Mental health gains sought

Hospitals across the state are actively working to address the state’s top health concern – mental health, including substance abuse, according to plans made public this fall through a mandated community-needs assessment. These goals include:
• South County Hospital will establish a mental-health first-aid course for health professionals and community members.
• Roger Williams Medical Center will produce public-service announcements and create a special mental-health referral telephone line.
• Care New England hospitals will increase the referrals to primary-care physicians for patients with mental illness or substance abuse when they are discharged from the health system’s hospitals.
• The Westerly Hospital will work to decrease the incidence of chronic and treatable medical conditions among people with mental illness, including substance-abuse disorders.
• Landmark Medical Center will create consistent screening tools used by primary-care providers to assess patients for mental-health risk factors.
These commitments through 2016 also specify how the hospitals will address diabetes, the second issue of most concern, and heart disease, determined to be the third-most-critical health concern in the state. Implementation plans were developed from the statewide Community Health Needs Assessment done from September 2012 through May of this year by the Hospital Association of Rhode Island.
Under the federal Affordable Care Act, nonprofit hospitals – all hospitals in Rhode Island operate as nonprofits – have to conduct a community-needs assessment every three years, develop implementation plans to address those needs and submit reports on the implementation to the Internal Revenue Service. “If a hospital doesn’t conduct a community-needs assessment, it gets a $50,000 tax penalty,” said Mike Souza, senior vice president and chief financial officer for the Hospital Association of Rhode Island, who coordinated the assessment.
Results were published in May and under the requirements of the Affordable Care Act, hospitals had a deadline of Sept. 30 to complete implementation plans.
“We’re moving pretty quickly now to see how the hospitals can collaborate and reach out to partners in the community to implement the plans,” said Souza.
“The hospitals really need to get going and start doing these things because three years from now, when they submit their tax forms again, they need to attach their reassessment and how well they’ve done in their implementation plans,” said Souza.
Even before the Affordable Care Act, health care perspective was changing, he said.
“Rather than being focused on hospital care or treating disease or illness, it’s more about getting awareness and prevention in on the front end, in primary care or a community setting,” said Souza
“We want to make people aware of the disease or condition, rather than treating them once they get it.”
In addition to the assessment done with input from about 50 leaders in varied segments of health care, the community-health needs were determined from data collected by the state health department from 8,500 households.
While there were many health issues to be addressed, the implementation plans were developed based on needs on which hospitals and community groups can have a significant impact, said Souza. And many issues, like obesity, will be addressed under the diabetes-implementation plans.
Mental-health conditions have an impact on a broad range of health concerns, said Patricia R. Recupero, a physician who is president and CEO of Butler Hospital, the state’s only nonprofit hospital dedicated to treating adults and senior citizens with mental illness. “If you look at reports over the past 15 years, there’s a burden of disease associated with behavioral health issues such as depression, bipolar disorder, schizophrenia and substance abuse,” said Recupero. “If you take those four disorders, the amount of impact on individuals through loss of productivity and loss of life is equal to or greater than from cardiac disease.”
A recent study by the Centers for Disease Control and Prevention found that Rhode Island had the highest rate in the country of people considering suicide, said Recupero.
“On the other side of the coin, we had the lowest rate of completed suicides in the country,” she said.
What does that say about access to mental-health services in Rhode Island?
Under new regulations announced by Secretary of Health and Human Services Kathleen Sebelius on Nov. 5, insurers will be required to cover treatment of mental health and substance abuse in the same way they cover physical ailments.
From Oppenhiemer’s perspective, especially from his work with children and families, he would like to see more emphasis, and insurance coverage, for time spent talking with patients, especially young people.
The value of communication is a focus in the implementation plans for all three of the state’s top medical issues, with education and awareness key elements.
The goals and implementation plans developed by hospitals are on the website launched May 1 and funded 50/50 by the R.I. Department of Health and the hospitals, maintained by the Hospital Association of Rhode Island, at www.rihealthcarematters.org/. •