Delivery of Care

Changing the laws to improve mental health care

A new package of 14 proposed bills by Senate leaders offers a comprehensive, coordinated approach to help fix a broken system of care

By Richard Asinof
Posted 2/20/17
Here are the details of the legislative package prepared by Senate leaders seek to make investments in improving prevention, treatment, early intervention and access to care for Rhode Islanders who have mental health and behavioral health problems. Coupled with the criminal justice reform legislation, the two proposed packages of legislation represent a thoughtful, coordinated approach to addressing the current broken system of mental health care in Rhode Island.
Who among the business community in Rhode Island will step up to become champions of this package of proposed legislation? Will Joseph Paolino speak out in support of the legislation? Will commercial health insurers voice their support for the legislation? Will the newly engaged community of activists alarmed by the agenda of the Trump administration lend their support? How will the current House leadership respond to the legislative proposals? How will this approach be integrated into the overall strategy for overdose prevention and recovery in Rhode Island? Will other cities and towns follow the lead of Central Falls and increase the legal age of smoking to 21 years of age?
In Rhode Island, 321 residents died of drug overdoses in 2016, at least a 16 percent increase over 2015. In 2015, some 125 Rhode Islanders committed suicide. About 20 percent of the prisoners being held at the ACI have serious and persistent mental illness, turning the prison system into our largest mental hospital, according to Judge Judith Savage.
The recent study by Shannon Monnat found that Rhode Island had the highest percentage of young white adults, male and female, who between 2010 and 2014, had died from drugs, alcohol or suicide, at 59.8 percent. Monnat suggested that the high numbers could be correlated with economic distress. What may be needed in Rhode Island is public health research that replicates Monnat’s study here in Rhode Island, accompanied with public health research that connects the data with economic despair.

PROVIDENCE – On any other day, it would have big news: on Feb. 15, Senate leaders in Rhode Island introduced a package of 14 bills aimed at improving prevention and treatment of  mental illness in Rhode Island

That news, however, was overshadowed by big news conference held by Gov. Gina Raimondo earlier that morning to discuss her new approach to the botched rollout of the $364 million Unified Health Infrastructure Project, a day after the Governor accepted the resignation of Elizabeth Roberts, the secretary of the R.I. Executive Office of Health and Human Services.

The news conference about the package of mental health legislation featured brief remarks by Senate President M. Teresa Paiva Weed and by Sen. Joshua Miller, chair of the Senate Health and Human Services Committee, which had held months of extensive hearings on the subject.

The news event, held in the Senate Lounge, closed with remarks by A. Kathryn Power, regional administrator of the U.S. Substance Abuse and Mental Health Services Administration, which put the package of proposed legislation in a national perspective.

A coordinated, comprehensive approach
The package of legislation offered by Senate leaders is a comprehensive, coordinated approach to improving mental health prevention, early intervention, and access to treatment The message from the Senate President was clear and concise: “Prevention works. Treatment works.”

The package of 14 proposed bills seeks to put forward proven, effective remedies, as an investment in the health of Rhode Islanders.

Here is a brief synopsis of the proposed legislation, according to the news release from the event:

Prevention and Early Intervention
Children in Rhode Island face greater economic, social, and familial risks for developing mental health and substance use disorders than children in other New England states and the nation. Bills to address prevention include:

1. Substance Abuse & Suicide Prevention Education
This act would require the Department of Elementary and Secondary Education, in consultation with the Department of Behavioral Health, Developmental Disabilities, and Hospitals, to consider incorporating evidenced-based substance abuse and suicide prevention education into their health education curriculum.

2. Mental Health Services on College Campuses
This bill requires CCRI, RIC and URI to develop and implement policies to meet the mental health needs of students in a timely fashion, including identifying and addressing the needs of a student exhibiting suicidal tendencies or behaviors.

3. Marijuana fines to fund youth prevention
This bill would direct 50 percent of the current fines collected as civil penalties for marijuana offenses to BHDDH for youth substance abuse prevention and treatment programs. Current law requires a portion of these funds go to youth programming, but that investment is not being met.

4. Fund Preventative After-school Programs for Youth
This act would provide the Department of Health’s Health Equity Zones with $300,000 in funding for evidence-based after-school educational and recreational programs to decrease mental health problems in children and teens.

