Latest / The Mental Health Evolution / Ep 48: Everybody's Talking About Mental Health But Nobody's Funding It with Stephanie Slowly Little

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Ep 48: Everybody's Talking About Mental Health But Nobody's Funding It with Stephanie Slowly Little · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast
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Network.
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Learn more at listenfrederick.com.
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Welcome to Mental Health Evolution, a podcast about
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what's changing in mental health and why it
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matters.
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I'm your host, Rachel Harrison, inviting you into
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honest conversations with people from all perspectives in
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the field, clinicians, tech founders, investors, insurance companies,
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and all the folks in between.
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Let's explore what's working, what's not, and what's
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next.
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Welcome back, everyone, to the Mental Health Evolution
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podcast.
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I'm Rachel Harrison, and today I'm speaking with
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Stephanie Slowly Little, Executive Director of NAMI Maryland.
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We often call that NAMI, kind of short
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script, and it stands for the National Alliance
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of Mental Illness.
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Stephanie is a licensed clinical social worker and
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public health executive with more than 17 years
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of experience in behavioral health, policy innovation, and
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organizational transformation.
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She has managed more than $100 million in
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grant programs, led statewide reforms, and built systems
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of care focused on equity and access.
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She stepped into the executive director role at
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NAMI Maryland in October 2025, and she is
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already deeply engaged in the legislative and advocacy
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work that shapes how mental health care reaches
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or fails to reach people across the state.
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Like many states, Maryland is comprised of large
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metro areas alongside more remote rural communities, and
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the gap between who can access behavioral health
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care and who cannot looks very different, depending
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on which one you live in.
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That gap is shaped by geography, workforce shortages,
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insurance barriers, and a system that advocates say
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has been underfunded for decades.
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Nearly every county in Maryland has been designated
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as a partial or full mental health shortage
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area.
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The contrast between urban and rural access, what
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telehealth can and cannot solve, and what it
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will actually take to redesign a system that
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works for everyone is exactly what we are
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going to dig into today.
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So I want to start, as usual, by
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talking through some articles to sort of set
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the stage for our listeners and for the
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conversation with Stephanie.
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This first one is from NAMI Metro Baltimore,
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and it's called Mental Health Care Gaps Persist
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in Maryland Rural Urban Areas.
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This piece looks at how the mental health
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care landscape differs across Maryland, depending on where
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you live.
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It covers the provider shortage data, the distinct
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challenges facing urban versus rural communities, and what
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Maryland's permanent extension of telehealth coverage under the
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Preserve Telehealth Access Act does and does not
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solve, and what advocates say needs to change.
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It's a strong frame for understanding the specific
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context Stephanie is working in every day.
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Article two is an article that we've referenced
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before.
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Listeners may remember that we looked at this
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report a few weeks ago in our conversation
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with care achievers from Inseparable, and this is
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called the Workforce Report Bridging the Mental Health
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Care Gap Maryland State Snapshot.
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This national workforce report includes a Maryland-specific
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snapshot that offers a somewhat different picture of
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the state mental health care access here.
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It shows Maryland meeting about 22% of
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its recommended psychiatrist ratio, with shortage levels rated
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as moderate rather than catastrophic, which compared to
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many other states is a relatively measured assessment.
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That contrast with some of the other data
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we'll be referencing today is something we want
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to dig into in our conversation with Stephanie.
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Different reports measure different things, and understanding what
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is behind the numbers matters.
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The third article is titled Rural Minds, Barriers
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to Health Care for Rural Americans, and Rural
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Minds is the only national nonprofit focused exclusively
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on advocating for rural mental health care equity.
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This piece draws on survey data showing that
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82% of rural residents report one or
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more barriers to accessing health care, and suicide
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rates in rural communities are 64 to 68
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% higher than urban areas.
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That data helps contextualize why the access gap
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is not just a supply problem, it's also
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a structural one.
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And lastly, in the fourth article from the
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Journal of American Medical Association Network OPEN is
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called Community Resources and Hazards Across the Rural
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Urban Continuum.
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This peer review study uses data from all
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residential addresses in Maryland to examine how community
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level social determinants of health vary across the
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rural urban continuum from urban to large rural
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to small rural to isolated rural areas.
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For clinicians and practice owners, it offers a
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granular picture of how geography shapes the conditions
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their patients are living in, well beyond what
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zip codes alone can tell us.
