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.

IBHC FY25 RECOMMENDATIONS

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.

CONFERENCE RECAP

On September 19, 2023, the Idaho Behavioral Health Association held its first annual conference that focused on education and advocacy for the behavioral health community. This conference put patients, payers, and providers in the same room to discuss changes they would like to see and highlight areas where new techniques or practices have been implemented. The keynote discussions were delivered by the Chief Medical Officer and Chief Executive Officer of the Fletcher Group, Dr. Ernie Fletcher, and Dave Johnson. They started by discussing Idaho's history of behavioral health. Mr. Johnson spoke on how 20% of the Idaho population has some mental health needs, which follows the national average, but Idaho's suicide rate is greater than the national average. Dr. Fletcher focused his time on recovery ecosystems and the importance of establishing these due to their unique impacts on mental health and recovery in a community.

The Idaho Behavioral Health Council (IBHC) is an excellent tool for the state, and he stressed the importance of working with those in the community to see what changes they need. Dr. Fletcher discussed the clinical system and the current process for getting an individual into recovery housing takes time, and this is an area that could be looked at for reform. From his experience, he has learned people will build a system that works if they have sustainable funds to do so and it is essential to measure the outcomes. However, it is crucial to design a system that can accommodate change because those in charge will design what they think will work. However, those who are providing and delivering services will know what they have to do to be successful, and they will adapt the system to fit what they need it to look like. He concluded his speech by touching briefly on Opioid Abatements, the resources available, and new opportunities arise when we bring them all together. 

After the keynote, the conference moved into the education panel, moderated by Bobbi Hamilton, Vice President of IBHA. Those on the panel were:

• Sara Omundson, Administrative Director for Idaho Supreme Court

• Beth Markley, Executive Director of NAMI

• Ross Edmunds, Administrator of IDHW Division of Behavioral Health

• Wes Trexler, Deputy Director of Idaho Department of Insurance. 

Each panel member was asked questions about their background and experience with behavioral health in Idaho. Director Omundson discussed her involvement in behavioral health as co-chair of the IBHC and spoke briefly on the creation of this Council. The Council was created through all three branches of government coming together to create statewide goals. The Council created a four-year strategic plan that outlines what they want to accomplish and stresses their need for private sector involvement and aid. 

Director Omundson discussed SIM mapping as one of the projects the Council has been working on. The SIM maps show where resources are located throughout the state, and there is one for each of the seven (7) judicial districts. These maps show not only what resources are available but also where gaps are. She invites the private sector to participate in data collection so they can get a more thorough map. 

When asked about resources the courts have for individuals to utilize, she discussed those available for individuals arrested or in the criminal justice system. The courts have coordinators to help find resources or get on Medicaid, but these are for convicted felons. There are also drug courts for when individuals are convicted of a felony. She also mentioned how the courts are working on building up housing options and having guardianship coordinators. Still, they need to remove the stigma that people won’t get help until convicted of a felony. 

Director Markley briefly explained the National Alliance on Mental Illness (NAMI) and how the organization works to improve the quality of life for those affected by mental illness. NAMI has facilitated support groups and educational support groups for families and peers. Director Markley spoke about her family's mental illness experience and that Idaho rehabilitation centers can’t offer the same services as out-of-state facilities. 

Ross Edmunds, Administrator of the Division of Behavioral Health, discussed some recent strides the division has made, highlighting crisis centers across the state. He also mentioned that they are working on implementing youth crisis centers. Administrator Edmunds also discussed how the Idaho Behavioral Health Plan has historically been fractured, which they are working on; the Division would like to have a greater look at comprehensive care. There is a contract in place that would take inpatient and outpatient individuals covered through Medicaid and those not covered through Medicaid. When asked about the most significant gap that he would like to see fixed, Administrator Edmunds discussed how, under the current system, adults must reach a certain level of severity before the state will help them. He highlighted the desire to have trauma specialists to aid caseworkers in understanding trauma responses and models better. Other panelists voiced support for a better behavioral health workforce, addressing the healthcare worker deserts in the state, and having more experienced and professional caretakers. Part of the problem is that insurance will pay for polar ends of the spectrum, whether it’s counseling or primary crisis/hospitalization, but not the intense services in the middle. 

