This article is part of MACo’s Policy Deep Dive series, where expert policy analysts explore and explain the top county policy issues of the day. A new article is added each week – read all of MACo’s Policy Deep Dives.
Recent coverage on Conduit Street highlighted the well-known challenge of emergency room delays in Maryland. The issue has been documented and debated for some time across the state. A recent Baltimore Sun article reiterated the sentiment:
Besides Washington, D.C., and Puerto Rico, there’s no place in the United States where people wait longer to be seen.
A bill to establish a task force to tackle this problem with new insights failed last year during the legislative session. But the General Assembly moved forward with a study anyway due to the urgency and persistence of the problem in Maryland. The 28-member work group released their findings earlier this month.
New Report On an Old Problem
At the request of the Maryland General Assembly, the Hospital Throughput Work Group was convened last July to develop policies for the legislature to consider in reducing emergency room wait times across the state. They met monthly to research root causes and develop a list of policy recommendations for consideration by the General Assembly. Representation on the work group came from state agencies, state departments and commissions, the legislature, patients, hospitals, unions, behavioral health providers, and health care professionals such as nurses and emergency personnel.
The final report covered seventeen policies for consideration that are driven by a number of correlated factors across communities in Maryland. Specifically in comparing Maryland to other states who are not experiencing the severity of wait times, researchers found four major factors that differentiate Maryland and the challenges therein. Specifically, the state is:
- more densely populated
- has a larger share of its population in minority racial groups
- has fewer beds per capita
- has more stringent certificate of need guidelines for expanding bed capacity
Above all these factors, was the looming weight of unmet behavioral health care needs in communities. This was the primary driver of congestion in emergency rooms.
There Is a Lot to Leverage in Counties
One major directive from the report that could help address these challenges, and is specific to county level resources, is the need to expand community access to behavioral health care options. While expanded services are needed according to the report, the lack of knowledge of, or willingness to access, even available services has been a major barrier to preventative behavioral health care. Untreated issues then compound, leading to more serious problems such as substance use disorders and crisis level incidents. Additionally, the report specifically discusses the unmet needs of uninsured and resource scarce communities in Maryland, many from minority racial groups, that are putting additional strain on hospital emergency departments by seeking routine services in an emergency setting.
These types of clinical services and routine screenings are one of the core offerings in local health departments particularly for communities with numerous and significant barriers to accessing care. And it’s not just the local health departments where services exist. When it comes to behavioral health options, services and service connection channels exist within four major divisions of local governments:
- schools
- human and citizen service divisions
- law enforcement and detention centers
- local health departments
A recent U.S. Department of Education report even found that students are six times more likely to complete mental health treatment in schools than in the community. Some of the available programs are collaborations across divisions, like the local health department and the schools working together to provide programs like the Screening Teens to Access Recovery program for high school and middle school aged children with a substance use disorder. Detention centers collaborate with health departments on treatment programs for incarcerated individuals. As previously covered on Conduit Street, counties like Frederick, Montgomery, and Prince George’s have been making efforts to bolster crisis stabilization resources. In essence there is a great deal of available infrastructure to build on if new investment and resources are localized.
Statewide Efforts on Behavioral Health Service Expansion
In addition to requesting this report, the state has taken some considerable strides in expanding resources for behavioral health needs in the last year. Major efforts include:
- allocating $107M in the FY24 budget for behavioral health care expansion
- funding the 988 suicide prevention hotline during the 2024 legislative session
- authorizing assisted-outpatient treatment statewide for individuals with serious and persistent mental illness
Additionally, the Commission on Behavioral Health Care Treatment and Access will be working for the next three years on access to care assessments and recommendations for a handful of vulnerable subsets including:
- Geriatric Behavioral Health
- Youth Behavioral Health
- Individuals with Developmental Disabilities
- Individuals with Complex Behavioral Health Needs
- Criminal Justice–Involved Behavioral Health
- Behavioral Health Workforce Development, Infrastructure, Coordination, and Financing
Will Any of This Work?
It’s too soon to tell which of these efforts will make Maryland a more robust and sustainable healthcare ecosystem. With the number of initiatives currently underway, it’s hard to imagine residents wouldn’t begin to see some improvement, particularly when the report reinforces the need for a multi-pronged approach. And then, of course, there’s the obvious context of being so close to the bottom – there’s almost no where else to go but up. Of the seventeen policy proposals now on the table from the work group, the 2025 legislative session could be a jumping off point for a more significant and comprehensive package of policies moving forward on the issue.