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So, with that as our backdrop, I want
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to dig into a conversation with you, Stephanie.
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So welcome.
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Thanks for being here today.
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Thank you for having me, Rachel.
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I'm excited to be here and excited to
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be with your listeners.
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Awesome.
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So let's just start with the very beginning.
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Can you tell us a little bit more
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about what you do?
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What is the key focus for you right
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now in your role with NAMI Maryland?
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Yes.
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So here at NAMI, I am the executive
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director for the state organization.
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So NAMI Maryland represents over 60,000 advocates,
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persons living with, and individuals across the state
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who are living with or surrounding or supporting
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someone living with mental health need challenges or
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are facing it day to day.
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And so that looks different for every person.
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You could be personally going through your own
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mental health challenges, advocating for yourself, or you
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know someone that's living with it.
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Or you could just be a person that's
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an advocate for it and know that it's
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somebody that needs support and you just care
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about the cause and you want to stand
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in the gap.
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So that could be a provider, that could
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be a worker, that could be just someone
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that's listening on here and says, you know
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what, I think mental health matters and I
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want to stand in the gap.
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NAMI is for everyone.
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And so the one thing that we always
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say is a peer led, driven organization.
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And it began at the national level and
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started with two parents really who said we
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need to have someone help us support our
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families.
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And it's grown exponentially to this nationally grassrooted
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organization that serves all across this country.
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The uniqueness of our organization is that we
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believe it's still a grassroots, from the ground
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up organization.
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So some of the articles you read is
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from one of our local affiliates that's in
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metro Baltimore that is rooted right here in
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Baltimore.
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And they serve Baltimore City, Baltimore County, and
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then one of our rural communities in Caroline
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County.
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And so the beauty of that is that
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they are there supporting the local community.
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So I sit at the state.
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So we have the national organization, right, that
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serves the entire country.
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I serve as the national state organization.
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So I serve the entire state.
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Then you have Baltimore who serves their local
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community.
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And we have other affiliates that are across
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our state.
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So you have them throughout.
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You have Howard County is one.
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You have one in Georges County, Montgomery County,
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Anne Arundel.
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And then you have other ones throughout the
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state.
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So Frederick County is another one.
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You have some in the lower shore, which
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is going to be in your Salisbury County,
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Talbot County.
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You have some in now.
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We just started one in Western Maryland.
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I'll talk about that a little later.
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We're doing in the rural community.
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And there's some out with Cecil in Hartford
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County and some in Southern Maryland.
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So my role really overarchingly is to provide
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support to the entire state.
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So the way I see it is that
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we are one nominee for every community.
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And my job is to continue to support
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and create access for every community.
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So we are the training hub.
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We are the advocacy arm.
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And we are the program machine for this
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state.
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And we're supposed to support all of our
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affiliates to help continue to support them to
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do that local on the ground organizational work.
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We also have a huge responsibility to coalesce
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our advocacy work at the state level.
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So when policies come down for mental health
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support, we're supposed to be providing that level
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of support to them on that level.
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And it would seem like, well, why are
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you guys in the political space like that?
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Well, it's important because a lot of times
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laws are written not with the peer voice
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in mind.
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A lot of times people don't think about,
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politicians don't think about how these rules are
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being made and how they're going to be
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impacting that from what medications are being taken
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on or off, you know, insurance lines, whether
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you're going to cert or provide or expand
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services or restrict services, what insurances will or
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will not cover.
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And sometimes what is not going to be
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restricted.
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And we see every single day that sometimes
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our best intentions do not serve the community
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well.
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So we stand up and we speak out
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for our community to make sure that the
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peer voice is led.
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And then finally, my job is to do
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program innovation, to provide opportunities, to do innovation
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programs over and above what National provides us,
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to make sure that we're meeting the needs
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nuanced to Maryland.
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Because to your point of what you reach,
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every community is different and Maryland is very
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diverse.
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So what looks like in my heart of
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our community is a lot different.
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Even within one county, one part of the
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county could look a lot different than another
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part of the county.
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Some counties could look very urban in one
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part and that same part could still have
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a rural aspect to it.
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So I think you have to be cognizant
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of that as well.
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So it's just my job to always keep
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my hand on the pulse of that, advocate
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and ensure that we're meeting the needs of
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now.
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I love that.
