Leadership from the House Health and Government Operations Committee slammed the Maryland Department of Health Wednesday afternoon for what they view as the agency’s slow approach to addressing mental health policy.
“I’m totally disheartened,” said Committee Chair Shane E. Pendergrass (D-Howard).
Pendergrass pointed to a number of issues, including an increased need for services due to the COVID-19 pandemic, rollbacks on reimbursements for telehealth services and slow development on a program that would expedite getting patients to psychiatric beds.
Wait times for treatment for mental health crises can be lengthy, leaving many people languishing in hospital emergency departments for hours — sometimes even weeks.
According to Erin Dorrien, director of policy for the Maryland Hospital Association, a 2019 study conducted by 29 hospitals found that 4,748 people reported to emergency rooms for behavioral health services over a 45-day period. More than 40% of those patients experienced a delay in referral to their next level of treatment, with an overwhelming amount waiting for bed space in a mental health care facility.
A 2020 bill sponsored by House Health and Government Operations Vice Chair Joseline A. Peña-Melnyk (D-Anne Arundel and Prince George’s) sought to change that.
Under the 2020 legislation, the Maryland Department of Health is to create a searchable database of available treatment space at all mental health care providers, as well as an electronic system that all health care providers can use for referrals.
According to the bill, a mental health care resource directory is to be developed and accessible by Dec. 1, 2021. By that same date, a pilot program for the registry and referral system, as well as a plan to expand it statewide, is required to be operating in at least two jurisdictions.
“This is a major IT project with an initial cost estimate of approximately $6 million over two years,” Dr. Aliya Jones, deputy secretary of the Department of Health’s Behavioral Health Administration, said.
She said that funding for the program’s technical buildout won’t be available until 2023, running past the deadline in Peña-Melnyk’s legislation.
Steve Kolbe from the Department of Health’s Department of Information Technology said that he is expecting “full implementation” of the system by March 31, 2024, but added that the date could change based on the ability to fully implement the requirements of the legislation.
Peña-Melnyk asked members of the panel what Marylanders in crisis are supposed to do in the interim, noting that she’s received calls from constituents whose children have spent up to seven weeks in the emergency department waiting for their next level of mental health care.
According to Dorrien, more than half of the patients seen during the 2019 study didn’t require an inpatient stay in a hospital, “further illustrating the need for more appropriate alternative destinations to help patients experiencing behavioral health crises not end up in the emergency department in the first place,” she said.
Jones suggested finding better ways to manage people in crisis in the community, pointing to the Greater Baltimore Regional Integrated Crisis System plan as an example: Last year, the Maryland Health Services Cost Review Commission approved $45 million in grants to Baltimore-area hospitals to expand mental health and substance abuse services through a crisis hotline, crisis units and expanded walk-in clinics.
The money, which comes from the state’s rate-setting system, began to flow at the beginning of this year and will last until Dec. 31, 2025.
But that answer wasn’t suitable to Pendergrass.
“The fact that this is taking so long — not only the bed registry but everything else that the department seems to be not resolving — maybe you’re making slow progress, but, at the same time, you’re making things worse, simply put,” Pendergrass said of the Department of Health.
The committee chair also pointed to a general policy of the Hogan administration to not testify for or against bills during the legislative session as a possible source of delays.
“The legislature can pass some amount of laws but when it takes five to seven years to implement a law, something is going wrong,” Pendergrass said. “Maybe it’s because the department doesn’t participate in our hearing process, they prefer to wait until after we pass the bill before they make comments.”
“If we had had more input from the department during the process of this bill, maybe we could have made it work faster,” she continued. “I can’t say that we could have, but I’d like to think we could have.”