Primary care doctors in Utah need greater support in their efforts to connect opioid-addicted patients to the right behavioral health services in a timely manner, state lawmakers were told Wednesday
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SALT LAKE CITY — Primary care doctors in Utah need greater support in their efforts to connect opioid-addicted patients to the right behavioral health services in a timely manner, state lawmakers were told Wednesday.

"The challenge I most often hear from (physicians) and others is, 'Where do I send them? I know there are waiting lists,'" Brent Kelsey, assistant director of the Division of Substance Abuse and Mental Health, told the Health and Human Services Interim Committee. "What we're trying to do at the division is create those linkages where there's some support."

Beginning with Wednesday's hearing, the committee will meet each month through November to study issues surrounding the state's opioid epidemic, mental health, implementation of new marijuana-related legislation, reforms to the state Medicaid program, services for people with disabilities and more.

Kristina Swickard, chief of social services at Salt Lake Legal Defender Association, told the committee her job exists largely because "the world of social services and criminal justice are basically colliding."

Swickard says her responsibilities include tracking down rehabilitative behavioral health resources for Salt Lake County clients who struggle with substance abuse disorder, as a way to help them get the best possible outcome in their criminal cases.

"Our focus is on how to ... guide attorneys, judges and clients to ... holistic services," she said. "We are more and more having requests from individuals in our community."

But she said her organization would prefer that those clients be first referred to a behavioral health program by their doctor, either as a step ahead of the curve to get them into treatment as their case is ongoing, or ideally, before their addiction leads them to the criminal justice system.

"I would rather resources go into the front end than having to catch up on the back end," Swickard said.

Rep. Ray Ward, R-Bountiful, who himself is a family doctor, described several common obstacles doctor's face in seeing a behavioral health referral through to completion in a timely manner.

Beyond behavioral health providers' wait lists, he said, obstacles could include an opioid-dependent patient's lack of access to Medicaid or other insurance coverage, their transportation options lining up poorly with whoever is the nearest available provider, and doctor time constraints.

Kelsey said state health officials are well aware of the strain involved in successfully making those referrals.

"We're trying to (strengthen) those ... handoffs between primary care providers and behavioral health clinics," he said.

Evidence-based treatment

Rep. Kelly Miles, R-Ogden, told Kelsey he remains interested in pursuing legislation promoting the use "evidence-based" behavioral health and addiction treatment. Miles' prior work on such legislation has failed to gain enough support.

"I'd like to feel better about the transparency and knowing the public money we're spending is really producing outcomes," Miles said.

Miles was the sponsor of HB199, a 2018 bill which initially would have required that certain thresholds of local health authorities' behavioral health programs be considered by definition to be evidence based in order to receive state funding.

The bill was later pared back to only require reporting on how many programs are evidence based, without giving the state power to withdraw funding. But the measure still failed to get out of committee amid objections from 12 of the 13 local health authorities that comprise the Utah Behavioral Health Committee and that contract with the Division of Substance Abuse and Mental Health to provide services.

Miles told Kelsey that it seems to him the local health behavioral health programs in the state "are all focusing on what they (individually) think is working," and asked Kelsey about the feasibility of bringing them to a consensus on what can be considered evidence based.

Kelsey responded that the concerns raised during the legislative session "were not necessarily with the direction" of Miles' bill, but how the measure defined what or can't be considered evidence based. He was optimistic those groups don't believe "the discussion is over" regarding the accountability Kelly wants to see.

"You as a payer have every right to ask that this system implement evidence-based practice," Kelsey told Miles.

Mindy Vincent, executive director of Utah Harm Reduction Coalition, cautioned that in trying to pin down the results of any given treatment program, no metrics should be used that could encourage a client to lie to a provider about their sobriety.

"We have to be really careful about what kind of outcomes we're looking for, Vincent said.

Miles responded that he understands metrics measuring results need to look much deeper than abstinence rates. But he added that state legislators, who don't get to see clients' progress up close, need objective ways of understanding how effective the various state-funded programs are.

"How do we know where to put the money?" Miles said. "If they're not getting better, then let's not go down that road."