PROVIDENCE – One of the agencies hardest hit by the fallout from the coronavirus has been the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, whose new director, Kathryn Power, assumed her role earlier this year, replacing Rebecca Boss, just as the virus was burgeoning into a pandemic that continues to ravage the state, the nation and the world.

In an effort to engage with Power, ConvergenceRI sent a series of questions, seeking answers that could not be given simply, yes or no, as a way to understand the complexities of Power’s role in helping to design a response where the delivery of behavioral health services and treatment, including in congregate living situations, had been severely disrupted by COVID-19.

The diverse populations in Rhode Island served by BHDDH are often invisible to many, far removed from day-to-day news coverage – until there is a crisis or a tragedy or a budget shortfall. [Witness the recent noise about budget cost orverruns at Eleanor Slater Hospital.]

In Powers own words, the Rhode Islanders her agency serves are “individuals who often are medically fragile, who often are socially marginalized, and who have mental and substance use, co-occurring conditions or have stand-alone mental and emotional problems or substance use and addictive disorders.”

At the same time, Powers believes that “people are much more adaptive and much more resilient than they give themselves credit for.” In the long term, Powers continued, “they are profoundly more capable and inventive and much more creative than they expected.”

It is, in a time of great peril, in keeping with the Rhode Island state motto, “Hope,” a message of hope and resilience.

Here is the ConvergenceRI interview with Kathryn Power, a long-time player in building a network of coordinated efforts around the delivery of behavioral health care in Rhode Island.

ConvergenceRI: What are the most important takeaways that you have learned about behavioral health issues during the coronavirus pandemic?
POWER: BHDDH needed to be a calming and informative resource for our providers and we had to stay focused on providing supports for the more than 50,000 Rhode Islanders who need assistance with a mental health or substance use condition; an intellectual or developmental disability; or care in the State’s hospital system.

We were and are still in the midst of two epidemics: the COVID-19 pandemic and the opioid epidemic. Both have influenced how we react to our environment, and both bring their own sets of behavioral health challenges.

Fortunately, in the middle of the pandemic, we applied for and were awarded a $2 million grant from SAMHSA to use primarily on direct service. This grant:

• Assisted our providers by increasing telehealth capacity at community mental health centers

• Maintained funding for the 24/7 buprenorphine tele-induction and treatment phone line

• Provided video-translation/interpretation services not covered by insurance, and

• Provided outreach to refugee and immigrant communities regarding telehealth services and tele-translation/interpretation services, as well as Healthsource RI information for those who are uninsured.

These services have been vital to our communities and we were gratified to be of service to individuals who depend on us.

In the midst of these epidemics, we have also seen the importance of our behavioral health care workers, who have truly been essential during COVID-19 pandemic. They are not often recognized, but without the sacrifice of the workers who kept our group homes, detox facilities, day programs, residential programs and opioid treatment programs open, many other behavioral health issues may have arisen.

Dedicated staff members stayed at their respective stations, keeping treatment options available, which meant people could continue to receive the medications and services they needed to sustain behavioral health recovery.

Another takeaway is the importance of telemedicine in serving our most at-risk clients, as well as those with challenges related to isolation and quarantine, transportation, childcare, eldercare, agoraphobia and paranoia. Telehealth is helping providers support clients across the entire spectrum of behavioral health services.

ConvergenceRI: There has been an apparent increase in the number of overdose deaths in Rhode Island in the most recent data results for the first quarter in 2020. In your opinion, what have been the causes for the spike?
POWER: There are a few possible explanations.

The isolation caused by the COVID-19 pandemic may have led to more people using illegal drugs without someone nearby to administer Naloxone in the event of an overdose.

Another possibility is the presence of extremely lethal synthetic opioids such as carfentanil, a synthetic opioid far deadlier than fentanyl, which already is highly lethal. Illicit drugs have always been dangerous, but they are now more deadly than ever, are difficult to detect and are found in counterfeit pills and cocaine.

We also know that in general individuals who overdose have other substances in their system, including alcohol.

[Editor’s Note: BHDDH has recently launched a new online advertising campaign, produced by Duffy & Shanley, to get people to think about the potential life-threatening consequences of using illicit substances that may contain fentanyl. The campaign was pulled after criticism about the content.]

ConvergenceRI: In the most recent edition of ConvergenceRI, Ian Knowles of RICARES talked about the lessons learned from the recovery community around change and transformation. Have you read the story? Do you believe that Knowles’ observations could provide great value to the Governor’s team in thinking about the post-pandemic world? What is the best way to make such observations part of the conversation around economic “recovery" in RI? [See link below to ConvergenceRI story, “When radical change, connectedness and hope converge.”]
POWER: Yes, I read and appreciated Ian’s commentary. I have witnessed the transformational changes we see in individuals who find their path to recovery. I have met countless people in recovery who are simply inspiring and their experience can certainly inform the reopening of Rhode Island.

We are actually striving to have this conversation with the Governor’s Overdose Prevention and Intervention Task Force and the Governor’s Council on Behavioral Health. The Task Force is built on four major pillars: Rescue, Prevention, Treatment and Recovery. It is based on the belief that in order to find sustainable recovery, people need basic supports that only a community can provide.

ConvergenceRI: In your statements, for the first time, when you became director, I heard you include “alcohol” related substance use disorders as a key problem to be addressed by the Governor's Task Force. Does that require new data constructs around the metrics of substance use disorder treatment and recovery in Rhode Island?
POWER: Yes. There are as many people in treatment for alcohol as for opioids within the continuum of licensed behavioral health care providers. Many individuals also have poly-substance issues that include one or both of these substances. In addition, alcohol sales have dramatically increased during COVID-19, which in combination with isolation and quarantine can create further emotional complications.

