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May 21, 2019


The precarious state in which community mental health and substance use provider organizations find themselves is a most serious situation which should be of concern to all of us.

The Mental Health Association of Rhode Island is an advocacy, policy, and education organization that was established in 1916, in the proverbial dark days of mental health treatment. It was a time when institutional care was considered to be progressive, but we know that patients with mental illness were subjected to ill-conceived interventions and horrible living conditions.

We have made progress over the years, leading to more enlightened and effective methods of care. In Rhode Island, we saw the de-institutionalization of patients from the Institute of Mental Health to community-based programs. This movement was generated by the passage of both state and federal legislation.

In 1962, in  Rhode Island, it was Rep. John H. Chafee and Sen Eleanor Slater who sponsored the legislation that enabled local communities to operate mental health clinics in partnership with state government. At the federal level, it was through the vision and leadership of President John F. Kennedy that the Community Mental Health Centers Act was enacted into law.

For several years, the State of Rhode Island was the leading state in the nation for offering an array of salubrious, comprehensive, and effective services to persons living with mental illness. Correspondingly, there was wide acceptance and understanding of the importance of these community-based programs among elected and appointed officials and the general public.

However, over the last 20 years or more, that commitment to supporting mental health services and the concern that was so much in evidence among community and state leaders seem to have largely dissipated. We are now in a full-blown crisis as seen in the deleterious situation with how Medicaid clients with behavioral health problems are seeing access to their services being caught up in a bureaucratic nightmare.

In recent years, the State of Rhode Island made a policy decision to assign the management of its Medicaid program to managed care companies, assumedly for cost-savings and other efficiencies. A noble goal.

But, we have seen this new arrangement functioning in just about the worse way possible. Organizations such as Newport Mental Health, Community Care Alliance, CODAC, and numerous other, like agencies all over the state are being denied claims for services they have provide. They have been providing these services for many years. They know how to serve people and they know how to bill for such services.

Still, we have the sorry circumstance where these managed care companies are unduly holding up legitimate payments, putting these non-profit community organizations in serious, fiscal jeopardy. Moreover, they are making serious mistakes like sending confidential client information to the wrong locations.

Several of these community providers have had to take drastic action such as staff lay-offs, reduction in staff salaries, selling of property, reducing services, etc. All of these accrue to the distinct disadvantage of their clients.

What happened to our concern for the well-being of one another, especially for those who are living with an illness that they didn’t choose? Have we forgotten to honor a value system that says that it does matter how we treat others who are faced with problems, and, that, with understanding, support, and empowerment, they can control and even overcome them?

The slippage of the level of financial support that a viable community mental health system needs in Rhode Island is a disgrace. It is also a denial of the civil rights of individuals who are entitled to be treated like any other medical patients. We must display our profound concern and let our community and state leaders and our policy makers know that we need them to fix this god-awful mess. And, we need immediate and effective action because this crisis will only get worse, all to the detriment of people who need our support and understanding.


Please call your Legislator and/or the Governor’s office.


Clement Cicilline, M.S.
Board of Directors
Mental Health Association of Rhode Island