In the constant pursuit of help for their sons, Bonnie Nuendel of Eastham and Meegan Erving of Wellfleet have honed their stories into elevator pitches to perform for therapists, the rare Outer Cape psychiatrist, and any number of other gatekeepers who might keep the men safe.

“The help is out there,” said Erving, whose son, Lucas, is 18 and has been diagnosed with attention-deficit/hyperactivity disorder, bipolar disorder, oppositional defiant disorder, anxiety, obsessive-compulsive disorder, and autism. “It is just really hard to get. You have to be completely and totally on fire or nobody’s going to even look at you. I had a social worker in a psychiatric unit tell me, ‘Unfortunately, something catastrophic is probably going to have to happen before he gets the help he needs.’ That is the most devastating thing to hear as a parent.”

“There is a huge blank space where help should be,” said Nuendel, whose son, Andy, is 49 and suffers from bipolar and alcohol- and marijuana-use disorders.

State Sen. Julian Cyr said the ABC Mental Health Act, which then-Gov. Charlie Baker signed last year, will force private insurance to reimburse payment for services at a rate comparable to other medical treatments. This, along with more than $300 million in loan forgiveness and scholarships to encourage people to enter social work and psychiatry, should begin to attract people into the chronically underfunded and underpaid mental health and substance disorder professions. But that is going to take at least two or three years.

“You cannot just conjure up a psych nurse,” Cyr said.

Twenty percent of the already inadequate number of psychiatric beds in the state are empty due to a staffing shortage, according to a 2022 survey by the Mass. Health & Hospital Association and the Mass. Association of Behavioral Health Systems.

Meanwhile, families live day to day and crisis to crisis.

Meegan Erving’s elevator pitch goes something like this: Lucas was born two-and-a-half months premature. At age five, he started seeing a therapist after his dog died and “he was not bouncing back,” said Erving. Though he is smart, charming, and articulate, he has terrifying meltdowns that can turn violent. First diagnosed with a mood disorder at age seven, he has been hospitalized several times. The last two times, he languished in emergency rooms for days.

Lucas was kicked out of Nauset middle and high schools for making violent threats. On Feb. 13, he was expelled from Pilgrim Academy, a therapeutic school in Plymouth for students with behavioral issues.

He punched a female student, Lucas said. “She was a friend of mine and we had been going back and forth, and it just kind of came to a boiling point,” he said.

The police took him to Beth Israel Deaconess Medical Center, where he spent eight days in the emergency room waiting for a psychiatric bed to open up. He turned 18 there and then went home.

Cape Cod Healthcare’s Director of Behavioral Health Bea Forrest, a psychiatric nurse, said the shortage of beds for pediatric and geriatric patients is most acute. “Prior to Covid, our emergency centers might have seen an average of two to six youths for evaluations a month,” she said. “It has increased to an average of 10 per week, with youth as young as five years old presenting with suicidal ideation.”

Children under 18 “boarded” at Cape Cod hospitals waiting for beds for an average of 55 hours in January, while elderly people waited 84 hours, and adults waited 40 hours, Forrest said.

The parents of the girl Lucas struck did not press charges and, so far, Lucas has avoided arrest. But once, after he knocked his mother down during a meltdown when he was 16, it almost happened.

“You don’t know what it takes to have to decide that you’re going to call the police on your son who weighs 250 pounds and is African American,” Erving said.

The Wellfleet police advised her against it. “They said, ‘He has developmental disabilities — he doesn’t belong in court. You need services.’ We said, ‘We’ve been screaming that we need services and they’re not out there,’ ” Erving told the Independent.

No Arrest, but Jailed

Though Andy Nuendel lives on his own, Bonnie carries caretaking responsibilities on her shoulders both for her son and for her husband, Don, a retired engineer with Alzheimer’s disease.

