In early October, the Wolf Administration released a report on adult mental health services. The General Assembly, via PA Act 54 of 2022, required the creation of a Behavioral Health Commission and tasked the Commission with recommending how to spend $100 million in one-time American Rescue Plan Act (ARPA) funding to support the behavioral health needs of adults in Pennsylvania. The Behavioral Health Commission was co-chaired by Michael Humphreys, Acting Insurance Commissioner and Dr. Dale Adair, Chief Psychiatric Officer for the Department of Human Services (DHS). The Commission was comprised of appointed members, as outlined in the Act, who represented law enforcement, consumer-led advocacy organizations, legislators, county commissioners, Medicaid behavioral health managed care organizations (BH-MCOs), state officials, and behavioral health providers. Act 54 also required the Commission members to visit a rural county (Centre) and an urban county (Dauphin).
Act 54 specified ten areas of adult behavioral health for the Commission to focus and report back on. Some of those areas included workforce development and retention, the expansion of peer-run services, the development of crisis services, and the impact of social determinants of health on behavioral health.
The Commission met four times during August and September 2022 in public “sunshine” meetings. The Commission’s final Report includes recommendations that 38 percent of the $100 million in ARPA funds be spent on workforce development; 23 percent on the criminal justice system as it relates to behavioral health; 38 percent on service expansion; and 1 percent on evaluation.
Counties and healthcare providers reported workforce development and worker retention issues to the Commission as a major barrier to behavioral health service delivery with providers leaving the field in record numbers. The Report recommends spending $32 million on salary increases, bonuses, and increased benefits to retain existing staff; incentive programs such as tuition assistance; and offer opportunities for entry-level staff to advance their education and credentials. The Commission recommends $5 million be given to county behavioral health offices to address unique county needs.
The Commission recommends $23.5 million for improvements to the criminal justice system and public safety systems. The lack of a vibrant crisis service system and fully staffed breadth of behavioral health services has resulted in the criminal justice system becoming the default service system for far too many Pennsylvanians. The Commission also recommends $13.5 million be spent to provide comprehensive services to incarcerated individuals and increased funding for specialty courts for those with behavioral health conditions. Additionally, the Report recommends $5 million be spent to develop and expand pre-arrest diversion programs and $5 million for counties to develop and expand co-responder programs, with law enforcement and behavioral health professionals working together and providing increased training for crisis responders.
The Commission recommends that $39 million be used to broaden the scope of behavioral health services and supports available to Pennsylvanians. The Commission suggests innovative service models such as 24/7 crisis walk-in centers and collaborative care models that integrate physical and behavioral health. Specific recommendations include $15 million for various models of crisis services, $10 million to integrate physical and behavioral health care, $8 million for counties to address social determinants of health, and $6 million to support peer-led services.
The Commission recommends that the remaining $500,000 be used for an evaluation of the services developed or expanded with this one-time funding. The evaluation would provide both accountability for the funding and insights for future funding allocations.
The Commission also recommends either that it continue or that a new Commission be formed that is dedicated to the ongoing analysis of the behavioral health system and needed reforms. The group suggests continued dialogue regarding topics involving legislative and regulatory reforms can also improve PA’s current behavioral health system without additional dollars needed to make those reforms.
Lastly, while not in the scope of this Commission or within the use of the one-time $100 million, the group recommends sustained increases in county behavioral health funding. The 10% reduction to county “base” dollars that occurred in 2012 has never been increased. Counties continually trying to do more with less is not sustainable and has contributed to the erosion of Pennsylvania’s behavioral health system as the needs for services only increases.
Important Note: The above $100 million in mental health funding has not been released because on Wednesday, October 26th the General Assembly recessed for an Election Day break without passing a spending plan. Agencies, struggling to meet demand for mental health care in the wake of the pandemic and the ongoing opioid crisis, will need to wait at least a few more months. Although a handful of voting days remain on the calendar in November, the issue (and spending authorization) may not be taken up again until January 2023 at the earliest when a new legislative session begins. PHLP will monitor and report on the above recommendations and spending authorization.