Behavioral health leaders cite staffing shortages but report steep declines in fatal overdoses; diversion center expansion advances

Montgomery County's Behavioral Health and Crisis Services (BHCS) reported a marked decline in fatal overdoses in 2024 even as officials warned of long-term workforce shortages and pay inequity that limit service capacity.

Monica Martin, chief of Behavioral Health and Crisis Services, told the HHS Committee that county fatal overdoses declined about 40 percent in 2024 compared with 2023, with opioid-involved overdoses down roughly 48 percent and fentanyl-involved deaths down about 52 percent. Emergency department visits for opioid overdoses also fell by about 30 percent, the department said. BHCS credited expanded prevention and harm-reduction efforts, including a large increase in Narcan distribution and training and community outreach programs, as contributors to the decline.

Why it matters: A steep, multi-year reduction in overdoses changes the immediate demand profile for crisis services, but county leaders cautioned that persistent workforce and funding challenges could erode capacity to sustain gains. The department said more staff are needed to meet current demand; officials estimate Montgomery County would need roughly 50 percent more behavioral health staffing to meet present-level service demand.

Workforce and access: Martin summarized statewide and local workforce constraints cited in a Maryland Health Care Commission report and county data. Highlights presented to the committee included: - Many behavioral health professionals are nearing retirement; the state report projected a significant near-term retirement rate among clinicians. - Montgomery County ranks roughly ninth statewide at about 68 behavioral health professionals per 30,000 residents; county leaders said the county would need to expand behavioral health staffing by about 50 percent to meet current demand. - Underrepresentation of Latino and Asian clinicians relative to county demographics: Latino clinicians were noted at roughly 10% of the behavioral health workforce while Latinos comprise about 21% of the population; Asian underrepresentation was also noted relative to the county's 16% Asian population.

Programs and outcomes: BHCS described several programs the county runs or supports: - STEAR (Stop, Triage, Engage, Educate, and Rehabilitate): served nearly 600 county clients in 2024; the packet states 82% of those clients completed screenings, about 52 received referrals to treatment, and 57% engaged in treatment following outreach. - Crisis Stabilization Room (opened September 2023): admitted over 400 individuals in 2024, 70% presenting with substance use concerns. - Youth residential treatment at Mountain Manor (reopened September prior year): 65 youth engaged in the first seven months; 38 were Montgomery County residents. BHCS emphasized enhanced reentry supports for incarcerated individuals, including Narcan provision at release.

BHCS also highlighted prevention work: Naloxone distribution and training increased substantially compared with FY22 (an 81% increase in doses distributed and a 67% increase in people trained across that period). The department reported outreach and school-based curricula reaching thousands of students and continuing growth in peer and youth ambassador programs.

Diversion center: Committee members reviewed CIP amendments that advance funding timing and add $500,000 in state aid tied to a new stabilization unit required by recent state regulation changes. DHHS said the diversion center on 7 Locks Road in Rockville will provide a noncarceral alternative for adults with minor, nonviolent offenses who are in behavioral health crisis. Design completion was projected in spring 2025, with construction through spring 2027 and project completion in spring 2028; the stabilization unit is expected to be completed in calendar 2025. The committee approved the FY25 supplemental and FY26 CIP amendments without objection; packet materials noted the county is pursuing MDH community health facilities capital grant funding and must meet matching requirements.

Licensing and new providers: Sarah Rose, director of the Local Behavioral Health Authority, described the state'led licensure and accreditation process for providers who seek to operate billable services in the public behavioral health system. Rose said the county receives notifications when providers apply for accreditation and that the local authority reviews applications and forwards eligible requests to the state; the state has final licensure authority. Committee members asked staff to share the county's provider directory QR code and to notify the committee when new programs apply to operate in Montgomery County.

Municipal partnerships and crisis response: Committee members heard updates on co-located crisis clinician models in partnership with municipalities. The Takoma Park pilot, where two county therapists are co-located at the police department to redirect appropriate calls to clinicians, will be annualized in FY26 with the city reimbursing salary costs under an MOA. Committee members also discussed the county's mobile crisis outreach teams (MCOTs); the packet documents a shift from federal grant funding to full-year county general fund support to sustain existing teams and add two more to reach a target of seven teams.

A final note from the session: BHCS asked the Council to sustain focus on workforce and retention strategies (paid internships, targeted recruitment, stipend/compensation adjustments) and to continue partnership with hospitals, first responders and community organizations to maintain the observed reductions in overdoses and expand culturally competent care.

Ending: The HHS Committee approved the CIP adjustments for the diversion center and asked DHHS to return with follow-up detail on the stabilization unit compliance timeline and on workforce-recruitment metrics.