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So I'm curious with this data about rural
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versus urban, and I love that you highlighted
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that that can be within the same county.
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It can just be a few miles away
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sometimes.
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Yes.
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What are you seeing are the needs for
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areas that are considered more rural?
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So I think it's always been the fact
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that when you look at rural communities, that
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the access is a lot different.
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Geographically, a space per capita is always different,
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right?
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When you think about a more urban community,
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there's just more dense population.
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So that just means you have more people
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in close proximity to each other.
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So by nature, you might see more people
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together.
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So compare a Baltimore City to, I'm going
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to use a Caroline County, so on the
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eastern shore.
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There's just more densely populated people in Baltimore
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City than a Caroline County.
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There's going to be more greenery.
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Houses are going to be more spread out.
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So in terms of how many providers are
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in a Caroline County, just opposed to what's
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in Baltimore City, it's going to be less.
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So that means there's less opportunities for individuals
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to get served.
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It's less people to have access to those
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people.
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So even if there are providers, how many
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providers are in that community to be seen?
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How often is it going to be able
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to be seen?
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The diversity of the people being seen and
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how in their capacity to see those people
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will be different, right?
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And that's just about space, access and availability.
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Now, if you compile that with like, what
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if the person has different needs?
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What if their insurances are different?
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What if their ethnicity or language barriers are
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different?
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What if they have ASL or disabilities or
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other comorbidities?
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What if they're neodivergent?
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What if they have transportation issues?
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What if they're on Medicaid?
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What if they have no insurance?
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What if the provider is not taking your
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insurance at all?
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Any type of complexities that you want to
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overlay that with, it makes it that much
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harder.
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So I used to work in government.
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I used to do a lot of work
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in health equity and health disparities.
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And one of the things that we always
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talked about is where you look at disparities
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is just transportation.
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And when you talk about rural communities, one
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of the big things is like having individuals
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go to see a provider.
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If you don't have transportation and you were
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just trying to get to a provider for
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some individuals, it was a loss of day
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of pay because they would need to have
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to find public transportation, which would be a
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half a day of work just to get
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there.
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So they would have to take half a
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day to get from their home to that
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provider.
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Now, if you're talking about a community such
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as Prince George's County, that might be a
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30 minute drive, but for a community that's
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more rural, it may be different.
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Not to be confused, though, if you think
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of a Hartford County, if you're thinking of
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the southern part of the county was more
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densely populated, it still may be a 45
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minute commute.
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The northern part where it's more rural, it
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still may be just as equitable to someone
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that's living in a rural community where the
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transportation is not as accessible.
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So when we say what's the difference, those
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kind of things matter.
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You don't always have the access and there
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may not be as many providers.
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And so that's the biggest thing.
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Also, I think you have to think about
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two ratio is just if the providers have
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capacity.
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We know that the mental health workforce is
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shrinking by the day.
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Providers are burning out.
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There's harder times for providers to really stay
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in the field just because the pay is
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not what it used to be.
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It's harder for them to be reimbursed.
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And depending on what the the socioeconomic statuses
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of a community is, which typically, depending on
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what it looks like, most of those individuals
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may be on Medicaid or Medicare.
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That also may be that they may not
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be able to take them or they don't
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want to take them because they don't get
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reimbursed at the rates that they want to
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or it's too much red tape.
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So then that creates another barrier of access.
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So there's so many factors that really inhibits
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people in rural communities from getting equitable services
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that may be herring.
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That last part may be still the same
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things being experienced in urban communities.
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But when you compile all the other disparities
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that they're impacted with, it just is just
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another added layer that they're facing.
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I mean, and I think that all makes
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sense.
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When when we talk about the transportation piece,
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it makes me curious about telehealth.
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And I reference that Maryland permanently extended telehealth
15:03
coverage in 2025, which is awesome under the
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Preserve Telehealth Access Act.
15:09
How much does that help and where does
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that still fall short for people?
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So that helps tremendously.
15:16
Right.
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I think that that has been a huge
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component.
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So ironically, in 2020, I was working at
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the Behavioral Health Administration when we first relaxed
15:26
those guidance and it was a huge conversation.
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I remember very distinctly when we were talking
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about telehealth and I was excited because I'm
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a clinician, too.
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So I have a background in this.
