They will work with incoming Health Secretary Laura Herrera Scott, a physician and former Gov. Martin Undersecretary for Health under Martin O’Malley, who inherited a wide range of vacancies at an agency with burnt-out staff after three years on the front lines of the fight against the pandemic.
Short-staffed, the state’s hospitals are operating at or near capacity as the legislative session opens Wednesday, with patients sicker than pre-pandemic levels and people with mental health crises in emergency departments, according to the Maryland Hospital Association. room for waiting beds. In the first year of the pandemic, the state had the worst average ED wait times in the country, according to the Centers for Medicare and Medicaid Services.
While lawmakers have made sporadic changes throughout the pandemic—expanding access to testing and vaccines and requiring implicit bias training for health care workers—officials say the coronavirus has exacerbated growing challenges that require Take a comprehensive response.
They want to restore staffing levels to full capacity, fully fund programs proven to help patients, and build community services to keep people out of hospitals and the criminal justice system. The bills, which could be introduced in the next week or two, call for a four-year behavioral health study and specific proposals, and a two-year public health study, lawmakers said.
House Health and Government Operations Committee Chairman Joseline A. Peña-Melnyk (D-Prince George’s) said the legislation would address structural issues but also social determinants of health, including financial instability, unreliable transportation, unacceptable Education and undercapacity housing.
Research shows that, in addition to the conditions under which people are born, grow, live, work and age, public health officials should also consider the role that structural inequalities, such as racism, class discrimination and gender oppression, play in health outcomes.
Del. Ariana B. Kelly (D-Montgomery) is spearheading a public health bill that would create a commission to examine the state’s response to the epidemic and racial and ethnic disparities in drug overdose deaths and maternal mortality and birth outcomes Reaction.
Costs will be calculated when the bill is introduced. Lawmakers said the investment would be significant. Their goal is to tap the state’s $2.5 billion surplus and $3 billion in “rainy day” savings accounts, though Moore warned the state cannot afford the more than $2 billion in requests it has already made to the state.
“You pay now or you pay later, how do you pay? When people commit suicide, when families aren’t functioning, somebody’s suffering, you pay the price,” Peña-Melnyk said in an interview. “
The pandemic has highlighted and exacerbated the mental health crisis, and many people do not have the resources to seek help even though the state has enough providers.
“If we’re not doing it now, are we going to do it?” said Del. David Moon (D-Montgomery), who will oversee the House’s behavioral health bill. “The demand is so great and there is so much funding at the moment, it would be a real shame if we didn’t pay a deposit for part of this expansion.”
In Maryland, 781,000 adults — 19 times the population of Annapolis — live with a mental illness, according to data compiled by the state chapters of the National Alliance on Mental Illness. In February 2021, a year after the pandemic, nearly 40 percent of Maryland adults reported symptoms of anxiety or depression, and about a third had no access to counseling or treatment, NAMI said.
Behavioral health patients account for about a quarter of emergency room admissions but account for 70 percent of all days occupied by patients who occupy emergency room beds while awaiting care elsewhere, according to an analysis by the Maryland Institute for Emergency Medical Services Systems.
Moon said that after trying to reform criminal justice in his eight years on the Judiciary Committee, now is the time to turn to the behavioral health system, hoping to keep people out of courts and prisons.
The bill would create a commission to figure out where the system is failing patients, create a behavioral health and drug treatment system in all counties for people seeking help, and how to train more providers, Moon said.
“It sounds simple, but how far are we from it,” he said.
Mental health advocates are urging lawmakers to strengthen community services through certified community behavioral health clinics, federally and state-funded clinics that provide outpatient mental health and substance use disorder treatment, case management and primary health checks.
Lori Doyle, director of public policy for the Maryland Community Behavioral Health Association, said the goal is to get people to outpatient care and services before their condition deteriorates enough that they end up in a hospital emergency room or prison. Without access to treatment, patients must rely on underserved and expensive inpatient psychiatric hospitals set up for long-term care—rather than rotating patients who can receive outpatient treatment once their condition stabilizes.
“If you have diabetes, we don’t say the best way to manage your diabetes is to go to the emergency room,” she said. “Beyond behavioral health, this is by no means what we advocate or think is a good approach.”
The Hogan administration missed a deadline last year to pilot a CCBHC in Maryland, despite sending a letter from most of the state’s congressional delegation.
Many states have had success in accrediting community behavioral health clinics, Doyle said. In New York, monthly behavioral health emergency department charges fell 26 percent; after three years, adult client admissions at psychiatric hospitals in Oklahoma, Missouri, dropped 93 percent, according to data compiled by the nonprofit National Council on Mental Health. State emergency department visits fell 36%.
Currently, most behavioral health clinics are losing money because reimbursement rates do not cover the cost of services, making it difficult to find services even for people with private insurance.
That’s the case at Cornerstone Montgomery, a certified community-based behavioral health clinic that sees 3,000 clients a year in Montgomery County and is poised to add 500 more in St. Mary’s, Calvert and Charles counties, the CEO said. Cary Guthrie said.
Thanks to the designated clinic, the center can get some federal funding, and as services have expanded, patient hospitalizations have fallen — a 59% drop in 2021 compared with the same period in 2018, Guthrie said.
“The results speak for themselves across the country,” she said of the demonstration lawmakers are considering.
