When Comprehensive Outpatient Services Inc. abruptly closed the doors to its four counseling centers on Sept. 30 due to bankruptcy, patients and clinicians alike were sent into a panic.
About 85 employees found themselves without jobs, and about 2,000 patients were left wondering how they were going to receive the mental-health care they need.
But many area mental-health facilities have stepped up to take on both groups affected by the closures in an effort to keep the gaps in employment and care as short as possible.
For two local organizations poised to grow, the timing was particularly impeccable.
Bridgewell, a nonprofit organization that provides behavioral health services in Lowell and Chelmsford, and the New England Center for Mental Health in Littleton are both in the process of hiring clinicians from the former COSI centers and welcoming their patients.
Representatives from both organizations said they have already interviewed a number of clinicians from COSI’s Lowell and Chelmsford centers, and are looking forward to welcoming as many on board as they can accommodate. While those clinicians are bringing some of their patients with them from COSI, former patients are also seeking services on their own.
Flurry of inquiries
Kimberley Haley, director of clinical services for Bridgewell and director of the organization’s Sovner Center in Danvers, said Bridgewell’s Lowell and Chelmsford facilities immediately began to feel the impact of the COSI closures. Patients and clinicians began to make inquiries about services and jobs the next day, she said.
“It’s a very unfortunate situation for both the staff and the clients,” Haley said. “Our primary concern is making sure people are living in the community with the supports they need.”
Andrew Stephens, clinic director for Bridgewell Counseling Services in Lowell, said the Market Street facility receives about 20 to 25 patient referrals each day, and since the COSI closures, he estimated that 15 each day have been former patients of the Center for Family Development on Bridge Street in Lowell and Stony Brook Counseling Center on Courthouse Lane in Chelmsford.
He said the Lowell facility serves 1,800 active clients while the Chelmsford location on Summer Street serves about 1,400.
Stephens expects hundreds more will be served thanks to an expansion that began shortly before the COSI closures. In recent months, the Lowell facility expanded to a third floor.
While there are only four vacant offices for clinicians in Lowell and fewer in Chelmsford, Stephens said the opportunities for outreach positions are “infinite.”
Haley said many patients were engaged in ongoing therapy, or were in crisis situations at the time of the COSI closures. She said Bridgewell is prioritizing those who need extra supports and is committed to ensuring continuity of care with their clinicians when possible.
Haley gave the example of one former CFD clinician who called Bridgewell the day after the closure inquiring if she could be hired and maintain her full caseload. Haley said the clinician was interviewed and hired the same week, attended orientation Oct. 5 and immediately resumed seeing her patients the following day.
Since then, the calls from former COSI clinicians have been “flooding in,” Haley said. As of Thursday, three had been hired and another six interviews conducted, she said.
Stephens said six more interviews are lined up for this week, and more are being scheduled.
“To be able to provide someone with a position that’s looking for a position, and to be able to bridge that continuity for all of those patients — it’s wonderful,” he said. “It’s working out really well.”
Jessica Hennessey, managing director for the New England Center for Mental Health in Littleton, which provides mental-health services to about 3,000 patients, agreed that continuity of care is key for mental-health patients.
“If you’ve had a traumatic event in your life and now you’ve got to tell your story all over again, just that alone may cause additional trauma,” she said.
Hennessey said the relationship between a client and therapist is “sacred.”
“You form a bond, and suddenly the rug has been pulled out from underneath these patients,” she said. “It takes time and trust with therapy. Once that bond has formed, it really should not be broken unless it’s by mutual decision.”
Hennessey said she conducted five interviews last week with former COSI therapists, mostly from the Chelmsford site. She said they were all quality clinicians and “the desperation in their voice was so sad.” The fact that many of their patients want to follow them “speaks a lot about the existing relationships” they have, Hennessey said.
Positioned between the former COSI centers in Chelmsford and Fitchburg, she said NECMH is an attractive option for those who are able to travel from both areas. Hennessey said she hopes to bring on as many of the COSI clinicians that fit in with the center’s collaborative model of care as she can.
She said the center was already looking at expanding to additional space in its building and is in talks to combine with another area therapy center that she declined to name. That move would bring in six new employees, Hennessey said, and the center has the capacity to add 15 of the COSI clinicians.
In anticipation of the growth, she said she has hired another practice director who will report to her.
Hennessey said the center is willing to expand its weekday hours of operation and consider opening on Saturdays to accommodate patients’ needs.
