A Different Stance on Mental Health Policy
‘Merger, monopoly and managed care’ may, conceivably, be a viable public policy stance for parts of the larger healthcare system. I believe such an approach would be backwards and unnecessary for RI’s community based mental health services. Restricting choice is neither new, nor innovative, nor will it achieve the ‘excellence’ consumers, advocates and providers seek. Mental health policy in the public sector does best when it focuses on those most at risk and least able to pay.
Mental health services are different than many other types of healthcare. Community mental health needs are inextricably effected by: the unemployment rates among handicapped , veterans ,fathers and minorities; the rates of protective services for children and the substance abuse problems of their parents; the “coming home” of ex-offenders, homeless, veterans; the proliferation of prescribed and street drugs that are highly addictive; the availability of safe, secure and affordable housing; the amount of trauma caused by domestic violence, community violence and military service; and even by the effectiveness of job training and employment options. Demand for services has increased so much in recent years that in some “catchment areas” state cuts have made it “hard to keep up with demand.”
RI for the last 10 years has reduced its financial support to the Division of Behavioral Health and the nonprofit, community based, mental health organizations (CMHOs). And in the past year the Executive Office of Health and Human Services has eliminated all state and federal funding for 24/7 mental health emergency services and all state and federal funding for services to the large number of underinsured and temporarily uninsured.
Providence Center’s assertion that CMHCs segregate their clients from the rest of healthcare is self-serving. You wouldn’t say this about an orthopedic practice, just because it wasn’t owned by Care New England or Lifespan. CMHCs work hard to coordinate with primary care physicians and, quite frankly CMHOs are the most informed about the clients’ financial, personal, family and community resources that can contribute to their overall health. CMHOs have collaborated for years with the RI DBH to reengineer services and incorporate best practices; they are ready to do so again.
Furthermore, the strengths of CMHOs has been their ability to provide evidence-based services that enhance medical services; supported employment; supported housing; peer support; unscheduled home-based services like assertive community treatment and crisis stabilization. More recently CMHOs in RI have been providing “health home” teams for thousands of Medicaid clients with mental illness, enhancing coordination with health centers.
The second major development that altered the mental health landscape was the empowerment of an Executive Office of Health and Human Services, inserted between the Governor and her appointed Department Directors. EOHHS promised the General Assembly it would integrate back office contracting and reimbursement mechanisms, reduce redundant state costs, and prioritize efficient delivery of services for our most at risk neighbors. Advocates at the time predicted EOHHS would constrain innovation by state department directors and would, by prioritizing short term budget cutting, actually increase State and Medicaid costs by not honoring the historical participatory process of designing services that reduce costs.
Perhaps the proponents of dismantling the system want the public to see only the current limitations; the mental health services in Providence are not representative of the rest of the state. Providence Center’s ‘de-marketing’ of all the other CMHOs, claiming CMHOs are only concerned with “the neck up,” is a backhanded way of promoting the medical model of Care New England. In fact, it is CMHOs that are the more “holistic,” recognizing that recovery involves the physical, spiritual, economic and social aspects of a persons’ life.
RI was ranked among the best community based mental health systems in the country and not through excess costs to the taxpayer. The state mental health plans leveraged all kinds of other community resources. R.I. was ranked highly because public and non- profit providers honored clients’ rights and jointly committed to housing, jobs, peer support, substance use treatment and care coordination. Today community mental health organizations are ready and able to continue to provide home and community based services that reduce use of hospital care and its associated costs.