GREAT BARRINGTON — As the Brien Center prepares to close its only South County location, the behavioral and mental health nonprofit is expanding higher-demand crisis services in Pittsfield.

Reimbursement shortfalls from all health insurance types and rising costs have led the Brien Center to reshape how and where it provides care in the Berkshires, according to CEO and President Diana Knaebe.

Because the Great Barrington location on Cottage Street is one of the least used facilities and has never made money, the Brien Center’s board voted to close and sell the building at the end of January.

The Brien Center serves about 9,000 patients at 25 locations across Berkshire County, offering therapy, psychiatry, addiction treatment, crisis services, ongoing support and rehabilitation for all age groups and levels of need.

“I feel very good about the Brien Center because care can be accessed the same day,” said Jennifer Michaels, the medical director of the Brien Center.

While the closure will leave South County without a physical Brien Center clinic, which is one of the area's only large mental health practices, Knaebe said the organization will continue serving current and prospective patients through telehealth and care at its other locations.

The Brien Center serves about 9,000 patients at 25 locations across Berkshire County, offering therapy, psychiatry, addiction treatment, crisis services, ongoing support and rehabilitation.

Knaebe described the closure as a shift in resources during a financially straining time. Shrinking reimbursement rates make it increasingly difficult to keep underused outpatient sites while demand for crisis stabilization, psychiatric emergencies and intensive care continues to grow.

The Brien Center’s primary funding source is Medicaid and Medicare reimbursements from the state and federal governments, which are intended to help low-income residents and older adults access care.

These programs once covered the full cost of providing services, but recently, there have been “significant reimbursement shortfalls from all payers.” The gap between what it costs to deliver care and what the government reimburses has widened in recent years.

“It’s not just delayed, it’s that the reimbursement rate doesn’t match what the cost of services are,” Knaebe said.

The cost of doing business is not reflected in the rates that are brought in through contracts and grants.

Public filings show that the Brien Center has managed a small annual surplus in recent years, with revenues and expenses being around $30 million. While that has allowed the nonprofit to remain financially stable, margins are tight and costs continue to climb — pressures Knaebe said made the South County closure unavoidable.

The Brien Center’s Community Behavioral Health and Emergency Services center on Fenn Street in Pittsfield.

Despite those challenges, the organization remains operationally stable, Knaebe and Michaels said. There is broader uncertainty across the nonprofit sector but the Brien Center continues to move forward.

“Currently, times are hard financially,” Michaels said. “I think that's true for all nonprofits, and there's maybe a level of uncertainty that didn't exist before, but we're forging ahead."

The center also is preparing for anticipated federal funding changes, including possible cuts to Chapter 257 rates that support human services agencies statewide. Knaebe said peer organizations across Massachusetts are facing similar financial strain, raising concerns about long-term sustainability if reductions come.

“They're not fully sustainable as it is, and so cuts could mean further cuts for organizations like ours,” Knaebe said.

This is not the first time the Brien Center has consolidated services. In 2022, it closed Keenan House for Women, a residential treatment program in Pittsfield, citing low enrollment, staffing shortages and financial pressure.

The Great Barrington closure does not signal broader downsizing, said Mary Murphy, executive assistant for the center.

“Yes, we did close one site,” Murphy said. “But we have many programs still in full operation, and we don’t anticipate those going away.”

Knaebe said the Cottage Street building serves primarily as a small outpatient therapy site and has had “light traffic” for years. About 500 patients are on medication prescribed by practitioners at the facility and fewer receive therapy, she said, adding the location does not have a waitlist.

“We are a nonprofit, so we do need to have some money to keep the lights on,” Knaebe said. “Sometimes we have to take stock of our entire portfolio, and unfortunately, we had to make a difficult decision that we needed to pull away from that area.”

All patient care can continue either via telehealth or relocation to another location. Anyone in South County can still begin care with the center, either at a different location or via telehealth, Knaebe said.

The center purchased the building in 1978 for $34,000 and still has a mortgage on it, according to a mortgage agreement that was updated in 2024. The site has never broken even operationally in nearly 50 years and selling the property will help reduce the nonprofit’s financial burden.

“Our clinicians are in constant touch with patients, and their care will be transferred, moved, rearranged,” Murphy said. “The building itself and the finances associated with it are the equation that forced what we have here now.”

The closure comes at a time when South County has few major mental health providers, particularly those that accept Medicaid or Medicare. Many private practices do not take those plans because they return lower reimbursement rates.

The news that the Great Barrington location would be closing was concerning for many due to the lack of major mental health providers in the area, especially ones that accept Medicaid and Medicare.

The Select Board voted to send a letter to Knaebe and political representatives throughout the state expressing concern about the loss of mental health services in Great Barrington, which is the hub for those services in South County, in hopes of supporting options for care in the community.

“The Brien Center announced that they were closing their only center in South County for mental health and that's really unfortunate, because South County seems to take the brunt of things, and losing a service like that is huge,” Town Manager Liz Hartsgrove said, crediting board member Garfield Reed with the suggestion to express concern.

Chair Steve Bannon said the Brien Center in Great Barrington was “a very large source for many people.”

“For many people, though it's a short drive, driving to Pittsfield is not practical, and telehealth is not always effective or practical for a lot of people,” Bannon said.

Berkshire County continues to have some of the highest rates of suicide and overdoses in Massachusetts and more people are ending up in the emergency room because of substance use.

“There's psychiatric issues where they don't meet criteria for inpatient care, and or there is a larger demand for inpatient care than what the Berkshire Medical Center is able to handle at any time,” Knaebe said.

To help ease a bit of the burden on emergency rooms by having a place to send those who have been stabilized but aren't ready to go home, two more beds are being added to the Adult Crisis Stabilization Center in Pittsfield, also known as the Pomeroy House, where individuals who need more support than outpatient care but do not require hospitalization can be treated.

Dr. Jennifer Michaels, the medical director at The Brien Center, said because of the center's 25 locations in the county, she feels "very good" about being able to deliver same-day care to those who need it.

One bed will be added in December and another in January.

“We'll be increasing to eight beds to help with what we realize and recognize is a mental health and a substance use crisis and especially here in the Berkshires,” Knaebe said.

The Pomeroy House is designed to provide short-term stabilization in a residential setting for people who need more support than outpatient care but do not require hospitalization.

“It's very homey. It's very comfortable, and the two new beds will not squish people together," Michaels said. "But more, it'll be done very respectfully and very mindfully,”

Michaels said the expansion reflects a broader shift toward investing in services that meet growing community needs, even as the organization adjusts its overall footprint.

“This illustrates how the Brien Center is accepting that there are some limitations and some things will change, but also growing programs with the community in mind, like more people need the Pomeroy service, and we're going to grow that,” Michaels said.