusetts, I am grateful for the dedicated partnership of my friend, Representative Adrian Madaro, and the Commission members who thoughtfully informed swift and equitable ways to allocate these critical funds.”
“Health care providers and support staff are the backbone of our health care system. These recommendations reflect a commitment to fostering sustainable and equitable career pathways for a new generation of behavioral health professionals while investing in populations that have experienced disproportionate barriers to care,” said Commission co-chair Representative Adrian Madaro. “I look forward to the speedy deployment of these dollars so that we may begin to address the unique challenges faced by providers and communities seeking timely and high-quality care. I commend my good friend Senator Julian Cyr and fellow Commission members for their thoughtful recommendations on how to quickly disperse these critical funds to bolster behavioral health in the Commonwealth.”
With appointments from Former Governor Baker, the Senate President, the Speaker of the House, and the Senate and House Minority Leaders, as well as many behavioral health organizations and providers, the Commission included a wide array of stakeholders from government, business, nonprofit, academic, and advocacy sectors.
“The Behavioral Health Advisory Commission took a critical vote on May 3rd to providing $192 million in relief to beleaguered children and adults in the Commonwealth who wait too long to access critical care because of workforce shortages in the behavioral health provider sector,” said Danna Mauch, President and CEO of the Massachusetts Association for Mental Health. “Targeted investments will be made in funds designed to address reimbursement inequities, scholarships, loan repayments, and practice costs needed to retain, train, recruit, and reengage the behavioral health workforce. Kudos to Commission members and government leaders for taking affirmative action on our thorniest dilemma as we strive to implement reforms in the Commonwealth to timely meet unprecedented levels of need for mental health and substance use services.”
The Commission was established by Chapter 77 of the Acts of 2022, An Act Establishing the Behavioral Health Trust Fund and the Behavioral Health Advisory Commission. Credited with $192 million in federal American Rescue Plan Act (ARPA) dollars, the Behavioral Health Trust Fund presents an unprecedented opportunity to fill long unaddressed gaps in the behavioral health delivery system.
“Recruiting and retaining the workforce necessary to serve the behavioral health system requires acknowledgement that these positions have too often gone underpaid and under-appreciated,” said Lydia Conley, President and CEO of the Association for Behavioral Healthcare. “Through a historic $192 million investment in interventions including loan repayment, scholarships, and internships, the Behavioral Health Advisory Commission is taking a critical step toward ensuring that we are sustaining a vital workforce, providing a fulfilling career path, and continuing to serve individuals with substance use and mental health disorders with the high-quality, accessible care they deserve. We thank Chairs Cyr, Madaro and members of the Legislature for the opportunity to support the backbone of our behavioral health system – our workforce.”
The Commission was tasked with submitting recommendations to the Legislature on the disbursement of money from the Trust Fund to address barriers to the delivery of an equitable, culturally-competent, affordable, and clinically-appropriate continuum of behavioral health care and services. The Commission’s report recommends allocating funds in a manner that has the most immediate impact, including investments in the behavioral health workforce via multi-million dollar recruitment and retention initiatives. The report also prioritizes resources to help children and adolescents access behavioral health services.
“We are currently experiencing a nationwide behavioral health crisis, particularly among our youth,” said Amara Anosike, Director of Behavioral Health Policy & Advocacy at Boston Children's Hospital. “Moreover, with most conditions beginning in childhood, we have both a responsibility and opportunity to prioritize the behavioral health needs of children now. I applaud the Legislature and the leadership of Representative Madaro and Senator Cyr, for outlining investments, that if adopted, can make a meaningful impact for years to come.”
The Commission commenced its work in November 2022 and met a total of five times, with a final meeting occurring May 3, 2023. The Commission’s report outlines key findings on the overall state of behavioral health in the Commonwealth. The Commission found that years of underinvestment in the behavioral health workforce has fueled the ongoing workforce crisis, and more providers are now leaving the field than entering practice due to burnout and inadequate reimbursement. The Commission also found the COVID-19 pandemic intensified the strain on an already struggling behavioral health system, ultimately creating more barriers to care and further increasing behavioral health care needs among younger populations. Further, the Commission identified that the shortage of behavioral health providers has disproportionately impacted Black, Indigenous, and other People of Color, LGBTQ+ individuals, and other marginalized groups.
