CHA mental health professionals sound the alarm on dangerous departures and waits for patients
Cambridge Health Alliance mental health clinicians say their department is in crisis due to misguided leadership and staff exodus, and patients are suffering. The dismayed and worried psychiatrists, psychologists and social workers formed two groups over the summer with the aim of negotiating with heads of psychiatry departments, who had refused attempts to collaborate, according to the clinicians.
In recent interviews and in a letter from the groups to the CHA board of directors in July, clinicians said that more than a third of the staff had left in the past year at 18 months, and that there had long waiting lists for therapy and to see a psychiatrist for a prescription for psychiatric medication. Patients whose therapists have left are presenting to the emergency room and teams serving ethnic and racial minorities and those with other special needs cannot function due to understaffing, they said.
The department is struggling to hire employees as it has become known as a place that overloads staff, clinicians said. A business model adopted after the CHA appointed Philip Wang chief psychiatry in 2019 relies too much on data, they said. “It does not serve our people. It is out of touch with the critical needs of our population, ”said social worker Jayme Shorin, former associate clinical director of the department’s Victims of Violence program, who retired this month after 32 years. Psychiatrist Judith Herman, co-founder of Victims of Violence, called the department’s system a “model of factory care”.
As a result, therapists cannot provide the level of treatment needed, clinicians said. “If I had a new patient and he was in crisis… I wouldn’t have my next appointment for five weeks” because “my schedule is full,” said Shorin, a member of one of the groups that wrote to administrators. Herman, former director of training for the Victims of Violence program and professor of clinical psychiatry at Harvard University, said clinicians “are told they can see patients once a month or once every three. months for severe trauma, that’s not going to cut this. “
Readers who call themselves patients of ACS clinicians say they have had to find new therapists because of the departures. One reported a similar problem in another local health system.
The Revolutionary Victims of Violence Program was founded in 1984 in what was then Cambridge Hospital with a small grant from Cambridge City Council to help victims of crime. The award-winning program now offers therapy to victims of trauma, such as victims of rape, incest and domestic violence, and advocates and works in the community to reduce domestic violence. Victims of Violence is not the only program that would have been affected by the loss of staff and the change in business model; the letter to CHA administrators stated that the problems had affected the entire department, although Shorin said most of the effects were in outpatient treatment.
Few vacancies, says CHA
Responding to questions from Cambridge Day, health system spokesperson David Cecere said CHA mental health therapists are not told how often they see patients, waiting lists are smaller than clinicians have reported and specialist teams continue to operate, except for the one serving Asians.
“Although we have seen some turnover related to our transition to a treatment model that reflects current best practices and offers more options to meet the needs of our patients – as well as several retirements and departures related to the changes lifestyle – we have very few vacancies among our therapists and are actively recruiting and hiring providers to join our team, ”said Cecere.
Cecere was interviewed but did not provide details on the size of waiting lists, patient wait times or the number of vacancies. He did not say how many patients had lost their providers in the past three months due to resignations and retirements, how many had gotten a replacement, or many emergency psychiatric patients had recently lost their therapist.
He placed the problems of access and personnel to the CHA in the context of “a national crisis which has been exacerbated by the Covid-19 pandemic and a staff shortage which affects all health establishments in the country”. This crisis includes a “huge demand for mental health and addiction services” and “unprecedented levels” of psychiatric patients waiting long periods in emergency rooms, Cecere said.
CHA responds by “developing same-day access plans to mental health services for our patients [and] to diversify our clinical offerings “with” evidence-based treatments that will increase access, provide effective therapies in the short term, and ultimately allow our patients to become more involved in their care, “said Cecere. Long-term traditional psychotherapy will still be available, he said.
A model in danger
In an interview, Herman agreed that “there is a huge shortage nationwide” of mental health providers and services. Yet, she said, “the CHA department has been a shining light,” demonstrating how to provide “community care” to people in poverty, homeless and undocumented immigrants. “We have been a role model for how you treat patients like this ethically and successfully,” she said.
It is now in danger, Herman said.
Shorin said clinicians must “provide ethical and healthy care, and you can’t do that when you’re bombarded with patient after patient. People are getting exhausted. Challenging Cecere’s claim that staff are not informed about how often to see patients, she said, “Clinicians cannot schedule patients based on clinical need.
After the two provider organizations, the Psychiatry Physicians Collective and the Clinicians Collective, sent their letter to the trustees on July 19, several working groups were formed; they proposed changes but there was no action for weeks, Shorin said. Representatives of the groups met with CHA executive director Assaad Sayah in early September and Sayah said he was ready to meet again. But again, there was no commitment, she said.
Cecere said “action plans” for the task force’s recommendations were announced last week and ways to implement them “are being developed.” Sayah met with representatives from the clinician groups last week and said he was ready to continue meeting with them, Cecere said.