Name: Charles E. Maynard
Occuption: President and chief executive officer, The Providence Center
Backround: Hired by the state in 1969 to establish a not-for-profit mental health clinic. Today, The Providence Center is Rhode Island’s largest behavioral health organization with headquarters on Hope Street, Providence.
Education: Masters in social work, Columbia University, NYC, 1964; Bachelors in sociology, St. Michael’s College, Colchester, VT.
Age: 63
Family: married, three children
Residence: Warwick
PBN: How has the definition of a behavioral health organization changed over 30 years?
MAYNARD: Today we deliver services to people with mental health problems and also we’re into substance abuse services. That changed a few years ago, I think, when health insurance looked at both substance abuse and mental health as one benefit.
Why would someone seek help at The Providence Center over a psychiatric hospital?
What’s happened in mental health over the years has been the moving of the patient out of the hospital, moving the patient out of state institutions and treating them in the community. This has been the history of The Providence Center in terms of being very much involved in the deinstitutionalization of patients from the state institutions.
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We offer a very different kind of a service than, say, a hospital or a private practitioner in that we can provide a continuity of care. Not only can we provide (patients) with an array of services going from an intensive group home experience where they need to be watched 24 hours, down to an individual who might need to come to us every few months for a medication check. In between those two extremes, you have people with an array of needs. We deliver that not only by a psychiatrist but you’re talking about a team of professionals, including psychiatrists, psychiatric nurses, psychiatric social workers, psychologists. Now we have case managers, residential counselors, vocational counselors, substance abuse counselors, all of them working as a team to be able to deliver proper care for the individual who can now live in the community, rather than live in an institution.
How does managed care fit into that picture?
The way we deliver that care is exactly what managed care companies are looking to do. Our focus is an alternative to hospitalization, keeping people in the community and treating them there. But their (managed care companies’) systems aren’t in place to do it as of yet. We always say we’ve been doing managed care before its time. If you were to treat the patient on an ongoing basis at different levels of intensity, you can keep people out of the hospital. Otherwise, they can deteriorate and end up back in the hospital.
Are managed care companies at least acknowledging the link between mental and emotional health, and physical health?
Not fast enough for me. The way health is financed today, there’s still a whole separate track for behavioral health and physical health, and the two haven’t come together yet.
There is such denial about emotional problems and behavioral health problems among all of us in society. In medicine, that’s not their orientation. With the exception of psychiatry, of course. But that’s a very small part of medicine. Health insurance companies want to save money, but they don’t tie that together.
I’ve spent time in emergency rooms just observing what was going on over a three- or four-hour period and see the people that are coming through. I maintain that many of them had no physical problem, were put through an expensive evaluation procedure – which is necessary for the hospital to do – and it was some kind of a social problem. Some problem going on back home. I really think there would be tremendous cost savings if people did turn to behavioral health and there was more funding and more support for behavioral health and more acceptance on the part of medicine that this is a first step. It’s starting to happen a little bit and I think that’s where managed care may play a positive role because the way you’re funded through managed care is that you want to keep people healthy. With fee-for-service, every time you see your provider he gets paid. So there’s no incentive to stop seeing him.
What is the goal of an employee assistance program? How popular are they among area companies and how do they work?
Companies – and I consider them enlightened companies – recognize that many of their employees may be having difficulty at work, not because they’re not competent but because they have a personal problem. They contract with The Providence Center or somewhere else. We have about 45 companies that we work with. All their employees are eligible to come to us for an evaluation – either one visit or two visits or three visits to do an evaluation and to work on an issue, depending on the contract. And then, of course, if it’s a serious problem, it flips into their health insurance and they can get some treatment.
There are two types of patients that we will see. There’s the patient that comes voluntarily and the employer doesn’t know anything about it. The other one is a troubled employee to whom the employer says we know you’re competent, we hate to see you be out of work, but you need to go to The Providence Center because we know that there is something that’s interfering with your work. It could be depression, substance abuse, personal problems at home, domestic violence.
Are such programs costly?
Not costly at all. The cost runs in the range of $25 to $30 a year per employee. Not bad. About 3 to 5 percent of the employees make use of that service. Most of those are voluntary. There’s just an occasional referral. We also go out and do some training two or three times a year with supervisors or with employees in general. We present training on stress management or whatever. Sometimes it’s how to differentiate between personal problems an employee may be having as opposed to a work problem.
The EAPs are changing. Companies are now looking to (EAPs) to help them deal with managerial problems and work teams and those kinds of issues. What’s driving that (trend) is behavioral risk management kinds of issues. Increasingly, employers are in jeopardy because of workers’ compensation and those kinds of issues. We live in a very litigious society. So it’s important to help the clients address an awful lot of behavioral health issues.
Are such programs cost effective?
Yes. It’s a very inexpensive benefit that the employer has to pay. And you have to look at the amount of money that the company saves by just being able to work with one employee that’s highly valuable to the company and not having to re-train somebody – especially in today’s society when employees are technically skilled.
How has your funding changed over the years?
When we’re talking about the seriously mentally ill population, for the most part, they are the responsibility of the state. In the earlier years, when we began to treat that population, state contracts supported their care. Then over the years, Medicaid came into place to take advantage of the federal dollars that matched that state’s. And then the state’s dollars began to decrease. For example, The Providence Center hasn’t received an increase of state dollars over the past 10 years.
What’s important here is that the state needs to realize that this is their responsibility. They’ve decided to privatize that care – and I totally agree with that concept – but they still have the responsibility to see to it that the service continues to happen. We are concerned about it right now because the dollars have not been coming through. I think the problem is it’s worked so well that people forget how difficult it is to do that kind of a job and the necessity of it to be funded. So we are working very hard to keep the General Assembly and the Governor’s office informed that they’re responsible financially to see that these individuals get the proper care.
Looking back over 30 years, what are the center’s greatest accomplishments?
I think there are three areas. The biggest change I’ve seen in 30 years obviously has been that we’re treating the very seriously mentally ill in the community in a very humane way and in a very effective and efficient way. That’s not just because of the mental health centers. It’s also because of the psychotropic medications. And there are other kinds of factors. That’s been a movement across the country. But it’s been particularly very effective here in Rhode Island.
The second major change has been that people have accepted mental illness more than they did in the early days. In the early days, it was very shameful even to admit that you had some kind of a problem. People didn’t want anyone to know they went to see a counselor; and when you went to the counselor, you never talked much about the issue until you formed a relationship over two or three visits. There’s still a lot of stigma attached. But I see a change. Unfortunately and ironically, now that people are not reluctant to come for services, there’s a limitation in the available funds either through the state or the health insurance companies. Behavioral health has been hit the hardest with managed care.
The third one is really substance abuse and mental health coming together. We know that so many people with mental illness also may have a substance abuse problem and vice versa. Not all, but more than half. So it made sense for the professions to come together.
In 30 years, what has been your greatest frustration?
I think the frustration – and maybe the next stage that evolves – is behavioral health coming together with physical health. And that when we look at the individual, the final way is to look at the whole person. Those two worlds are still very separate.
