Laurie Marie Pisciotta
You are the Executive Director of the Mental Health Association of Rhode Island. For those who may not be familiar with the MHARI, please give an overview of the organization and its services and objectives.
Founded in 1916, MHARI’s mission is to promote and nourish mental health through advocacy, education, and policy development. Our vision is that all people living with mental illness will be treated with dignity and receive all the support, treatment, and services needed to live their best lives. MHARI is the mental health community’s watchdog. We listen to, speak for, and advance the interests, needs, and rights of people with mental health conditions. We advocate in five general areas: (1) holding insurers accountable to state and federal mental health parity laws, particularly around reimbursement rates (2) preventing the incarceration of people with serious persistent mental illness (3) establishing an Olmstead Plan (4) increasing diversity, equity and inclusion in the behavioral healthcare system and (5) workforce development.
One of MHARI’s recent major efforts was a report, “The State of Behavioral Healthcare in R.I.,” completed in partnership with Brown University’s Initiative for Policy. What is the state of behavioral healthcare in the state?
That report was published in late 2020, about six months into the pandemic. We are now facing a systemic crisis. Demand for services has increased, while our supply of providers has decreased.
Anecdotally, we know there are waitlists for every level of care. Unfortunately, we can’t cite hard data because the data does not exist. Currently, the state does not systematically collect, analyze and publicize waitlist data for all levels of care. There is no law requiring providers to submit weekly or monthly waitlist tallies to the state, which is surprising considering the public health crisis we are facing.
Decades ago, Rhode Island had a system of care that was a national model. What happened to bring us to where we are now?
In the 1960s, Rhode Island passed a law that established community mental health clinics. Communities that developed community mental health clinics and raised money at the local level received matching funds (dollar for dollar) from the state. Rhode Islanders who were discharged from the Institute of Mental Health were referred to these clinics. In the 1970s, the Department of Mental Health, Retardation and Hospitals (now called Dept. of Behavioral Health, Developmental Disabilities and Hospitals) engaged in a “Transfer Contract” program. It required some of the funding used to hospitalize a person to follow them into the community upon discharge, where they would receive services and possibly supportive housing. Deinstitutionalization increased the demand for community services and group homes.
The state no longer has a “Transfer Contract” program in place. Its investment in supportive housing and community services has declined over the past several decades, and it has overly relied on Medicaid reimbursement rates to cover costs. Last year, our leaders made a good start toward rebuilding the system. In its 2023 Fiscal Year Budget, the state invested nearly $50 million from its own coffers and over $80 million from federal sources (mostly ARPA funding) on behavioral healthcare. We need our leaders to prioritize behavioral healthcare again. We need the state to continually invest in the system, just as we continually invest in schools. We need the state to hold Medicaid and commercial health insurers accountable to federal and state parity laws. For years, Rhode Island has let insurers pay unfairly low reimbursement rates to behavioral health providers. Many providers lose money when they accept insurance because reimbursement rates don’t cover the full and true costs of providing a service. Poor rates discourage providers from participating in insurance networks. Some move their practices to nearby states where the rates are higher. Ultimately, it’s the patients who suffer on waitlists because there are too few providers available. As we wait, our conditions worsen.
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