It’s Children’s Mental Health Awareness Week in Maryland. This weeklong campaign will raise awareness of the importance of children’s mental health. And it’s already off to a great start.
Archive for Advocacy & Public Policy
Baltimore City Mayor Catherine Pugh honored the Mental Health Association of Maryland and other advocates this week as part of Mental Illness Awareness Week (MIAW). MHAMD was recognized for our 100+ years of advocacy to ensure that the one in five Marylanders living with mental health problems have access to high-quality services, resources and information. Thank you, Mayor Pugh, for helping to increase awareness to such an important issue.
An annual part of MIAW is National Depression Screening Day. Major depression affects about 16 million American adults each year, and brief screenings are the quickest way to determine if you or a loved one should connect with a mental health professional- to get a checkup from your neck up. You can take a free, anonymous and confidential screening on our website. You’ll see your results immediately and receive recommendations and links to resources. Please note that the screenings provided are educational and not diagnostic, but can help you determine if your recent thoughts or behaviors may be associated with depression, a common, treatable mental health issue.
Additionally, Maryland has a statewide crisis hotline that can be reached day or night to provide support, guidance, and assistance to those in need. That number is 1-800-422-0009 and they can direct you to resources and providers in your community. Please reach out if you think you or a loved one can benefit from this service.
Network Adequacy Part V: Proposed Regulations a Win for Behavioral Health Consumers
You may remember from Part IV of our Network Adequacy series that the Maryland General Assembly passed landmark legislation in 2016 requiring that health insurance plans in the state have adequate numbers of providers in their networks to ensure that behavioral health consumers can access timely care. This legislation, enacted after years of advocacy with state regulators and decision-makers, required the Maryland Insurance Administration (MIA) to promulgate new regulations by 2018 to implement the law for plans beginning in 2019.
We are excited to share that the proposed regulations are a huge win for privately-insured behavioral health consumers. Throughout the past year, the MIA held public hearings on various topics relevant to network adequacy. MHAMD and other healthcare consumer advocacy organizations worked together to submit comments and testimony with a singular message: privately insured Marylanders deserve timely access to care and the only way to ensure that is by holding the insurers accountable to meet appointment wait time standards. The MIA agreed; the proposed regulations not only include geographic standards (travel distances), but they also include some of the strongest appointment wait time standards in the country.
While the regulations aren’t perfect and they aren’t yet final, they provide strong network adequacy requirements and consumer protections. The regulations require insurance carriers:
- Have enough providers within a geographic area to ensure that consumers can access appointments within:
- 10 days for non-urgent behavioral health care
- 15 days for primary care
- 72 hours for emergency behavioral health care
- Have providers within a specific distance of a member’s home or workplace depending on their geographic area:
- 10 miles for urban areas
- 25 miles for suburban
- 60 miles for rural areas
- Have one mental health and one substance use disorder provider for every 2000 members, and
- Make available an executive summary explaining how they reached network sufficiency
MHAMD joined a number of our partner organizations in submitting comments to point out a few of the concerns remaining, mainly that insurers can apply for a waiver of the requirements and that there is no limit to the number of times they can apply for the waiver. We hope the MIA addresses these concerns and upholds all the strong protections in the final regulations, which should be published later this fall. Check back on the blog or subscribe to our email list for updates.
Network Adequacy Series Posts
The Maryland General Assembly passed the Heroin and Opioid Prevention Effort (HOPE) Act of 2017 (SB967/HB1329), today, a comprehensive behavioral health measure aimed at expanding treatment options for those with mental health and substance use disorders and allocating more resources to reducing opioid dependency in Maryland. MHAMD and the Maryland Behavioral Health Coalition worked with legislators throughout the session to refine various provisions of the HOPE Act. The act includes Keep the Door Open Act provisions to properly resource community mental health and substance use providers.
