St. Mary’s - A Healthcare Shortage Area
Originally Published: November 10, 2023
Mental Health Considered During Solomon’s Bridge Update
St. Mary’s County is in serious need of expanding behavioral health services. Designated as a healthcare shortage area by the Department of Health and Human Services, many who seek care experience long wait times if they find a provider accepting new patients. Web-based health visits help bridge the gap, but expanding the network of local providers, across all specialties, is essential as the county continues to grow and hopes to attract and retain a vibrant community.
According to the Maryland Rural Health Plan, St. Mary’s County has over 6100 mental health related visits to the ER per 100K people, twice the state’s goal; our domestic violence rate is almost twice the state’s goal; ER visits for addiction related conditions is also high. These facts highlight a lack of behavioral health resources needed to meet demands of the community. Hospitalizations related to Alzheimers are nearly triple the rate they should be, pointing to a lack of senior care resources.
Mental health has been discussed lately alongside the Solomon’s Bridge. Numerous people have tragically lost their lives leaping from the top of the bridge. A petition, started by a St. Mary’s County resident last year, to install suicide prevention measures on the bridge now has over 10K signatures. Commissioners from St. Mary’s and Calvert Counties asked the State Highway Administration to investigate the idea. SHA said installing suicide prevention barriers of any kind would be impossible due to age concerns and the bridge’s ability to withstand additional weight or wind pressure. But that’s not quite the whole story.
There are two categories of suicide prevention barriers, physical (walls/nets) and non-physical (signs, callboxes). Each option was explored in a report generated from SHA, with the bridge’s overall condition weighing heavily in the viability of any solution being installed. Right now, the prevention measures include signage and a call box. The report states “the bridge was built in 1977.” On the National Bridge Inspection Standards’ scale of 0-9, with 9 being the best, the bridge is rated as a 5, or “fair” condition. The main span on the bridge is “fracture critical, or a steel member in tension whose failure would probably cause a portion of or the entire bridge to collapse.” MDOT is required, as a result, to perform a hands-on inspection every 12 months. The Solomon’s Bridge has 50% more average daily traffic than the Harry Nice/301 Bridge.
Commissioners met with the MD Secretary of Transportation back on 10/17 to review transportation issues in St. Mary’s County. The subjects of installing suicide deterants and replacing the bridge were discussed. A SHA representative said the bridge was in acceptable condition for service and was not in danger of collapse due to ongoing remediation efforts. There is no current estimated replacement schedule, only planning and studies to prepare. SHA asserted installing self-harm prevention on the bridge was not feasible for several reasons. First, attempts elsewhere in the state to install prevention only diverted the act to another location; second, the cost involved and risk of impeding the required 12-month inspection was too great; and finally, SHA is focused on getting people the mental help needed to prevent a crisis situation. Details on how SHA is addressing that piece were not provided.
Reasons to justify lack of action include potential hindrance of inspection activities, additional effects of wind, weight, and ice, and questions on the value of spending money on an aging structure needing replacement. “The American Association of State Highway and Transportation Officials bridge design codes do not include specific criteria for suicide deterrent systems,” says the report. A certain liberty of design exists in creating and installing barriers. As the report notes, “the addition of barriers affects access to areas under the bridge” for inspection. However, “options such as designing removable sections of the barrier could be evaluated to mitigate the effect within the fracture critical spans.” Cost estimates for installation were between $8-13M, with a 26-34 month schedule.
Analysis of potential extra weight, wind, or ice on the bridge “found overall adequate capacity to resist the additional loads.” Further, SHA’s report said inspections occurring after barrier installation “can be performed without major changes to current practices in most spans.” It also noted that current inspection processes in fracture critical spans would require “modifications to current practice.” This could be accomplished by “incorporating removable panels to allow the boom for under-bridge inspection vehicles to be lowered for access to difficult to reach areas.” Where there’s a will, there’s a way.
The Rural Health Information Hub, available on the website for Maryland’s Rural Health Plan, identifies 16 of 24 (66%) Maryland jurisdictions as being mental health professional shortage areas; 7 counties are partial shortage areas; and only one county, Howard, is not a shortage area. St. Mary’s County is in the first category.
When I ran for office last year, mental health was a major portion of my platform. Part of my plan was to create an incentive program to attract behavioral health professionals to St. Mary’s. The idea could also assist in other economic development goals. More broadly, it could be adapted to address shortages across the state. I discussed the subject with Lt. Gov Aruna Miller last year during Oyster Festival weekend while touring St. Mary’s with her aboard the Moore/Miller campaign bus.
The initial idea was education loan repayments offered to behavioral health providers in exchange for opening a physical practice in St. Mary’s and operating for at least 5 years. For an initial investment of $1M in funding, split over 5 years ($200K / yr), the program could support payments to 10 providers in the amount of $20K each. The total budget for St. Mary’s is generally around $320M, while Maryland’s is $64B. Comparatively, $1M in funding is .003% of St. Mary’s budget and .00000000001% of Maryland’s budget.
Thus far, $2M in funding has been secured for studies related to the replacement of the Solomon’s Bridge, a project estimated to cost at least ten times more. I don’t foresee funding being in place to replace the bridge any time soon. From a more global perspective, we do need to address root causes of behavioral health. In my opinion, if we can afford to allocate funding to a far off project, we can also invest in providing healthcare options and building that infrastructure instead.
There may be better ideas. But too often “No” is taken as a final answer. Relying on a SHA representative’s promise of finding other ways to solve the mental health crisis is not enough. We need bold, proactive strategies, ideas, and choices to solve these issues. Budgets are always tight–many families live on them everyday. Government budgets are a scaled up version, but because of their expansive nature these budgets can be adept at addressing and alleviating daily pressures residents face. We have to start somewhere, and by engaging key players who can assist in crafting a well-intentioned program based on educated decisions, we can achieve a solution.
Maryland can benefit from decisive and targeted action from Governor Wes Moore and Lt. Gov Aruna Miller’s administration. But, I firmly believe it would benefit St. Mary’s County for the Commissioners to consider more inventive solutions in the current absence of action by the state government.
