Psychiatrists taking on policy, "existential problems"

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BOSTON (SHNS) – As psychiatrists lament persistent barriers to mental health care access and “existential problems” revolving around medicine and science, top health care figures in the Legislature are seemingly on board with implementing more mental and behavioral health reforms.

“This is a moment where psychiatrists really need to speak to key issues in mental health care that aren’t always articulated in the political scene,” Massachusetts Psychiatric Society President Dr. Jhilam Biswas said. “This is a moment where organized medicine needs to be visible, because we need to speak to the science and to medicine and what we know to be truths.” 

“We’re facing existential problems around medicine and science and research right now, and generally, we’re just really busy because there’s access issues. There’s a huge need for doctors to be in clinics doing the work, but we’re recognizing we can’t do the work without people knowing how important it is to get the truth out about different issues in health care,” Biswas told the News Service.

The Legislature and former Gov. Charlie Baker in 2022 teamed up on a comprehensive mental health care law that introduced mental health parity in Massachusetts and attempted to reform mental and behavioral health care access. House Public Health Committee Chair Rep. Marjorie Decker emphasized a need for continued focus on the field at a Wednesday event at the State House.

“Why should it matter to us? We have a lot of things that are happening in the state right now, and the country is literally on fire. They are burning down so many resources, opportunities, tools, programs, data and pathways to helping people,” Decker said. “And if that happens, anyone who’s involved in the field of supporting behavioral health and mental health, your work only becomes, not only more important, but the demand continues to grow.”

The society, which represents around 1,600 psychiatrists, is fresh off of a 2024 win after putting thousands of dollars behind opposition to a ballot referendum that would have legalized some psychedelic drugs, Dr. Nassier Ghaemi, past president of the society, reminded a room full of psychiatric residents.

“We came out against it. We spent $10,000 and they spent 10 million, and we won,” Ghaemi said. “That’s an example of how, I think, if it was not for our society, that bill would have passed without question. So that shows you the influence that we can have.”

Psychiatrists like Alex Rains, a resident at Brigham and Women’s, are hoping their support for a bell-to-bell cellphone ban in K-12 schools (S 2581) will help push it over the line. The bill, which the Senate approved at the end of July, has sat in House Ways and Means since early August. 

Senate President Karen Spilka said students in other places, like a district in New York where her son teaches, are “paying attention” and “clearly learning more” with the ban, but there are some issues Massachusetts will have to “take into account” — like there being some students who put fake phones into the locked pouches. 

But at a time “when mental health needs have never been greater,” according to incoming society president and Mass General outpatient geriatric psychiatrist Dr. Anderson Chen, the most pressing issue facing psychiatry is access, especially providing evidence-based care to the older adults he treats. 

“A lot of issues with older adults, something small can become something big, and the wait is just incredibly long everywhere. And I know [primary care physicians] are having to do geriatric psychiatry jobs — I think that really spreads even beyond geriatric psychiatry,” Chen said. “So I think access is an issue, and how do we solve that? Might be creative ways — I write treatment algorithms, so I try to write evidence-based care flow charts that are easy to follow so it can do a better job, etc.”

Chen and his colleagues are eyeing bills that would create “more timely treatment” for inpatient mental health care (S 1401) and address the continuum of care for mental health (S 1115), both of which are Sen. Cindy Friedman bills revolving around involuntary hospitalization of people facing mental health emergencies. Friedman, the Senate’s health care point-person, said Wednesday that the bills “are simply opening up a channel, an opportunity, for somebody to receive care,” putting the state “on notice” that it must provide it. 

In previous court cases, “the state has set a bar for whether or not somebody can receive treatment that one might deem to be coercive, or where they are not part of the decision-making process,” Friedman said. “The fight has always been, they look at these court cases and they say, ‘You can’t do that, you can’t coerce somebody into care,’” Friedman said.

“Our biggest adversaries are the lawyers. And I understand it. But their narrative is around ‘you can’t take rights away from someone.’ And my reaction has always been, ‘So it’s okay if we put them in jail, and it’s okay if we criminalize them – that’s not taking their rights away, but if you want to find a way to get them treatment, somehow, we stepped into this world of denying people’s rights. And I think we have to be really good at explaining that,” Friedman said.

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Ella Adams

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