Utah behavioral health assessment & master plan

Utah, like the rest of the country, is facing a behavioral health crisis. Numerous gaps in care exist across Utah's continuum of behavioral health services and supports, in Utah's rural and culturally diverse communities, as well as across Utah's population lifespan (from infant and early childhood to older adults).

Utah Behavioral Health Assessment & Master Plan Mother reports fair/poor mental health 5.2% This draft is for public review and feedback. A final report is expected Utah ranks 2nd highest to be released in September 2023. 12.6% Parent reports not coping very well with the daily demands of raising children 44.6% 0% 10% 25% Integrated Physical & Behavioral Health Care Utah 40% 50% 25.3% 22.8% 20% 15% Utah ranks 3rd highest among states. 10% 7.2% 5% 0% Any Mental Illness Utah ranks 4th highest among states. 6.3% 5.6% Serious Mental Illness Utah 4.9% Serious Thoughts of Suicide U.S. Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2021. The Benefit of Addressing Behavioral Health Depression is a leading cause of disability and national cost estimates of mental, emotional, and behavioral disorders 48% White among youth amount to $247 billion per year in mental health and health services, lost productivity, and crime. Investing in 52% Other Populations high-quality behavioral health services can help reduce costs across public and private health 51% systems sectors such Hispanicand or Latino as education, corrections, criminal4%justice, housing. NH Black and or African American More importantly, it saves lives. 1% American Indian or Alaska Native 9% NH Asian 5% NH Native Hawaiian or Pacific Islander Promotion and Prevention Primary Care Based Behavioral Health 30% U.S. Utah ranks 11th highest among states. Figure 1: Utah’s Continuum of Behavioral Health Services and Supports Community Education & Services 20% Figure 2: Adult Mental Health Indicators in Utah and U.S., 2021 Share of Adults Utah, like the rest of the country, is facing a behavioral health crisis. Numerous gaps in care exist across Utah’s continuum of behavioral health services and supports, in Utah's rural and culturally diverse communities, as well as across Utah's population lifespan (from infant and early childhood to older adults). Utah ranks 11th highest among states in terms of the share of adults with any mental illness, 3rd highest for adults with serious mental illness, and 4th highest for adults with serious thoughts of suicide. The share of young adults in Utah with poor mental health more than doubled over the last 10 years, which is reflected in escalating demand in Utah’s higher education institutions. More than 60% of children ages 6-11, and 50% of children ages 12-17 with a mental or behavioral health condition do not receive treatment. And among the children who need treatment, close to half of parents report that services are difficult, or sometimes impossible to obtain. Methamphetamine is a main driver of Utah's drug-related fatalities. Utah ranks highest among states in terms of the share of children ages 0-3 whose mothers reports fair or poor mental health, which impacts the emotional and behavioral needs of infants, toddlers, and preschoolers. As Utah’s population ages, the demand for behavioral health services is shifting to older adults, but there is a severely limited number of geriatric psychiatrists in the state. among states. 31.8% EXECUTIVE SUMMARY The Problem July 2023 Utah ranks highest among states. Outpatient Specialty Services 30%NH Some Other Race and Two or More Races Crisis/ Diversion Services Subacute Care Acute/ Inpatient Care Stabilization Supports and Wraparound Services Note: This continuum was developed as a part of the 2020 Roadmap for Improving Utah’s Behavioral Health System. Source: Utah Hospital Association The full version of the report, including citations, is available at https://gardner.utah.edu/economics-and-public-policy/health-care/utah-behavioral-health-coalition-master-plan/. U TA H B E H AV I O R A L H E A LT H A S S E S S M E N T & MA S T E R P L A N - E X E C U T I V E S U M MA RY I 1 Figure 3: Utah’s Behavioral Health System-Level Issues To ensure a comprehensive approach to addressing Utahns' behavioral health, the Utah Behavioral Health Coalition came together to assess the state’s current system of behavioral health services and supports and develop a Master Plan. The Master Plan outlines key decisions and proposed continuum changes with a now, next, and future timeline. It is important to consider the Master Plan