The last two years of the COVID pandemic has taken a toll on Maryland, particularly in the field of behavioral health. Data from the Community Behavioral Health Association of Maryland (CBH) reports emergency department visits for behavioral health increased by 12% over the last few years, while all other visits decreased by 11%.
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For CBH Executive Director Shannon Hall, one of her top concerns is the dramatic increase in child suicide attempts—as much as 47%.
“I go down to the playgrounds, and it feels like every mother is struggling with the same thing … You’re talking about your kid’s mental health struggles and comparing notes and resources on what to do about it,” she said.
Behavioral health providers are facing a three-pronged challenge: the increase in demand of services during the pandemic, a widespread workforce shortage, and a claims payment crisis involving the Department of Health and its system vendor, Optum.
Due to an operational failure within Oputm’s system in January 2020, behavioral health providers were unable to reconcile their claims at the correct amount, a problem that has spanned over two years now.
Hall is concerned that the payment crisis is affecting the already-strained workforce. She said that some CBH members, particularly the providers in residential programs and therapists, are experiencing more vacancies.
“[Staff are leaving] the residential programs because of COVID, safety fears, and low-paying jobs. The therapists [are leaving] because with the expansion of telehealth and interest in uptick in the commercial side, they get higher-paying jobs elsewhere. What this means is that there’s a big reduction in access to services right now,” she said.
Emergency legislation is currently moving through the House of Delegates to help rectify the payment crisis.
Despite these challenges, Hall says there has been major improvement over the last few years, particularly in the field of data exchange, an area in which the smaller behavioral health provider community has trailed behind the rest of the health care field. About 17 CBH members have partnered with CRISP, the Maryland state health information exchange, to standardize their data and improve quality measurement standards.
These standards are helping inform providers of the best ways to improve patient care. For example, Hall cited the importance of tracking therapeutic alliance, or a mutual agreement between the patient and provider to engage in treatment.
“A weak therapeutic alliance is one of the strongest predictors for people referred for addiction treatment, dropping out of treatment early on,” she said. “It’s like an early warning system for who’s going to drop out of care, which is one of the biggest problems facing behavioral health.”
In total, CBH providers are measuring the outcomes of about 22,000 patients in the public behavioral health sphere.