The Maryland Behavioral Health Care Treatment and Access Commission held its first-ever meeting last month to discuss report findings and next steps.
Under House Bill 1148, which passed in the Maryland Legislature earlier this year, the commission is required to create four workgroups: one for geriatric behavioral health, one for youth behavioral health and the behavioral health of individuals with developmental disabilities and/or complex behavioral health needs; one for the justice-involved population’s behavioral health; and one for behavioral health workgroup development, infrastructure, coordination, and financing.
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Sara Barra, chief of staff for the state’s Behavioral Health Administration, broke down the commission’s initial needs assessment.
“We really want to think of behavioral health as a continuum of care. We really want to understand that all of these pillars—prevention, promotion, primary behavioral health and early intervention, acute urgent care, and treatment and recovery—they are one continuum and people may be in different places at different points, based on their needs.”— Barra
In comparison to 2021 data, 2022 data showed 7.6 percent fewer fatal overdoses in Maryland. The Maryland Department of Health (MDH) is in phase one of analysis, and will continue to analyze data and trends that fall within each of the four workgroups. Questions for future discussion include what additional information or analyses are needed to drive workgroup discussions or recommendations, and how the commission can better capture unmet need and demand for services and resources.
Jordan Fisher, chief of staff at MDH Operations and Healthcare System, broke down the reports that were used to guide each of the four workgroups, and provided recommendations for each. MDH reviewed four reports on geriatric behavioral health that focused on examining and evaluating crisis services for older adults, including policy, operations, and other requirements necessary to promote and deliver crisis services across the state.
The reports also examined appropriate long-term care placement in Medicaid for older adults, identified current cognitive and behavioral health needs of Maryland’s aging population, and provided ways to address those needs.
“The recommendations of these reports focus largely around strengthening the pre-admissions training and resident-review program, establishing an interagency coordination process relating to aging, and an enhanced residential rehabilitation program model for individuals with serious mental illness to allow them to age in place,” Fisher said.
Additional recommendations include establishing crisis walk-in and mobile crisis team models for each jurisdiction, and addressing workforce shortages, funding and accountability measures, and transportation accessibility.
MDH identified nine reports it used for the youth behavioral health workgroup, and primarily focused on youth-centered behavioral health prevention and intervention techniques.
“Through this review, we found some key recommendations, which include integrated behavioral health models, considering a pilot program in Maryland which would utilize the co-design model, along with recommending additional programming for transitional-aged youth, and expanding residential treatment center capacity,” Fisher said.
MDH used a total of 19 reports in its review of complex behavioral health needs, which focused on disparities in overdose deaths, and expenses and expenditures associated with serious, persistent, mental illness, among other areas. Key recommendations for complex behavioral health needs include increasing data on collection and analysis about opioids, evaluating medication adherence strategies, increasing treatment resources, and decreasing stigma.
For the justice-involved population, MDH analyzed 16 reports and placed attention on improving the continuum of care for mental health services and the statewide crisis response system, substance use disorder treatment accessibility, and improving access to care.
“Key recommendations coming out from these reports suggested increasing treatment resources for those leading correctional settings, to include diversion programs and access to substance use disorder treatment, increasing the forensic services and bed capacity,” Fisher said.
MDH based its recommendations for addressing the behavioral health workforce, development, infrastructure, and coordination off of 12 reports that noted how there’s a lack of providers who are trained to treat co-occurring disorders, and a lack of social workers and substance use disorder providers. Additionally, reports noted a high turnover rate for the behavioral healthcare workforce, which can be attributed to burnout and noncompetitive salaries. Recommendations include strengthening efforts to hire and retain psychiatrists—especially in rural areas—and nurses.
MDH analyzed six reports relating to behavioral healthcare, and focused on the need for increased spending in certain areas of the behavioral healthcare system like psychiatric rehabilitation programs, and creating new residential substance use disorder benefits.
“The recommendations from these reports focused on cost-containment strategies for the psychiatric rehab program, along with related recommendations for the public behavioral healthcare system,” Fisher said.
The four workgroups have met once since the commission’s initial meeting. Each workgroup is preparing reports based off of information shared at the first commission meeting, and will meet again on Dec. 18th to discuss initiatives going forward in further detail.