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And I remember doing therapy at one time
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and, you know, the novelty of like, oh,
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this would be so great to do that,
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because one, it creates an ability to reduce
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recidivism, which basically is, you know, reducing the
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time of people canceling appointments because they can't
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find child care, they can't get to work,
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they can't get off work, they can't make
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the appointment.
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So people are more likely to keep their
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appointment because they can, you know, jump out
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from work or take lunch break or, you
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know, just, you know, do it in their
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home with their kid on their arm and
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still see their clinician.
16:06
So it does create an opportunity to have
16:08
access because now they're not beholden to whom's
16:10
just in their community.
16:12
They can see someone across the water.
16:14
They can see someone in another part of
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the state.
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So it opens up another portal of more
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providers in the state for them to see.
16:21
That being said, it still doesn't necessarily change
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the factors of a couple of things.
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What you find is there are broadband issues
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in rural communities.
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All the time there may be.
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We are doing a lot of expansion here
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at NAMI in terms of wanting to create
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more access to free supports that we do
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here at our organization.
16:43
So we're expanding out into Western Maryland, which
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are rural communities.
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One of the things that we say is
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that not everybody has access to Internet.
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You would think in 2026 that's just commonplace,
16:52
but that's not commonplace.
16:53
So some individuals, some communities still don't have
16:56
reliable access to Internet.
16:58
Even I live in a suburban community.
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My broadband doesn't always work.
17:03
Or we have to get routers and extenders
17:05
because it jumps out.
17:07
As more people are home or more people
17:09
consume Wi-Fi, the Wi-Fi is less
17:11
reliable.
17:12
Right.
17:12
Data centers are coming up.
17:14
More people consume data.
17:15
It's still a problem.
17:16
So compound network for a community is already
17:18
stretched or doesn't have that access.
17:21
So even if you have telehealth, if you
17:23
don't have broadband, if you don't have Internet
17:25
access, if it's not a thing for you,
17:27
is it accessible?
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It's not.
17:29
So it's not one of those things that
17:30
is accessible for them.
17:33
So that's another component.
17:35
That's another component that creates another barrier for
17:38
them.
17:39
So I think ultimately that's a huge component.
17:42
If they don't have it, then that's another
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thing that they don't have.
17:45
So, yeah, that's another issue.
17:47
Yeah.
17:48
Do you feel like certain people are struggling
17:50
to be able to like, what if they
17:54
want to come in person?
17:56
Right.
17:56
I feel like there are certain disabilities or
17:59
diagnoses or situations where telehealth might not be
18:03
as effective or might not be preferred by
18:07
the client.
18:08
Or some.
18:09
Yes, that is a huge factor.
18:11
And there's some there's some diagnosis and some
18:13
insurances that require you to see people in
18:15
person.
18:15
Right.
18:16
So depending on what your diagnosis is or
18:18
depending on what services you're receiving, you are
18:21
required by your insurance to see somebody in
18:23
person.
18:23
Right.
18:23
So if you're getting partial hospitalization or you're
18:26
getting intensive outpatient treatment, those services are not
18:30
always allowable to or, you know, medication assisted
18:33
treatment.
18:34
You're not going to be able to do
18:35
that via tele or, you know, so some
18:37
things are going to require you to be
18:39
in person and you might just have a
18:41
preference.
18:41
Even if you're just getting standard mental health
18:43
treatment, you might just want to see your
18:45
provider in person.
18:46
So we're back to the transportation issue or
18:47
back to the access issue.
18:49
So if your provider is not in your
18:51
community and your provider, you're in Western Maryland,
18:54
but your provider is in Baltimore, your provider
18:56
is in Anne Arundel County, you're not going
18:59
to be able to drive from Garrett County
19:00
all the way to Anne Arundel County, per
19:02
se, to get those services.
19:04
That's a three hour drive.
19:05
And that is not accessible.
19:06
So we're back to the access issue.
19:08
So it's better, but it's not ideal.
19:11
Right.
19:11
And so what is the perfect world for
19:13
that?
19:13
I think, you know, what's the best thing
19:16
for rural communities is for them to feel
19:18
or to incentivize providers to be enrooted and
19:22
indoctrinated in their community for a couple of
19:24
reasons, because we want to ensure that communities
19:27
have the opportunity to have providers that are
19:30
in their community, that understands what's happening in
19:32
their communities and are culturally appropriate to respond
19:34
to the needs of their community, because that
19:37
provides a different level of treatment.
