Everybody's Talking About Mental Health But Nobody's Funding It with Stephanie Slowly Little

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies, and all the folks in between. Let's explore what's working, what's not, and what's next. Welcome back everyone, to the Mental Health Evolution Podcast. I'm Rachel Harrison, and today I'm speaking with Stephanie Slowly Little, Executive Director of NAMI Maryland. We often call that NAMI kind of short script, and it stands for the national alliance of Mental Illness. Stephanie is a licensed clinical social worker and public health executive with more than 17 years of experience in behavioral health policy innovation and organizational transformation. She has managed more than 100 million in grant programs, led statewide reforms, and built systems of care focused on equity and access. She stepped into the executive director role at nami Maryland in October 2025, and she is already deeply engaged in the legislative and advocacy work that shapes how mental health care reaches or fails to reach people across the state. Like many states, Maryland is comprised of large metro areas alongside more remote rural communities, and the gap between who can access behavioral health care and who cannot looks very different depending on which one you live in. That gap is shaped by geography, workforce shortages, insurance barriers, and a system that advocates say has been underfunded for decades. Nearly every county in Maryland has been designated as a partial or full mental health shortage area. The contrast between urban and rural access, what telehealth can and cannot solve, and what it will actually take to redesign a system that works for everyone is exactly what we are going to dig into today. So I want to start, as usual by talking through some articles to sort of set the stage for our listeners and for the conversation with Stephanie. This first one is from NAMI Metro Baltimore, and it's called Mental Healthcare Gaps Persist in Maryland Rural Urban Areas. This piece looks at how the mental health care landscape differs across Maryland depending on where you live. It covers the provider shortage data, the distinct challenges facing urban versus rural communities, and what Maryland's permanent extension of telehealth coverage under the Preserve Telehealth Access act does and does not solve, and what advocates say needs to change. It's a strong frame for understanding the specific context Stephanie is working in every day. Article 2 is an article that we've referenced before. Listeners may remember that we looked at this report a few weeks ago in our conversation with Care achievers from inseparable and this is called the Workforce Bridging the Mental Health Care Gap Maryland State Snapshot this national workforce report includes a Maryland specific snapshot that offers a somewhat different picture of the state mental health care access. Here it shows Maryland meeting about 22% of its recommended psychiatrist ratio, which with shortage levels rated as moderate rather than catastrophic, which compared to many other states, is a relatively measured assessment. That contrast with some of the other data we'll be referencing today is something we want to dig into in our conversation with Stephanie. Different reports measure different things, and understanding what is behind the numbers matters. The third article is titled Rural Barriers to Healthcare for Rural and Rural Minds is the only national nonprofit focused exclusively on advocating for rural mental health care equity. This piece draws on survey data showing that 82% of rural residents report one or more barriers to accessing health care, and suicide rates in rural communities are 64 to 68% higher than urban areas. That data helps contextualize why the access gap is not just a supply problem, it's also a structural one. And lastly, in the fourth article from the Journal of American Medical Association, Network Open is called Community Resources and Hazards across the Rural Urban Continuum. This peer review study uses data from all residential addresses in Maryland to examine how community level social determinants of health vary across the rural urban continuum from urban to large, rural to small, rural to isolated rural areas. For clinicians and practice owners, it offers a granular picture of how geography shapes the conditions their patients are living in, well beyond what zip codes alone can tell us. So with that as our backdrop, I want to dig into a conversation with you, Stephanie. So welcome. Thanks for being here today.

Thank you for having me, Rachel. I'm excited to be here and excited to be with your listeners.

Awesome. So let's just start with the very beginning. Can you tell us a little bit more about what you do? What is a key focus for you right now in your role with NAMI Maryland?

