RI’s mental-health system is unraveling

Falling down
By STEVEN STYCOS  |  July 12, 2006

More than 120 uninsured Rhode Islanders are waiting for mental health services at the Allen Berry Health and Dental Center on Prairie Avenue in Providence, according to one of its administrators. Two years ago, says Andrew White, a University of Rhode Island doctoral student in clinical psychology, there were only 15 people on the waiting list. The situation shows how a growing number of Rhode Islanders, especially those without health insurance, cannot find mental health services.

State-funded care focuses on those with the most severe mental health problems, White says, leaving “people on the edge” to fend for themselves and risk becoming suicidal or a danger to others.

Several blocks away from Allen Berry, the Rhode Island Free Clinic on Broad Street is expanding its number of counseling rooms, from one to five, to handle growing mental health-care needs, says executive director Lisa Smolski. Low payments from insurance companies and a shortage of psychiatrists and psychologists make it hard even for people with insurance to find mental health-care, she notes.

Eleven percent of Rhode Island adults have serious mental illness — the highest rate of mental illness in the US, according to the latest survey of the federal government’s Substance Abuse and Mental Health Services Administration. Other New England states, except Maine, are below the national average of 9.2 percent. Despite Rhode Island’s mental health problem, however, the National Alliance on Mental Illness (NAMI), rates state mental health services with only a “C.” NAMI’s criticisms include a shortage of mental health professionals and low insurance payments. By contrast, says Charles Gross, NAMI-Rhode Island’s executive director, his group rated Rhode Island with an “A” in 1990.

White, who has volunteered at Allen Berry for four years, attributes the exploding waiting list to word-of-mouth referrals about the free service, plus the improved ability of doctors at the four other Providence community health centers to diagnose mental illnesses and refer patients to Allen Berry. And Allen Berry’s services are far from ideal. The half-dozen URI student volunteers provide only short-term therapy. Without a staff psychiatrist, they cannot alter prescription drug therapies.
The Rhode Island Free Clinic, whose doctors are volunteers, also cannot provide mental health-care to everyone who needs it. Until two years ago, the clinic provided no mental health services, relates Smolski, but then the clinic’s doctors reported they were unable to find outside psychiatrists and psychologists to accept their patients. In response, the clinic recruited a volunteer psychiatrist, psychologist, and social worker. Nevertheless, the clinic still turns away about 20 people seeking health-care every month, Smolski says.

Rhode Islanders with serious mental health problems — those who are suicidal or a danger to others — receive treatment at the state’s eight mental health centers. The centers see some uninsured people with less severe problems, says Elizabeth Earls, president of the Rhode Island Council of Community Mental Health Organizations, but they also have waiting lists. Tight Medicaid and Medicare payments leave little extra money to provide for the uninsured, she explains.

Mental health-care, summarizes NAMI‘s Gross, is increasingly only for those who can afford to pay for it. For everyone else, he laments, “We have a complete unraveling of the private psychiatric health system.”

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