As opioid addiction increasingly pushes users into emergency rooms with the advent of fentanyl into Baltimore’s drug markets, city officials are looking to address a gap created in part when people are released from the hospital after an overdose without any connection to follow-up treatment.
The state has awarded the Behavioral Health System Baltimore $849,000 for fiscal year 2020 to address the problem, which the organization says stems from a lack of staff on the city’s Mobile Crisis Team.
The system applied for roughly $1.15 million in grant money from the state of Maryland to expand the team, writing in its grant application that it is underserving people with drug addictions because of a lack of staff, funding and availability.
Adrienne Breidenstine, director of Behavioral Health System Baltimore, said the city’s mobile crisis team has no staff to respond to crises from midnight to 7 a.m., leaving a significant gap when it comes to responding to crises resulting from overdoses.
“It results in people decompensating, meaning their mental health or substance abuse gets worse,” Breidenstine said. “It also results in people getting caught up in the criminal justice system.”
In addition, the team is restricted to responding to drug overdoses, writing in its grant application that a “crisis” must be “primarily mental health driven, often with a co-morbid addiction or somatic disorder.”
“Co-morbid addiction” means that the person must be suffering from addiction in addition to another disorder or illness while “somatic disorder” means the person is experiencing an actual physical crisis, such as pain.
“This narrow definition of crisis makes it difficult for teams to respond to individuals who are dealing primarily with an alcohol or substance use crisis,” the team wrote.
It’s a problem many counties in Maryland are looking to address. The Baltimore grant is one of many throughout the state as agencies look to increase their capacity to divert drug users from hospitals to treatment centers by meeting them at their homes and in the community when they’re having a drug-related episode or overdose.
Baltimore’s Mobile Crisis Team is split into eight groups composed of licensed mental health therapists and nurses who respond to crises in hopes of directing certain people to treatment options and away from emergency services.
The $849,000 will fund additional staff to create a team that can respond to alcohol and substance use crises 24 hours a day, seven days a week. It will fund the salaries of a mental health counselor, registered nurse and two peer support specialists, with one specifically meant to cover an evening shift.
Tricia Christensen, policy manager for Baltimore Harm Reduction Coalition, said that while the city continues to explore more avenues to address opioid addiction, officials need to address the disproportionate role Baltimore plays in the state’s drug community.
While the state has touted a decrease in fatal opioid overdoses, Baltimore saw a slight increase in fatal fentanyl overdoses from January to June when compared with the same period last year.
She said “the amount of funding Baltimore gets to address opioid overdoses compared to other counties is about the same” when adjusting for size, despite the fact that the city sees significantly more overdoses than any other county. According to state statistics, the city accounted for 44 percent of all fentanyl deaths in Maryland from January to June.
She said the city could be more aggressive in offering harm-reduction programs, such as safe-injection sites, sometimes referred to as overdose prevention sites.
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The idea — giving drug users a monitored space to use their drugs so as to respond more effectively to overdoses as well as connect them with treatment resources — has gained traction in recent years, and Baltimore State’s Attorney Marilyn Mosby supports the idea.
As for why the city is not seeing the same recovery as its surrounding counties, Christensen said it could be a result of the city being a known hub for drugs as well as a location for a variety of treatment and addiction recovery services.
The Mental Health Association of Frederick County wrote in its grant application to establish behavioral health crisis services that Frederick Regional Health Systems. the county’s only hospital, “is experiencing a higher than average shortage of community-based mental health professionals.”
“Due to this shortage, individuals in Frederick County are seeking behavioral health treatment from their primary care doctor at a rate of approximately 3,000 encounters per year,” the association wrote.
Mid Shore Behavioral Health wrote in a grant application to expand mobile crisis teams on the Eastern Shore that “there are currently no child/adolescent-specific crisis intervention services” offered in Caroline, Dorchester, Somerset, Talbot and Wicomico counties.
Christensen’s point is that, because the state’s data on overdoses reflects where the overdose was and not where the person was from, it could be more heavily weighted on Baltimore because it’s where people come to buy drugs and recover from addiction.
“As we see more of these programs popping up ... we might be seeing people accessing the services closer to home,” Christensen said.