A panel of experts led a discussion on the gaps, challenges, and pathways forward for Utah’s mental healthcare system during the 2023 Utah State of Reform Health Policy Conference on April 26th.
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Rep. Steve Eliason (R- Sandy) along with members of the Utah steering committee developing the state’s Behavioral Health System Assessment and Master Plan highlighted the progress made in the state’s crisis response and intervention.
Utah’s suicide rate fell to 20.1 deaths per 100,000 residents in 2021, ranking the state the 14th highest in the nation for suicide rates, according to CDC state-level data released last month. It marked the first time in recent years that Utah did not rank among the top 10 in suicidality—the state’s rate declined while the national average climbed during the pandemic.
Eliason, who has been leading legislative efforts on mental health reform over the past several sessions, emphasized the importance of early intervention.
“So for a crisis call, after all is said and done, the cost of that call is about $40,” Eliason said. “A mobile crisis outreach visit is about $380. A short-term up to 23-hour stay at a crisis stabilization center could be $1,250. And then when you move into sub-acute [care], you’re going to be typically over $1,000 a day, and a stay could range from, on average, seven to 10 days.
Then of course [for state hospitals] those costs go way up, so the earlier we intervene, the less impactful it is on the individual and the cheaper the cost is to both the state as well as to the individual …”
Eliason reflected on efforts to strengthen crisis intervention in rural parts of the state where suicide rates are typically higher. In 2017, Utah launched a statewide crisis line, which merged with the 988 line last summer. In 2018, Utah deployed five mobile crisis outreach teams, launched the Live On Utah program, and expanded SafeUT, a youth-targeted crisis intervention program.
In recent sessions, the legislature established crisis receiving centers in critical areas and continued to invest in crisis response and intervention, culminating in efforts this year to broaden these supports to more counties.
Laura Summers, director of industry research at the Kem C. Gardner Policy Institute, who is working to develop the state’s Behavioral Health Master Plan, said the draft plan will be released soon, possibly as early as this month.
Summers explained that the assessment of the behavioral health system that will inform the plan was built upon a previous assessment in 2019 that aimed to determine gaps and challenges. She said one of the biggest issues to come out of the current assessment was the lack of system-level coordination.
“It’s really just the level of coordination that’s lacking—as more and more sectors are becoming involved or impacted by or connected to Utah’s behavioral health system, or dealing with populations that have behavioral health needs,” Summers said. “So we have corrections, we have law enforcement, we have housing—all of these different sectors are dealing with behavioral health issues now and are putting forth great initiatives.
But we heard over and over again [about] that lack of system-level coordination and some of the challenges that it creates in terms of the boots on the ground and being able to provide the best care that providers can to their patients…”
Summers added that the lack of coordination and administrative burden associated with state and federal regulations have contributed to the creation of siloed systems. The siloes present a challenge to the system’s efficiency, exacerbating workforce issues and prompting an increasing number of providers to move to a cash-only market.
“Now we’re seeing by trifurcation, between the public the private [sectors] and this cash-only market, where a certain segment [of] people are only able to access care if they can truly afford to pay cash for services,” Summers said.
Once the draft plan is made public, the master plan’s steering committee will hold meetings where stakeholders can offer their input on formulating the policy recommendations that will fortify the behavioral health system.
Two members of the panel, Patrick Fleming, chair of the Utah Substance Use and Mental Health Advisory Council, and Greg Bell, former lieutenant governor and CEO of the Utah Hospital Association, serve as co-chairs of the steering committee.
“We want to be able to make policy recommendations to the legislature and to payers that makes sense for them,” Fleming said. “[We want to] get people [care] so they don’t have early onset of these diseases. We can have better prevention services, but we need to do this holistically.
We’ve never had an opportunity to do this before, [but] we have the opportunity now. So I just say to everybody, when this master plan comes out, it’s not going to be perfect—we will get some pushback from some very important people in the state. We need to push back against them.”
Bell called upon conference attendees to come together in the coming months to help build recommendations that will benefit everyone.
“It’s down to the working level and I think you’ll be very pleased with this [draft master plan],” Bell said. “If you find something in there that you think is baloney or could be done better, we’re hoping you’ll tear it apart and bring it back to us so that when we come up with a report by September [or] October—that we present the legislature with prioritized funding and recommendations that your stamp is all over as well.”
Utah ranked number one overall in the U.S. News & World Report’s Best States rankings for 2023, with healthcare ranking seventh among states.
Utah’s measures of child and infant health, physical health, and illnesses like diabetes fared better than national averages. Mental health was the only health outcome where Utah fared worse than the national average.
The panel noted that Gov. Spencer Cox and the legislature have been dedicated to creating, funding, and supporting behavioral health-related initiatives.
“We really do want your feedback on this,” Fleming said. “This is not about turf. This is not about who gets to be the boss. This about us all pulling on the rope in Utah in the same direction. We have an opportunity to fix this and we need to do it.”