Fixing Mental Health Care Gaps

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03 February 2026 – HARWICH, MA – State officials, including Dr. Kiame Mahaniah, secretary of the executive office of health and human services for Massachusetts, received a full plate of gaps and needs for mental and behavioral health services across rural Cape Cod and the Islands.

What are Cape and Islands behavioral health service needs?

During a listening session February 3 at the Cape Cod Regional Technical High School in Harwich, the group said that services coordinated or delivered from the designated Southeastern Massachusetts mental health hub, Brockton, flat out fails people on the Cape and Islands. The groups said distance, coupled with transportation realties and rural needs required its own approach.

In addition, prevention services as well as services directed to youth and senior populations can be hard to come by. Nantucket Cottage Hospital noted that it has had children in crisis wait as long as eight days for a physiatriac inpatient bed – leaving the child essentially stranded in the hospital emergency room while waiting.

What is the state’s new prevention initiative?

In December, the state launched a new Office of Behavioral Health Promotion and Prevention. The roundtable, hosted by State Sen. Julian Cyr, brought together Cape and Island behavioral health providers and state officials for input as the office gets up and running.

Many of the 70 or so participants traveled hours by boat and car to join in person and a contingent also participated virtually by teleconferencing – a fact that was used to remind the state just how inaccessible services can be for people.

Why does prevention matter?

In Barnstable, as in other places, the mix of mental health, behavioral health, and addiction form a layered complex issue  – but behavioral health always seems to be nexus for everything else, said attendees, who also represented a broad set of professionals – from law enforcement, to schools, to health care.

One area of consensus? The new focus on prevention is a good thing.

What is relation between crime and behavioral health?

Barnstable County Sheriff Donna Buckley said that without wellness programs, people literally end up in jail. Their data shows that behind every incarceration lies some combination of addiction and mental health issue. She says programs that prevent people from spiraling into crisis also prevent crime.

How does prevention work?

The group agreed that by and large most of them were interventionists trying to be preventionists – that is, most had training in how to respond to crisis. In everyday reality, the current structure offers no practical way to meet needs in a clinical setting.

The solution, said participants, lies in bringing services into community.  No matter how hard people work to increase clinicians and access, at the end of the day it would be far better to simply have less people needing detox or mental health beds.

What does youth need on the Cape and Islands?

Children and youth form a special issue. Barbara Dominic, a long-term Nauset schools social worker who now consults with Barnstable County said that the rural reaches of the Cape and Islands creates extreme social isolation in youth, with a lack of safe and accessible gathering spaces. The regional also has highest rate of suicide among young adults, she said.

Dr. Kim Mead-Walters, founder of Sharing Kindness, added that suicide is not an individual program, but a community-wide one. Kids on the Cape also have a high rate of grief trauma. By the age of 18, 1 in 13 young people statewide have experience significant loss and grief. In Barnstable County, that figure is 1 in 9.

Outer Cape Heath Services representatives agreed, noting that we need to have programs to treat and support these bereaved kids now to prevent huge issues later.