ConvergenceRI: Have you had any conversations with Dr. Megan Ranney around her efforts on coordinating research into gun violence as a public health and behavioral health issue, particularly around domestic violence?
POWER: I have not had the pleasure to meet with Dr. Megan Ranney on this issue. The state did revise the “It’s OK to not be OK” campaign to focus on domestic violence for a one-month period during the height of COVID-19 isolation.

ConvergenceRI: The rapid adoption of telehealth by the behavioral health community has changed how services are being delivered, in a positive manner, according to a number of service providers. How involved are you in discussions with the R.I. General Assembly and with the R.I. Office of the Health Insurance Commissioner to push for the legislative change to make that a reality?
POWER: BHDDH has been in conversations with EOHHS/Medicaid, OHIC, state Sen. Joshua Miller, U.S. Sen. Sheldon Whitehouse and our licensed providers and community members around telehealth.

We support the goal of continuing telehealth because our clients and providers have found it to be extremely helpful. Telehealth is helping providers reach more people and accommodate their schedules and limitations in terms of work hours, childcare and being able to travel to appointments.

Making telehealth a permanent part of our health-care landscape will require some changes in policy and potentially some legislative changes, which are being proposed.

[Editor’s Note: In a surprising move, the Rhode Island Business Group on Health has declared its opposition to legislative changes to make telehealth insurance reimbursements more permanent.]

ConvergenceRI: One of the areas that has drawn less attention than it might need is the PTSD that health care workers on the front lines are experiencing in relationship to patients dying in hospitals and nursing homes. Is BHDDH designing any interventions around those needs? What are they?
POWER: Yes, we have provided support through a RIEMA grant to add phone screeners to the BH Link help line. We are also funding support groups for the hospitality and medical industry at our recovery centers, and we are funding translation, interpretation and outreach to non-English-speaking communities to make sure they can access the support they need.

In addition, we have been in conversations with Lifespan and Care New England, offering support for their help line, which is a statewide resource for health care workers.

ConvergenceRI: What kinds of coordination is happening between BHDDH and health equity zones in RI around data collection, if any?
POWER: The Rhode Island Regional Prevention Task Forces have collaborated extensively with the health equity zones around substance use prevention and mental health promotion activities, particularly related to opioid overdose prevention. There has also been data sharing between BHDDH and the HEZs around behavioral health issues, though this has not necessarily been linked specifically to COVID-19 and the pandemic.

ConvergenceRI: What haven't I asked, should I have asked, that you would like to talk about?
POWER: The impact on our developmental disabilities population was considerable, and we have yet to fully realize the behavioral health impact. Looking at the sequela of previous adverse effects, we know mental health issues may come to the forefront.

We have found great success with our mental health and substance use diagnosed population, specifically by reaching out to those sheltered in their homes by using telehealth/telephonic services. This has helped us to realize that we need to develop solid guidelines around these services, and hope that there will be extended waivers for telephonic services.

Moving forward, we have also begun to think differently about our approaches with prevention and methadone. Our new policy changes need to reflect the more permissive actions that have been allowed during the COVID-19 pandemic.

I would also like to talk about housing issues, which are always front and center at BHDDH. Having a home in a community, having a place to put down roots, is essential. It is a stabilizing factor in everyone’s life, especially for individuals with differing intellectual or developmental abilities, or mental health conditions and/or substance use disorders.

Stable housing for individuals increases their opportunities for greater independence and greater self-sufficiency, which is one of our primary departmental goals. Our Department has long been a proponent of housing initiatives and our commitment is reflected in our work and through our numerous partnerships with the Office of Housing and Community Development, Rhode Island Housing and many advocacy organizations.

Individuals who need our assistance because of depression, or bipolar disorder, or anxiety, or substance use disorders also need hope, and housing is a critical part of providing hope. Homelessness itself can create or exasperate behavioral health conditions, and behavioral health conditions themselves can be a contributing factor in the experience of homelessness.

Our commitment is focused on community integration across all populations, with the goal of placing people in a community with the supports they need so they can enjoy a healthy, safe quality of life.

Finally, I’d like to touch on prevention. When we have dueling or competing pandemics, we are disproportionately affected across the general population, but also across the populations that we serve – individuals who often are medically fragile, who often are socially marginalized, and who have mental and substance use, co-occurring conditions or have standalone mental and emotional problems or substance use and addictive disorders.

We’re particularly concerned because we have to ensure that individuals who have these conditions have access to services and can stay in connection with the services that will help to ease their way through this very stressful period.

There’s a lot of information available in terms of what people can do to try to maintain their sense of control, and that is probably the most important thing. They can avoid watching or reading too much news, have an exercise plan, learn how to meditate, learn how to get outside and get some fresh air, make a plan for eating the right foods, avoid alcohol and drugs and tobacco if it’s possible, and make sure they have a plan to at least connect with someone by phone or computer and take time to do things that they enjoy.

Beyond accessing needed services, there are steps that we encourage people to take to monitor and understand their mental health. We’ve seen over multiple disasters from a behavioral health standpoint that people are much more adaptive and much more resilient than they give themselves credit for.

They face these disasters and say “Oh my gosh, I’ll never get through it, I don’t know what I can do.” Yet, in the long term, they are profoundly more capable and inventive and much more creative than they expected. The human spirit is often galvanized by surviving arduous events.