Within its wide range of provisions, the HOPE Act:
- Requires specified increases in funding for community behavioral health services (Keep the Door Open Act). Payments to providers increase by 3.5% in each of the next two fiscal years, and by 3% the following year. The bill also requires that the Behavioral Health Administration and Medicaid, in consultation with stakeholders, conduct a rate-setting study for community behavioral health services and implement a payment system based on the findings. The study must be completed by September 20, 2019.
- Requires the establishment of behavioral health crisis treatment centers consistent with forthcoming recommendations from the Maryland Behavioral Health Advisory Council, and requires at least one crisis center be established by June 1, 2018.
- Makes expansion and promotion of the statewide 24/7 crisis hotline a statutory requirement, and requires hotline staff to be trained to screen callers for mental health and substance use disorder needs, conduct risk assessment for overdoses and suicides, and connect callers to appropriate behavioral health resources and supports.
- Repeals a requirement that an individual be trained in overdose identification before receiving the overdose-reversal medication naloxone from a pharmacist.
- Requires hospitals to have protocols for discharging patients treated for a drug overdose or identified as having a substance use disorder. The protocols may include coordination with peer recovery counselors, connection to a community-based treatment, a prescription, etc.
- Requires development of a plan for increasing substance use disorder treatment in jails and prisons.
Measures like the HOPE Act pass with the continued support of behavioral health activists like you. Between rallying in Annapolis for expanded behavioral health services, testifying in legislative hearings and calling and emailing legislators, your voices were heard by Maryland legislators.
The Task Force to Study Maternal Mental Health has submitted its recommendations for improving prevention and care for perinatal mood and anxiety disorders (PMADs) in Maryland to Governor Larry Hogan and the Maryland General Assembly. The Assembly passed legislation in 2015 to establish the Task Force, assigning the group with identifying vulnerable populations and risk factors for PMADs and making recommendations on legislation, policy initiatives and budgetary priorities to address and improve unmet maternal mental health needs in Maryland. Read the full report here.
One in seven women experience depression during pregnancy or in the first 12 months after delivery, and more than 400,000 infants every year are born to mothers with depression, making perinatal depression the most underdiagnosed and untreated obstetric complication in the United States. Perinatal mood and anxiety disorders (PMADs) are treatable once recognized, yet 50 percent of all mothers who experience these disorders are never identified.
Through a total of 15 recommendations, the Task Force urged the state to:
- Improve early identification and treatment of PMADs through increased screening, treatment resources and expanded provider education,
- Enhance peer support programs for mothers, coupled with public education initiatives aimed at increasing awareness about PMADs, and
- Expanded maternal mental health services for pregnant women and new moms.
Improve early identification, treatment resources and provider education
Screening and identification of PMADs greatly improve the likelihood of a quick recovery for mothers, supports healthy child development and offers long-term health care cost savings. Women typically visit their obstetrician and gynecologist during pregnancy and visit a pediatrician for infant check-ups more often than other health professionals, so these providers are in an ideal position to screen for PMADs. The Task Force recommends requiring mental health screenings for women during pregnancy and throughout the first year postpartum suggests offering maternal mental health information and resources for care to mothers and families.
In addition to screening, the Task Force recommends developing free maternal mental health CME/CEU training for providers to ensure improved clinical outcomes for mothers and continued support beyond the initial screening. The Task Force also advises expanding the psychiatric consultation programs provided through the Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) to assist providers in addressing the emotional and mental health needs of their pregnant and postpartum patients.
Develop peer support and public education programs for mothers
Peer support programs allow individuals who lived with mental health disorders to use their experiences to help others guide their own recoveries, and have been proven to reduce symptoms and hospitalization, increase social support and improve well-being. The Task Force recommends that Maryland expands resources for peer support programs to enable more specialized and comprehensive support for new and expectant mothers. The Task Force report uses the Massachusetts program MotherWoman as an example of a comprehensive peer support program for pregnant women and new moms. To supplement peer support programs and to reduce the stigma associated with PMADs, the Task Force proposes creating centralized, multicultural public education materials and resources for patients and families to more easily find information. The MHAMD Healthy New Moms campaign is an existing public education campaign that provides materials and information to pregnant women and new moms.
