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Report identifies gaps in RI services for mental illness, addiction

Providence Journal - 9/20/2021

PROVIDENCE — Fresh eyes have found that years-old problems persist in Rhode Island's programs for people with mental illness, drug and alcohol addictions, or developmental disabilities.

A newly released report that state Health and Human Services Secretary Womazetta Jones prepared for the governor found:

-Inadequate oversight and coordination of services and contracts

-A lack of diversity at many levels

-Ill-defined leadership roles

-"The need to build a more robust continuum of care that provides the right services at the right time" from the state's intertwined network of hospitals, state-run programs and community centers.

Despite years of discussion about gaps in available services for people in crisis, Jones also found: "Comprehensive continuum of care for both our mental health and substance use system not fully developed. ... Possible gaps in services. ... Substance abuse needs and services significantly focused on opioids and not all drugs and alcohol."

In an interview Monday, Jones gave examples of where these gaps exist, including one area her now 19-year-old son mentioned to her when he was a high-school senior: the dearth of services available to youth "using and abusing alcohol ... because we've been so focused on opioids."

"One thing my son tells me all the time - [and] it scares the heck out of me - is, 'Ma, you do know that in high school we still, like, get sloshed on booze. ... Where are the treatment programs for teens who are abusing alcohol?'

"We have them but they are not, I don't think, in as much abundance [as] we need them ... [and] we don't have them for all Rhode Islanders, not just white Rhode Islanders.

"We have people of color in the state who sometimes don't seek out treatment because they can't find people, or groups, that are comfortable for them and their cultures,'' said Jones, who is a Black woman.

"We also have not invested money ... with addressing cultural taboos such as, believe it or not, drug usage, but even more importantly, mental health in our communities of color.

"Those are the type of gaps that I am talking about,'' she said. "How do we reach everybody, and serve everyone and give everyone access."

Among Jones' recommendations: "Review all Substance Use and Addiction grants, allocations, and contracts to better align dollars with needs and service gaps. ... Review all Mental Health grants, allocations, and contracts to better align dollars with needs and service gaps."

Also: "Eliminate, to the extent possible, the profound number of silos in Behavioral Health by bringing in a strong and focused leader and creating a solid and understood chain of command."

And this: "Detox and Residential Services Expansion."

Her report, months in the making, also looks at the status of the state's efforts under three governors to comply with a 2014 consent decree.

The landmark agreement required the state to move intellectually and developmentally disabled Rhode Islanders from segregated settings into the workforce and the community at large. It followed a year-long investigation by the Department of Justice's Civil Rights Division that found that Rhode Island grossly violated the Americans with Disabilities Act.

The U.S. Department of Justice is currently seeking fines of up to $1.5 million a month for alleged noncompliance. The filing is in connection with a contempt hearing scheduled for mid-October before U.S. District Court Chief Judge John J. McConnell.

One of the agencies under Jones' umbrella - the Department of Behavioral Healthcare, Developmental Disabilities - is responsible for authorizing and reimbursing payments for home and "community based" services for more than 3,900 Rhode Islanders with intellectual and/or developmental disabilities.

A subset of this population, 115 adults with developmental disabilities, is living in 22 group homes.

Jones did not respond to the allegations in the federal legal filing in her report or in her interview with The Journal.

She focused her comments instead on moving past the consent decree and said the state would respond during the federal court hearing next month. In the meantime, she said, state officials are working on a three-year plan.

Earlier this year, state lawmakers budgeted an extra $39.7 million to raise the pay of "direct care'' staff who work with Rhode Islanders with developmental disabilities, including hikes in the minimum wage up to $15.75 an hour for front-line workers, and $21.99 for supervisors.

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