It’s not surprising, in a time of high unemployment, long-term economic recession, a depressed housing market and the increasingly high cost of living – everything from gasoline to groceries, Rhode Islanders may be suffering from increased anxiety and depression. However, the state recently topped the lists as being the highest in substance abuse, mental illness and suicide attempts.
Providence Business News asked Deb O’Brien, chief operations officer at The Providence Center, to explain what the causes are.
PBN: Rhode Island has recently “won” the behavioral health trifecta – first in substance abuse, first in prevalence of mental illness and first in suicide attempts? Why is that?
O’BRIEN: I think the fact that Rhode Island has been identified as the state with the highest prevalence of substance abuse, mental illness, and suicide attempts really needs to be seen as a call to action for the system and the state.
Certainly I can’t think of any other part of our health care system that, if we scored as the worst in the country, there would be so little discussion around addressing the problem.
I am not sure if anybody can state definitively why we rank so high – I have heard everything from the fact that it is a reflection on the availability of treatment options in Rhode Island to merely a result of the way data is collected.
Going forward, we need to look at this problem not just as a behavioral health problem but instead look at it as a problem that cuts across all disciplines. We need to be talking with education to determine what can be done to address the problem in the schools; with the criminal justice system [we need] to make sure that we are providing access to treatment services so that we stop criminalizing mental illness; and we need to work with primary health care to ensure that we are screening for behavioral health causes for many of the chronic health conditions they are dealing with.
Only by bringing all the different stakeholders in the process together will we be able to improve our results.
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PBN: In the last year, the Providence Center has hired about 160 people – including the creation of 56 brand new jobs. Is this a response by the agency to the need for more behavioral health services?
O’BRIEN: Our increase in hiring and the creation of additional jobs is both a response to the increased demand we are seeing and a result of a strategic focus on making sure that The Providence Center is capable of serving our patients in a holistic way. By holistic I mean that we recognize that to be successful and achieve optimal outcomes and recovery we need to provide and/or help our clients access more than just therapy and medication. For example, we recently added a primary care nurse position, which allows us to address the primary health needs of our population, and we also added staff to work with our clients who are enrolled in our InShape program, a wellness program which promotes weight loss and nutrition.
When you consider that national statistics indicate that individuals with serious mental illness die 25 years earlier than the general population, often from preventable medical causes such as smoking, diabetes, etc., it is clear that in order to meet their needs we need to expand our definition of what treatment encompasses, and this expansion has resulted in our needing to create new jobs to provide these services.
We have also seen an increased demand for our services. In the last three months we have seen a 10 percent increase, both in the number of phone calls we have received from people seeking service as well as the number of people who are referred to us, in comparison to the same period last year.
PBN: At a time of high unemployment, where are the resources coming from to hire new workers?
O’BRIEN: We have been fortunate enough to receive four grants from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) in the last two years as well as a number of new state contracts. I think ultimately, our ability to look at unmet need and then develop solutions that will address them has really been the key to getting outside funders – whether it has been government, the health plans, or other providers – to commit resources to help us achieve our vision.
For example, about a year ago we saw that there was a need in the Providence area to provide an alternative level of care for patients with acute behavioral health needs. To address this we worked with the state and the health plans to identify funding that might be available, and we were able to launch Crisis Stabilization Unit, which can provide acute services at costs significantly below what it would cost to receive care in an inpatient setting.
In another instance we saw a need to provide integrated primary and behavioral health care to our patients, and so we partnered with the Providence Community Health Center to launch Rhode Island’s first integrated health care clinic. In this instance, we were able to convince funders such as The Rhode Island Foundation and SAMHSA to provide grant funding to help get this up and running.
PBN: Is there a business model that you are following that has helped identify growth opportunities?
O’BRIEN: I believe that we have been able to achieve growth primarily through strategic analysis, a commitment to a shared vision of the future, and careful adherence to our core mission.
Rather than be driven by funding streams, we have been driven by ongoing research into client needs and the careful evaluation of community, partner, and our own resources. The result is sustainable programming that staff and clients can depend on because each program is part of a larger strategic plan that is client focused rather than funding dependent.
We produce an annual strategic plan that is disseminated throughout the organization’s management team. The center’s senior leadership team then meets regularly throughout the year to determine whether we are meeting the objectives of the plan, and to assess whether new opportunities are a fit for our vision. All new opportunities are looked at through the lens of existing programs or as an opportunity to grow the existing focus in a way that supports a targeted population, accessibility issue or unaddressed need.
PBN: What are the lessons learned that other community agencies can learn from the Providence Center’s strategic approach?
O’BRIEN: The main lesson here is that agencies need to determine what their mission is and then go out and try to identify funding opportunities that are consistent with that mission. In times of shrinking resources it is very tempting to merely chase whatever funds are available, whether they fit within your core mission or not. This approach, though, forces you to spend time and resources either chasing those funds or developing new programs and expertise. By really focusing on your core mission first, developing a vision and then selling that vision to potential funders, I believe you can really improve your chance of success.