Expand maternal mental health services for pregnant women and new moms
The Task Force recommends establishing specialized maternal mental health programs to best meet the needs of mothers experiencing PMADs and proposes coordination of treatment for substance use disorders (SUDs) and maternal mental health. Methods for coordinating treatment include screening for SUDs throughout the pregnancy, improving post-partum follow-up and ensuring SUD treatment providers incorporate both prenatal care and mental health care into their treatment plans.
The Task Force recommendations facilitate a path toward more comprehensive support and treatment for women who are experiencing PMADs, reduce stigma associated with maternal mental health conditions and a greater level of oversight for Maryland to continue improving its maternal mental health services.
Expanding crisis services in Maryland
Earlier this year, Governor Hogan signed SB 551 / HB 682 into law. The bill requires the Maryland Behavioral Health Advisory Council (BHAC) to develop a strategic plan for ensuring that all Marylanders have access to 24/7 clinical crisis walk-in services and mobile crisis teams.
The Crisis Response System was established in 2002, but it currently exists as a patchwork of services from jurisdiction to jurisdiction. While all jurisdictions in Maryland currently have one or more components of a comprehensive crisis system, none has an adequate continuum, and only three counties currently offer a walk-in capacity.
Crisis services have been shown to significantly reduce preventable mental health and substance use disorder crises and offer earlier intervention, providing less costly and more therapeutic care. A statewide network of 24/7 walk-in and mobile crisis services will allow individuals to receive effective treatment for behavioral health crises, thereby lowering avoidable incarcerations, emergency room visits, hospitalizations and readmissions.
Development of the strategic plan is underway. Between now and December 2017, BHAC will work to develop a plan that meets the needs of all Marylanders by reviewing local and national crisis service models, identifying systemic challenges specific to our state and ensuring that the plan is coordinated with other ongoing healthcare reform efforts.
As an initial step in the process, the BHAC Executive Committee has developed a survey to gather certain information from interested stakeholders and the public at-large. This survey will inform an environmental scan being performed by a consultant to the project. The questions have been designed to generate feedback related to the availability of clinical crisis walk-in services and mobile crisis teams and to help identify priorities that will be used to guide decision-making as we work to expand these services.
Your input is essential to ensuring that the final strategic plan reflects the needs of the community. Please take a moment to complete the survey, then share it with your friends and family and urge them to complete it as well. Make your voice heard as we work to create an effective statewide network of 24/7 clinical crisis walk-in centers and mobile crisis teams.
This week, September 5-11, individuals and organizations are sharing personal stories, information and resources on social media for National Suicide Prevention Week. Suicide is the eleventh leading cause of death in Maryland and the numbers have increased in recent years. What can you do to raise awareness during National Suicide Prevention Week? Here are five simple actions that you can take now to spread the word about suicide prevention.
Join the National Suicide Prevention Week conversation on social media
It’s easy to share information and meaningful stories during National Suicide Prevention Week. Consider sharing your personal story about the impact of suicide or re-post an infographic like the ones you can find at the American Foundation for Suicide Prevention (ASFP). And don’t forget to use any of the campaign hashtags: #NSPW16, #StopSuicide, #BeThe1To or a hashtag for each day of the week.
Download the “There is Hope” App
Keep a quick reference on the risk factors and warning signs for suicide as well as tips on how to talk with someone who may be considering suicide with the “There is Hope” app. There’s even a suicide risk self-assessment. There is Hope was just released in Maryland during the Department of Health and Mental Hygiene’s kickoff event for National Suicide Prevention Week. Download “There is Hope” and share with friends or family.
Get involved locally
Register for an event in your community. Consider signing up for a Mental Health First Aid® course or one of the many local Out of the Darkness walks. Learn more about Mental Health First Aid in Maryland here.
Tune in to the World Suicide Prevention Day Twitter Chat
On Friday, September 9, the National Suicide Prevention Lifeline will lead into World Suicide Prevention Day with a Twitter Chat. Tune into this event, cosponsored by several national organizations such as Mental Health America, The Jed Foundation and Active Minds. Join the discussion using the hashtag #BeThe1To.
