Eleanor Slater Hospital
As many of you know, MHARI has been advocating to save Eleanor Slater Hospital’s (ESH) civil commitment facilities, an important part of the State’s continuum of care for people with disabilities. We have testified in the House Oversight Committee and the Senate Committee on Rules, Government Ethics and Oversight. And we continue to organize a group of community advocates around this issue.
Last week, MHARI and other concerned stakeholders met with staffers from Governor McKee’s office. Our advocacy efforts are paying off, as Governor McKee just publicly vowed to “pause” the implementation of the Department of Behavioral Health, Developmental Disabilities and Hospital’s (BHDDH) plan to close the civil commitment facilities to save money. Governor McKee has also acknowledged the need for more community and stakeholder input, and we are grateful. We have also urged Governor McKee to:
- Issue a bid to conduct a statewide needs assessment of our continuum of care
- Create a new Community Liaison position at BHDDH.
- Appoint a new person to Chair the Governor’s Council on Behavioral Health. This person should come from the community, not the state.
- Create a mechanism for community input when appointing the new director of BHDDH.
- Partner with us to establish an Olmstead Plan in Rhode Island.
Just as mental health and serious persistent mental illness fall on the opposite ends of a spectrum, the phrase “continuum of care” describes the full range of settings and services from the outpatient level to the inpatient level and everything in between. People with disabilities often “step up” and “step down” to settings and services across the spectrum as their condition improves or worsens over a lifespan. ESH is considered a “placement of last resort” for patients with complicated co-occurring behavioral health and medical disabilities. It falls on the farthest end of the “continuum of care” and is the most restrictive. The fact that it is so restrictive does not make it an illegitimate option for the patients who need the most intensive level of care.
Rhode Island currently lacks a suitable alternative to ESH, and patients in ESH have nowhere else to go. Many of them have already tried and failed at lower levels of care like nursing homes and assisted living facilities. Even a nursing home with behavioral health “enhancements” would not meet the needs of many of these vulnerable patients. Deinstitutionalization works only when there is an appropriate alternative. Discharging patients in ESH’s civil commitment facilities puts them at risk of homelessness and incarceration. In essence, they trade the institution of a hospital setting for a prison setting.
It must also be noted that in the Olmstead v. L.C. ruling, the United States Supreme Court held that individuals have the right to receive treatment in the least restrictive placement available when:
- Such services are appropriate
- The affected persons do not oppose community-based treatment and
- Community based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs or others who are receiving disability services from the public entity.
Therefore, patients and their guardians who feel that community-based treatment is not appropriate for their loved one should be allowed to remain in ESH.
We appreciate the State’s desire to cut costs, but rather than gutting our already inadequate “continuum of care,” we respectfully encourage the State to establish a "living" Olmstead Plan to (1) assess current and future supply and demand (2) coordinate and (3) fund the full continuum of care for Rhode Islanders with disabilities. We have to spend money to save money. Without permanent supportive housing and services, people with disabilities cycle in and out of emergency departments, hospitals, shelters and prison. Doing nothing is not free.
With creativity and the will to succeed, we can fund the full “continuum of care” in Rhode Island. For example, we can follow suit with Massachusetts and strategically utilize the Affordable Care Act’s “community benefit” provision by requiring nonprofit hospitals to fund supportive housing for people with disabilities. We can use federal relief dollars to support ESH’s renovations and other gaps in our continuum of care. Lastly, if the proposed merger between Lifespan and Care New England is approved, we can explore the possibility of requiring funding for Rhode Island’s continuum of care as a precondition of the merger.
MHARI will continue to organize community advocates around this issue, and we will keep pushing for more transparency, community involvement in the selection of the next director of BHDDH, and a commitment to funding the full continuum of care in Rhode Island.
Lifespan/Care New England Merger
As a member of the Protect Our Healthcare Coalition, MHARI is working to ensure that the proposed merger between Lifespan and Care New England does not increase consumer costs; decrease access to treatment; impair quality; or reduce equity in our healthcare system. In our first meeting with staff from the Attorney General’s office, we requested a commitment to guarantee ample community input before the Attorney General reaches a decision on the proposed merger. If the merger is approved, then we will work to incorporate quality control measures and guarantees that patients’ access to care won’t be harmed by the monopoly.
The Mental Health Association of Rhode Island (MHARI) continues to fight for mental health consumers and providers at the State House. Here is an update on this year’s most important legislation to the mental health community.
Fair Housing Practices - House Bill 5257 and Senate Bill 561 were passed by the General Assembly and signed it into law by Governor McKee! This is a huge VICTORY! These bills prohibit landlords from discriminating against lawful sources of income like housing vouchers, alimony and child support. People with disabilities, including serious persistent mental illness, often receive SSI/SSDI benefits and housing vouchers. Prohibiting such discrimination will make it easier for people with disabilities to find affordable housing.
Behavioral Health Provider Reimbursement Rates (House Bill 5546 and Senate Bill 591)
These bills mandate incremental increases in the reimbursement rates paid to behavioral health providers over a period of five years. Rhode Island has a shortage of outpatient providers, especially psychiatrists, because of low reimbursement rates from public and private insurers. This bill would incentivize providers to participate in insurance networks, so that patients won’t have to go on long wait lists to see a provider when they need one. Both bills were heard in committee.
Mental Health Treatment Court - Senate Bill 678 and House Bill 6025 create within the district court a dedicated calendar offering treatment and sentencing alternatives to eligible defendants deemed to suffer from serious and persistent mental illness. This will help hundreds of Rhode Islanders with serious and persistent illness avoid incarceration. MHARI will testify in favor of these bills when they are heard in the Senate Judiciary Committee and House Finance Committee.
Budget Article 16 - Housing - MHARI submitted testimony to the House Finance Committee in support of funding affordable housing in Rhode Island. Housing is recovery. Housing is food security, education, and employment. In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) considers the four pillars of recovery to be: health, home, purpose and community. Safe, stable housing is the foundation of all the good things in our lives.
Telemedicine (Senate Bill 004 Sub A and House Bill 6032) - Makes expanded access to telemedicine permanent in Rhode Island, ensuring that reimbursements to behavioral health providers are paid equitably across in-person, video conferencing, and telephone appointments. The bill passed the Senate Floor and was heard in the House Finance Committee. MHARI submitted testimony supporting the bill.