The Pulse: Can Legislators Fix What's Broken With Our Mental Health Care System?

Feb 23, 2017

Credit Kristin Gourlay / RIPR

What’s broken about Rhode Island’s mental health system and what would it take to fix the problems? 

The Senate Health and Human Services Committee took up those questions in a series of hearings over the past few months. The result: a report and a package of legislation to address the issues. For this week’s The Pulse, we check in with mental health care experts to find out if the bills go far enough.

Legislators heard  testimony from mental health care workers and advocates. And the report they produced neatly summarized a host of concerns about the state’s mental health system. Then lawmakers came up with 14 bills to address those problems. The bills fall into three basic categories: intervening early enough in a child’s life to prevent major mental illness…improving access to mental health treatment for all Rhode Islanders…and improving the state’s overall system of mental health care. But reaction from those who testified is mixed.

The Providence Center’s Dr. Michael Silver testified about the shortage of psychiatrists in Rhode Island. He says it’s hard to attract these professionals because the pay is so much better in other New England states.

“Money is always an issue. I work in a community mental health center and funding has been decreased over the past couple of years, so services are harder and harder to deliver. And I’m not sure that’s going to change. Nothing the committee has done has really addressed that piece of it.”

Lori Ziegler Halt represents another community service provider called the Community Care Alliance. She says the already low salaries for entry level mental health care workers took a hit when the state changed the way it pays for their services last year.

“And unfortunately that had a huge impact on us over the summer when we actually had to do a 10 percent cut in everybody’s wages in our agency. And you’re talking about taking 10 percent from people who are already not making much money.

Some of them just 13 dollars an hour. Halt says she’s delighted the committee took the time to listen to testimony about the problems in mental health care. But she’s….

“Disappointed that there’s no plan in place or legislation to improve our salaries for mental health. We saw things for developmentally disabled and home care workers and by all means they absolutely need help in pay and funding but I guess we were hoping for a more holistic approach for all of us.”

Better pay might help retain good staff, says Halt. Rhode Island Family Service’s Margaret Holland McDuff says better prevention efforts might lessen their workload.

She testified about the need to intervene early to help children at risk for mental health problems. She wants legislation that empowers school staff to spot kids with something psychologists call “adverse childhood experiences.” Those include traumatic events, neglect, a parent with a substance abuse problem. And research shows children with these experiences are much more likely to have trouble later in life. McDuff says she thinks legislators heard her request for help.

The prevention recommendation to minimize mental health factors through prevention and early intervention I was very excited about. And they did capture around the screenings we’re recommending in schools for adverse early childhood experiences. So we were really excited and applaud the senate for including that.

Still, there’s just one bill that calls for raising awareness about adverse childhood experiences. Not funding for screening for them in schools.

The recommendation to raise awareness is included in a bill that directs the state’s health and human services agency to submit a comprehensive report about the state’s mental health needs. One piece of that report has to include plans to expand capacity at Eleanor Slater Hospital for people who can avoid jail by getting mental health treatment. Ruth Feder of the Mental Health Association of Rhode Island testified about the importance of these kinds of diversion programs.

“Some of the people don’t belong at all in a punitive setting. The trauma of going through arrest and going through winding up in the ACI for people with mental illness is doubly worse. So a diversion program that truly diverts people before they’re even arrested that is truly the way to go. Give people treatment, not incarceration.”

But again, the bill only directs the state health and human services agency to produce a report about the possibility of creating a better diversion program. And, Feder says, the bills have only just been introduced.

“Now, the legislation, the 14 bills they proposed have to pass. And I think there will be some controversy around them especially when it involves finances.”

Michael Silver of The Providence Center says many of the issues he and his colleagues raised are complex and will take more than legislative action to tackle.

“I’m not so sure legislation can solve many of these issues but I’m glad to see they’re trying to do whatever they can.”

Many who testified say they were glad to have the opportunity to share their frustrations with the Senate committee. But many were disappointed their solutions didn’t come with the money to effect real change.