Take or share MHAMD’s free mental health screening
MHAMD offers a free, anonymous and confidential mental health screening for individuals who are concerned that they may be experiencing mental health complications. Brief screenings are a quick way to determine whether you or someone you care about should connect with a mental health professional. MHAMD recently updated the screening with more options and availability in Spanish. Take the screening or share the link with those you care about.
On April 26, 2016, Governor Hogan signed HB1318-Health Benefit Plans-Network Access Standards and Provider Network Directories into law. This landmark legislation based on the National Association of Insurance Commissioners (NAIC) Network Adequacy Model Act will dramatically improve insured Marylanders’ ability to use their health insurance to access care. The legislation enables the Maryland Insurance Administration (MIA) to enforce network adequacy requirements. The MIA will promulgate and enforce regulations with real standards, such as limits on travel requirements and wait times for appointments. The legislation also requires the insurance carriers to improve the accuracy of the directories – no longer should there be retired doctors or wrong numbers in the online directories members use to make appointments. The insurers must also provide information to members about how they can request to see an out of network provider at the same out of pocket cost as an in-network doctor, allowing them more timely and affordable appointments.
Maryland advocates, including MHAMD, worked tirelessly through the Maryland General Assembly session to ensure the passage of this legislation, but our work isn’t over. The MIA has begun the work of drafting regulations, holding monthly hearings to allow stakeholders to provide feedback on the suggested topics. The first hearing on June 9, 2016 focused on other state and federal standards that Maryland could consider adopting. MHAMD and other consumer advocates pressed the MIA to strongly consider the Medicare Advantage standards and to look at the states that have most recently updated their standards. These states have added maximum wait times that members can be expected to wait for appointments for primary and specialty care providers. The next meeting will be held July 14, 2016, and will focus on a topic of much importance to behavioral health consumers: geographic accessibility of specialty providers.
We need your help! As we draft our comments and testify at each hearing to ensure strong regulations are adopted, we need your stories! Please contact us with any examples of having difficulty finding a behavioral health provider who accepts your insurance and is available for a timely appointment. We would love to have you share them with the MIA at the hearing, but if you aren’t able to attend, we can share them on your behalf. It is important that the Commissioner and the MIA staff hear how inadequate networks have affected you and your family.
Network Adequacy Series Posts
A guest post from consumer advocate Jessica S.:
As a consumer of behavioral health services for many years, it was not until I pursued specialty treatment for PTSD that I learned the depth of the injustice to behavioral health consumers done by insurance companies. It was an accepted norm that the therapy I needed would not be covered by my insurance because the network of providers available to me through my insurance company was laughably inadequate.
Upon starting treatment with my new provider I was encouraged to file for reimbursement with my insurance company and informed of my rights as a consumer to have mental health covered the same way physical health is. I began filing my claims and was denied any reimbursement by my insurance company due to a rule they were enforcing only for consumers – a requirement that all claims had to be filed within 90 days of service. The claims filing system is burdensome, so I had been saving my claims to file at one time rather than take on this tedious process. Devastated by this outright refusal to acknowledge my treatment costs, I contacted the Maryland Parity Project who helped me figure out who I needed to contact and what I needed to do to get my money. It took a long time, and it was not easy. I had to involve the Attorney General’s office and the Maryland Insurance Administration. The Health Education and Advocacy Unit of the Attorney General’s office took my complaint seriously and agreed that the insurance company was violating my rights. They were able to get the insurance to waive the 90-day requirement and after 5 months I received 1/5 of what I had paid out. It was so low due to insurance low reimbursement rates. What happened next changed my life in more ways than I have fully processed. I was asked to testify (share my story) in front of the Maryland State Legislature about my experience and the need for legislative action to prevent insurance companies from imposing such an unfair standard onto consumers.
