Massachusetts Commission Seeks Ways to Strengthen Behavioral Health Policies

Editor’s note: This page was updated Sep. 24, 2018, to reflect the enactment of Massachusetts H.B. 4742, which establishes a commission on community behavioral health promotion and prevention within the commonwealth’s Executive Office of Health and Human Services.

Massachusetts can better respond to the opioid epidemic and address the state’s behavioral health needs by boosting training for health and law enforcement professionals, fostering violence prevention programs in schools, and providing support for those who intervene routinely with people in need of help, according to a new report from the state’s Promote Prevent Commission.

The detailed report includes recommendations to improve the state’s behavioral health system. The panel proposed new funding for behavioral health training for pediatricians and law enforcement personnel, as well as programs in the schools that encourage social and emotional learning and violence prevention. The report says that enacting the recommendations would help Massachusetts build an infrastructure that prioritizes prevention and positive health outcomes.

The commission created by the legislature in 2016 convened in February 2017 to identify public health initiatives that would help prevent substance use disorders, mental illness, and youth violence. Its members include leaders in public health, mental health, criminal justice, medicine, education, and social work.

The commission focused on assessing what works to prevent a range of mental, emotional, and behavioral health problems. The report describes what could be achieved if the state uses an evidence-based policymaking approach to fund the most effective prevention and early-intervention strategies.

In particular, commission members sought to recommend ways to forestall risky behavior in youth and young adults from turning into harmful and costly disorders. In Massachusetts, those ages 18 to 24 report higher levels of problem drinking, nonmedical cannabis use, and tobacco smoking than any other age group in the state; these young adults also report the highest rates of depression.

Proper interventions can help curb these kinds of behaviors and prevent more serious outcomes. On the other hand, failing to address behavioral health problems effectively increases the likelihood that these young people end up in the state criminal justice system. That reality compounds already challenging recovery processes and triggers additional public costs.  

Shortly after it convened, the Promote Prevent Commission partnered with the Pew-MacArthur Results First Initiative, which helps states and counties implement an evidence-based policymaking approach. Results First offers tools to assess existing programs, conduct cost-benefit analyses to project the potential return on investment of rigorously evaluated programs, and use evidence to inform spending and policy decisions. These tools helped the commission identify effective, evidence-based programs that could improve outcomes and maximize the impact of limited tax dollars.

Working with the commission, the state departments of public health and mental health customized the Results First cost-benefit model to compare the value of investing in evidence-based prevention programs—as delivered in Massachusetts—to the risks and costs involved. With technical assistance from the Results First team, they worked to identify and assess   programs designed to reduce the development of substance use and mental health disorders in children and young adults.

The departments provided information about the evidence of effectiveness and cost-benefit analyses for key current and prospective programs. The results show that most of the programs would be cost-beneficial and would provide varying levels of long-term value by avoiding costly treatment, involvement in the criminal justice system, and loss of income.

The commission’s work has been well received by state leaders and the media, as indicated in part by the level of interest. The agencies that worked with the panel have found that the data collected were valuable and officials were shown holes and blind spots in how they provide behavioral health services. Based on these findings, state leaders say they want to continue evidence-based health work.

Representative Jim Cantwell, the commission chairman, filed legislation in March that would establish the commission permanently within the state’s Executive Office of Health and Human Services. Doing so would mean more cross-agency collaboration, regular use of program evidence review, and cost-benefit analysis analyses for advancing state and local policies, practices, systems, and programs. 

Sara Dube is a director, Benjamin Fulton is a senior associate, and Steven Lize is an officer with the Pew-MacArthur Results First Initiative.