Signs of hope in mental-health care

MINDFUL APPROACH: R.I. has experienced mental-health budget cuts, but Craig Stenning, director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, says the state has mitigated some of the negative effects. / PBN PHOTO/RUPERT WHITELEY
MINDFUL APPROACH: R.I. has experienced mental-health budget cuts, but Craig Stenning, director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, says the state has mitigated some of the negative effects. / PBN PHOTO/RUPERT WHITELEY

Chaz Gross has a theory on improving mental-health services that involves more than just spending additional money.
The executive director of the National Alliance on Mental Illness Rhode Island and former long-time social worker says funding cuts hurt services but that a broken mental-health system needs more than dollars to be fixed.
“You can’t throw good money after bad. I think that [Rhode Island] changed the way we provide services in a lot of ways,” Gross said. “At one point we had the best mental-health system in the country. We slid to the middle of the pack. There were lots of stuff that sort of slipped by.”
Gross is referring to the state’s middle-of-the-pack “C” grade given in a 2009 report card by the National Alliance on Mental Illness. It’s the last such report issued by the national organization and recently resurfaced in media reports looking at what states have done since to better their scores.
Rhode Island, which also received a “C” grade in the previous 2006 report, was criticized in 2009 for inadequate public mental-health services, long waits psychiatric patients faced for hospital admissions and a depleting patient bed capacity that led to an overreliance on hospital psychiatric units.
Those problems and more, the report said, disintegrated what once was one of the country’s best systems and a leader in community health services.
Three years later, without another national report card projected due in part, the national group said, to state budget cuts, Rhode Island mental-health leaders claim much progress has been made. That’s largely due to the state’s decision to focus on a recovery-oriented care system, they say, but those leaders also agree much work remains to bring Rhode Island’s services back to what they were a decade ago.
“I think we are in a bit of a mixed-bag situation,” said Susan Jacobsen, executive director of the Mental Health Association of Rhode Island. “It’s a combination of very strained budgets and an effort to change the way we do health care as a whole. I think that puts Rhode Island along with other states in the nation that have seen devolution of our system in some ways.”
Rhode Island had suffered mental-health budget cuts since 2008 but, said Craig Stenning, director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, the state isn’t suffering as much as some others. That’s in part due to the state’s Health Home initiative, which integrates physical and mental-health services. Another factor was the state requiring care providers to collaborate with community organizations, which allowed for a change in federal reimbursement, he said. Rhode Island in November 2011 received a $58 million grant, payable over two years, from the Centers for Medicaid and Medicare Services for the initiative.
And despite past budget cuts, state funding for services is looking up, too. Rhode Island, according to the National Alliance on Mental Illness, saw a 7.4 percent increase in state mental-health expenditures from fiscal 2009 to fiscal 2011.
The behavioral-health department’s fiscal 2013 budget of $445.7 million is a 3.3 percent increase in state general-revenue funding over the previous year. The budget includes $234.1 million in federal funds, which is $5.8 million more in federal funding than the department received in fiscal 2012.
“Rhode Island has not had the type of significant budget cuts in behavioral health that have been seen in some other states,” Stenning said.
The largest increase in the department’s fiscal 2013 general-revenue-appropriated funds is for additional funding for state-operated-facility personnel, meant to decrease overtime expenditures and allow the facilities to regain appropriate staffing levels.
Stenning said workforce is a national issue in the mental-health field and that Rhode Island is left to compete with every other state for professionals at the physician and nursing levels, especially within the child psychiatric sector.
Some blame, he said, can be placed on the concern about insurance and Medicaid reimbursement within the private system.
A recent change in mental-health billing codes that included a decrease in time allotment for treatment sessions, for example, resulted in hundreds of denied claims from mental-health providers in Rhode Island.
“Workforce development is certainly an area of concern for us. It’s not that it’s being ignored. It continues to be a challenge,” Stenning said.
The department has been holding, in collaboration with the R.I. Department of Labor and Training, job fairs for health care position openings. A recent fair advertised more than 50 job openings for registered nurses, certified nursing assistants and community aides through the Eleanor Slater Hospital Division in Cranston and Burrillville and the Rhode Island Community Living and Supports state group-home system. Workforce has benefited from the state’s peer-wellness coaching-certification program that last year trained 28 people as recovery coaches who now work on small home- health teams at community mental-health centers or as employment specialists.
That’s part of the focus on recovery, one outcome of the Governor’s Council on Behavioral Healthcare subcommittee on recovery-oriented systems on which Jacobsen sits. Such systems are seen as progressive in recognizing patients as “the central change agent in their own care,” she said.
Stenning said the coaching program not only helps solve the system’s workforce issues but keeps those patients from recycling through the system.
Other areas of improvement over the past three years have included increasing patient capacity at Butler Hospital and Hasbro Children’s Hospital by 26 and eight beds respectively; creating a diversion and crisis-intervention care level to divert patients away from hospitalization that now has 28 beds within three community agencies, and training at mental-health centers in recovery principals.
While the state’s adult-care reform will continue to focus on recovery programs, Jacobsen and Cross said child psychiatric care needs more attention following a decade of “decimating” cuts, though this year’s budget remains about level from last year. Since 2008, according to the National Alliance on Mental Illness, Rhode Island has seen a 65 percent increase in the number of children living with mental illness boarding in public hospital emergency rooms.
Cross also said he would like to expand the crisis-intervention program to have beds in every mental-health center to help combat the current lack of beds for children.
He also would like to see increased collaboration between the state’s mental-health system and community agencies like his.
“It is frustrating as an advocate … to try to change the system,” Cross said. “We don’t [treat] holistically. We have symptoms and medicines. Let’s trust the community partners. •

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