19:39
Because sometimes when you're dealing with individuals, they
19:43
need to know or be able to express
19:45
to you what they're dealing with and environmental
19:47
factors matter.
19:49
And so if you don't know what I'm
19:50
dealing with in my community, it might create
19:53
a barrier of treatment.
19:55
You may not understand what it looks like
19:56
about why I'm struggling to go to work
19:59
every single day and deal with the things
20:01
I'm dealing with at my steel mill or
20:04
my work environment if you don't know what
20:06
it looks like to be in my community.
20:08
And so having providers understand what they're facing
20:11
matters.
20:12
And I think that that's a huge part
20:13
of what NAMI is and why we believe
20:15
in being community rooted, because we know that
20:19
when we are in those communities and we're
20:21
from those communities, we provide that level of
20:24
peer led, peer understood support that is a
20:27
lot different than what other people are experiencing.
20:30
So we try to stand in the gap
20:31
where sometimes the providers can't.
20:32
Yeah, yeah, no, I love that perspective of
20:36
understanding a local culture and local environmental factors.
20:40
I want to talk a minute to you've
20:43
managed a lot of grant funding, and I'm
20:46
curious what you're seeing about the landscape of
20:49
funding right now.
20:50
I feel like so many things have shifted
20:52
in that arena.
20:54
And I'd love to kind of get an
20:56
update of where are we?
20:58
What's possible?
21:00
Things are a lot possible.
21:01
But if you ask me, it's very overwhelming,
21:03
to be quite honest with you.
21:05
So where there's possibilities, there are still challenges.
21:07
Right.
21:08
So I'm seeing some innovation.
21:10
I just actually went for a peer recovery
21:12
grant yesterday, but I'm actively advocating for ourselves
21:16
because there's still challenges in what they're doing.
21:19
So there's access, but there's obstacles, too.
21:22
I'm trying to be optimistic.
21:24
I always try to see the glass half
21:25
full for everyone.
21:26
Right.
21:27
I think there are opportunities in every landscape.
21:29
I think it's not what we are traditionally
21:33
accustomed to seeing.
21:35
And I think that is not what we
21:37
probably all would like to see in the
21:39
way that we know intuitively how mental health
21:43
and behavioral health should be treated.
21:45
But if we are imaginative and if we
21:48
are innovative and if we are willing to
21:51
move with the tide, then we can find
21:54
opportunities to still serve our communities in the
21:57
best way that we possibly can.
21:59
Because I think if we stick our head
22:03
in the sand and say this is not
22:06
working for us, this is wrong, this is
22:08
not right, we can't do it, what they
22:11
want us to do is wrong.
22:12
I'm not saying do things that are unethical.
22:14
I'm not saying align yourself with things that
22:16
are not fundamentally what we want to see.
22:20
I'm saying that if you see an opportunity
22:23
grant wise that can provide an opportunity for
22:26
you to reimagine how to better serve the
22:29
community and you can write to it in
22:32
a way that will allow you to serve
22:35
and competitively bid for it and you get
22:38
awarded and you can still get to the
22:40
opportunity to serve your community, go for it.
22:43
They're not making it easy, though.
22:44
I will tell you that 110 percent and
22:46
I'm just telling you based off my own
22:48
lived experience, they're not making it easy.
22:50
But I think you can't be deterred.
22:52
I think you have to know that it's
22:54
worth the fight.
22:55
It's just the environment is very challenging at
22:58
this point.
22:59
It is challenging in every landscape, in every
23:02
world, whether it's in philanthropic, whether it's foundational,
23:05
whether it's state and federal, every facet of
23:09
grant and fundraising is challenging right now.
23:12
And it's funny because I was having this
23:15
conversation yesterday, says everybody's talking about I'm going
23:17
to help, but nobody's funding it.
23:19
And that's the truth.
23:20
Everybody's talking about it, but nobody is funding
23:23
it.
23:25
And it's the buzzword, but it's not the
23:28
investment.
23:29
And I used to work, I used to
23:31
work in equity and I used to tell
23:32
people when I worked in equity, everybody wanted
23:34
me to come to their conferences.
23:36
Everybody wanted me to come to their speeches.
23:37
Everybody wanted me to be a part of
23:38
their panels, but nobody gave me money.
