Mind and Body

A culture war on behavioral health infrastructure

Gov. McKee’s proposed FY 2024 budget seeks to dismantle the state’s behavioral health infrastructure, putting blame on community agencies for not paying rent on state-owned facilities

Photo by Richard Asinof, from screen shot of Capitol TV video

From left: Brian Daniels, OMB, Director James Thorsen, and Elena Mertus, CFO, testifying at the March 20 Senate Finance Committee hearing.

By Richard Asinof
Posted 3/27/23
The director of the R.I. Department of Administration, James Thorsen, blamed the breakdown of behavioral health infrastructure in Rhode Island on the failure of community agencies to pay rent, at a Senate Finance Committee hearing. Five days later, the McKee administration announced his departure.
Is the city of Woonsocket intent on acquiring the property at 181 Cumberland St. that was auctioned off for $730,000 on March 15? Does the proposed $5 million put in as a placeholder in the Governor’s proposed FY 2024 budget to develop a plan by BHDDH to remedy the infrastructure for behavioral health services a wise use of resources? When will BHDDH submit its report, being completed by a consultant, on the plans for the new psychiatric hospital? With the departure of DOA Director Thorsen, who will be held accountable for the doubling of the RICAP budget in the state budget? Will United Way of Rhode Island, which has been focused on strengthening the infrastructure of nonprofit community agencies, challenge the idea that community agencies should be blamed for not paying rent at their state-owned facilities?
What does health equity mean? On Monday, March 27, ONE Neighborhood Builders will announce its10-year Central Providence Roadmap, a 59-page document that makes public its vision for its partnership with the Central Providence Health Equity Zone, with three “North Star” objectives: Everyone has a safe and affordable place to live; everyone has access to the resources they need to be healthy and well; and everyone is equipped and empowered to take action affecting change in their community. Stay tuned.
Blue Cross and Blue Shield of RI announced that work would commence on the fifth annual RI Life Index on March 26, in partnership with the School of Public Health, in collaboration with 14 community and statewide organizations, working through an equity lens to address social needs and to improve population health.
As an example of what health equity does not mean, reporting by ProPublica revealed that Cigna, one of the countries largest insurers, had built a system that allowed its doctors to instantly reject a claim on medical grounds without opening a patient file, leaving people with unexpected bills.
It has been 44 years since the nuclear accident at Three Mile Island on March 28 in 1979, which resulted in a partial meltdown at one of the three reactors, changing the trajectory of the nuclear industry in America. All the public relations bravado could not change the equation that nuclear power had been proven to be unsafe and uneconomical.
Five years earlier, Sam Lovejoy, living on a communal farm in western Massachusetts, sought to put nuclear power on trial, loosening the guide wires on a weather tower erected on the Montague Plains, causing it to tumble, and then hitched a ride with a police patrol car to turn himself in for his act of civil disobedience.
Around this week’s dinner table, I would envision a gathering of activists from the No Nukes movement, including Lovejoy, Al Giordano, Cort Richardson and Ginny Callan, Cathy Wolfe, Harvey Wasserman, Sandy Playa, and Raye Fleming, to talk about how the citizen action proved to be successful – and the ways that such actions might be reborn to focus on plastics and fossil fuels.

PROVIDENCE – In a Friday, March 24, news dump, Gov. Dan McKee revealed a major shake-up in his administration, announcing that James Thorsen, the current director of the R.I. Department of Administration, would be stepping down as of April 28, smack-dab in the middle of the budget negotiation season at the State House. Thorsen was said to be returning to the U.S. Treasury after a two-year stint in Rhode Island. [Thorsen also serves as chair of RI Housing.]

His departure was somewhat perplexing, in ConvergenceRI’s opinion, given Director Thorsen’s performance during the Senate Finance Committee hearing earlier in the week, on Monday evening, March 20, where he had been brimming with confidence as he talked about his agency’s increased spending plans – including the rollout of a new IT system.

The two-and-a-half-hour hearing had focused on his agency’s budget planned expenditures, both for the Supplemental FY 2023 budget and the Governor’s proposed FY 2024 budget. It had been filled with the usual numbing slide presentations on the numbers, as the financial team, which included Thorsen, Elena Mertus, the chief financial officer, and Brian Daniels from the Office of Management and Budget, did their best to deflect and parry questions from inquisitive committee members, including the Chairperson, Sen. Lou DiPalma, and Sen. Sam Zurier. [See link below to Capitol TV video of the hearing.]

For instance, Sen. DiPalma expressed frustration that the amount appropriated last year for the building of a new state psychiatric hospital to replace Eleanor Slater Hospital had not moved forward after 10 months. The financial team explained that they were waiting for a report commissioned by R.I. BHDDH that was due to be delivered on April 22, which was being prepared by a consultant, and depending on what the report contained, it might be possible to move ahead. Sen. DiPalma expressed worry about what that delay meant for employees and patients at the current facilities, and whether it would be 2028 before the new hospital opened.

For sure, there were no emotional fireworks at the hearing, unlike what happened when House Rep. Robert Quatrocchi had crudely asked Rep. Rebecca Kislak, during a hearing on proposed legislation focused on equity, whether she was a pedophile.