Yeah, so here at NAMI, I am the executive director for the state organization. So NAMI Maryland represents over 60,000 advocates, persons living with and individuals across the state who are living with or surrounding or supporting someone living with mental health need challenges or are facing it day to day. And so that looks different for every person. You could be personally going through your own mental health challenges, advocating for yourself or you know, someone that's living with it, or you could just be a person that's an advocate for it and know that it's somebody that needs support and you just care about the cause. And you want to stand in the gap. So that could be a provider, that could be a worker, that could be just someone that's listening on here and says, you know what? I think mental health matters and I want to stand in the gap. Nominees for everyone. And so the one thing that we always say is a peer led, driven organization. And it began at the national level and started with two parents, really, who said we need to have someone help us support our families. And it's grown exponentially to this nationally grassrooted organization that serves all across this country. The uniqueness of our organization is that we believe it's. It's still a grassroots from the ground up organization. So some of the articles you read is from one of our local affiliates that's in metro Baltimore that is rooted right here in Baltimore. And they serve Baltimore City, Baltimore county, and then one of our rural communities in Carolina County. And so the beauty of that is that they are there supporting the local community. So I sit at the state, so we have the national organization, right? That serves the entire country. I serve as the national state organization, so I serve the entire state. Then you have Baltimore, who serves their local community. And we have other affiliates that are across our state. So you have them throughout. So you have Howard county is one, you have one in Prince George's County, Montgomery County, Anne Arundel, and then you have other ones throughout the state. So Frederick county is another one. You have some in the Lower Shore, which is going to be in your Salisbury County, Talbot county, you have some in now, we just started one in Western Maryland. I'll talk about that a little later. We're doing in the rural community and then some out with Cecil in Hartford county and some in Southern Maryland. So my role really overarchingly is to provide support to the entire state. So the way I see it is that we are one nominee for every community. And my job is to continue to support and create access for every community. So we are the training hub, we are the advocacy arm and we are the program machine for this state. And we're supposed to support all of our affiliates to help continue to support them, to do that local on the ground organizational work. We also have a huge responsibility to coalesce our advocacy work at the state level. So when policies come down for mental health support, we're supposed to be providing that level of support to them on that level. And it would seem like, well, why are you guys in the political space like that? Well, it's important because a lot of times laws are written not with the peer voice in mind. A lot of times people don't think about, politicians don't think about how these rules are being made and how they're going to be impacting that from what medications are being taken on or off, you know, insurance lines, whether you're going to cert or provide or expand services or restrict services, what insurances will, will not cover, and sometimes what is not going to be restricted. And we see every single day that sometimes our best intentions do not serve the community well. So we stand up and we speak out for our community to make sure that the peer voice is led. And then finally my job is to do program innovation, to provide opportunities to do innovation programs over and above what national provides us, to make sure that we're meeting the needs nuanced to Maryland because to your point of what you reached, every community is different and Maryland is very diverse. So what looks like in one part of our community is a lot different. Even within one county, one part of the county could look a lot different than another part of the county. Some counties could look very urban in one part and that same part could still have a rural aspect to it. So I think we have to be cognizant of that as well. So it's just my job to always keep my hand on the pulse of that advocate and ensure that we're meeting the needs of now.

I love that. So I'm curious with this data about rural versus urban and I love that you highlighted that that can be within the same county. It can just be a few miles away sometimes.

Yes.

What are you seeing are the needs for areas that are considered more rural.

So I think it's always been the fact that when you look at rural communities that the access is a lot different geographically. A space for capita is always different. Right. When you think about a more rural urban community, there's just more dense population. So that just means you have more people in close proximity to each other. So by nature you might see more people together. So compare a Baltimore city to, I'm going to use a Caroline County. So on the Eastern Shore, there's just more densely populated people. In Baltimore City than a Carolina county, there's going to be more greenery, houses are going to be more spread out. So in terms of how many providers are in a Carolina county juxtaposed to within Baltimore City, it's going to be less. So that means there's less opportunities for individuals to get served, is less people to have access to those people. So even if there are providers, how Many providers are in that community to be seen. How often is it going to be able to be seen, the diversity of the people being seen and how in their capacity to see those people will be different? Right? And that's just about space, access and availability. Now if you compile that with like, what if the person has different needs? What if their insurances are different? What if their ethnicity, their language barriers are different? What if they have ASL or disabilities or other comorbidities? What if they're neurodivergent? What if they have transportation issues? What if they are on Medicaid, they have no insurance? What if the provider's not taking your insurance at all? Any type of complexities that you want to overlay that with, it makes it that much harder. So I used to work in government, I used to do a lot of work in health equity and health disparities. And one of the things that we always talked about is where you look at disparities is just transportation. And when you talk about rural communities, one of the big things was like having individuals go to see a provider if you don't have transportation and you were just trying to get to a provider, for some individuals, it was a loss of day of pay because they would need to have to find public transportation, which would be a half a day of work, just to get there. So they would have to take half a day to get from their home to that provider. Now, if you're talking about a community such as Prince George's county, that might be a 30 minute drive, but for a community that's more rural, it may be different. Not to be confused though, if you think of a Hartford county, if you're thinking the southern part of the county was more densely populated, it still may be a 45 minute commute. The northern part, where it's more rural, it still may be just as equitable to someone that's living in a rural community where the transportation is not as accessible. So when we say what's the difference? Those kind of things matter. You don't always have the access and there may not be as many providers. And so that's the biggest thing also I think you have to think about too, Rachel, is just if the providers have capacity, we know that the mental health workforce is shrinking by the day, providers are burning out. There's harder times for providers to really stay in the field. Just because the pay is not what it used to be, it's harder for them to be reimbursed. And depending on what the socioeconomic statuses of a community is which typically, depending on what it looks like, most of those individuals may be on Medicaid or Medicare. That also may be that they may not be able to take them or they don't want to take them because they don't get reimbursed at the rates that they want to, or it's too much red tape. So then that creates another barrier of access. So there's so many factors that really inhibits people in rural communities from getting equitable services. That may be. That last part may be still the same things being experienced in urban communities, but when you compile all the other disparities that they're impacted with, it just is just another added layer that they're facing.

