Public Mental Health Treatment in Maryland: Past,

Present and the Future

Gayle Jordan-Randolph, M.D.Deputy Secretary for Behavioral Health

and DisabilitiesNovember 5, 2013

Maryland’s Mental HealthMemory Lane

1798 – Maryland General Assembly authorizes Medical and Chirurgical Faculty of Maryland “to protect citizens from ignorant medical practitioners and quacks by disseminating medical knowledge and licensing doctors.” (Md. Archives)

The 1700’s1797- Maryland Hospital

– Established ‘for relief of indigent sick persons and for the reception and care of lunatics.” (Acts, 1797)

– Prior-“inebriates,” “feeble-minded” and lunatics resided at home, jails and almshouses.

– Maryland’s first public health hospital– Coincided with Yellow Fever Epidemics– Provided physical and mental health treatment for the

indigent population– Originally overseen by the Mayor and the City Council of

Baltimore with some State influence– State assumed governance in 1834 in response to concerns

about conditions at the hospital

The 1800’sCare in Maryland Hospital• average cost of care estimated at

$150/year• served both private and indigent

patients • physicians “gratuitously” provided

services (briefly)• State funds physician

services-$500/year

Maryland Hospital for the Insane

• Established in 1938• 1839 – devoted to the treatment

of lunatics and inebriates. • half to be devoted to the

treatment of “pauper lunatics.”

Board of Mental Hygiene – Early 1900’s

Board Assumed commission’s duties (1922)

Previously state mental institutions came under the Department of Welfare

Overcrowding Funding Staffing

Department of Mental Hygiene 1950’s-1960s

• Replaced the Board of Mental Hygiene in 1949

• Coordinated research activities• Managed the state mental health

institutions• Maryland Alcohol Commission established• Provided education/training of personnel

within the institutions• Drug Abuse Authority established• Maryland state hospital systems

desegregated.– Patients redistributed regardless of race.

The 1970’s• Approximately 4500 beds state-wide• Inpatient treatment emphasis of care• State facilities had individualized residency

training program• State plan merged State residency training

programs with The University of Maryland, – Increased trainees expose to public mental

health, encouraged graduates to seek state employment

• Drug Abuse Administration and Alcoholism Control Administration consolidated under Mental Health Administration.– Later removed from MHA administrative oversight

The 1990’s

• Merger of Drug and Alcohol Administration and Alcohol Control Administration to form Alcohol and Drug Abuse Administration in the late 1980s.

• Expansion of community mental health services,• Downsizing of state-operated inpatient beds• Development of evidence based practices, • Creation of Health Choice MCOs• Mental Health Carve Out

National Mental Health Agenda

New Freedom Commission Report (2003) Mental Health is Essential to Overall

Health Mental Health Care is Consumer and

Family Driven Emphasizes the elimination of

disparities in mental health services Mental Health Care is Delivered and

Research is Accelerated While Maintaining Efficient Services and System Accountability

Technology is Used to Access Mental Health Care and Information

Early 2000’s

• Evidence Based Practices• Expansion of Community Services• Expansion of Consumer Involvement in Policy

Development and Planning• Embracing Recovery principles • Integration of Services/Systems• Technology

Transformation• Mental Health First Aid• Veterans Initiative• Wellness Recovery Action Plan• Integration of Care • Recovery Trainings for providers,

consumers, and clinicians• Cultural and Linguistic

Competence Training Initiative

Behavioral Health Integration in MarylandBetter Care, Better Health, Lower

Cost

DHMH-Behavioral Health Services 2013 and Beyond

Mission: To develop and manage an outcome

guided behavioral health service delivery system:

Integrating prevention, health disparities, recovery principles evidence based practices and cost effectiveness

Key features of Integrated BH System

• Increase public health and outcomes focus• Increase prevention efforts and early

intervention• Promote clinical integration• Increase data collection and outcome

measurement• One point of contact for BH providers• Coordination for individuals moving between

Medicaid and Maryland Health Benefit Exchange

• Preservation of Safety Net• Reduce Health Disparities

Significant Changes Planned• ADAA and MHA to integrate into a single

Behavioral Health Administration – July 1, 2014

• One Administrative Services Organization (ASO) will manage behavioral health benefits for Medicaid recipients and uninsured

• New integrated regulations

• Accreditation

Behavioral Health Administration

– Restructured organizational chart

– Staff integration and cross-training

– Increased public health mission• Overdose Prevention Initiative, Suicide

Commission, Drug Monitoring, Smoking Reduction, Primary care consultation, Problem Gambling, Early Intervention

Administrative Services Organization

• Manage behavioral health benefits for Medicaid recipients and uninsured

• Single point of contact for behavioral health providers• Collect and analyze data • Make data available to local authorities to improve

monitoring and management of behavioral health services

• Train and assist providers new to ASO system

Regulations and Accreditation

Streamline regulations and maintain quality of care

Accreditation – Consistent with current medical practice– Reduces redundancy– Simplification of the regulations with some

degree of flexibility– Integrates evidence based practice

Regulations to address services not covered by accreditation

Need for Flexible Integration Options

• Seriously mentally ill have significant comorbidity

• Seriously mentally ill have difficulty navigating health service delivery system

• Promote clinical integration of mental health, substance use disorder, and somatic care

• Health Homes

Outcomes• Increased consumer participation in entire

health care service delivery system• Reduction in the morbidity associated with

chronic medical and behavioral health conditions

• Improved communication and collaboration that leads to integration

• Reduction in the overall cost of health care• Change in consumer satisfaction and

wellness

Exciting Times

Health Care Models- -OTP Health homes

Consolidation of the Behavioral Health ManagementImplementation of the New ModelUtilization of data to improve service delivery systemSupport and improve the overall wellness of the citizens of Maryland.