But, what became fully visible through the testimony and in Director Thorsen’s response to questions from Senators was the full extent that the McKee administration had embraced a culture war in the way it has prioritized infrastructure investments for behavioral health services.

Thorsen had proudly talked about the infrastructure investments his agency was planning to make in the coming year, at the behest of the McKee administration, such as a new, combined police and fire station in Woonsocket, costing some $35 million, in response to an alleged problem that the city’s hazmat equipment supplies were currently being stored in a potentially hazardous situation.

Yet, when it came to the state’s failure to make investments in the infrastructure related to the delivery of behavioral health services, such as the repair of a state-owned building in Woonsocket, which resulted in a community agency providing behavioral health services being evicted, and then the building being sold on March 15, the biggest problem, according to Director Thorsen, was the fact that nonprofit behavioral health agencies “do not pay rent” for their use of state-owned facilities, such as group homes.

In his response to questioning from State Sen. Melissa Murray, vice-chair of the Senate Finance Committee, attempting to explain the reasoning behind the state’s eviction and subsequent sale of the property at 181 Cumberland St. in Woonsocket, Thorsen said: “These agencies, most of these agencies [that] are housed in these buildings are not paying rent.” To quote the hard-working WPRO reporter Steve Klamkin, “Really?”

Here is the full, revealing dialogue between Sen. Melissa Murray: vice chair of the Senate Finance Committee, and Director Thorsen:

SEN. MURRAY: Thank you. You just talked about RICAP [Rhode Island Capital Plan Fund] expenditures, and the big double [a doubling of the RICAP expenditures] that you want to spend on all these projects.

I have personally talked to you, Director, about behavioral health facilities, or rather, state-owned buildings that house behavioral health facilities, and you had informed me earlier this year that the state was divesting from those properties.

As you know, the state-owned building at 181 Cumberland St., that the state let deteriorate, went up for auction, and I believe that it sold for $750,000 [the actual price was $730,000].

So, the state made quite a bit of money on that. Unfortunately, the losers were the Community Care Alliance, who was housed in that building for at least 30 years, maybe longer, 40 years.

So, what is the plan for these other buildings? Is there a time line? How is it going to happen?

These other behavioral health agencies that are housed in these state-owned buildings that are still not getting repaired, that were on the list to be repaired in last year’s budget, where do those buildings stand?

If we are going to divest from those buildings, how are we going to make sure that the losers aren’t the organizations that are housed in them – and the community members that they serve?

DIRECTOR THORSEN: OK. Thanks for the question. As we discussed before, there is approximately 174 group homes, of which over the course each of the last 3 or 4 years, there has been an average of four or five per year that have gone up for sale, because state law mandates that if they are vacant for a year, they are to be put up for auction. And, that auction resulted [in sale to the] highest bidder – with the locality in that area having the right of first refusal. And, the law reads [that the price of the sale] goes into the IT Investment fund, which I have never agreed with.

In our portfolio of homes, there is an estimated $100 million worth of deferred maintenance. This didn’t happen over night. This has happened over 30 years, [because of] inadequate funding.

There are a number of problems associated with this, One is that the proprietary price we pay for behavioral health services does not reflect the cost, because it doesn’t incorporate the cost of maintenance on these homes.

So, in other words, what we budget for, and what we’ve been paying, is not the cost. Because what we have not been paying for is the cost of replacing and repairing these facilities. That needs to change. In this year’s proposed budget, there is $5 million proposed for that purpose. It’s a placeholder, until a plan is developed. We need to have BHDDH develop a plan for how they are going to, working with us, help fix this problem.

Because it is two-fold. One is programmatic, [the other is] a facilities fix. A programmatic and facilities fix. These agencies, most of these agencies,[that] are housed in these buildings, are not paying rent [emphasis added].

So, if there is a situation where they need to move, for any reason, it’s nearly impossible to place them anywhere else, because they don’t pay rent. So, this is a problem that continues.

So, BHDDH and DOA and particularly DCAMM, have been working together to develop a plan. In the meantime, there is $5 million proposed [in the Governor’s recommended budget] as a placeholder to address that issue in the upcoming fiscal year until a plan that is more comprehensive is developed.

In addition, we had a finding from the Auditor General a couple of years ago that said there was a problem associated with letting non-state entities into state-owned facilities without a lease [because] there are liability issues, all kinds of issues. So, we’ve put one-year leases [in place]. Why one-year? Why wouldn’t we make them 10-year leases?

Because, I want this problem to be dealt with. If we don’t deal with it this year, we are going to deal with it next year. We are not going to kick the can down the road for 10 years. I don’t have a plan for you this year. I expect to have a plan for you next year. Does that address your question?

SEN. MURRAY: To clarify, this wasn’t a group home, and it actually wasn’t vacant. And, it housed a commercial kitchen that [once] served 1,800 people a week and [as many as] 3,000 a week.

I am waiting with baited breath to see the plan, because what I don’t want to see is that other behavioral health organizations, not group homes, that provide services to different communities, they are the ones that come up the losers.

