Dr. Patricia Recupero says science has made big strides, but access to mental health care is too limited.
INTERVIEW
Dr. Patricia R. Recupero
POSITION: President and CEO of Butler Hospital and executive vice president for behavioral health of Care New England since January 1999. Originally a lawyer, she has been on Butler’s staff since 1989, serving both administratively and clinically in roles including executive vice president, medical director, chief of forensic psychiatry and director of managed care, among others. She also is a clinical professor of psychiatry at Brown Medical School; immediate past president of the National Association of Psychiatric Health Systems in Washington, D.C.; and secretary of the American Academy of Psychiatry and the Law.
EDUCATION: B.A. in mathematics from the State University of New York, New Paltz, 1969; J.D. from Boston College Law School, 1973; M.D. from Brown University, 1985.
RESIDENCE:Providence
AGE: 56
Dr. Patricia Ryan Recupero has a long history of advocating for the rights of the mentally ill, as a psychiatrist and a health care administrator. She has worked with policy-makers to expand access to behavioral health services, improve the delivery system and ensure parity in coverage for mental and physical illnesses, and was part of the expert panel behind last year’s SHAPE Foundation study of behavioral health care in Rhode Island, which concluded that the system is fragmented, and there are many obstacles to access.
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PBN: Have things improved since the SHAPE study, or could the same report be issued today?
RECUPERO: Honestly, I think the same study could be released today. I think the problems of access to care have continued. Outpatient care is difficult to obtain, particularly for a child or an adolescent. [There are] long waits, and oftentimes child psychiatrists are not participating in insurance [plans], so the parents are at their wits’ end trying to get an appointment for their child. Many patients that we discharge from the hospital [also find it] difficult; … and the mental health centers for the seriously mentally ill are stretched to their limit as well.
PBN: What would it take to make a dent in this?
RECUPERO: One of the things the SHAPE study identified is Rhode Island is an unattractive place to practice for all physicians, not just psychiatrists. But psychiatrists have led the way in [leaving health plans’ networks] because the levels of reimbursement for behavioral health have been lower, and the number of hoops people have to go through to ensure the patient will be authorized for service have been higher.
PBN: Both Blue Cross and United have done things to improve that. Has it made a difference?
RECUPERO: Blue Cross in particular has made improvements. … But the problem is people who have elected to become non-participating providers have no incentive to [return] because they are very busy, and there’s a demand for their services. … And even the improvements have raised Rhode Island physicians – not just psychiatrists – to the level of Medicare. In most states, Medicare is considered the floor, the lowest payer, so there’s still a competitive disadvantage. We graduate a lot of residents, and many find they have large debt and need to go to a place where they can make enough to repay it. So we’re still losing a lot of people; they’re moving out of state.
PBN: How are high-deductible health plans affecting your field?
RECUPERO: They’re a major problem for all of medicine. One of the first problems people encounter is if they don’t have money to pay that bill, they’re likely to postpone seeking treatment, and the longer someone postpones treatment, the more likely it is that their condition is going to exacerbate to the point where they require more care … and they have no choice but to get admitted to the hospital.
PBN: Do you think employers are aware of the behavioral health needs of their workers?
RECUPERO: I don’t think they’re aware of the good return on their investment when they cover [those] needs. An employee with depression is out of work more than three and a half times as much as one without depression, but when the employee with depression is treated, he returns to base line. … I don’t think people realize the connection between people’s behavioral health and their physical health. The single biggest predictor of whether someone who’s had a heart attack is going to get better is whether they have depression or anxiety. It’s not how high their cholesterol is. It’s not whether they smoke.
PBN: What are some things you’re doing here at Butler?
RECUPERO: One of the things we’re excited about is [Marketing Director Patricia Melaragno] is putting together a directory so people who are trying to access behavioral health care in the state will have a source of information to help them. … Obviously, being an academic institution, there’s a lot of research going on. We’re excited about a number of things. We’re researching a vaccine that might help people who are in the early stages of Alzheimer’s from having a progression of the disease. … We’re also working with people developing treatments for major depression for people who have not responded to drugs or therapy. There are treatments out there used for disorders like Parkinson’s that are being tried for patients with depression, and they seem to be helpful.
PBN: It seems “behavioral health” is now the favored term, rather than “mental health.” Doesn’t that suggest behaving badly, rather than being ill?
RECUPERO: The Institute of Medicine recently issued a report … and they noted the term “behavioral health” had the connotation that you suggested … and they urged the use of a different term. I don’t recall exactly, but I think it was mental health and substance use disorders. So yes, that is a concern. I think a good example is in the obsessive-compulsive disorder arena. Twenty-five years ago, [OCD] was thought to be a disorder of how you were toilet-trained by your rigid mother, and you needed to have that analyzed by a psychotherapist. It didn’t work. And now [OCD] is considered one of the most biologically based disorders. … So there are some issues that people deal with that are related to counseling, and people can figure out what’s going on, and there are others who require more than counseling. I don’t think you can say most people can be “straightened out.”