23:41
And I always say, you know, when people
23:42
care about something, when they invest in it
23:44
and I feel the exact same way about
23:47
mental health.
23:48
As many times as people talk about mental
23:50
health and as much as as much as
23:52
I hear people speak about mental health, then
23:54
no organization such as NAMI, who provides free,
23:58
unfiltered access to know every program we provide
24:03
is free cost to the individuals we serve.
24:05
We should never be at a deficit.
24:08
We should be giving, people should be freely
24:10
wanting to partner with us.
24:12
And we are all struggling up and down.
24:15
There's not one organization.
24:16
There's not one affiliate that's not struggling.
24:18
And the fact of the matter is, is
24:20
that people say that they support it, but
24:22
they don't support it in the way that
24:24
we need it to be.
24:25
And with the pending changes to Medicaid that
24:29
are coming in July, very honestly and very
24:31
truly, there is no better time to partner
24:34
with an organization such as NAMI than right
24:36
now.
24:36
If you, if you're listening to this podcast
24:39
and you're saying, where can we go to
24:42
better support communities that need help?
24:45
It is to work with organizations such as
24:47
NAMI, because the landscape is very challenging right
24:52
now.
24:52
And every time we're looking at it, it's
24:55
making it harder.
24:56
And the other thing I will say to
24:58
answer your question more to poignantly, there is
25:00
a bill that is out right now.
25:03
There is out for public comment that is
25:05
going to make it very difficult if it
25:08
passed, that the office of budget and management
25:11
at the federal level has the opportunity to
25:14
have discretion on grants that they can unilaterally
25:17
cancel or not fund nonprofits and other grants
25:23
and organizations such as NAMI to receive services.
25:27
And so I highlight that for your listeners
25:30
too, because that is also another challenging landscape
25:36
that we're facing.
25:37
And so it is difficult.
25:39
It is difficult.
25:39
But what I stand on and why I
25:42
still sit here is because it is not
25:44
in times of feast that we do our
25:49
greatest time.
25:49
It is times of our greatest adversity that
25:51
we show our character, our resolve, and we
25:53
do our best work.
25:54
We cannot, for the people that we serve,
25:57
for the people who are counting on us
25:58
and for the people who will never sit
26:00
in mics and sit on podcasts and sit
26:03
in front of stages such as ours, have
26:05
opportunities to sit before legislators, have opportunities to
26:08
advocate and fight.
26:09
Do we do that?
26:10
We'll get a lot of nos, we'll get
26:12
a few yeses, but we still get up
26:14
every day and we fight because it's required
26:16
of us to continue to do the things
26:18
we must do.
26:19
If we don't, then the people that we
26:21
serve will never see it.
26:24
And that's the truth of the matter.
26:26
Wow.
26:29
I love that perspective.
26:32
I'm wondering too, you mentioned the bill that
26:35
was open for comment.
26:36
I would love it if you can connect
26:38
us with a link or something and we'll
26:40
include that in the show notes too.
26:43
I think what I'm hearing, and I love
26:46
it from Stephanie, is that despite the challenges
26:48
here, we have to be innovative.
26:50
We have to be collaborative.
26:53
I see that more than ever.
26:55
And there are lots of people who treat
26:58
and are passionate about treating and supporting mental
27:01
wellness.
27:02
And that is no small thing.
27:05
That is a huge thing and we have
27:07
to work together and we have to continue
27:09
to be innovative.
27:11
So Stephanie, I'm inspired by you.
27:15
Thank you.
27:16
Thank you for what you're doing and thank
27:18
you for continuing the work and for NAMI
27:22
and all of their work as well.
27:24
So I really appreciate you taking your time
27:27
out to be here today.
27:29
For our listeners, if you want to get
27:31
more involved in NAMI Maryland's work or NAMI
27:34
Nationwide, you can visit namimd.org for Maryland.
27:40
As always, links to everything we discussed today
27:43
will be in the show notes.
27:45
I'm Rachel Harrison.
27:46
This is the Mental Health Evolution podcast, and
27:49
I will see you next time.
27:51
Thanks for being here.
27:53
Thanks for listening to the Mental Health Evolution
27:56
podcast.
27:57
Join the conversation, find us on socials, send
28:00
us your thoughts, and tell us what you're
28:02
seeing in your corner of the mental health
28:04
world.
28:04
Until next time, stay curious and keep evolving.