R.I. looks to fix mental health system
Is Rhode Island’s public mental health system working? The answer was a resounding no from the crowd that filled Rhode Island College’s Sapinsley Hall for a forum on the subject one rainy night last November.
But how to fix this broken system had no clear consensus, according to those polled at the November Publick Occurrences event, “Rhode Island’s Mental Health System: Condition Critical?” sponsored by the Providence Journal and Leadership Rhode Island.
Nearly 100 audience members used remote controls to vote on multiple-choice questions. Eighty-six percent said the public mental health system was broken, the Providence Journal reported in an interactive feature on its Web site.
“We have a treatment system that is set up as a gatekeeper system, keeping people out of treatment until they are seriously ill, the standard being a danger to self or others,” says James McNulty, executive director of Mental Health Consumer Advocates of Rhode Island and a forum participant. “All too often the public mental health system is focused on stabilization and maintenance, not on recovery.”
But a new year and a new governor taking office finds policymakers and advocates pushing for a recovery-focused system. Instead of providers treating people in ways that foster dependency, the goal is developing a collaborative model of care that supports people in their own efforts to manage and overcome addictions and mental illness, says Craig Stenning, director of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).
That’s the guiding framework in a concept paper Stenning says his department has developed for use in several grant proposals and in conversations with other state departments. As of press time, however, there was no word on whether Gov.-elect Gina Raimondo would re-appoint Stenning, who has led BHDDH since 2008.
Funding cuts, greater demand and rising costs have intensified the challenges facing BHDDH. In an email, Stenning mentions the state recently commissioned a study of the needs, capacities and gaps related to mental health in Rhode Island which is expected to provide guidance and recommendations.
“We believe that there are opportunities for our community mental health systems to collaborate in a more effective business model that does not detract from their ability to be very present in the communities that they serve,” Stenning adds.
State Sen. Josh Miller (D – District 28, Cranston, Warwick), chair of the Senate Committee on Health & Human Services, agrees that the mental health system is broken, “but I think we can make a lot of progress.”
For 2015, Miller expects the legislature to tackle securing reimbursement for case management services, starting with an effort to refine the definition of case management. “I personally have asked for people to look at it,” he says.
That will continue the push for recovery-focused care, building on legislative efforts in 2014, including a new parity law signed last June by Gov. Lincoln Chafee. The law ensures insurance coverage for drugs that treat opioid addictions and also requires hospitals to develop continuing care plans for patients with opioid and other substance use disorders.
Miller says the state Department of Health is also attempting to revise utilization review regulations to reduce the maximum time allowed to complete an assessment for the need for emergency commitment from 72 to 24 hours.
Restoring state funding was named by 46 percent of the Publick Occurrences audience as the best approach to fix the system while 19 percent favored exploring unspecified other models of care, 18 percent favored creating partnerships and 17 percent advocated using a holistic approach.
“The easy answer is to say that the Rhode Island General Assembly does not adequately fund mental health and substance use services,” McNulty says. “That is true, but I believe it is true because the General Assembly does not see any return on the money that is spent.”
McNulty calls a single, unified public mental health system “the best way to ensure that people do not fall through the cracks” and says it would also allow for earlier identification of children and youths who need help and interventions that would prevent encounters with the juvenile justice system.
“There is a balance to be struck here, but if we think meeting the real needs of individuals is expensive, not meeting those needs is probably more expensive still,” McNulty says.
The Publick Occurrences poll is not a statistically significant indicator of general public opinion but does reveal telling demographic information on attitudes. Men, people over age 50, and those without a four-year college degree were more likely to say the system was working. Only 11.8 percent of those who identified as a health care provider said the system was working while zero percent of those who identified as mental health advocates said it was working.