The second panel was monitored by Janice Fulkerson, COO of The Fletcher Group, and focused primarily on advocacy. The panelists included:

• Chief Roger Schei, Pocatello Police Department

• Sarah Samson, LCSW, Trivium Life Services

• Adrean Cavener, Director of Public Affairs and Governmental Relations for Regence BlueShield of Idaho.

The questions were directed towards the panel as a whole, with some specific to the individual. Still, they began with Ms. Samson, LCSW, providing an overview of Trivium Life Services for those who were unfamiliar. Trivium Life Services works closely with the community, the Idaho Department of Corrections (IDOC), those on misdemeanor probation, the Boise Police Department (BPD), and others. She spoke on how BDP is interested in the clinical side of treatment regarding suggestions and interpretations when dealing with individuals. She discussed their harm reduction programs and the harm reduction vending machine, where numerous goods are available to the public, including hygiene supplies, clean needles, and sharp disposals. 

One of the questions that prompted a considerable discussion was one about stigmas and working to eliminate them. Chief Schei discussed how officers are trained in de-escalation and that while they do everything they can to de-escalate a situation, they are sometimes forced to take an individual into custody. They don’t ask about insurance but will turn individuals over to a crisis center or hospital. Director Cavener discussed options that insured individuals have and that Regence BlueShield has Care Navigators who will help individuals find the correct way to move forward with insurance. Trivium has a program with Saint Alphonsus where case managers will work with Trivium to see what insurance will cover and get a list of what services will be covered by insurance. They all want to work to reduce barriers to treatment. 

Chief Schei also discussed how different Idaho regions have different behavioral health problems. The number one thing we can do is build relationships within the community, and jail is not the solution; he believes that drugs and mental health go hand in hand, and community relations are essential in this sense. One prevention effort that the state could make is having more programs for those convicted of a misdemeanor and shifting more towards this rather than felonies. It is essential to talk about adults, but there is also great importance in talking to juveniles and addressing patterns and behaviors among juveniles. 

After a great day of discussions surrounding the resources, needs, gaps, and inter-laps between behavioral health and criminal justice, many joined our networking sections and receptions, where attendees continued these discussions. Many expressed how many great programs there are and how their sectors can get involved to build out these successes. More conversations and follow-up are to be had in the coming months as we move towards the 2024 Legislative Session.

IDAHO BEHAVIORAL HEALTH ASSOCIATION HOSTS ITS FIRST ANNUAL “LEADERS IN BEHAVIORAL HEALTH CONFERENCE” IN DOWNTOWN BOISE

The Idaho Behavioral Health Association (IBHA) hosted its first annual conference: “Leaders in Behavioral Health: Behavioral Health and Criminal Justice Reform in Idaho.” The conference was held at Treefort Music Hall and gathered behavioral health and public safety professionals from across the state.

The Conference featured a keynote speech from the Chief Medical Officer and Chief Executive Officer of the Fletcher Group, Dr. Ernie Fletcher and Dave Johnson. Each discussed the history of behavioral health services and the importance of allocating resources and focusing on outcomes to create an ecosystem that can sustain successful programs.

“Harm reduction is incredibly important, but we have to move beyond harm reduction,” Dr. Fletcher said. “We still have to provide it, but we can’t stop there. Idaho has taken some goods steps but there is also tremendous opportunity to do more, and we can, together.”  

Two separate panels presented and discussed behavioral and mental health, and the opportunities therein to improve resources in Idaho. The first panel, focusing on education, featured Beth Markley, executive director of National Alliance on Mental Illness (NAMI), Sara Omundson, director of the Idaho Supreme Court, Weston Trexler, deputy director of the Idaho Department of Insurance, and Ross Edmunds, administrator of the Division of Behavioral Health.

The second panel, focusing on advocacy work in behavioral health featured Roger Schei, Pocatello Chief of Police, Adrian Cavener, director of government affairs for Regence BlueSheild of Idaho, and Sarah Samson, therapist team coordinator lead & mental health court therapist with Trivium Life Services. 

“This conference served as an opportunity to bring together all those working in behavioral health and criminal justice to learn that when we work as a coalition, we are able to discuss ideas that will better serve Idahoans needing access to mental and behavioral health,” IBHA Executive Director Peyton Nunes said. “Our ultimate goal as an organization is to improve systems in the state to remove barriers to access to these vital services.”

Currently, Idaho does not have enough housing, workforce, or in-patient facilities to care for everyone experiencing severe mental illness and as a result, some individuals needing care are instead placed into correctional facilities.

