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Talbot Council declares May to be Mental Health Month

The Star Democrat - 5/18/2017

EASTON - In proclaiming May as Mental Health Month, the five members of the Talbot County Council on May 9 unanimously encouraged their fellow citizens to "recommit to increasing awareness and understanding of mental health."

To that end, council members began with increasing their own awareness and understanding of current trends in mental health services - and how those services are paid for.

Holly Ireland, executive director of Mid Shore Behavioral Health, provided the council with a half-hour assessment of the progress being made loosening the stigma of mental illness and connecting the dots for those who need healing.

At the council meeting,

Ireland provided a basic snapshot of the range of services available for those with mental illness and substance use disorders (SUD). Most services provided by the organization are confined to Kent, Queen Anne's, Caroline, Talbot and Dorchester counties.

"I've been coming before the council for (about) eight years," Ireland said, "But this the first time I've represented Mid Shore Behavioral Health." Mid-Shore Mental Health Systems re-branded itself in September 2016 to integrate the "treatment of mental health and substance related disorders ... into one delivery system," Ireland said.

Ireland, an Easton native who is a licensed clinical social worker, told the council that there is a "growing body of evidence that relates our physical well-being to mental well-being" and vice versa.

Ireland wants to see mental health and substance use screened in primary medical care visits "so that people can be identified as in need and directed to specialty care when necessary, as (they) are with most other conditions," Ireland said.

"It's important for people to understand that substance-related disorders (as well as other addictions) are still addictions," Ireland said in a May 17 interview. "Whether it's heroin, gaming or food - (those substances) are all messing with the feel-good receptors in our brains."

"If our brain receptors are affected by substances that can create dependencies that overtake our lives," Ireland said, "it's all brain disease of one kind or another. Ireland said that it's important to have compassion for those with brain-based diseases, even if the disorder originally began with a choice.

"We have compassion for those with cancer or heart disease or diabetes," Ireland said. "Yet conditions that are brain-based are stigmatized. The brain is just as important as the heart and lungs." Ireland shared similar analogies with the council.

One of the aspects of treatment the state is working on is withdrawal management, Ireland said. "When people are ready for treatment, they need it immediately," she said. "There is a recognition that we need to provide crisis level services."

To address this need, the federal Substance Abuse and Mental Health Services Administration recently awarded more than $10 million in grant money to the state of Maryland. The award will be used to provide crisis level services in the wake of the state of emergency declared by Gov. Larry Hogan to deal with the opioid crisis.

Ireland told the council that the $4.6 million budget had experienced very little change, but had a "slight decrease of $214,000" associated with an expired five-year grant. A decrease in funding from the U.S. Department of Housing and Urban Development (HUD) affected projects supporting those transitioning from homelessness into housing.

Councilman Corey Pack questioned the decrease. "You're losing $5,600 for homelessness? How does that affect Talbot County?"

Ireland said that those who had applied were still eligible but would have a longer wait.

"Our housing program (is) considered, by HUD's definition, ?permanent supportive housing' which means once you're eligible for the program you will remain eligible for the subsidy, and there's no limit on that," Ireland said. "But we work with people to graduate from the program so that we can continue to help people who are homeless to move through the program, and we have had some graduations from homelessness to subsidized housing to home ownership."

A couple of council members said, "Great," and "Wow." Ireland said, "And that's been amazing. The most diligent work we can do at this point is to help people prepare to graduate so that if we do receive cuts, we can help those people move into secured housing and not back to homelessness."

Still, Ireland said that HUD dollars may become more competitive, and that while all of the agencies and organizations addressing homelessness in Talbot and surrounding counties had a wait and see stance, they were "trying to be very cautious."

"Stay in touch with (County Manager Andy) Hollis over next several months," Pack told Ireland. "Homelessness is a big problem on the Eastern Shore whether we want to admit it or not, and when you compound that with mental illness, it's a double deficit. Let him know what kind of impact you're seeing out there."

Ireland provided numbers related to those receiving mental health services, noting that "this is the first year that addiction services has been a fee-for-services system," she said.

"A total of 1,496 individuals accessed Medicaid-related mental health services in Talbot County in fiscal year 2016, and the vast majority of those was on an outpatient level," Ireland said.

"Because not all were on an outpatient level, it's important to note that some people only access mental health services when they're in a crisis because they've gone without treatment for one reason or another," Ireland said. "It's also important to note that of those, 613 of them were children younger than 18 years old."

"Overall, 95 percent accessed outpatient mental health (care)," Ireland said. "The cost per person for Talbot County is $3,598, which is actually $764 less than the cost per person statewide, so we're a little more cost-efficient in our region."

"The vast majority of the budget that moves through our office of state and federal resources (we receive) moves out into the community," Ireland said. "About 90 percent of which is used ... for the delivery of services where your health insurance doesn't work, like in your detention center, and also, a majority of that funding supports our crisis system which has been very busy."

Because the Maryland Mental Health Administration and the Drug and Alcohol Abuse Administration were integrated as the Behavioral Health Administration, Ireland said that the financing was also integrated as of Jan. 1, 2017. "Grants that people talk about going away - they're not going away," she said.

"It's actually a 50-50 (funding) match," Ireland said. Maryland is actually doubling the amount of treatment that will be compensated. Grants are being moved into the fee-for-service system, rather than a set grant amount."

In other words, reimbursement for services is now based on a set of symptoms criteria. Rather than a one-size-fits-all treatment plan, "the state and fed government have an obligation to provide care that is identified through assessment," Ireland said. "You're opening up access and expanding choice."

"If you didn't have insurance or the ability to pay out of pocket, you had one choice - the health department. Now you have a choice of approved Medicaid service providers who are participating." Talbot Countians now can receive mental health care from, for example, Eastern Shore Psychological Services or Corsica River Mental Health.

Ireland stressed that those in need can still go their county health department for assistance and a list of providers.

In her 27-year career, one of the more positive changes Ireland has seen in the mental health care field is a gradual shift from institutionalization to rehabilitation.

"I've seen more people live productive lives in the community," Ireland said. Because of the transfer of granted-based mental health services to fee-for-service and tremendous cooperation among local agencies, more and more people are "contributing to the health and well-being of our community," Ireland said.

Ireland said only 14 people work in the Mid Shore Behavioral Health offices at Mary's Court in Easton. They serve five counties and are "the leanest of agencies," she said. "They're a crackerjack team."

On Monday, May 17, Ireland announced that the organization had received state approval of its Community Behavioral Health Plan for fiscal year 2018. It will be posted on the Mid Shore Behavioral Health's website later this month.

"I'm really proud of the people here and the passion and commitment with which they work and commitment of the board (of directors)," Ireland said.

Follow me on Twitter @ connie_stardem.


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