McLean Hospital Opposes Massachusetts Ballot Question 1

This letter, drafted by the multidisciplinary leadership team from across McLean Hospital’s seven divisions, outlines why Question 1 is bad for the health of Massachusetts citizens.

Dear Members of the McLean Hospital Community:

This November, voters across Massachusetts are being asked to cast a ballot that has the potential to devastate the mental health system statewide. Driven by the Massachusetts Nursing Association, ballot Question 1 seeks to impose rigid nurse-to-patient staffing ratios that we believe would be catastrophic to the already overburdened behavioral health system.

If Question 1 passes, McLean, as well all hospitals in Massachusetts, will be affected. Most concerning to us is the severe negative impact it will have on the state’s most vulnerable population—the people we serve every day. Here’s why:

Question 1 will reduce access to critically needed psychiatric beds statewide.

• There is already a nursing shortage in Massachusetts and an even greater dearth of psychiatric nurses.
• If behavioral health facilities are unable to recruit the additional registered nurses required to meet the mandated ratio, an estimated 1,000 beds (of the approximately 2,900 beds currently in service) would need to be closed.
• Some institutions providing behavioral health services would need to close entirely.
• Statewide, it is projected that we would experience a 38% reduction in available inpatient services, limiting the ability to provide crucial acute care for those in crisis.

McLean would be affected by Question 1.

• The cost to McLean, if Question 1 passes, will be greater than $10 million annually, assuming that nurses could be hired to meet the mandated ratio.
• McLean’s projected nurse shortage would be more than 80 FTEs.
• McLean, as with all behavioral health facilities, would be mandated to have the same number of registered nurses for all three shifts, requiring a dramatic increase of nurses needed for the night shift.

Beyond the psychiatric community, if passed, Question 1 will do much more harm than good.

• There are no exceptions to the proposed mandated registered nurse-to-patient ratios. The law would prevent hospitals from having any flexibility to make essential and last-minute changes, even if they are faced with an unexpected influx of patients due to a mass casualty event, major car crash, or the height of flu season, among other situations.
• Under this law, hospitals would be required to turn away patients when the number of nurses on duty at that moment doesn’t meet the mandate; this would force people to seek care elsewhere and cost precious time that is crucial to lifesaving care, such as in emergency rooms.
• Treating patients as individuals with unique needs is at the heart of health care and the practice of medicine. This law reduces every patient—and nurse—to simply a number.

There is no scientific evidence supporting it.

• There are no scientific studies or reports that demonstrate the effectiveness of one-size-fits-all staffing in improving quality of care.
• California is the only state that has implemented nurse-to-patient staffing ratios, and there is no evidence that those mandates have increased the quality of care patients receive. In fact, Massachusetts hospitals already equal or exceed California hospitals in nearly every meaningful measure of patient care.
• Similar efforts in other states to impose nurse-to-patient ratios have been soundly rejected.

It will cost us—in more ways than one.

• All hospitals—especially community hospitals and mental health facilities—will struggle to comply with the massive staffing costs and workforce shortages associated with the law. This will lead to the cutting of unprofitable programs and services—including behavioral health, opioid addiction treatment units, and community health programs—that benefit some of the most vulnerable patients.
• The cost of implementing these ratios—estimated at $1.3 billion in the first year—will be felt across the entire Massachusetts health care system and beyond.
• It is anticipated that the additional costs would ultimately be passed on to families and local businesses in the form of higher insurance premiums, copays, deductibles, and taxes.

Fundamental to our mission is advancing public education to inform policies that improve the lives of people and families affected by psychiatric illness. Ballot Question 1, if passed, would have a profoundly negative impact on the health of the people of Massachusetts.

If you would like to read more about Question 1 and the impact it will have on psychiatric care in the Commonwealth, please read these important points or the paper put together by the Massachusetts Behavioral Health System on the implications of mandated nurse staffing ratios.

Kristin Beville, MSW, LICSW, MPH, Director, Social Work
Bill Carlezon, PhD, Chief, Jerry and Phyllis Rappaport Center of Excellence in Basic Neuroscience Research
Lori Etringer, MBA, Vice President and Chief Development Officer
Linda M. Flaherty, RN, PMHCNS-BC, Senior Vice President, Patient Care Services
Brent P. Forester, MD, MSc, Chief, Division of Geriatric Psychiatry
Catharyn Gildesgame, MBA, Vice President, Strategic Planning and Implementation
Joseph Gold, MD, Chief Medical Officer
Michele L. Gougeon, MSS, MSc, Executive Vice President & Chief Operating Officer
Shelly F. Greenfield, MD, MPH, Chief Academic Officer, Chief, Division of Women’s Mental Health
David A. Lagasse, MA, MHSA, Chief Financial Officer
Philip G. Levendusky, PhD, ABPP, Senior Vice President, Business Development and Communications
Dost Öngür, MD, PhD, Chief, Division of Psychotic Disorders
Lisa D. Pratt, MBA, Vice President, Human Resources
Scott L. Rauch, MD, President and Psychiatrist in Chief
Kerry J. Ressler, MD, PhD, Chief Scientific Officer, Chief, Division of Depression and Anxiety Disorders
Roger D. Weiss, MD, Chief, Division of Alcohol, Drugs, and Addiction