“We had a great mix of public safety officials and behavioral health professionals, all who agree that we need better resources available to those needing behavioral or mental health care in Idaho” IBHA Board President Erin Hudson said. “Our hope is that this serves as an opportunity to continue these conversations so we may improve and expand how we are able to provide care to those needing behavioral or mental health services.”

Some goals highlighted at the conference for the association included their commitment to support the Idaho Behavioral Health Council’s recommendations to the Governor, increasing the supply of behavioral health professionals helping to add a much-needed resource of workforce, and addiction education and recovery.

IDAHO BEHAVIORAL HEALTH COUNCIL

On May 5, 2023, the Idaho Behavioral Health Council (IBHC) held its quarterly meeting and provided updates. Director of Idaho Supreme Courts and IBHC Chair Sara Omundson welcomed all participants and council members to the meeting. She spoke of the tremendous progress the Council and Idaho have made over the past few years. Like always, Director Omundson reviewed the guiding principles and vision that the IBHC abides by, which pilot the progress made. 

With many new members on the IBHC, the new project manager, Cheryl Foster, reviewed the implementation roles, framework, and general updates. She noted we are two-thirds of the way through the implementation timeline, but the implementation has surpassed the timeline. 

The council reviewed the FY 24 Funded Recommendations and what the 2023 Legislative Session brought for advancing behavioral health in Idaho. The funded recommendations included the following: 

• Onetime funding for housing initiatives

• Ongoing funding for community recovery centers (50% more than the Governor’s Request)

• Ongoing funding for the pilot pre-plea intervention program

• Onetime pilot low-risk, high-need treatment court or track within existing Inpatient treatment programs through the courts, such as:

  • IDHW Behavioral Health Plan 

  • IDJC Lewiston Youth Treatment Facility 

Some additional recommendations include IDHW secure mental health facility (not funded) and State Hospital South patient treatment facility addition (not funded). The recommendations must be provided by September 1, 2023, for the following legislative session. The public may submit recommendations on how to spend the Opioid State Funds to the IBHC until July 1, 2023. 

Laura Keihl, Canyon County, gave an update on the early intervention court program. The pre-plea pilot program will be for those who may have a mental health condition, diagnosed or not, to assist in diversion efforts. Upon a potential person entering custody, a plan is created for screening and then put into the program to dismiss cases upon entering behavioral health treatment; this will target misdemeanor-level offenses and will be a one- to two-year program based on the client’s needs. There are models utilized nationwide, and the Council members are very excited to see this implemented here in Idaho. 

The Division of Behavioral Health administrator, Ross Edmunds, spoke on the next steps of the DMI program for Civil Commitments. He spoke about how an individual is deemed competent, dangerous, and mentally ill (DMI). There are two ways that people are committed to the state for mental health reasons. The first is a civil commitment or restoration of competency; if any party determines that the person doesn’t seem fit to stand trial, the judge can commit an individual. There are currently nine (9) beds at the Idaho Maximum Security Institute (IMSI) for the DMI population, and they are considered civil commitments. The Legislature did not fund this project during the 2023 legislative session. Still, the Idaho Department of Corrections (IDOC) and Idaho Department of Health and Welfare (IDHW) would like to see this as a priority during the 2024 legislative session. 

If the DMI does not receive funding, a policy piece will change that a clinician gives an opinion of the mental state, an expansion of the definition of dangerous behavior, how many requirements need to be met, and other small cleanup changes. Senator Ricks (R-34) spoke to the legislation, stating he likes the legislation but asked about the timeline of recommendation. A patient needs to be seen within seven days of being committed; he wanted to ensure the patient was not sitting awaiting screening for an extended period; this is also to prevent events from months ago from being the sole reason they were in the facility. If the DMI facility receives funding, the entire section could be repealed. Representative Green (D-18) motioned to endorse the proposed changes to DMI statute Title 66, Chapter 13, and Senator Ricks (R-34) seconded the motion. The motion passed unanimously and will receive support. 

Laura Kiehl gave an update on the Sequential Intercept Mapping (SIM) for Idaho. The most recent mapping report completed were in Ada and Boise Counties. Bonneville County also just conducted its workshop; this allowed stakeholders and legislators to begin finding the gaps and needs of the communities. This analysis includes services, housing, and specific regional needs. The Idaho Supreme Court has sponsored the mapping in all judicial districts. Counties created their reports, which will all become available on the Idaho Behavioral Health Council website. 

