Five Questions With: Rebecca Boss

Since 2017, Rebecca Boss has served as director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. She came to the department in 2004 after years of work with people struggling with substance abuse and other disorders. This May, which is Mental Health Awareness Month, Boss shares her perspective on the status of mental health care and the opioid crisis in Rhode Island.

PBN: It’s been almost two years since you were appointed head of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Has the position allowed you to implement any new programs or services?

BOSS: I have been at BHDDH for more than 14 years, most of them as the associate director for the Behavioral Health Division. Too often, I heard individuals and their families say that they did not know how to get help for mental illness or substance use disorders. The challenge of navigating a complex and fragmented system presented a barrier that frustrated many, and we are reminded of that with May being Mental Health Awareness Month. When the path to treatment is too complicated, people delay seeking needed care. As a result, individuals and their families end up in crisis, with nowhere to turn. We know that treatment works, and recovery is possible, but the lack of access was a crucial missing element.

For much of my time at BHDDH, I wanted to create a crisis and triage center, with a hotline, open 24/7. Gov. [Gina M.] Raimondo was completely supportive, and it was a wonderful day when BH Link opened last November. We found great partners – Horizon Health Partners and Community Care Alliance – and they helped us create a truly one-stop shop for behavioral health care. Whether someone is struggling with a substance use disorder or needs support for a mental health condition, BH Link, 414-LINK, provides the connection to the appropriate level of care.

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The focus of this program is providing services in the community – not in a hospital or an emergency room and not through the criminal justice system. BH Link has a team of specialized nurses, counselors, psychiatrists, peer specialists and case managers who ensure an individual is stabilized and linked to the right care and services. It also has a mobile unit that can assist people who need help but have no transportation. I am grateful that after all these years, and with many helping hands, BH Link has become a reality.

PBN: Do you see any sign that mental health care is gaining ground on physical health care in terms of equal funding?

BOSS: I see signs of progress. Last year, Gov. Raimondo signed an executive order that brought agencies and people together with the aim of reducing the negative perceptions of mental illness, improving access to treatment and services, and establishing parity so that insurance coverage for behavioral health issues is equal to that for physical health issues.

In the year since the governor signed this order, a lot has happened. The order required the Office of the Health Insurance Commissioner to make sure that commercial insurers are following behavioral health parity laws. It also required Medicaid to see if existing policies or regulations hinder the delivery of behavioral health care and take steps to improve access. And it required state agencies to develop an action plan to improve adult and pediatric behavioral health care systems. At the same time, the Executive Office of Health and Human Services and other state agencies such as BHDDH held a series of “Let’s Talk Mental Health” meetings to raise awareness of mental health and addiction issues. And the Office of the Health Insurance Commissioner created a fund to support and supplement the state’s behavioral health care system. The fund is administered by the Rhode Island Foundation, and Blue Cross & Blue Shield of Rhode Island is contributing $1 million a year for five years.

Also, the Mental Health Association of Rhode Island launched Rhode Island Parity, a statewide public awareness campaign to educate people and help them to understand their rights to health coverage for behavioral health concerns and drug use disorders. And the Hospital Association of Rhode Island partnered with BHDDH and other state agencies and groups across the state to launch The Campaign to Change Direction, which is part of a national effort to change the negative perceptions of mental illness and encourage people who are struggling with mental health issues to seek help.

So yes, I do see signs of greater awareness and signs that mental health care is gaining ground. We are working every day to ensure parity and erase the negative image often associated with behavioral health issues.

PBN: Is there any aspect of mental health in Rhode Island that you feel is particularly underserved?

BOSS: The negative perception of behavioral health issues is a major challenge. We still see a negative perception around these conditions and some of the treatments for them, particularly with substance use disorders with medication-assisted treatment. This is an evidence-based intervention, but some people experience barriers to access because personal beliefs are thrown into the mix, and people are stigmatized if they get the treatment they need. We must work on a community level and a government level to address the negative perceptions. We can talk to leaders in the community, legislators and folks at the federal level, but if it is not happening in the community, it will not have the kind of impact that we need.

Our system is also challenged in meeting the needs of people who require more-intensive treatment or outreach. This includes people with intellectual and developmental disabilities and co-occurring behavioral health care diagnoses, as well as many people who are homeless and many who become entangled in the criminal justice system. We need to work closely with the provider communities to ensure that our system is keeping up with the needs.

PBN: The opioid crisis continues to be front and center in discussions about mental health. Do you anticipate more funds being dedicated to resources specifically dealing with substance use issues?

BOSS: BHDDH is always ready to apply for federal funding opportunities that align with our strategic plan, and we are partnering with other state agencies to explore avenues in which federal funding can be used to address the opioid epidemic.

Rhode Island just received an additional $6.5 million for the State Opioid Response Grant, bringing the total to $18.5 million this year alone. This money provides greater access to treatments for opioid use disorder, helping more people and reducing opioid-related deaths. The added amount reflects an awareness that this is an ongoing crisis that must be addressed. We are grateful to our state’s congressional delegation for its help in securing this critical funding. We also expect to receive another $12.6 million next year through the same grant, and we are receiving $1 million a year through the Medication Assisted Treatment grant, which helps primary care providers to better serve patients who have opioid use disorders. So yes, I see greater awareness, and one indication of that is these grants.

PBN: Do you see any sign of progress in Rhode Island’s struggle with opioid addiction? Are there any programs that are seeing a lot of success?

BOSS: We know that opioid-related deaths in Rhode Island have declined two years in a row, including a 4.2% drop in 2018, so this suggests we are making progress. Of course, we still have a long way to go. We must make sure this trend continues, and that means focusing on many areas, such as ensuring the availability of naloxone to anyone who is at risk, as well as their families. We also have to make sure that we are providing access to treatment and changing the negative perceptions and attitudes about substance use disorders and medication-assisted treatments that can help.

The Centers of Excellence for Opioid Use Disorder, an effort that grew out of the governor’s Overdose Prevention Task Force, strives to make sure that people with opioid-related substance use disorder continue with their treatment programs and receive follow-up care and support after their treatment programs have ended. These centers provide assessments and treatment for opioid dependence and have multidisciplinary staffs who can help patients in many ways, providing counseling, vocational support and help with access to [Food and Drug Administration]-approved medications for treating opioid use disorders. This effort is being met with great success and must continue.

Elizabeth Graham is a PBN staff writer. Email her at graham@PBN.com.