Letter - No Longer Nationally Recognized
By Benedict F. Lessing, Jr. MSW, President/CEO, Community Care Alliance
Published in the Providence Journal, May 10, 2022
Rhode Island had a nationally recognized Behavioral Health System.
What is happening is unconscionable; a State Hospital full, hundreds of homeless people suffering with serious mental illness and addiction; overdose deaths weekly, a system collapsing. The adult system is bad but services for children are not much better. Children are being boarded in Emergency Departments, psychiatric units have waitlists, and kid’s get stuck in hospitals for weeks and months for lack of treatment resources in communities. Community organizations that once had robust teams with emergency, outpatient and intensive outreach services are a shadow of what they were. We are systematically abandoning people that should be a priority; children, people with disabilities, individuals with serious mental illness.
In the RI Senate and House of Representatives new rate setting bills could remake the funding of human services requiring the State reimburse through Medicaid and other social service contracts based on true costs. While this is pragmatic, we also know that increasing Medicaid rates has been a hot button. Historically, elected officials are pressured not to address this issue based on the fear of increased expenses. There is more than enough data to suggest that expenses are through the roof by investments we are not making to strengthen community services. More pertinent, we cannot continue to ignore the suffering of our most vulnerable citizens.
The immediate problem is that the State’s Behavioral Health System needs help now, requiring short and long-term funding. For decades, organizations adapted to government’s funding indifference. The slow march to where we are at present suddenly accelerated with the Pandemic. No longer were Behavioral Health and Social Service professionals doing the most difficult work in the field; namely, caring for people with complex medical and social needs willing to do so while also holding a second or a third job.
While rate setting legislation would be a game changer as it has been elsewhere, this reform will not have an impact for 18 months. Our core safety net is in such poor shape that organizations cannot wait and will be even more depleted without immediate assistance. What does this mean? It means that thousands of children and adults will not receive the vital community-based treatment and support services they need. Without funding, cash strapped providers will neither be able to retain nor recruit Clinicians, Case Managers, Nurses, Psychiatrists and other allied professionals to serve individuals and families.
The questions we must grapple with are; do elected officials understand the market forces at play here that cannot be ignored? Do they understand the value of a well-resourced human service system from a humanitarian perspective? Do they understand that sound community-based systems of care are smart, long term economic policy?
One painful fact is that as staff attrition mounts among community-based organizations, the level and quality of care begins to decrease. This is an inevitable consequence. Even deeply committed staff can only go above and beyond for so long. They get tired—caseloads grow to excess and every client is a priority with multiple needs. Human Service professionals can only absorb so much pain and trauma particularly on sub-par salaries. Our organization now has 15 case managers caring for hundreds of people with severe and persistent mental illness; about half of where we should be. This means individuals with acute needs may not get the enhanced supports required and people with less severe needs may not have consistent or frequent enough access to the human connections that are important to their ongoing well-being. Research has revealed again and again, it is the human connections that matter.