This organization [Community Care Alliance] had a lease. Yes, it was agreed [upon]. But the maintenance was $300,000. And folks can debate that, right?

But the investment in the community we’re talking about is millions here [in the proposed RICAP spending budget]; $300,000 could have saved this organization from having to vacate. Instead of investing the money, we evicted them.

I am very much looking forward to the plan, because I don’t want to see this happen in [other] communities. I know how important this organization is to Woonsocket and the people they serve, [because of] housing insecurity and food insecurity and a myriad of other issues. I don’t want to see this happen again. The state made money [from the sale]. But Woonsocket is not going to see that.

Translated, the answers given by Director Thorsen to Sen. Murray’s questions deflected and danced around the situation at 181 Cumberland St., which has been documented at length by reporting by ConvergenceRI. [See links below.]

The answers given by Thorsen represent a direct attack on the infrastructure of the state’s community mental health center network, in ConvergenceRI's opinion. It had been built out with the state underwriting the expense of both the capital needs for buildings such as 181 Cumberland St. and residential group homes.

Now, Thorsen, at the apparent direction of the McKee administration, voiced his intent to dismantle that system. And, by Thorsen’s own admission, there is no plan in place to replace the current infrastructure – only a proposed placeholder of $5 million, with the promise that BHDDH would develop such a plan.

And, with Thorsen’s imminent departure, the question is: Who will be held accountable for the policy being promoted to unravel the behavioral health infrastructure?

The final disposition of the building at 181 Cumberland St., which was purchased for $730,000 through an auction, remains up in the air. Will the city of Woonsocket seek to acquire the building, given its right of first refusal under law? If it does seek to acquire it, what plans does it have for the building or the property for future development? The answers remain clouded. According to the amended agenda for a special meeting held on Monday, March 20, of the City Council of Woonsocket, the council went into executive session for “any discussions or considerations related to the acquisition or lease of real property for public purposes, or of the disposition of publicly held property wherein advanced public information would be detrimental to the interest of the public.”

Unpacking the culture war around behavioral health
To put the blame, incorrectly, on community health agencies for allegedly not paying rent at state-owned facilities, reflects a common thread that has been heard before from the McKee administration, when in December of 2022, the Governor said that it was the agencies that were “trying to keep the homeless, homeless.”

That same rationale had been repeated by city officials in Woonsocket, at a City Council meeting in Woonsocket following the forced dismantling of a homeless encampment in the city on Jan. 4, 2023: “Maybe they should be doing better,” said Steve D’Agostino, the director of the Woonsocket Department of Public Works, who took responsibility for ordering the dismantlement of the homeless encampment earlier that day, as Katie Mulvaney reported in The Providence Journal.

No one disputes, really, that the state of Rhode Island is in the midst of a behavioral health crisis:

• A coalition of pediatricians and psychiatrists in Rhode Island declared a state of emergency in April of 2022, with the doctors saying they are dealing with skyrocketing rates of depression, anxiety, trauma, and suicide. It has resulted in dramatic increases in emergency room visits for all child mental health crises, according to the president of Bradley Hospital. “In my 21 years as a pediatrician, I have never seen so many children experiencing mental health challenges or [lacking] access to community resources to meet their mental health treatment needs,” said Dr. Alison Brindle, president of the Rhode Island chapter of the ‘American Academy of Pediatrics, [RIAPP], as reported by WPRI.

• There is a shortage of providers, caused by low wages, as well as a continuing failure by the state to increase the Medicaid rates being paid to providers.

However, the rationale that blames the breakdown on behavioral health services on the failure of behavioral health agencies to pay rent, as suggested by outgoing Director Thorsen, is a novel, groundbreaking theory.

Benedict Lessing, Jr. the president and CEO of the Community Care Alliance of RI, offered this comment in response to the Director Thorsen's new strategic direction. The state's policy for over 40 years has been to support the capital infrastructure of community-based organizations [i.e. community mental health centers], providing vital behavioral health services that saved the state millions of dollars in unnecessary hospitalizations.

Lessing continued: It is disingenuous and frankly incongruous with reality and history to imply and/or blame this situation on 'non-profits not paying rent' when the General Assembly and multiple Administrations have known that these organizations have been severely underpaid for decades.

Moreover, Lessing said, It is beyond disrespectful to the hard-working, community-based behavioral health professionals in the state of Rhode Island who serve our neediest citizens.

In response to a question from ConvergenceRI, Laura Hart, communications director for the R.I. Department of Administration, offered this clarification of Director Thorsen’s testimony: “As you can see, he was speaking of the group homes in the collective, not as individual properties, when he responded, and he made the caveat that most agencies are not paying rent.

“You should know that CCA had not been paying rent recently because it did not have an active lease with the state. When it had an active lease, the rent was negligible: 10 cents a year.

“Lastly, as you can see from the director’s testimony, DOA is working hand-in-hand with BHDDH to come up with a plan to address the larger issue of leasing and maintaining state-owned group homes while strengthening our continuum of care and behavioral health services. I hope this clarifies the matter.”

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