Developing a Statewide Implementation Blueprint to Expand Access to Long-Acting Psychiatric Medications in Massachusetts Community Behavioral Health Centers
1. Cheryl Y. S. Foo
2. Kim T. Mueser, Center for Psychiatric Rehabilitation, Department of Occupational and Brain Sciences, Boston University
3. Catherine J. Leonard, Massachusetts General Hospital Center of Excellence for Psychosocial and Systemic Research
4. Sarah A. MacLaurin, Massachusetts General Hospital; North Suffolk Community Services
5. Michael C. Angelini, Massachusetts College of Pharmacy and Health Sciences University
6. Ryann Abrams, Greater Lawrence Family Health Center; Massachusetts Pharmacists Association
7. Massachusetts General Hospital Treatment Resistant Schizophrenia Advocacy, Clinical Consultation, Education, and Support Service (TRS ACCESS) Network
8. Deirdre Calvert, Massachusetts Department of Public Health
9. David Hoffman, Massachusetts Department of Mental Health
10. Margaret Guyer-Deason, Massachusetts Department of Mental Health
11. Donna Frates, Massachusetts Behavioral Health Partnership
12. Lee Robinson, MassHealth Office of Accountable Care and Behavioral Health
13. Jessica Zeidman, Massachusetts Department of Public Health
14. Amam Saleh, Massachusetts Department of Mental Health
15. Corinne Cather, Massachusetts General Hospital Center of Excellence for Psychosocial and Systemic Research; Harvard Medical School
Background: Long-acting antipsychotic medications reduce relapse and hospitalization for people with schizophrenia spectrum disorders, with greatest benefit early in illness, yet utilization among people with early psychosis remains low (US: 4%; MA: 11%). SMI-REACH is a statewide initiative expanding long-acting psychiatric medication (LAM) access and use across Massachusetts’ 29 community behavioral health centers (CBHCs), which increasingly serve as the entry and continuing care setting for young people after a first episode.
Methods: Phase 1 (2025) built a cross-sector coalition of state agencies, CBHCs, and clinical/research experts aligned on the principle of “no wrong door” to LAM treatment. Phase 2’s landscape analysis (2026) surveyed all 29 CBHCs on ability to prescribe, administer, and store LAMs onsite, yielding a typology of capability stages. Listening tours with 15 purposively sampled CBHCs identified multilevel barriers and facilitators. At a September summit, agency and CBHC stakeholders prioritized barriers and refined candidate strategies to inform a statewide implementation blueprint.
Findings: Sites spanned five capability stages: Fully Capable (21%; routine prescribing, onsite administration and storage of all LAMs); Capable (28%; onsite administration without storage, limited same-day treatment); Partly Capable (17%; onsite administration of long-acting antipsychotics only); Referral-Based (21%; prescribe but refer for administration); and Not Capable (14%; not prescribing due to absent administration workflows). Fewer Southeast (25%) and Western Massachusetts sites (38%) had onsite administration. Listening tours revealed leadership commitment, provider willingness, and patient need were high, while barriers experienced were primarily systemic: licensing requirements delaying onsite administration, non-billable nurse-led care coordination, and fragmented hospital-to-CBHC transitions. Facilitators included whole-team training on discussing LAMs, nurse champions for administration, and pharmacy collaboration for ease of access.
Conclusions: SMI-REACH applies implementation science at the scale of a state behavioral health system to bridge practice gaps in schizophrenia pharmacotherapy across the care continuum beyond coordinated specialty care. Multilevel barriers necessitate use of strategy bundles combining policy action, expanded access, provider training, and patient-facing supports. A capability typology enables stage-tailored strategy deployment, while state agency partnership enables structural change. An actionable blueprint will be finalized in December 2026.