New commissioner outlines priorities
Gov. Deval Patrick recently announced that Marcia Fowler, M.A., J.D., had been chosen to take on the role of commissioner for the Massachusetts Department of Mental Health (DMH), replacing the departing Barbara Leadholm.
Fowler had been serving as the DMH’s deputy commissioner and has had a cumulative 16 years with the agency. In congratulating her on the appointment, JudyAnn Bigby, M.D., the state’s secretary of health and human services, noted that Fowler was instrumental in implementing a new service code for contractors designed to create a better system of care for community services.
A lawyer as well as a clinician, Fowler brings a unique mix of talents to her new role. She has worked directly with clients as well as in supervisory positions for adults with developmental disabilities and mental illness from the start of her career with the Department of Mental Retardation and the Fernald State School, to her work with the New England Home for Little Wanderers, Morgan Memorial Goodwill Industries, the Foundation for Children with AIDS, and Polaris Healthcare Services.
Fowler spoke with New England Psychologist’s Catherine Robertson Souter about her position, her goals for the future of the department and what she sees as its strengths and weaknesses.
Q: You have worked with the DMH for 16 years – in what roles?
A: My cumulative years with the department are 16 but they were not all consecutive. I started with the department many years ago in a direct care position working in the facility and then as director of investigations and the Northeast area director. I left for a period of time and came back in 2008 as assistant commissioner and then I became the deputy commissioner.
Q: Secretary Bigby mentioned your work with Community Based Flexible Support (CBFS) services. Can you tell us about that?
A: I was the project leader for the re-procurement of our adult community based mental health system. We procured approximately $220 million of services and we redesigned services that had been purchased separately and discretely to provide a seamless continuum of care.
We also incorporated key values into CBFS including the use of an enhanced consumer workforce using the principles of person-centered planning in treatment planning and we integrated an employment model called the Individual Placement and Support model which has been shown to have the best employment outcomes for persons with severe and persistent mental illness.
Q: You helped to “procure” $220 million? The money was already there but being used to purchase these things independently?
A: Yes. For example, one of our primary service models is our residential treatment program. Previously, we discretely purchased group homes and supportive housing, which provides people with intense support in their own living situations and community rehabilitative supports, where someone might get a daily or monthly or weekly check-in. We also discretely purchased respite services. Looking at the cyclical nature of mental illness, where people make great strides and improvements and sometimes have relapses, we were finding that when people went through cycles of mental illness it was difficult to get the appropriate level of service they needed as quickly as they needed it.
Our contracting system was administratively burdensome for both the department and for the providers so people ended up being hospitalized because providers did not have the ability to more nimbly adjust the level of service.
The department serves over 21,000 people and well over 90 percent of that are served in the community. We serve approximately 12,000 people through this service model.
Q: Mental health care in Massachusetts has taken major steps towards more community-based care.
A: That is in alignment with the Patrick Administration’s Community First Initiative which looks at people with mental illness, people with developmental disabilities, people in nursing homes and really looks at the fact that everyone has a right to be in the community with the appropriate level of support and shouldn’t be institutionalized unnecessarily.
Q: What are the department’s future goals?
A: This summer, we are opening a new state-of-the-art psychiatric facility in Worcester and we are very excited about that and the possibilities that will bring for us. We are continuing to provide a continuum of services and we are happy to be able to provide a good number of those services in this new facility that is designed specifically to treat people with mental illness. We think that it is really supporting the dignity and respect people with mental illness deserve. When they go for treatment, just like anyone would want to go to a state-of-the-art cardiac unit, we are happy we will have a state-of-the-art psychiatric facility.
We have started a statewide training initiative looking at developing and standardizing best practices in all of our inpatient services.
Q: And in the community?
A: As always we continue to expand our community-based system. Any one day we have more people who are waiting for discharge for community placements than we have a need for continuing care beds. We have invested $60.6 million into the community system since 2004 and we will be continuing our community expansion into the summer with the development of 80 new placements.
In addition, we are committed to expanding the participation of our consumers in the development, implementation and delivery of mental health services as well as in the evaluation of those services.
Q: What do you see as the strengths and weaknesses of the DMH?
A: We have an incredible and talented workforce with a lot of experience working with persons with mental illness. We have persons with mental illness working with us to improve our services. We are committed to working with communities and stakeholders to understand the issues.
There are always challenges any state agencies face when you are working with individuals with disabilities. One of the biggest challenges we face is the stigma related to mental illness. Our consumers have difficulty getting access to housing, employment, primary care. Another major challenge for our consumers is poverty – because their work lives have been so interrupted. Our overall commitment is our belief in recovery. We strongly believe that people do recover from mental illness and that everybody has the capacity to recover from mental illness.
Q: And weaknesses?
A: It is our goal to increase consumer participation in all aspects of our service. We want to increase the participation of people with experience in the development delivery evaluation of services.
Budget constraints must be difficult. People want to cut taxes but don’t like when services are cut.
The economy rises and falls and state revenues rise and fall and various administrations have a responsibility to come out with a balanced budget and state agencies have a responsibility to live within their appropriations. We have a core number of services we always maintain – anything that provides any type of housing support, etc. and we prioritize our services.
From a budgetary perspective, we take every opportunity to expand community-based services. For every bed we take offline, we fund 1.7 community placements. Not only are they better for treatment and respect people’s human rights to live in the least restrictive setting but they are also cost effective in terms of the expense of the service and because they enhance recovery and get people back into the workforce.