Opinion: State’s Public Behavioral Health System Struggles at a Critical Moment

Behavioral Health
CDC image.

As the COVID-19 infection rate increases and the death toll continues to climb, there is hope that the availability of multiple vaccines portends an end to this calamitous period for our state and our nation. But a second public health emergency is on the horizon, and we are not ready.

We are 10 months into this pandemic and the mental and emotional toll of COVID-19 has become heartbreakingly clear. Isolation, loss of income and grief resulting from the loss of a loved one – not to mention the threat of actually contracting the virus itself – are all having a profound impact on our mental health.

Up to 40% of Marylanders have reported feeling anxious or depressed as a result of the pandemic, and state crisis hotlines are receiving a startling increase in calls from individuals at risk for suicide. Drug- and alcohol-related deaths jumped by more than 18% in the second quarter of 2020 as compared to the same period a year earlier, including a 30% increase in opioid-related deaths. A recent study of over 69 million patients in the U.S. found that individuals who contracted the coronavirus had a significantly higher likelihood of developing a mental illness within three months of their COVID-19 diagnosis.

And as with COVID-19, this parallel pandemic is not affecting us all equally. Black and Brown individuals, older adults, lower socioeconomic groups of all races and ethnicities, and health care workers are bearing the brunt of this behavioral health crisis. The Centers for Disease Control and Prevention has reported a much higher suicide risk among racial/ethnic minority groups, unpaid caregivers for adults and essential workers. While overdose fatalities in Maryland actually decreased among White individuals by over 10% during the first six months of 2020 as compared to 2019, substance use deaths increased 35% among Black and Brown Marylanders during the same period.

As we emerge from the shadow of the coronavirus pandemic, the need for quality mental health and substance use treatment will continue to increase. But the professionals we trust to deliver public sector mental health and substance use services are struggling to survive at the time we need them most.

Twelve months have passed since the Maryland Department of Health transitioned management of the state’s public behavioral health system to a new vendor, Optum Maryland. To say the transition has been a challenge would be an understatement. Optum’s IT system failed immediately, and a year of chaos and uncertainty have followed.

The Optum system is unable to perform even the most basic claims processing functions. Mental health and substance use treatment providers do not have the information they need to determine their financial position or their ability to make payroll. Optum has not provided clear and consistent communication or basic technical assistance support, leaving behavioral health providers mired in a system that requires duplication of effort and diversion of their attention away from clinical care. This is a situation that would be untenable in normal times. It is particularly disconcerting at a time of skyrocketing demand for treatment.

Maryland has managed many of these vendor transitions over the past 20 years. Never before has the process been so dysfunctional and disruptive.

When the state opened Maryland Health Connection – its Affordable Care Act health insurance marketplace – in October 2013, the rollout was a disaster. But instead of spinning its wheels to fix a broken IT system, Maryland quickly scrapped the platform and ended its contract with the initial vendor in early 2014. Why is this situation different? Why has the Maryland Department of Health not required Optum Maryland to replace its faulty IT system?

It is unacceptable that a year into this failure there is no fix in sight.

Despite the continuing financial uncertainty, frontline behavioral health professionals throughout Maryland continue to go above and beyond the call of duty every day, placing their health and safety at risk to serve their communities during the COVID-19 emergency.

As the pandemic wanes and the public need for mental health and substance use treatment continues to increase, these services will be more important than ever. But if this situation continues unabated many behavioral health providers will find it difficult to carry on. Programs will close, service capacity will diminish, and we will be left as unprepared for the second public health emergency as we were for the first.

— DAN MARTIN

The writer is the chairman of the Maryland Behavioral Health Coalition.