I mean, and I think that all makes sense when. When we talk about the transportation piece, it makes me curious about telehealth. And I referenced that Maryland permanently extended telehealth coverage in 2025, which is awesome. Under the Preserved Telehealth Access Act. How much does that help and where does that still fall short for people?

So that helps tremendously. Right. I think that that has been a huge component. So ironically, in 2020, I was working at the Behavioral Health Administration when we first relaxed those guidance, and it was a huge conversation. I remember very distinctly when we were talking about telehealth. And I was excited because I'm a clinician too, so I have a background in this. And I remember doing therapy at one time and, you know, the novelty of like, oh, this would be so great to do that, because one, it creates an ability to reduce recidivism, which basically is, you know, reducing the time of people canceling appointments because they can't find childcare, they can't get to work, they can't get off work, they can't make the appointment. So people are more likely to keep their appointment because they can, you know, jump out from work or take lunch break or, you know, just, you know, do it in their home with their kid on their arm and still see their clinician. So it does create an opportunity to have access because now they're not beholden to whom just in their community. They can see someone across the water. They can see someone in another part of the state. So it opens up another portal of more providers in the state them to see. That being said, it still doesn't necessarily change the factors of a couple of things. What you find is there are broadband issues in rural kies all the time. There may be. We are doing a lot of expansion here at DAMI in Terms of wanting to create more access to free supports that we do here at our, at our organization. So we are expanding out into western Maryland, which are rural communities. One of the things that we say is that not everybody has access to Internet. You would think in 2026 that's just commonplace, but that's not commonplace. So some individuals, some communities still don't have reliable access to Internet. Even I live in a suburban community. My broadband doesn't always work or we have to get routers and extenders because it jumps out as more people are home or more people consume WI fi. The WI fi is less reliable. Right. Data centers are coming up. More people consume. Data is still a problem. So compound that with a community that's already stretched or doesn't have that access. So even if you have telehealth, if you don't have broadband, if you don't have Internet access, if it's not a thing for you, is it accessible? It's not. So it's not one of those things that is accessible for them. So that's another component. That's another component that creates another barrier for them. So I think ultimately that's a huge component. If they don't have it, then that's another thing that they don't have. So, yeah, that's another issue.

Yeah. Do you feel like certain people are struggling to be able to, like, what if they want to come in person? Right. I feel like there are certain disabilities or diagnoses or situations where telehealth might not be as effective or might not be preferred by the client or some.

Yes, that is a huge factor. And there's some, there are some diagnosis and some insurances that require you to see people in person. Right. So depending on what your diagnosis is or depending on what services you're receiving, you are required by your insurance to see somebody in person. Right. So if you're getting partial hospitalization or you're getting intensive outpatient treatment, those services are not always allowable to, or, you know, medication assisted treatment. You're not going to be able to do that via tele or, you know, so some things are going to require you to be in person and you might just have a preference. Even if you're just getting standard mental health treatment, you might just want to see your provider in person. So we're back to the transportation issue or back to the access issue. So if your provider is not in your community and your provider, you're in Western Maryland, but your provider is in Baltimore, your provider is in, out, Anne Arundel county, you're not going to be able to drive from Garrett county all the way to Anne Arundel county per se to get those services. That's a three hour drive and that is not accessible. So we're back to the access issue. So it's better, but it's not ideal. Right. And so what is the perfect world for that? I think, you know, what's the best thing for rural communities is for them to feel or to incentivize providers to be rooted and indoctrinated in their community for a couple of reasons. Because we want to ensure that communities have the opportunity to have providers that are in their community that understands what's happening in their communities and they're culturally appropriate to respond to the needs of their community because that provides a definite level of treatment. Because sometimes when you're dealing with individuals, they need to know or be able to express to you what they're dealing with. And environmental factors matter. And so if you don't know what I'm dealing with in my community, it might create a barrier of treatment. You may not understand what it looks like about why I'm struggling to go to work every single day and deal with the things I'm dealing with at my steel mill or my work environment if you don't know what it looks like to be in my community. And so having providers understand what they're facing matters. And I think that that's a huge part of what NAMI is and why we believe in being community rooted. Because we know that, that when we are in those communities and we're from those communities, we provide that level of peer led, peer understood support that is a lot different than what other people are experiencing. So we try to stand in the gap where sometimes the providers can't.

Yeah, yeah. No, I love that perspective of understanding a local culture and local environmental factors. I want to talk a minute to. You've managed a lot of grant funding and I'm curious, curious what you're seeing about the landscape of funding right now. I feel like so many things have shifted in that arena and I'd. I'd love to kind of get an update of where are we, what's possible?

