May is Mental Health Month.
Approximately 20 percent of Americans, almost 44 million, experiences mental illness in a given year; almost 10 million have what is defined as a “serious” mental illness that can severely limit life’s activities. Mental illness affects people of all ages and can happen at any time throughout life. And untreated mental illness can result in health problems and unwanted stigma.
Note: This is the first in a series of posts on legislation that was passed during the 2018 Maryland legislative session and how it will affect mental health care in the state as well as various issues related to mental health.
MHAMD established a new Children’s Behavioral Health Coalition in late 2017 – a short time before the Maryland General Assembly convened for the 2018 legislative session. Immediately, members began expressing concern about a lack of transparency and access with respect to data that can help to improve the delivery of services for children and youth with behavioral health needs.
One of the annual highlights of Children’s Mental Health Awareness Week is the Celebrating Through Art: The First Lady’s Mental Health Awareness Youth Art Display & Reception hosted by Maryland First Lady Yumi Hogan in Annapolis, which was held last Monday.
The reception featured a display of artwork submitted by close to 50 children and youth from across Maryland.
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.
The Mental Health Association of Maryland expresses its deep sorrow in response to the tragic fire that claimed the lives of three residents of a Residential Rehabilitation home operated by Arundel Lodge in Severn this past weekend. Our hearts go out to the families of the victims, Walter McCardell, William Garcia and Barbara Brown, as well as the residents, staff and the entire Arundel Lodge community.
We share this statement from the executive director of Arundel Lodge, Mike Drummond, “We are deeply saddened by this tragedy and grateful to the Anne Arundel County Crisis Response Team for their quick response. This is the first incident of this kind in the over 40 years of Arundel Lodge’s service to the community, and we are absolutely devastated. This is an incredibly difficult day for all of us, and we will be providing support to family, friends and staff as we all process this tragedy.”
Please consider supporting Arundel Lodge in its rebuilding efforts by making a donation. You can do that here.
A few weeks ago, I joined the Mental Health Association of Maryland as its communications director. One huge reason I came to work here was the opportunity to share what MHAMD does all across the state of Maryland.
As I learned more about MHAMD, I became very intrigued by one of its programs called Mental Health First Aid Maryland.
The nation’s attention is now focused on Maryland as the home of the most recent school shooting. Today, at least three students were injured at Great Mills High School in St. Mary’s County.
As the story continues to evolve in the media, parents are faced with the difficult decision of what to say to our kids.
The reality is that there is no one way to have this conversation and we don’t always even have to have the conversation. What we say, when we say it and how we say it depends on our child’s age, maturity level and temperament. And, as parents, we also have to think about what our child may hear from the news, from older siblings or neighbors, and from their friends.
Most national experts agree that children under 8 should be shielded from the story unless they are directly impacted by it or exposed to the aftermath. Here are a few thoughts about addressing the topic with older students.
- First, process your own emotions before you talk with your child. As a parent, this is scary and we may feel vulnerable, angry or have other strong reactions.
- Plan what you want to say to your child, thinking specifically about what you want them to take away from the conversation.
- Reassure your child by highlighting what the school and the people in the school do to keep students safe. As details unfold, consider telling the stories of the heroes.
- Address images as well as words if your child has seen photos or video in news coverage. Balance the scary photos with positive images of safety officers, school officials and other heroes who help keep students safe.
- For elementary school students, keep the story brief — just a sentence or two about what happened — and then take your cues from your child’s questions. Note your child may ask questions right away, or may come back to you after having some time to think about what they’ve learned.
- For middle and high school students, start by asking what they’ve already heard. In today’s quick news and social media culture, odds are that they’ve already heard about the situation. Let them share their thoughts and feelings with you, and use the conversation as an opportunity to share your values and thoughts on the topic. And, consider discussing potential solutions or actions. You may even want to connect the conversation to the “walk outs” and “step ups” that many students participated in or heard about earlier this month.
- Recognize that students of all ages will process the news in their own way and in their own time. A student who is already anxious, who worries about school or who has experienced trauma may feel greater anxiety, need more time to talk and require extra reassurance about their own safety.
Sadly, our nation’s recent history of school shootings have led to the development of extensive guides on how to talk to children and youth about school violence. Here are a few additional resources to guide your conversation including information developed by Maryland’s Children’s Mental Health Matters Campaign*:
CMHM Fact Sheet on Wellbeing & Resiliency
CMHM Fact Sheet on Trauma
CHMH Fact Sheet on Traumas (Spanish)
At the end of the day, no one knows your child better than you. Review the resources that are out there, make your own decision and do what’s best for your child.
*The Children’s Mental Health Matters! Campaign is a collaboration of the Mental Health Association of Maryland (MHAMD) and the Maryland Coalition of Families (MCF) supported by the Maryland Department of Health – Behavioral Health Administration. The Campaign goal, with partners across the state, is to raise public awareness of the importance of children’s mental health. For more information, please visit www.ChildrensMentalHealthMatters.org.
At the urging of MHAMD and others, the Maryland General Assembly and the Maryland Insurance Administration have taken important steps in recent years to ensure the proper implementation of the federal Mental Health Parity and Addiction Equity Act. Unfortunately, according to the findings in a groundbreaking new national report, there is still much work to be done. This is the message MHAMD shared at a briefing on January 30 for members of a key legislative committee.
According to an independent report by the Milliman Group, Maryland is among the worst states for access to affordable in-network behavioral health (mental health and substance use disorder) services. The national actuarial firm analyzed three years of insurer claims data from 2013 to 2015, covering approximately 42 million Americans in all 50 states and Washington, D.C.
The data demonstrates that insurers in Maryland are much more likely to provide in-network care for physical health services compared to mental health and substance use treatment services. This limits access to care and results in higher out-of-pocket costs that can make treatment unaffordable, even for those with insurance.
Among the key findings:
- In 2015, Maryland consumers were nearly 1,000 percent more likely to go out-of-network for behavioral health office visits compared to primary care visits. That’s nearly twice the national average, and third worst in the nation.
- Marylanders were 700 percent more likely in 2015 to utilize out-of-network facilities for inpatient behavioral health care compared to those accessing inpatient treatment for physical health care.
The study also uncovered a troubling disparity in reimbursement rates for the professionals treating individuals with behavioral health needs as compared to those providers delivering physical health treatment. In 2015, mental health and substance use treatment providers were paid over 27 percent less than other providers for the very same office visits billed using identical or similar payment codes. This disincentives medical professionals from entering the behavioral health field, exacerbating an existing workforce shortage and further limiting access to care for Marylanders in need.
MHAMD is proud of the work we’ve done in recent years to implement the critically important federal parity law, and we are appreciative of our ongoing partnerships with members of the Maryland General Assembly, the Maryland Insurance Administration and stakeholders in the behavioral health community. Together, we have passed laws and created regulations designed to improve treatment options and availability for individuals with mental health and substance use disorders. We still have a long way to go, but MHAMD will keep working to ensure Marylanders with behavioral health needs have access to treatment when and where needed.
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