5. Home Visiting Program Expansion
This act requests that the Department of Health develop a plan to expand the reach of the existing evidence-based family home visiting programs in Rhode Island. The goal is to gradually expand upon this service to eventually offer voluntary access to all eligible at-risk families in the state, beginning with increased funding for pregnant and parenting teens in FY 2018.

Access to Treatment for Mental Health Care
Individuals in Rhode Island are more likely to report unmet need for behavioral health care services than adults in any other New England State. One in five Rhode Island Medicaid beneficiaries hospitalized for a mental illness had no follow-up mental health treatment 30 days after discharge. Rhode Island has fewer behavioral health and substance abuse counselors per capita than other New England states. The ACI houses approximately 500 inmates with severe mental illness. Bills to address access to treatment include:

6. Residential Treatment Insurance Coverage
This legislation seeks to ensure equal treatment for behavioral health inpatient and residential treatment as exists for persons with physical illness. Patients could be admitted in an emergency situation, and presumed eligible for continued inpatient or residential stays based on an appropriate assessment and treatment plan. Currently, behavioral health services may be subject to an authorization process that may interrupt needed care.

7. Expanding the Use of Advanced Practice Nurses
As one means to address the shortage of psychiatrists, this act would allow licensed advanced practice registered nurses who are certified in psychiatric/mental health, to recommend mental health treatment in emergencies and for the purposes of civil court certifications.

8. Health Insurance Provider Approval to Treat Patients
This bill would improve the insurer approval process so that physicians can become eligible for insurance reimbursement and treat patients without the current lengthy delays. The bill standardizes “credentialing” application requirements and imposes a 45-day limit on the issuance of a decision.

9. Medicaid Waiver to Fund Overall Access and to aid Homeless Individuals
This act would direct and authorize EOHHS to apply for any necessary federal waivers to improve overall access to MH/BH services. In addition, waivers could ensure that individuals who are homeless have access to supportive housing services and mobile MH/BH services.

10. Patient Planning to Ensure Adequate Care Post-Emergency Room Discharge
This bill will require the EOHHS to prepare standards for emergency room discharge planning to ensure that persons with a primary mental health diagnosis are referred to appropriate services to receive the community care needed. This will decrease re-admissions and further deterioration of health.

Health Care System Improvement
Numerous barriers to care exist, including many patients’ and families’ feeling of shame and stigma, a shortage of mental health service professionals and community services, a lack of integrated physical and behavioral care, and the need to continuously train first-responders and educators to identify mental health crises. Bills to improve the mental health care system include:

11. Leadership Role of the Executive Office of Health and Human Services
This resolution requests that EOHHS submit a report to address identified mental health service needs, including plans to: improve screening and treatment of depression; raise awareness of early childhood adversity; raise the entry level wages of behavioral health direct care workers; increase capacity of Crisis Stabilization Units; clarify regulations to facilitate provider referrals; streamline license reciprocity with other states to address the shortage of MH professionals; support housing initiatives and mobile outreach efforts; expand the Emergency Department opioid standards to other behavioral health patients; and expand the forensics unit at the Eleanor Slater Hospital to avoid inappropriate ACI use.

12. Importance of the state Mental Health Advocate and Child Advocate
This resolution requests that the Department of Administration conduct a comprehensive study of the staffing needs of the Offices of Child Advocate and the Mental Health Advocate to fulfill their respective missions to advocate for Rhode Islanders and for system improvements.

13. OHIC Findings and Recommendations on Mental Health Parity
This legislation requires OHIC to submit recommendations based on preliminary findings and observations from their market conduct examination to ensure insurance providers are complying with mental health parity provisions. These recommendations must include strategies to reduce unreasonable prior authorizations, and remediate areas of insurer non-compliance. OHIC will also propose guidelines that require payors to develop adequate telemedicine reimbursement rates and propose innovative cost sharing procedures to reduce co-payment barriers for mental health/behavioral health patients.

14. Law Enforcement Training Funds
This would authorize the appropriation of $2 million to the Rhode Island State Police Municipal Academy for law enforcement mental health training for correctional officers and an array of other public safety officers at the state and local level.

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