No more waiting lists for community-based mental health and substance use services

No More Waiting Lists for Community-Based Mental Health and Substance Use Services

Certified Community Behavioral Health Clinics (CCBHC) are transforming behavioral health and healthcare in Rhode Island.

CCBHC is a care model that offers solutions for behavioral health organizations to meet the growing demand for services. A simple, but central and critical element of the CCBHC model, is that wait lists are not allowed. Access to care is the number one priority - too many times individuals are ready for mental health and substance use care but access is delayed due to long wait lists for providers.

The CCBHC model ensures that community-based services are offered at the right level of care and at the right time – meeting people where they are. CCBHCs must have sufficient staffing to offer immediate walk-in access to care. In addition, community outreach and 24/7 mobile crisis teams are core components – individuals call 988 or their local CCBHC to receive behavioral health services on demand. Professional therapists, prescribers, and peer recovery specialists are available in the moment of need to de-escalate a crisis and connect individuals to services like medication-assisted treatment, walk-in detox, outpatient and intensive outpatient counseling services, medical detox, psychiatric evaluation, general medical evaluations, and other evidenced-based programs which provide integrated physical and behavioral health services for all ages.

Thrive Behavioral Health, Community Care Alliance (CCA), and Newport Mental Health are the first community mental health organizations in Rhode Island to strive for, and achieve, this breadth of services and high standard of excellence.

How it started

CCBHCs were created on a federal level in 2014 after Congress passed the “Excellence in Mental Health and Addiction Act,” an initiative to expand access to behavioral healthcare across the United States. Eight states were selected as “demonstration states” and received Medicaid reimbursement status along with grants to expand services.

Rhode Island was not in this first group, but Newport Mental Health took note and began adopting the CCBHC model. Newport Mental Health received the first federal CCBHC grant in 2018 and, while grants helped get Rhode Island’s CCBHC programs off the ground, they are not a sustainable source of funding.

How it’s going

Rhode Island is in the running to be one of the next 10 states designated by the federal government as a demonstration program. This designation brings with it reliable funding through Medicaid. Missouri has been a CCBHC under the federal program for six years and reports the following outcomes:

· 84% increase in access to patient care.

· 49% increase in services provided to veterans and active military.

· 181% increase in licensed clinicians.

· 36% reduction in Emergency Department encounters.

· 35% decrease in inpatient hospitalizations.

The National Council 2022 CCBHC Impact Report estimates that 2.1 million clients are currently being served by CCBHCs nationally. They also estimate that 11,240 staff have been hired among the active CCBHCs. This increase in licensed clinicians facilitates an increase in overall access, including an increase in services for veterans and active military. Increased staffing also provides increased access to medication-assisted treatment and results in a reduction in unnecessary and preventable hospital and emergency department utilization.

Within the CCBHC framework, program configuration, and standards of practice, each state sets its own criteria and process for certifying CCBHCs. Rhode Island’s requirements exceed the federal standard and have put us in an excellent position for the next round of demonstration funding. Rhode Island will be notified in June if it has been accepted. In the meantime, consistent funding from the State is urgently needed to maintain the critical programs and increased staffing levels achieved with the grant funds.

A concrete example of how expanded Medicaid will help Rhode Islanders is the Rhode Island Outreach (RIO) program. RIO is a team of trained professionals that responds to crisis calls through 988 or Newport Mental Health’s crisis line to provide de-escalation and behavioral health services instead of dispatching law enforcement or utilizing the hospital’s emergency department. This evidenced-based model reduces unnecessary incarceration, recidivism, and unnecessary hospital involvement through early intervention. There is no fee for the crisis call or a visit from RIO; it is currently grant-funded, but the grant runs out in September. Calls and visits would be covered by Medicaid in the CCBHC model.

Transformation is on our doorstep

The CCBHC model is proven to reduce the total cost of care by improving outcomes for individuals with mental health and substance use disorders. By providing integrated care that addresses both behavioral and physical health needs, CCBHCs prevent costly unnecessary emergency department visits and, if implemented to fidelity, improve transitions of care which will decrease preventable hospital re-admissions. Additionally, by increasing access to care and early intervention, CCBHCs can help individuals manage their conditions more effectively, reducing the need for high-cost treatments that result when care is delayed, including extended hospitalization and, in extreme cases, involvement with the justice system.

The CCBHC model requires collaboration, integration, and partnership with other healthcare providers, community organizations, and social service agencies to share resources, expand reach and impact, and provide more comprehensive care to individuals with mental health and substance use disorders. Collaborating with other providers helps streamline the referral process, improve care coordination, and ensure that individuals receive holistic care that addresses all their needs.

Integration of services and treatment approaches can also lead to more effective outcomes and a seamless experience for individuals seeking care. By working together with a variety of partners, CCBHCs create a network of support that enhances the overall quality of care for Rhode Island, leading to comprehensive and coordinated care for patients. The current and aspiring CCBHCs in Rhode Island will serve 91% of the population, putting us on transformation’s doorstep.

Rhode Island’s CCBHCs are already providing the high-quality care and access so desperately needed by its citizens. Our government leaders need to find a way to close the funding gap that is opening in front of us, or we will all be back on the waiting list.

Please consider joining us at the Rhode Island Statehouse on May 1 for a “May is Mental Health Month” kick-off event to encourage our legislators to support funding for CCBHCs. Learn more: mhari.org/mimhm2024

Dayna Gladstein is president & CEO of Newport Mental Health in Middletown. Peace of Mind, which is co-written with Kristan McClintock, appears monthly in the Newport Daily News and online at newportri.com.

This article originally appeared on The Providence Journal: Community-based mental health, substance use services easier to find in RI