During the peak of the pandemic in 2020, Heywood Hospital in Gardner offered doctors and therapists a $50,000 sign-on bonus to work in its mental health unit.

“We still couldn't get enough clinicians,” Heywood co-CEO Rozanna Penney said. “We also offered tuition reimbursement, retention bonuses. But there just weren’t enough of them.”

Like many hospitals across the state, the community-owned healthcare system struggled to retain clinicians in the face of a worsening mental health crisis, and was forced to close its mental health unit in 2021. This month, the hospital is finally staffed enough to reopen six beds on Jan. 11, with a goal of recruiting enough clinicians to eventually support a 12-bed unit.

“That’s our next step, our big focus,” Penney said. “Just because we don’t have beds doesn’t mean that people don’t come to the hospital. They just end up staying in the emergency room, which isn’t a good environment for them and doesn’t have the right professionals to care for patients who are staying there for weeks at a time.”

Nine patients are currently receiving mental health care in the 20-bed Heywood emergency room. Some of those patients will move into the facility, which has been upgraded with a grant-funded sensory room, enhanced security measures and specialized training for staff and security personnel.

Reopening the unit is “a great step in the right direction,” Penney said, adding that the hospital is still struggling to recruit new staff, though COVID has subsided a bit and fewer clinicians are taking high-paying traveling positions that took them away from the local workforce in recent years.

“In general, we’ve seen people exiting health care,” Penney said. “Especially during and after a pandemic, it’s a very challenging field to be in.”

Heywood’s staffing struggles reflect a scenario playing out across the state: a report last year from the Massachusetts Health and Hospitals Association found that 25% of emergency department beds were occupied by people awaiting behavioral health treatment, citing staffing and space constraints. Last year, state officials implemented a Behavioral Health Roadmap to address the worsening crisis through expanded services, community-based alternatives, more mental health services offered at primary care facilities and a mental health hotline.

The FY24 Conference Committee budget includes $192 million in federal funds for a Behavioral Health Trust Fund.

“The legislature appropriated additional money to improve access and to help address the issue, but there’s still a huge problem with access to providers,” said Michael Doonan, executive director of the Massachusetts Health Policy Forum. “We need to do more to address the workforce shortages in mental health, and we need to improve actual access. Even if people have insurance, they may not be able to see a mental health provider in a timely way.”

Part of the state’s roadmap includes encouraging more providers to take insurance — a huge factor in access to care, according to Nancy Byatt, a psychiatrist and physician-scientist at UMass Chan Medical School.

“Whether somebody has private or public health insurance makes a huge difference in their ability to access care,” she said. “We have a very differential access to mental health care in our country that really needs to be addressed.”

Simply hiring more psychiatrists and mental health practitioners wouldn’t solve the problem, Byatt says, due to a slow training process and the sheer need for mental health resources everywhere.

“What we really have to be thinking about is how we build the capacity of other health care professionals, other community based professionals who are working with individuals that may be experiencing mental health challenges,” she said, “so they can integrate mental health care into the kind of services they're providing.”

A lack of mental health resources, professionals and services across the state — and country — was an issue long before the pandemic hit, Byatt says.

“We’ve had significant mental health challenges for decades in this country … We as a country and as a health care system haven't put the resources in to address this,” she said. “We’ve had a crisis from quite some time, and it has now become an emergency.”