Out of BBH story, Maryland needs to improve its integration of care

November 11, 2010

The Sun's series on Baltimore Behavioral Health ("Hooked on treatment," Nov. 7 and "Sheltered addicts, strained recovery," Nov. 8) is full of sad irony. I worked in this field for six years and know that not enough agencies are capable of providing intensive and integrated mental health and addiction treatment. For several years, Baltimore cross-trained professionals in each field, so that each problem would not go unrecognized in treating the other. Now we have the opposite extreme.

Another tragic irony of the BBH case is that non-profit treatment providers have struggled to learn how to bill Medicaid. In the late '90s, some mental health providers went out of business, and more recently it has been a big hurdle for addiction treatment programs. Fragmentation of social and medical services is another abiding concern. Services for uninsured people are in short supply, especially housing to go along with treatment. How ironic that BBH learned to bill, combined services and included housing, only to be a case study in pitfalls!

The worst of it is that our systems of care force us to treat diagnoses rather than whole persons. We need a system that supports evaluation and treatment that is right for the individual, not the diagnosis. In Maryland, mental health and substance abuse services are under different state administrations with different revenue streams; primary health care services and housing are even further separated. As long as this is the structure, human beings will continue to lack the integrated care they need. If something good comes of the sad and ironic story of BBH, perhaps it will be a new approach to building a comprehensive recovery oriented system of care.

Rebecca Ruggles, Baltimore

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