Things are a lot possible, but if you ask me, it's very overwhelming, to be quite honest with you. So where there's possibilities, there are still challenges. Right. So I'm seeing some innovation. I just actually went for a period of recovery grant yesterday, but I am actively advocating for ourselves because there's still challenges in what they're doing. So there's access, but there's obstacles too. I'm trying to be optimistic, right? I always try to see the glass half full for everyone. Right. I think there are opportunities in every landscape. I think it's not what we are traditionally accustomed to seeing and I think that it is not what we probably all would like to see in the way that we know intuitively how mental health and behavioral health should be treated. But if we are imaginative and if we are innovative and if we are willing to move with the tide, then we can find opportunities to still serve our communities in the best way that we possibly can. Because I think if we stick our head in the sand and say, this is not working for us, this is wrong, this, this is not right, we can't do it, what they want us to do is wrong. I'm not saying do things that are unethical. I'm not saying align yourself with things that are not fundamentally what we want to see. I'm saying that if you see an opportunity, grant wise, that can provide an opportunity for you to reimagine how to better serve the community and you can write to it in a way that will allow you to serve and competitively bid for it and, and you get awarded and you can still get to the opportunity to serve your community, go for it. They're not making it easy, though. I will tell you that 110%. And I'm just telling you based off my own lived experience, they're not making it easy. But I think you can't be deterred. I think you have to know that it's worth the fight. It's just the environment is very challenging at this point. It is challenging in every landscape, in every world, whether it's in philanthropic, whether it's foundational, whether it's state and federal. Every facet of grant and fundraising is challenging right now. And it's funny because I was having this conversation yesterday, says everybody's talking about mental health but nobody's funding it. And that's the truth. Everybody's talking about it, but nobody's funding. And it's the buzzword, but it's not the investment. And I used to work in equity and I used to tell people, when I worked in equity, everybody wanted me to come to their conferences, everybody wanted me to come to their speech, everybody wanted me to be a part of their panels, but nobody gave me any money. And I always say, you know, when people care about something, when they invest in it. And I feel the exact same way about mental health as many times as People talk about mental health. And as much as. As much as I hear people speak about mental health, then no organization such as NAMI who provides free, unfiltered access to no. Every program we provide is free cost to the individuals we serve. We should never be at a deficit. We should be giving. People should be freely wanting to partner with us. And we are all struggling up and down. There's not one organization, there's not one affiliate that's not struggling. And the fact of the matter is that people say that they support it, but they don't support it in the way that we need it to be. And with the pending changes to Medicaid that are coming in July, very honestly and very truly, there is no better time to partner with an organization such as NAMI than right now. If you're listening to this podcast and you're saying, where can we go to better support communities that need help? It is to work with organizations such as nami. Because the landscape is very challenging right now, and every turn we're looking at it is making it harder. And the other thing I will say, to answer your question more too poignantly, there is a bill that is out right now. There is out for public comment that is going to make it very difficult if it's passed, that the Office of Budget and Management at the federal level has the opportunity to have discretion on grants that they can unilaterally cancel or not fund nonprofits and other grants and organizations such as ANAMI to receive services. And so I highlight that for your listeners, too. Wow. Because that is also another challenging landscape that we're facing. And so it is difficult. It is difficult. But what I stand on and why I still sit here is because it is not in times of feast that we do our greatest time. It is times our greatest adversity that we show our character, our resolve when we do our best work. We cannot, for the people that we serve, for the people who are counting on us, and for the people who will never sit in mics and sit on podcasts and sit in front of stages such as ours, have opportunities to sit before legislators, have opportunities to advocate and fight. Do we do that? We'll get a lot of no's. We'll get a few yeses, but we still get up every day and we fight because it's required of us to continue to do the things we must do. If we don't, then the people that we serve will never see it. And that's. And that's just the truth of the matter.

Wow. I love that perspective. Um, I'm wondering too, you. You mentioned the bill that was open for comment. I would love it if you can connect us with a link or something and we'll include that in the show notes too. I think what I'm hearing, and I love it from Stephanie is that despite the challenges here, we have to be innovative. We have to be collaborative. I see that more than ever. And there are lots of people who treat and are passionate about treating and supporting mental wellness. And that is no small thing. That is a huge thing. And we have to work together and we have to continue to be innovative. So, Stephanie, I'm inspired by you.

Thank you.

Thank you for what you're doing and thank you for continuing the work and, and for NAMI and all of their work as well. So I really appreciate you taking your time out to be here today for our listeners. If you want to get more involved in NAMI Maryland's work or NAMI nationwide, you can visit namimd.org for Maryland. As always, links to everything we discussed today will be in the show notes. I'm Rachel Harrison. This is the Mental Health Evolution Podcast and I will see you next time. Thanks for being here.