as a starting point. As work begins, and more research is conducted, existing decisions and recommended changes may be modified, and more priorities, decisions, and continuum changes will be identified. The Master Plan also does not intend to dictate or oversee all activities within or connected to Utah’s behavioral health system. It is meant to serve as a guide for state, private, and public sectors, systems, and stakeholders striving to create more aligned and efficient behavioral health systems for Utah. System-level fragmentation limits the ability to access the right care at the right place and at the right time. Assess system-level gaps and key areas of need. System-level issues create and exacerbate gaps and challenges in Utah’s behavioral health system. These system-level issues interconnect and impact providers and services across Utah’s continuum of behavioral health services and supports. Draft a Master Plan that can serve as a guide for state, private, and public stakeholders. Create aligned and efficient behavioral health systems for the state of Utah that provide timely, equitable access to high-quality care across a comprehensive continuum of behavioral health services and supports. The Master Plan includes six strategic priorities (p. 3). Key decisions and specific recommendations to achieve the strategic priorities are in the full report. nding / Comprehens ive Ne A Lack of System-Level Coordination Re im bu rs t Close to 300 participants engaged across more than 30 discussion groups and interviews. e Fu en Conduct an environmental scan to understand current gaps and challenges. f or Su sta bl in a em The Master Plan Process ed The Master Plan Across public and private sectors, systems, and stakeholders Siloed Systems Administrative Burden Workforce Shortages Limited Access to Care Source: Kem C. Gardner Policy Institute Silver Linings While this report primarily focuses on what could be improved, it is important to recognize the positives. For example: Utah’s leaders, including the Governor and Legislature, understand the importance of addressing Utah’s behavioral health needs. Utah’s behavioral health community is passionate about addressing these needs and there is a growing number of sectors and stakeholders invested in improving Utah’s behavioral health. There is a desire to meet people where they are and provide services that are easily accessible. Utah is leading the nation on many behavioral health innovations and reforms (e.g., SafeUT, 988, development of Utah's comprehensive crisis system, supported employment, etc.). There are examples of successful coordination at the local level. Note: In this report, the term “behavioral health” describes both mental health conditions and substance use disorders (SUD), unless otherwise specified. When mental health conditions or SUDs are separate, the report uses the term “mental health” or “SUD.” 2 I U TA H B E H AV I O R A L H E A LT H A S S E S S M E N T & MA S T E R P L A N - E X E C U T I V E S U M MA RY Strategic Priorities the creation, innovation, and 1 Support implementation of research-based interventions. 45% 42.0% 40% the availability of services and supports for 5 Improve individuals with complex behavioral health needs. 12.8% Medicaid ~9.0% Uninsured Discussion group participants noted behavioral health 35% messaging should focus on recovery being possible. Having 30% access to high-quality and outcomes-based services, supports, 25% and interventions can 18.7%help people achieve recovery. Engaging 20% in strategies that support this priority will promote a higher 15% standard of care 10%across public and private providers, payers 5% employer-based plans), and systems as (both public and they commit to0%transparent, measurement-based care. 2 Services for Utahns with complex behavioral health needs 12.7% Medicare 22.3% Commercial is a critical gap in the state (e.g., withdrawal management and detox services, residential, partial hospitalization, 0.3% CHIPother intensive 3.7% outpatient services, etc.). Access to these services is not FEHBP consistent4.7% across different communities, different populations, 33.6% Self-Funded PEHP and different complex behavioral health conditions. The Master Plan supports strategies to ensure these services are 2011 2012 2013 2014 2016 2017 2018 2019 2020 2021coordinated, expanded, enhanced, appropriately reimbursed, and community based. Strengthen behavioral health prevention and early intervention. Expand and support Utah’s behavioral 5.2% Utah ranks highest Effective promotion, prevention, and early intervention is Mother reports among states. fair/poor critical to getting ahead of Utah’s growing behavioral health mental health Utah ranks 2nd highest needs, reducing mental health12.6% and SUD stigma, andamong building states. resiliency. Preventing or delaying the escalation of worsening Parent reportswill also help improve behavioral health issues access by 31.8% not coping very reducing the need acute and costly mental health wellfor withmore the daily demands of 44.6% on public and and SUD services, and place downward pressure raising children private system costs. 