I am a very private person, and it scared me to think about so publicly sharing that I have suffered from PTSD. I knew it was the right thing to do and that the cause was greater than my desire to stay private. Standing up for myself and sharing what I had been through just to get my insurance provider to do what they were supposed to do was so empowering. One of the most important lessons that I’ve taken with me is just that: stand up for yourself. No matter how tedious and frustrating or how the odds aren’t in your favor. I kept going with this issue and realized I was involved in something much bigger than just me. I learned that battles like this take time, and all I really had to do was not give up. They depend on people giving up and sadly many do because the barriers put in place to keep consumers from accessing care are traumatizing. After my testimony, my insurance provider decided they should reimburse me fully due to the fact that they do not have any providers within their network who could provide me with the treatment I needed (and because I called them out publicly for their despicable treatment of consumers). After 10 months, I finally received FULL reimbursement with interest.
At times I feel saddened and angry that I had to sacrifice my privacy in order to get coverage for my treatment. Not only did I have to stand before a group of legislators, but I also was later informed that many other people had access to my claims information. I feel that my privacy was severely compromised by my insurance provider. I feel so passionate about what I went through and continue to feel outraged for myself and for all suffering from mental health issues that I am continuing to speak out and work with the Mental Health Association of Maryland on addressing these issues. I am still in treatment and will have to file claims again if I want to be reimbursed for my treatment costs.
For everyone in treatment for a mental health condition please know that your voice matters. Please speak up and utilize the resources that are available to help you. Find your voice and hold insurance companies accountable for their continued discriminatory behavior towards consumers with mental health disorders.
If you are interested in getting involved in advocacy or education, sign up for MHAMD’s Citizen Action Team. To commit to five minutes of change-making advocacy per week, join the Citizen Action Team’s Commit2Five campaign.
Earlier this week, six runners left California on the IceBreaker Run. These six runners will run a marathon each day as they travel from California to Virginia, stopping along the way to start community conversations about mental health. The six runners have diverse backgrounds and experiences, but each one has had their life touched by mental illness. Their goal is to “break the ice” and encourage others to feel comfortable enough to begin tough conversations about mental health and illness. The run will end on June 9, 2016 at the Mental Health America conference in Alexandria.
We are “breaking the ice” in Maryland in many ways. On May 19, 2016 the Maryland Coalition for Mental Health Awareness will present their fourth annual art event. This year’s theme: Walk in My Shoes: Raising Mental Health Awareness through Art asks participants to experience the artwork of individuals who are in recovery from mental illness and addiction. The event is free and open to the public from 1-5 p.m. in the 3rd floor banquet room of the American Visionary Art Museum. Each year the event gives attendees the opportunity to meet the artists and individuals in recovery and witness that treatment works and recovery is possible.
We know that not everyone can attend the art event or participate in a cross-country run, but most of us can walk or run a mile at our own pace on our own schedule. You can join the movement to eradicate stigma and commit to talking about mental health and its impact on you, family, friends or community by running or walking one mile between now and June 9, 2016. While you are running or walking, think about a five-minute, stigma-busting activity that you can commit to or who in your life you can engage in conversations or advocacy related to mental health.
We would like to highlight MHAMD and Citizen Action Team members who participate in the virtual walk/run on our MHAMD Perspectives blog and via social media. Please take a photo of you or your group before, during, or after your run with one of the downloadable signs or a sign you have made yourself and email it to us (using the subject, “Icebreaker”) with a short statement about what five-minute activity you have committed to or who you plan to engage in a conversation with about mental health. You can also share your photos on social media using #mentalhealthmatters or #weruntobreaktheice.
Update: In an effort to reduce the stigma surrounding mental illness, Sheppard Pratt Health System’s Dr. Thomas Franklin, medical director of The Retreat at Sheppard Pratt, wrote an inspiring blog post sharing his battle with depression. He will be racing the 140.6 miles of the Ironman Lake Placid triathlon to fight stigma, to show people that are suffering that treatment works, and to raise money for the Sheppard Pratt Patient Care Fund so that no one has to go without the treatment they need. Read more >>
For questions, contact:
Director, Healthcare Reform and Community Engagement
Mental Health Association of Maryland