Nantucket Behavioral Health Agencies Decry Proposed Closure Of Cape Cod Mental Health Center

Nantucket's behavioral health leaders are joining an outcry over the state's proposed closure of the Pocasset Mental Health Center in Bourne.

In late January, Gov. Maura Healey's administration announced its plan to close the 16-bed psychiatric hospital on Cape Cod and cut the number of Department of Mental Health case managers from 340 to 170.

On Nantucket, where there is no inpatient psychiatric facility, clinicians rely on a network of mainland hospitals and mental health centers to send behavioral health patients to when they require inpatient care. These transfers are logistically complex and are made even more challenging by the demand for inpatient beds across the state, as well as the time required to transport patients from Nantucket. So the potential loss of the closest inpatient facility to Nantucket does not sit well with the island's behavioral health providers, along with the proposed cuts to the number of state case managers.

"The governor’s decision to close the Pocasset Mental Health Center and to reduce the case manager workforce by 50 percent is a devastating blow to the efficacy of mental health services within the Commonwealth," said Roberto Santamaria, executive director of Fairwinds on Nantucket. "Behavioral health agencies across the Cape and the Islands depend on these services to provide the best care for their patients. Closing down services located on the Cape further diminishes any behavioral health center’s ability to reach and treat those in need. In light of our extreme national political shifts, now is the time to increase access to mental health services, not hinder them."

Even though Nantucket's utilization of the Pocasset Mental Health Center is not high - just seven patients in 2024 - the island-based non-profit group Community Solutions for Behavioral Health (CSBH) has already lobbied Gov. Healy in opposition to the proposed cuts.

"Community Solutions is opposed to the closure of Pocasset Mental Health Center," said Rosemary McLaughlin, the group's executive director. "As you're aware, access to inpatient psychiatric beds is very limited, and a closure anywhere can impact the entire system. Pocasset was 90 percent occupied in 2023, the last year data is available. As a state-operated facility, it has flexibility in regards to insurance coverage and length of stay for the patients they serve. Over the past couple of years, few patients have been directly admitted to Pocasset from Nantucket, but for those who need that treatment, it's priceless and maybe not available elsewhere. My understanding is that this closing is not a quality issue, rather an expense issue relating to the limited services, 16 beds versus the physical plant costs. An alternative could be to add services which are needed for Cape Cod and Islands. Behavioral Health treatment for adolescents and elders is difficult to find. Expanding Pocasset's capacity could be more cost-effective."

Nantucket Cottage Hospital spokesman Jeff Coakley declined to comment and referred any questions to McLaughlin at CSBH.

In a press conference last week, Gov. Healy attempted to justify the proposed cuts to the Department of Mental Health.

"I think of it as a redirecting of services, of care," Healey said. "In one place, we have a low utilization rate, only 16 beds. In another place, we have about 39 individuals housed, and a number of them -- the majority of them -- are over the age of 21, so looking at some other options, other facilities, places, where maybe it makes more sense in terms of consolidation of care or the right kind of care for those individuals."

A spokesperson for the Executive Office of Health and Human Services told the State House News Service, "We have taken these steps to improve the care and services we are able to offer."

"We recognize these changes have significant impacts on patients and families, and we are committed to supporting them through the transition of their care," spokesperson Olivia James said. "We will also work with employees and our partners in labor to support impacted employees and ensure they are able to transition to new roles."

According to the most recent Nantucket Behavioral Health Assessment report published in 2021, mental health patients on Nantucket who need to be transferred to an inpatient psychiatric facility on the mainland typically end up waiting for an available inpatient bed and/or transportation arrangement at the Nantucket Cottage Hospital emergency department  or its med/surg unit for one full day up to as many as nine days.

"Nantucket lacks intensive community and/or facility-based stabilization and treatment for individuals in crisis, people escalating toward crisis, and individuals requiring support after a crisis," the report states. "The lack of intensive treatment and support results in people being stabilized in the emergency room and either transferred off-island for inpatient care or returned home without intensive follow-up.

"Further, there is an inadequate system of care for people returning to the island following inpatient or residential treatment that can assist with reintegration. Off-island transport for treatment is expensive, disruptive, and in some cases contributes to more significant conditions than if treatment were available in familiar environments. While NCH has two beds in rooms modified for patient safety, there is a lack of continuity of treatment during the stay in the hospital due to changing physician and nursing coverage. This results in missed opportunities to stabilize individuals on-island.

"Further, hiring 'sitters' to supervise patients and transporting patients off-island is costly and consumes resources that might, in part, be redirected to providing additional treatment to avert and stabilize crisis on the island. Nantucket’s small scale makes it unlikely that higher levels of care such as inpatient and residential treatment will be provided on-island, but there are opportunities to enhance the continuum of care to more often avert, stabilize, and treat individuals closer to home and to bolster supports for people returning to Nantucket after an inpatient or residential stay. While individual organizations are providing pieces of the treatment services needed to prevent crisis, stabilize people after a crisis, and help people returning to the island after an inpatient stay, there is no systematic approach to service delivery."