LEADERS IN BEHAVIORAL HEALTH DECEMBER TOWN HALL
On December 19th, the Idaho Behavioral Health Association (IBHA) held its first Leaders in Behavioral Health Town Hall meeting, led by Erin Hudson, IBHA Board President, and Peyton Nunes, IBHA Executive Director. IBHA expressed its desire to hold more of these town hall meetings and have a place to discuss behavioral health policies and current events and be able to share them with the public.
Ms. Nunes provided some background information on the Idaho Behavioral Health Council (IBHC) and how it focuses on the public sector, composed of individuals from all three (3) branches of government and members of the public. Since its establishment in 2020, the IBHC has recommended to the Governor how best to use Opioid Settlement Funds to benefit Idahoans.
This year, the IBHC made four (4) recommendations, and Ms. Nunes stated the IBHA board has voted to support the recommendations. The first recommendation is addressing the shortage of behavioral health professionals in the state, and they hope to see Governor Little highlight some significant initiatives in his 2024 State of the State Address, as the behavioral health workforce needs to see more social workers, therapists, and other behavioral health personnel to better serve Idahoans. The second recommendation focuses on prevention measures, with numerous options for Governor Little to choose from. This ties in with the third recommendation, focusing on treatment for mental health. The final recommendation is catered to recovery services. This recommendation is broad but looks at a partnership with the National Alliance for Recovery Residences (NARR) and emphasizes the importance of recovery housing. One highlight from last year was ongoing funds for recovery services through the Millennium Fund, which provides excellent support for recovery housing and stability for those who rely on these services.
IBHA will also support the IBHC-endorsed legislation the Idaho Department of Correction (IDOC) will introduce. The proposed bill would repeal three (3) sections of the Idaho Code, which are as follows:
19-2524 – Considerations of Community-Based Treatment to Meet Behavioral Health Needs in Sentencing and Post-Sentencing Proceedings
19-2522 – Examination of Defendant for Evidence of Mental Condition, Appointment of Psychiatrists or Licensed Psychologists, Hospitalizations, Reports
19-2523 – Consideration of Mental Illness in Sentencing
IDOC would introduce a new section to the Idaho Code, combining the three statutes and having one assessment. One challenge is the Department would need a screening tool and a way for courts to order an assessment. The desired pre-sentencing situation is to conduct new screening tools and assessments where needed. The desired post-sentencing situation will use the assessment to drive treatment.
Ms. Nunes turned the discussion toward support of the Medicaid formulary for mental health drugs. There have been numerous conversations about cutting costs and removing mental health drugs from Medicaid, but this could have several unforeseen repercussions. She highlighted the importance of educating the public, stakeholders, and legislators on the importance of mental health drugs, especially for those in the criminal justice system and Medicaid. Janice Fulkerson, COO of the Fletcher Group, and Kimi Slater, Associate Director of Key Accounts for Alkermes, stated they haven’t heard any rumblings about changing the formularies. Still, they are both interested in learning and finding more information on this. Miren Unsworth, Deputy Director IDHW, mentioned a handful of legislators interested in the Medicaid budget and Medicaid pharmaceuticals, but nothing formal has been discussed.
Ms. Slater asked about the 1115 Behavioral Health Transformation Waiver. Ms. Nunes discussed IBHA’s conversations with Juliet Charron, Administrator of IDHW Department of Medicaid, and they believe IDHW won’t be moving forward with this in the upcoming session. However, IBHA members have supported this waiver.
BEHAVIORAL HEALTH TRANSFORMATION WAIVER
Liz Caval-Williams, Chair of the Medical Care Advisory Committee (MCAC), discussed how, at the previous MCAC meeting, they discussed Medicaid pharmacy handling and how there seems to be a consensus that IDHW is doing an excellent job at managing these. She voiced how IDHW is doing its due diligence in managing pharmacy benefits and supporting patients who need more help. Ms. Caval-Williams spoke on her experience with someone needing access to a long-acting psychiatric injectable and the benefit they can have on a patient’s life. Long-acting injectables stabilize patients in a population that is typically hard to treat. She discussed how it is typical in manic patients who don’t want to take medications when they are feeling “too good” and how the long-acting injectables provide stability for them.
Ms. Nunes discussed that one goal of IBHA is to release Behavioral Health 101 within the next year. The term is so ambiguous and broad that individuals either glaze over it or ignore it completely; the goal is to have a document that provides critical definitions and adds insight into what behavioral health is. She expressed her desire to partner with other entities who can offer more insight from first-hand experience on behavioral health and use this document to educate the public and legislators. Ms. Hudson expressed her desire to see budgets pulled from the local police or other entities and do a cost analysis to show how services stabilize communities. By offering various aspects, the interconnection and how taking away one area will start to break down the chain of command will be highlighted. Ms. Slater discussed her desire to work on Behavioral Health 101, especially since Alkermes works with medicine and long-acting injectables. They have health, economic, and patient resources. She also stated they have data highlighting an increased pharmaceutical cost and how much this saves the criminal justice system.
Ms. Nunes opened the floor for legislators to discuss what they are working on. Sen. Ron Taylor briefly touched on his work with the Behavioral Health Transformation Waiver and said he is meeting with soon-to-be IDHW Director Dean Cameron to discuss this further. Sen. Melissa Wintrow explained her potential legislation that looks at neurocognitive disorders. She noted while this is different than behavioral health disorders, she wants to see if there is any synergy between them. The legislation would provide a temporary protective placement in a hospital for those with a neurocognitive disorder. Ms. Nunes expressed her desire to see Alzheimer’s groups and other neurocognitive disorders brought into the association. Rep. Jack Nelsen requested ground-level information on what is and isn’t available regarding services to better understand where improvements are needed. Rep. Nelsen discussed his lack of knowledge in this area and wanted some extra details on what the Legislature is funding. He believes this would benefit those who want to help but aren’t involved in the mental health field. Ms. Nunes stated that IBHA will be provided summaries of bills of importance to IBHA and the mental health world.
Ms. Unsworth provided a couple of updates from IDHW. She started with some budget highlights for FY25; one is a $1.2M request for the IBHC Opioid Settlement recommendations, which would be one-time dedicated funds. Another is for State Hospital South and a request to increase direct care personnel. Ms. Unsworth explained a failed attempt last session to fund a Dangerously Mentally Ill (DMI) facility in conjunction with IDOC, but they are going to try again this year with the request being made by IDOC. This would still be a partnership between IDHW and IDOC as they have a common goal of getting those in need out of prison and into a hospital setting. The first official recommendation of IBHA was in support of the DMI facility.
Amanda Deaver, Partner of the National Council on Mental Wellbeing, provided some federal updates on how Congress struggles to pass bills. There are numerous mental health bills in Congress currently, and in the upcoming year, we could see larger ideas. The SUPPORT Act could be coming up at the end of the year. A big push for the National Council is expanding parameters on Certified Community Behavioral Health Clinics (CCBHCs) to allow more states to access funding and cater to more states.
Ms. Nunes ended the meeting with a call to action, asking individuals to continue conversations with their communities and inviting more stakeholders to join IBHA. The date for the next Townhall is tentative, but IBHA is hopeful to hold the next in April or May of 2024 and will focus on gaps in the system and where we can break down barriers.