Gov. Maura Healey’s proposed budget for the next fiscal year would cut mental health services for children and adolescents — including cuts to case management, eliminating flexible funding and closing three residential programs for kids with severe long-term mental health challenges.
Those who support cutting those services say the programs aren’t used enough, but critics warn of severe consequences. They say these changes could leave vulnerable children without crucial care and put a bigger strain on emergency departments, which are already seeing a problem of patients “boarding” in their beds while they wait for psychiatric care.
Lydia Todd, executive director of the NFI Massachusetts, joined GBH’s All Things Considered host Arun Rath to walk through the impacts of potentially losing funding for their residential beds. What follows is a lightly edited transcript.
Arun Rath: I just sketched it out in the barest of details at the top there. Could you give us a more detailed overview of the programs that are on the chopping block and what those programs do?
Lydia Todd: Absolutely. There are two programs that NFI operates that serve 15 adolescents each, so a total of 30 adolescents. These are youth who have cycled in and out of emergency rooms and psychiatric hospitals, creating challenges for the system; for themselves, of course; for their family members who have to struggle to maintain employment; for their siblings who may not be able to get to their routine activities because parents are occupied with cycling through the system.
[The adolescents] really need a much longer period of stabilization and treatment. The program specializes in working with not just the youth that we’re caring for, but also their entire family systems. And our job is to get them to be able to regulate sufficiently so they can get home and get back to the wonderful and messy business of growing up in their natural community.
Rath: We’ve done a lot of reporting over the last five years since the pandemic about the mental health crisis and, in particular, the mental health crisis for young people. Can you talk about what those reductions mean in the context of where we are right now?
Todd: Absolutely. I wanted to mention a third program that’s operated in Western Mass by Cutchins Family Services that serves 6- to 12-year-olds who are also experiencing similar challenges. All of these programs serve youth across the commonwealth.
What we know is that mental health needs in our young people have increased over the past few years, especially since the COVID pandemic — and certainly are on the increase now because of everything that is going on in the world. To lose these very deep-end programs would actually cause a backup further on in the system — in the psychiatric hospitals, in the emergency departments, youth and families, and emergency responders as well.
Rath: Walk us through a little bit of what that means on the individual level with the patients when these programs are shut down. What does it mean for these young people?
Todd: Sure. We don’t know what would happen to the young children because it is the only program in the commonwealth. I know they have 7 out of 12 of their beds filled now with youth that have very high intensity. And it is important to provide that programming right here in the commonwealth if the goal is to reunify them with families and not be shipping kids out of state. So, we haven’t heard yet what the plan would be for those youth.
For our youth at the NFI program, we are the only program of this type that is able to serve youth of every gender because we have single bedrooms and single bathrooms, so we can serve transgender, nonbinary, gender-fluid youth, as well as biological boys and girls. We have maximum flexibility in who we serve and what mix of genders we’re serving.
What we’ve been told is that our youth would need to be redeployed to the two other programs that serve this type of youth, so those programs would need to reconfigure themselves in some way to address this new service population. That would be a real shame because we have developed that kind of expertise, and our staff of 95 people are really well able to work with these youth and families.
Rath: The argument that these cuts are due to low utilization and others pointing to barriers in the referral process — could you talk about that?
Todd: Absolutely. We had been asking for a while about why we weren’t at full capacity, even though we have sufficient staffing to do so. Because of the Department of Mental Health’s sluggish referral process — and they’ll admittedly agree with this — the hospitals over time found it really taking a long time for kids to move from the psychiatric hospitals into these intensive residential treatment programs.
From a realistic perspective from the hospital, if it takes a hundred days to move a youth — or, what we’ve heard from some families is four to eight months to move a youth out of a psychiatric hospital — even though the service is technically available, that resource is really not accessible for these hospitals.
We’ve had a lot of conversations with them, and we believe that the focus should be on removing these barriers because the hospitals also state that they could really use these services if we could make them accessible in a timely fashion, which we think should be a matter of weeks, not months.
[Editor’s note: When asked for comment on the proposed closures, a spokesperson for the Healey administration provided the following statement: “The Department of Mental Health is committed to supporting mental health needs across our state, which is why our budget proposes more than $1.2 billion through DMH alone, a 7 percent increase, and we’ve expanded access to care through our 31 Community Behavioral Health Centers.”]
Rath: I’m curious what else you’ve been hearing from families, clinicians and mental health workers more broadly about these cuts.
Todd: I think, in general, you’re aware that the cuts are at other levels as well. And we really believe that the children and families of the commonwealth need to be held harmless while we do take a look under the hood and see what’s going on with underutilization and make sure that we’re fully utilizing all the services that are available to the citizens of the commonwealth. We want to keep the youth as close to home as we possibly can and work with them and their families so that they can be productive members of their own communities.
Many families have talked to us about how this level of programming saved their lives, that they wouldn’t know how to function without it, and that they were able to attend to the needs of other children after being overwhelmed for years, sometimes, cycling in and out of the emergency room.
I think you’ve heard about the issue of families needing to board in the emergency departments with their child, which means they’re waiting on a psych bed. Sometimes, families have to quit their jobs because they just can’t maintain that level of uncertainty with reliable employment.
Rath: It seems really important to note that we’ve been talking about, obviously, local funding and state funding. Meanwhile, on the federal level, we are seeing all kinds of funding cuts that are happening and could be on the horizon. Could you talk about what these local cuts that we’re talking about mean in the context of the current mental health landscape nationwide?
Todd: Oh, absolutely. I don’t think that we’ve digested — any of us — the full impact of what these federal cuts might mean to us. For example, the three programs I’ve just been talking about do receive some federal reimbursement to the commonwealth through Medicaid, and we don’t know if that’s going to be impacted as well.
I think, as this unfolds, we could be in an absolute mental health crisis, especially with our children and adolescents. And if we don’t get them the services that they need when they are young, not only are their families going to suffer and be devastated by this, but they run the risk of needing long-term mental health care as an adult.
