January 9, 2023

Dear Governor-elect Shapiro and Members of the General Assembly:

Thousands of Pennsylvanians are not receiving the right mental health care, at the right time, or in right setting—many aspects of our behavioral health system are in crisis. The Pennsylvania Provider Advocacy Coalition respectfully urges the General Assembly and the Administration in the strongest terms possible to expedite the release of the critically needed $100 million in mental health resources as recommended by the Behavioral Health Commission for Adult Mental Health. Addressing the challenges facing our mental health system will require an ongoing, sustained commitment by state government, counties, and all stakeholders. We believe the commission should be continued or another appropriately constituted body be created to serve as the forum to develop a longer-term roadmap to meet the behavioral health needs of all Pennsylvanians.

As you know, Act 54 of 2022 established the Behavioral Health Commission for Adult Mental Health to make recommendations to the General Assembly about the allocation of $100 million in special one-time- only American Rescue Plan funding designated in the fiscal year 2022– 2023 state budget for behavioral health services. The commission submitted its report and recommendations over two months ago which called for targeted investments in three major areas:

• Workforce
• Criminal Justice
• Service Expansion

We believe the commission recommendations are appropriately targeted and achieve the necessary balance in responding to urgent, emergency needs now while helping to position the commonwealth to begin a sustained multiyear effort to remediate and enhance our behavioral health system. Based on the recent Senate Health and Human Services Committee hearing as well as other comments, we understand there may be some ongoing concerns about sub-allocation of these funds and the gap-filling role of counties in mental services. From our perspective, all of these issues should be fully examined as part of developing a longer-term strategy for mental health services in the commonwealth, but should not hold up the short-term allocation of this initial, immediate investment of urgently needed resources.

Further, adequate funding for county mental health services is a critical element of the commonwealth’s response to these shared challenges. The county mental health services, their coordinating role and gap-filling services, are a key component of optimizing the commonwealth’s investment in mental health and improving outcomes for our families and neighbors. In addition to gap-filling services like supportive housing and residential services, county mental health funds are critical for access to treatment in the counties’ role as provider of last resort. There are uninsured individuals. There are individuals who have reached their private insurance limit that need services. This role will be put to a critical test during the anticipated unwinding of the public health emergency and the Medicaid eligibility redetermination process which likely will jeopardize Medicaid coverage for hundreds of thousands of Pennsylvanians next year.

Even before the pandemic many aspects of our mental health system were under significant stress. The ongoing COVID-19 pandemic has created an exceptional constellation of challenges for our mental health system, including dramatic increases in the need for mental health services, significant health staff shortages and unprecedented changes in the labor market, increases in completed suicides, and it has heightened ongoing ravages of diseases of despair/opioid addition.

The failure to invest in community-based mental health services is resulting in higher costs to the commonwealth in other systems like Medicaid, law enforcement, corrections, state-operated mental health hospitals, and community hospital emergency departments. The commonwealth’s mental health system is out of balance, and all too often lacks the capacity to intervene with the right service, in the right setting and at the right time. As a result, all too often the norm is responding when people are in crisis and in the most expensive settings whether it be an emergency department, inpatient hospitalization, or even worse, jail.

The cumulative effect of years of underinvestment, reduced service capacity, the COVID-19 pandemic, and now unprecedented staff shortages is creating an environment that is prone to dangerous outcomes. The failure to invest in community-based mental health services is leading to both higher costs and needless human suffering. It is in all our interests to begin the process of rebuilding and enhancing our community-based mental health system. The status quo is not sustainable.

In this context, we urge that a new commission or other appropriate body be created to serve as a forum to develop a shared vision and strategic action plan to build a mental health system for the 21st century. The scope of this effort should include both adult and adolescent/child mental health services. A key objective should be to ensure all Pennsylvanians with mental illness can reliably access a core set of needed mental health services regardless of the county in which they reside. Lastly, the commission membership should be broadly representative to ensure that all perspectives from all health delivery system service areas are included in the process and to promote the delivery of whole person care.

Thank you for the opportunity to share our views. We stand ready to assist in this vital work that will benefit all Pennsylvanians.

Sincerely,