Neundel’s elevator pitch: Andy was diagnosed bipolar at age 18 after getting a speeding ticket for driving 100 m.p.h. in New York. He moved back home with Bonnie and Don in Schenectady, N.Y. One night, he went berserk when Bonnie was driving him to his job at Pizza Hut. She called the police and they found alcohol and marijuana paraphernalia all over their basement.

After a three-week stay at the psychiatric unit of Ellis Hospital, Andy came out with “a full boatload of services,” said Nuendel, “a housing voucher, food stamps, a job coach, a psychiatrist, and a counselor through Medicaid. It was a dream come true.”

Despite Andy’s manic episodes and periods of noncompliance, he kept those services until he left New York. Bonnie and Don moved to the Cape in 2006. In about 2015, Andy became too hard to help from far away. They found him an apartment in Eastham. He has lived there on disability benefits with his girlfriend since 2016.

In December, Andy stopped taking medication for bipolar disorder and stayed in bed all day. When told he needed to get help, he became loud and abusive to his girlfriend and to his parents, Nuendel said.

His alcohol and pot use were problematic, but the primary issue was his manic episodes, Nuendel said. After many calls to the police for help with de-escalation, officers suggested a “Section 35” whereby Andy would be forced into mandatory treatment for up to 90 days for drug or alcohol abuse.

Nuendel filled out the paperwork and Andy was sent to the Mass. Alcohol and Substance Abuse Center (MASAC) in Plymouth. It is one of two facilities run by the state Dept. of Corrections for men with Section 35 orders.

The practice of putting people needing substance abuse treatment in jail has been criticized for years. In 2016, prisoner and addiction advocates succeeded in changing state law so that women locked up under Section 35 can be sent only to hospitals or mental health facilities.

In April 2022, Deborah Goldfarb of Boston Medical Center’s Grayken Center for Addiction testified at the State House in favor of banning Section 35 commitments in jails for men as well.

“Overwhelmingly, these men … suffer inhumane treatment and insufficient care while in these facilities and have quicky relapsed post-release,” she said, according to the State House News Service.

MASAC in particular has faced dozens of complaints from former patients and a lawsuit filed in 2019 by Prisoners’ Legal Services of Massachusetts. In 2020, Gov. Baker announced broad reforms at MASAC, including removing prison guards from inside the institution and staffing the facility with employees from Wellpath, one of the nation’s largest private prison health care companies. It is owned by the private-equity firm H.I.G. Other announced reforms included ordering MASAC to be accredited as a residential opioid treatment facility by 2022.

The Dept. of Corrections told the Independent that the guards have moved outdoors, and Wellpath has taken over treatment on the inside. Teresa Koeberlein, a senior vice president at Wellpath, stated by email that MASAC “recently passed its Commission on Accreditation of Rehabilitation Facilities accreditation.”

Only days into Andy’s commitment at MASAC, Nuendel said, everyone regretted the decision. Andy’s phone calls were agonizing, she added. Andy later told the Independent he had been sent to “solitary” or “the hole” three times in 28 days. He emerged bruised from fights with guards and another inmate.

On day three of his commitment, he told a guard he did not want to be there. The MASAC employee interpreted his statement as a suicide threat, Andy said. He was put on a suicide watch in a room with a camera and dressed only in an ill-fitting “turtle suit” that left him almost naked, he said.

“That’s humiliating — it’s degrading,” Andy said. “It should not happen to anyone who is in there.”

Nuendel said when she went to pick him up in Plymouth, he sobbed in his girlfriend’s arms. He then spent several weeks in a manic state; his distrust of medical institutions is at an all-time high, Nuendel said.

For people like Andy and their anguished loved ones, there is little help. Because of insufficient capacity at actual treatment facilities, three out of four Section 35 beds in Massachusetts are in correctional facilities, according to Prisoners’ Legal Services.

As for Lucas, his attack on a fellow student may have been catastrophic enough to get him some help. Since his expulsion last month, the nonprofit Justice Resource Institute has committed an array of services to the Ervings, including a family partner to provide parent support, two therapists, and an intensive care coordinator, said Erving. She said she had originally applied for JRI’s help last July.