“After months of work, I am thrilled that the Behavioral Health Advisory Commission has put forth an innovative slate of proposals that are responsive to the access and workforce challenges,” said Scune Carrington, Director of Integrated Care at the Massachusetts League of Community Health Centers. “I hear every day from the Mass League’s health center members and my peers in the social work community. I am particularly excited to see a commitment to scholarships, paid internships, and support for community-based providers who are the backbone of training for our behavioral health workforce but often do so without any funding. Importantly, these proposals all feature a diversity and equity emphasis. Together, coupled with an additional investment in the historic MA Repay Program, these efforts will make a real impact on access in our most underserved communities, and continue the work of building a workforce that reflects all our residents.”
A significant recommendation focuses on expansion of the MA Repay Program. The MA Repay Program is already repaying over $130 million in student loans for health and human service professionals across Massachusetts. The program aims to support key staff in community health centers, community mental health centers, inpatient psychiatric hospitals, the psychiatric units of acute care hospitals, and substance use providers. Funded by ARPA dollars and the Opioid Recovery and Remediation Fund, the program is administered by the Massachusetts League of Community Health Centers on behalf of the Executive Office of Health and Human Services.
"It was an honor to serve on this Commission along with such a diverse set of participants who carefully considered how to distribute funds in a way that helps achieve equity and capacity and strengthens the behavioral health workforce across the Commonwealth,” added Dr. Debra Pinals, Senior Medical and Forensic Advisor to the National Association of State Mental Health Program Directors. “Now that the Commission's report has been approved, the funding should be moved quickly as recommended. My gratitude goes to the Chairs for helping lead this to this important point."
The final report outlines eight recommendations to utilize the Trust Fund to bolster the Commonwealth’s behavioral health delivery system. The recommendations include:
- Loan Forgiveness. The Commission recommended allocating $80–$100 million to the MA Repay Program to retain a diverse workforce. The report outlines how loan repayment is as an essential tool to recruit and retain providers committed to serving diverse populations. The Commission also recommended directing $2–$5 million in loan repayment funds to providers serving justice-involved populations.
- Scholarships. The Commission recommended allocating $20–$30 million to create and fund a scholarship program for individuals seeking bachelor’s and master’s degrees in behavioral health who commit to work in areas of high need with a focus on diverse applicants.
- Paid Internships, Practicums, and Field Placements. The Commission recommended allocating $20–$30 million to fund historically unpaid positions for bachelor’s and master’s level candidates training in the behavioral health field. Awards would go to trainees who agree to work in areas of high need with a focus on diverse applicants.
- Reimbursement for Clinical Supervision. The Commission recommended allocating $20–$30 million to fund stipends or bonuses for currently non-reimbursable time spent providing clinical supervision to students and clinicians in training working toward licensure or certification with a priority on funding diverse applicants and providers in areas of high need.
- Professional Fees and Practice Costs. The Commission recommended allocating $2–$5 million to a pilot program that gives employers flexibility to cover fees associated with training or practice costs for behavioral health providers. The Commission also recommended a study by the Department of Public Health of licensure/certification processes and participation, including a demographic analysis of current behavioral health providers in Massachusetts.
- Behavioral Health Support for Health Care Workers. The Commission recommended investing $5–$10 million in programs that provide emotional support and resiliency training for behavioral health providers.
- Commercial Rate Analysis. The Commission recommended allocating $500,000–$1 million to fund a comprehensive study on rates paid by private and public payors and their impact on access to high-quality behavioral health care in the Commonwealth.
- Youth and Schools. The Commission recommended investing $5–$10 million in expanding school-based behavioral health programs for young people, including transitional programs in schools to help students adjust after medical or behavioral health hospitalizations or prolonged absences. The Commission recommended expansion of existing programs to focus on geographic equity and underserved regions.
The report and its recommendations now go before the Legislature for its consideration and action.