Writer

Again

In composition
2 weeks ago
7 Min read
Add comment

Crossposted @ NSH

BOSTON – On January 22, 2025, Secretary Walsh presented Governor Healey’s proposed $62 billion budget plan to the Commonwealth’s stakeholders—a strategy that, while promising hundreds of millions for the MBTA, would simultaneously eliminate vital mental health services for our most vulnerable populations. According to Stout and Huynh (2025), the proposal would also slash dozens of mental health caseworker positions—laying off 170 of the 340 statewide—and eliminate many of our key children’s mental health programs. The budget’s twin measures of taxing candy and cutting children’s services reveal a troubling juxtaposition that prioritizes revenue generation and cost-cutting over the long-term well-being of Massachusetts’ children and families. These proposed cuts are in opposition to the Governor’s claim that she deeply supports mental health services across the Commonwealth.

The Underutilization Misnomer

One of the most concerning proposals threatens the state’s only acute residential treatment program for children aged 6–12, as well as cuts to two other intensive residential treatment programs for adolescents. These programs provide the highest level of intensive residential care to children that struggle to stabilize under any other children’s programs in the state. Further, despite recent and major investments to move two of these programs to other locations, they are now being dismissed as “underutilized.” This “underutilization” is actually due in part to temporary disruptions caused by the pandemic, staffing shortages experienced by most industries across the state, and these recent program relocations. Inefficient admission and referral processes by state agencies serving these vulnerable youth is also part of the barrier to accessing these programs and thereby impacts utilization. Yet, this misclassification ignores the ongoing, urgent demand for specialized care. Dismissing these programs based on skewed utilization data jeopardizes the care these children desperately need.

A Wider Systemic Crisis: Behavioral Health Boarding

Massachusetts’ behavioral health system is facing unprecedented strain. As documented in the Capturing a Crisis – Weekly Behavioral Health Boarding Reports, patients—including children—are forced to “board” in emergency departments (EDs) or medical-surgical units while awaiting a psychiatric bed. Boarding is more than an administrative inconvenience: it delays access to appropriate care and often means that vulnerable children receive treatment in settings not designed for their needs. When EDs, designed for acute medical issues rather than long-term behavioral health care, become makeshift psychiatric wards, the result is a system stretched beyond its capacity—compromising the quality of care and contributing to repeated cycles of crisis.

Deep Cuts, Shallow Savings

Governor Healey’s budget plan proposes drastic measures to “save” money, including consolidating hospitals. For example, state officials expect to save about $31 million by closing the Pappas Rehabilitation Hospital for Children in Canton—a facility employing 225 workers—and moving its services to Westfield’s Western Massachusetts Hospital campus. Similarly, the Pocasset Mental Health Center on Cape Cod, which operates with 56 staff members, is set for closure. In addition, by eliminating half of the state’s mental health caseworkers, the budget would dramatically reduce the capacity to support those most in need of mental health services. These cost-cutting measures, justified by claims of “low utilization rates” and “aging infrastructure,” starkly contrast to the growing behavioral health crisis.

The Toll of Childhood Trauma

The pervasive effects of childhood trauma compound the impact of these cuts. The 2024 Annual Report from the Childhood Trauma Task Force reveals that 36% of Massachusetts children experience at least one adverse childhood experience (ACE)—including violence, maltreatment, or discrimination—with rates soaring to 63% among children living below the federal poverty level (Massachusetts Executive Office of Health and Human Services, 2024, p. 6). The report further notes that nearly half of Black non-Hispanic (48%) and Hispanic (54%) children face at least one ACE, compared to 30% of white children. This disproportionate exposure to trauma is an early driver of systemic inequality, affecting education, healthcare, judicial outcomes, and social services.

Moreover, the report highlights that “experiencing trauma can negatively impact children’s capacity to regulate their emotions and can lead to significant behavioral health issues” (p. 6). The situation is exacerbated by the fact that many of the adults that are caregivers of these children are themselves struggling with trauma and burnout. In the summer of 2024, the U.S. Surgeon General reported that 41% of parents felt so stressed on most days that they could not function—compared to 20% of non-parents—with similar trends of burnout observed among behavioral health providers and early childhood educators (p. 7).

Children that meet the criteria for services provided by our state organizations such as DMH or DCF often have far more ACEs than the examples listed above. The lack of services that meet the needs of children and families at this level of care is often retraumatizing and reinforces the very challenges that bring them to these programs that are designed and funded to support them in the first place. Further, when children do not receive the help they need in childhood, there is an increased risk of a continued need for mental health services into adulthood. Cuts to the state’s already low children’s services budget are seriously shortsighted, as the long-term outcomes will cost the Commonwealth far more over time.

Efforts and Investments: Progress Amidst Challenges

In response to these very real challenges, Massachusetts has made significant investments since 2022. Initiatives such as the Roadmap for Behavioral Health Reform, the establishment of a Statewide Behavioral Health Help Line, the creation of an Office of Behavioral Health Promotion within the Executive Office of Health and Human Services, and the launch of innovative programs like Community Behavioral Health Centers and Youth Community Crisis Stabilization have all aimed to help address the state’s behavioral health crisis (Massachusetts Executive Office of Health and Human Services, 2024, pp. 7–8).

Yet, despite these investments, children continue to interact daily with systems that are not trauma-informed or equipped to provide the crisis services needed, and therefore may even unintentionally re-traumatize them. One such example is when children are being boarded in hospital emergency departments, due to system issues impacting the ability to expedite referrals to higher levels of care.

The Numbers Behind the Services

The DMH FY24 Highlights (Massachusetts Department of Mental Health, 2024) further illustrate the current state of mental health services:

  • Total Served: 28,745 individuals (24,630 adults; 8.6% children)
  • Case Management: 6,436 individuals received case management
  • Children and Adolescents Services: Offered through intensive community treatment, day/therapeutic after-school programs, flexible supports, psychiatric intensive residential treatment, and first-episode psychosis programs
  • Facility Data: 62 licensed acute psychiatric inpatient hospitals/units with 3,161 beds
  • Staff and Budget: 3,580 DMH employees; FY24 budget of $1.2 billion, with 59.6% allocated to adult mental health, 22.8% to inpatient services, and only 6.2% to children, youth, and families

These figures reveal a system heavily weighted toward adult services, leaving children’s needs underfunded and under-resourced—an imbalance the proposed cuts would only worsen.

A Call to Action

The evidence is clear. While Governor Healey’s budget includes investments in behavioral health services, the simultaneous elimination of critical children’s programs, a staggering reduction in workforce, and the reduction and closure of essential facilities signals a dangerous trend. The combination of deep cuts and inadequate funding for trauma-informed, child-specific care threatens to destabilize the very systems designed to protect our future generations.

Now is the time for community leaders, parents, healthcare providers, and legislators to stand together and demand that Massachusetts prioritize its children’s mental health. Our state’s future depends on investing in the well-being of every child, ensuring that trauma-informed, comprehensive care is readily accessible—and that no child is left behind.

References

Add comment

Leave a Reply

Read more

Writer
Christopher J. Sparks