To keep up with medication-management needs, Haley said Bridgewell’s Lowell site recently hired a fifth nurse practitioner, and is hoping to add a third at the Chelmsford site. Hennessey said NECMH is also adding two nurse practitioners.
David Hudson, outreach coordinator at the Mental Health Association of Greater Lowell, said its Community and Family Counseling Center on Church Street in Lowell also has availability to take on patients displaced from COSI, and clients can usually get an intake appointment within a week.
According to the state Executive Office of Health and Human Services, 1,574 of COSI’s 2,000 former patients are MassHealth recipients.
They’re a good fit at Bridgewell, which sees mostly MassHealth and Medicare patients, Stephens said.
NECMH in Littleton also sees MassHealth patients, but Hennessey said the low reimbursement rates for behavioral-health services are often a factor in why so few private practices accept the state health insurance. For what is considered a Level 3 visit — described as an approximately 25-minute visit with a stable patient with one diagnosis who is responding to medication — she said MassHealth would reimburse NECMH as little as $37. The same visit covered by private insurance could reimburse as much as $152, Hennessey said.
Another factor is the risk. MassHealth patients often have compounding issues that require collaboration with multiple agencies to put all the services they need in place, she said.
Laurie Martinelli, executive director of the Massachusetts chapter of the National Alliance on Mental Illness, said her organization has been fighting against extremely low MassHealth reimbursements for several years.
“Society at large doesn’t adequately respect psychiatric services, so the reimbursement rate is low, and it doesn’t cover the cost,” Martinelli said.
She said reimbursements for mental-health services overall are so low that many outpatient clinics have had to close because they can’t make an adequate profit.
Hennessey said the biggest difficulty in bringing on the COSI clinicians is that none of them had individual credentials with insurance providers because COSI billed as a facility. So for each clinician who comes on board, she said NECMH has to apply with each insurance company to have them added.
Because NECMH is a private practice, “we are at the mercy of how the insurers allow us to credential,” Hennessey said.
In some instances, that can mean a 90-day or longer wait for an insurance company to credential a clinician, she said. In that time, Hennessey said, the clinician can’t see any patients who use that insurance.
Some insurance providers are more understanding than others, she said. Tufts Health Plan and Network Health allow NECMH to bill all providers under the facility, allowing them to see patients with those plans right away, Hennessey said.
But with Blue Cross Blue Shield and Massachusetts Behavioral Health Partnership, she said, all clinicians must have individual credentials. MBHP requires that the application be reviewed and approved by both local and national committees, Hennessey said, creating what she feels are unnecessary delays.
“If we’ve done our due diligence also, and we’ve presented all the paperwork and information, I don’t see why we should be delayed in being able to provide care,” she said.
According to Haley, the nonprofit Bridgewell can easily bring new clinical staff under its provider network.
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State Sen. Jennifer Flanagan, D-Leominster, chairwoman of the Joint Committee on Mental Health and Substance Abuse: The closure is having a dramatic impact on the community. It’s unfortunate a company would go through that and leave people unemployed. If they knew they were going into bankruptcy, they should have given the clinicians the proper time to close their cases, and transition patients to new therapists or facilities. The company has been nothing but irresponsible in handling this. My main concern is for the patients. When you talk about mental health, I can’t underscore enough how important it is that people have continuity of care. If someone was actively in therapy and working toward recovery, to have all of that just shut down immediately can be scary. They’re now scrambling to find the stability they once had. I can see jobs, family life impacted. Hopefully, the other agencies in our area can help, but what I can almost guarantee is that the local emergency rooms are going to see an influx of patients served by that company.
Sen. Jamie Eldridge, D-Acton, member of the Joint Committee on Mental Health and Substance Abuse: It’s very concerning. We already have a mental-health system that has a lot of gaps of coverage. These counseling centers provided immediate service for people with mental-health problems. To me, it’s an example of how our overreliance on the private health-care system in Massachusetts can cause emergencies. It leaves many people vulnerable to not getting adequate health care. If those centers were government institutions, where they had the more solid backing of state funding, I think this would be less likely to have occurred. I think we need single-payer health care, health care as a right. If you show up at a hospital with a broken arm or having a heart attack, you’re going to get direct care. But if you show up to the emergency room with a mental-health problem, often there’s a delay of days to weeks of getting access. This is yet another example of how broken our current health-care system is.
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