SALT LAKE CITY — Utah’s behavioral health system lacks a central oversight authority and does not have a strategic plan to reform the system, according to a legislative audit released Tuesday.
Behavioral health needs in the state are served by a variety of local mental health authorities, but the increasing number of organizations involved means many are siloed from one another, according to the report, which was presented to state lawmakers Tuesday afternoon.
“A lack of system-level coordination increases fragmentation and complexity of behavioral health care delivery. This complexity creates challenges with transition support and patient navigation, which contributes to the state’s access issues,” the report states. “Investing in and improving access to high-quality behavioral health services can help reduce or neutralize costs across these public and private health systems and sections — and save lives.”
The legislative audit — which is the first in a series of reports on the state’s behavioral health system — also found that Utah’s Office of Substance Use and Mental Health has been insufficient in oversight of the system and that local authorities have been inconsistent in monitoring subcontractors, “making it difficult to measure effectiveness.”
The report recommends several improvements to create a central oversight authority, including by tasking the Department of Health and Human Services with developing a governance model. If lawmakers pursue the path of a more central authority, the report recommends changing state law to give single entity decision-making authority and clarify how much power that entity has over other state and local authorities.
“A statewide issue like behavioral health coordination requires a statewide solution,” the report states. “While all entities are eager to provide solutions to gaps in behavioral health care, silos in care require an entity that is enabled to provide system-level solutions.”
Kyle Snow, chairman of the Utah Behavioral Healthcare Committee, responded to the report in a letter. While he said the committee concurs “with many of the audit’s recommendations,” he wrote that the audit at times “lacks context, especially when discussing the shortcomings of the (local mental health authority) system.”
“We believe that some of these shortcomings are mostly due to one or two (local mental health authorities),” he said. “However, we value the audit’s insights regarding the annual monitoring provided by (the Office of Substance Use and Mental Health) and are committed to collaborating closely with (the office) to refine the annual audit process.”
Other findings
Experts from the Utah Behavioral Health Coalition released a master plan to address growing mental health concerns in the state earlier this year. The audit praised the efforts of that plan but said the plan offers over 200 recommendations “with no concrete steps or an action plan for how to prioritize and then implement these recommendations.”
“Because of this, there is no unified, strategic approach to fix the problems and concerns pointed out in the various reports,” the audit states.
Auditors recommend that the master plan be “further developed into an actionable statewide behavioral-health strategic plan to include the following elements:
- Vision, mission and core values.
- Goals, objective, strategies and actionable steps fulfilling the goals.
- Measurable outcomes of long-term objectives.
- Key data elements to evaluate performance of measurable outcomes.”
The report also recommends that a central authority should lay out priorities for improving mental health treatment across the state.
When it comes to oversight of the various local authorities, the audit found the Office of Substance Use and Mental Health has “enabled deficiencies to persist” due to insufficient oversight. It recommends that the office establish better accountability, establish standards based on yearly audit filings and create “enforcement mechanisms to address multiyear findings.”
Auditors also recommend that the office require monitoring of subcontractors by local health authorities, noting that the current system makes it “difficult to measure effectiveness.”
“The Office of Substance Use and Mental Health is failing to address critical issues that hinder their oversight responsibilities,” the report states. “By setting up a robust accountability process and engaging local authorities in corrective action, the office can better address quality concerns in the behavioral health system and improve accessibility to services across the state.”
Tracy Gruber, the executive director of Utah’s Department of Health and Human Services, agreed with the findings and outlined specific plans for addressing each of the recommendations.
“Our entire department, including the Office of Substance Use and Mental Health, looks forward to partnering with the Utah Legislature on implementing additional modifications to Utah’s behavioral health system to ensure it is providing the highest quality of services and leading to the best outcomes for Utahns,” she wrote.
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