Idaho has fully implemented the 988 hotlines, but IDHW has had trouble finding providers. When the Idaho Behavioral Health Plan (IBHP) is awarded, the council hopes the private sector will utilize their providers to use their services beyond the mobile crisis units. 

In the next week, all four Youth Crisis Centers will open, and the first CCBHC opened just last week. The other three CCBHCs will open and serve clients within the following year. Administrator Edmunds is also excited about the ongoing funding for the recovery housing. Senator Ricks requested additional information on CCBHCs and how he can help further these efforts. 

Director of IDOC, Josh Tewalt, spoke on implementing IDOC Diversion Grants moving forward without rollover authority. Canyon County was a strong proposal applicant for targeting individuals before entering the criminal justice system, utilizing SIM 0 and 1 and key partnerships in the county. This proposal was a result of a SIM workshop in Canyon County. 

Director Omundson thanked the group for joining and looks forward to the next Council meeting on August 11, 2023. The Council is very excited the new members are becoming more comfortable with the group. The Council will determine recommendations for the 2024 legislative session during the next meeting. 

Governor Little Declares May Mental Health Awareness Month in Idaho

Governor Little has proclaimed May 2023 as Mental Health Awareness Month. He calls for Idahoans to pursue mental health treatments and educate those surrounding us. The mental health of Idahoans impacts both quality of life and the community as a whole. We want to thank Governor Little for his constant efforts to advance mental health awareness in Idaho.

With the Governor’s proclamation, IBHA, insurance groups, providers, patient advocates, and all who educate and advocate for mental and behavioral health can start bringing more awareness to a topic that often gets swept under the rug. Mental health enormously impacts one’s life and affects how we think, feel, and act. Our ability to make sound decisions, connect to those around us, be efficient at our jobs, and handle stressful situations connects directly to our mental health.

By having May as Mental Health Awareness Month, we can target schools and educate students on the importance of caring for their mental health. We aim to raise a generation of Idahoans who look after themselves and those around them to ensure they have happier and healthier lives. Educating the public on recognizing the signs of symptoms associated with mental health problems or substance abuse is a vital first step in conquering the mental health crisis.

Awareness is essential for growth, and for most individuals being aware that resources are available is just as supportive as seeking help. Individuals find comfort in knowing that their city, school, job, or state has resources available if they need care. By creating a positive narrative around mental and behavioral health, more people will be utilizing the resources available, leading to lower suicide and substance abuse rates in Idaho’s youth.

Governor Little’s proclamation states Idaho ranks 45th in the nation for children’s private insurance not covering mental and emotional problems, leading to over 18,000 of Idaho’s youth not receiving treatment for depression just in 2022. Prevention, diagnosis, and treatment in youth can be crucial to the future generation’s mental health as an adult. Thus, Idaho can make strides towards lowering its mental health illness in our young population and long-term in the adult population.

Another key feature of the proclamation is identifying the need for mental and behavioral health in Idaho. Nearly 25% of Idaho adults live with a mental health condition, and 40,000 Idaho adults with a mental illness are uninsured. The proclamation identifies having access to the necessary mental health services is in the best interest of the state as a whole for outcomes, productivity, and fiscal responsibility.

IBHA’s mission is to create safe and accessible mental and behavioral health care for all Idahoans. Access to resources is vital for completing this goal, and citizens need to be able to access resources to achieve the help they require; this is the first step that IBHA is taking, and every small step along the way is essential. Through education, IBHA aims to provide to break down stigmas and create more accessible mental health care in Idaho.

Idaho Behavioral Health Association Announces Board

Idaho Behavioral Health Association is excited to welcome our new board members:

• Erin Hudson, Board President

• Bobbi Hamilton, Board Vice President

• Adrean Cavener, Board Secretary + Treasurer

• Janice Fulkerson, Board Member

• Brooke Green, Board Member

Each member has a background either working in healthcare and/or volunteering for organizations that advocate for mental health and suicide prevention. We are excited to have them join IBHA and help us work advocating for a system that makes it easier for all Idahoans to access mental health care.

Erin Hudson - Board President

Bobbi Hamilton - Board Vice President

Adrian Cavener - Board Secretary + Treasurer

Janice Fulkerson - Member at Large

Brooke Green - Member at Large