0% 10% 20% 30% 40% 6 health workforce. Current Structure Utah’s ongoing—and growing According to the Bureau Prescribers Proposed (Psychiatrists, Structure behavioral health workforce of Labor Statistics, APRN’s) shortages are disrupting care there are approximately Psychologists across the state and continuum 334 behavioral health of behavioral health services providers per 100,000 Licensed Clinical Therapists and supports. In addition people in the United (MFTs, LCSWs, CHMCs) to supporting initiatives to States, compared to 222 50% Non-Clinical Licensed Practitioners grow Utah’s behavioral healthbehavior analysts) providers per 100,000 (social workers, workforce, the Master Plan Utah residents. DHHS Certifications includes a specific focus on (peer supports, case managers) increasing the use of certified or credentialed non-licensed professionals to support licensed more effectively Community Healthproviders Workers practice to the top of their license. 3 Integrate physical and behavioral U.S. health.Utah 4 Any Mental Illness Serious Mental Illness Serious Thoughts Improve patient navigation and continue to build out of Suicide Utah U.S. Utah’s behavioral health crisis and stabilization systems. Share of Adults Integrated care approaches address fragmentation, provide a holistic memberUtah experience, and are generally cost ranks 30% 11th highest effective. The Master Plan identifies three areas for improving among states. 25% physical and behavioral25.3% health integration in Utah: 22.8% (1) increasing clinical-level coordination between primary care 20% and behavioral health providers; (2) evaluating ways to reduce Figure 4: Building out Workforce Extenders to Support 15% Utahwithin ranks public barriers in the delivery of services across and Utah ranks Utah’s Behavioral Health Workforce 3rd highest 4th highest 10% physical and behavioral health systems; and (3) encouraging among states. among states. Build out workforce extenders better alignment5% of integrated behavioral public 7.2%health across6.3% that allow licensed providers 5.6% 4.9% and private payers and systems. to work to the top of Current 0% Structure Proposed Structure Prescribers (Psychiatrists, APRNs) their license. Helps with provider retention and burn out. Promotes a clear career ladder Improving crisis services is a current focus for the state, but Psychologists more work can be done to continue to expand these Licensed Clinical Therapists initiatives to ensure all Utahns have access to effective and (MFTs, LCSWs, CHMCs) sustainable crisis and stabilization services. Utah's Behavioral Non-Clinical Licensed Practitioners 48% White (social workers, behavior analysts) Health Crisis Response Commission is in the process of 52% Other Populations developing a comprehensive, coordinated crisis system. The DHHS Certifications (peer supports, case managers) Master Plan supports strategies that align with the 51% Hispanic or Latino Commission's recommendations as well as additional Community Health Workers 4% NH Black or African American strategies that: (1) promote effective behavioral health service 1% American Indian or navigation tools; and (2) expand and sustainAlaska Utah’s crisis Native Note: Data from OPLR’s review of mental and behavioral health licenses in Utah show Utah’s behavioral health workforce is currently missing the base levels, resulting in a diamond 9% NH Asian and stabilization services through improved reimbursement shape. OPLR suggests that building out the sections that require less training (i.e., certified 5% NH Native Hawaiian or and bundled payments. or credentialed non-licensed professionals) is an effective way to address the shortage. Pacific Islander 30%NH Some Other Race and Two or More Races Source: Kem C. Gardner Policy Institute. Based on OPLR’s review of mental and behavioral health licenses in Utah. U TA H B E H AV I O R A L H E A LT H A S S E S S M E N T & MA S T E R P L A N - E X E C U T I V E S U M MA RY I 3