In 2003, Kathryn Power left her position as Director of what was then called MHRH (now BHDDH) to work with the Substance Abuse and Mental Health Services Administration (SAMHSA) at the federal level. After retiring from this position at SAMHSA, Director Power chose to return to her position as Director of BHDDH. In this interview, Director Kathryn Power discusses how the behavioral health landscape has changed since she previously served as Director, her vision for prevention in Rhode Island, and her views on the important work that prevention providers are doing in the state.
In January, you accepted the position of Director of BHDDH. Previously, you were in a similar role as the Director of what was then called MHRH (Department of Mental Health, Retardation, and Hospitals). What prompted you to return to a similar position in Rhode Island?
I started as Director of MHRH in 1993 and I worked there for ten years. In 2003, I left that position, and for the last 15 years, I have been working with the Substance Abuse and Mental Health Services Administration (SAMSHA). After serving at SAMHSA, I retired from federal service and the Governor asked me to serve as volunteer Chair of the Governor’s Council on Behavioral Health (GCBH). I started as Chair of GCBH in October, but in December, the Governor asked me to return to former role as the Director of BHDDH because the director who preceded me was transitioning into another position. I agreed to return as Director of BHDDH for a limited time and I am delighted to be back as this is a very important department.
How has the role as Director changed in comparison to your previous experience? How has the behavioral health landscape in Rhode Island changed?
There have been many significant structural changes in terms of the overall healthcare delivery system in the state. There are fewer hospitals now, there were no managed care organizations (MCOs) when I previously served as Director, and the state had not yet created the Executive Office of Health and Human Services. Furthermore, the state is now a payer of expanded Medicaid services, which has resulted in a shift in terms of the services for which Medicaid will pay. In terms of departmental changes, BHDDH is half the size it was when I previously served as Director, which is partly because a number of functions were centralized under the Department of Administration. This has resulted in some shifting in terms of what I specifically control.
The behavioral health landscape has changed enormously since 2003. Firstly, there is much broader education around the importance of behavioral health, and I think the general population better understands the connection between mental health and substance use conditions. Certainly, the opioid epidemic has contributed to that shift in awareness, but there has also been a shift in terms of recognizing the significance of understanding our own mental and emotional well-being. There is much more openness around talking about behavioral health and seeking assistance when concerns arise, and I think there has been a tremendous push to better understand the congruence of mind and body. As a state, we have really come to understand the significance of the mind-body connection and many healthcare practices now have an integrated approach to assessing individuals in terms of behavioral health and physical health. Another critical change is that there are now more behavioral health providers in the state. Previously, we had only eight community mental health centers, but we now have over 30 different behavioral health providers. These changes have made an enormous difference in terms of the behavioral health landscape. I feel that the state is ahead of the curve in many ways regarding positive shifts in the behavioral health landscape. I think this is because culturally and historically, Rhode Islanders have always been very committed to understanding how to care for themselves and their families, and this has led us to cultivate a more prevention-minded society focused on optimizing well-being.
Do you have a vision for prevention in Rhode Island? If so, could you tell us a bit about your vision for prevention?
During my time at SAMHSA, I briefly served as the head of the Center for Substance Use Prevention, which is the national federal agency leading prevention strategies. In Rhode Island, we endorse the six strategies outlined by the Center for Substance Use Prevention as part of our vision for prevention. Firstly, we focus on information dissemination. We want people to understand what is preventable as well as the levels and forms of prevention. Secondly, we emphasize prevention education as we want to ensure that people are educated regarding the problems that can arise from particular lifestyle habits. Our third strategy is to help people understand that there are activities we can do to socialize and feel better that do not involve substances. Our fourth strategy is identification and referral. We need to be able to identify behavioral health problems in early stages and appropriately refer people to services that can help them. Our fifth strategy emphasizes strengthening community-based processes. We need to support communities so that they can provide appropriate and effective prevention services informed by community-based data. Lastly, our sixth strategy focuses on identifying environmental approaches to improving social and physical environments so that people feel safe within their communities. Using this strategy, we aim to get a sense of things like the number of liquor stores within a community, the frequency at which cigarettes are being bought, or the prescribing rate for opioids. Understanding these things helps us to more effectively target prevention messaging within communities. I think all states should adopt these strategies, and we have done an excellent job of doing this in Rhode Island.
What do you think are some of the most pressing behavioral health challenges in Rhode Island right now?
Clearly we are in the midst of the COVID-19 pandemic and the opioid epidemic. Both of these epidemics are influencing how we are currently reacting to our environment, and they each bring their own set of behavioral health challenges. Broadly speaking, one of the behavioral health challenges in any modern society is isolation. With COVID-19, it is difficult to socially distance ourselves, but we need to find ways to keep from feeling isolated. I think COVID-19 and the isolation that it brings contribute to the general behavioral health challenge of being self-aware about the choices that we make and their effects on our
behavioral health. Self-awareness is a constant behavioral health challenge for all of us.
Another behavioral health challenge is that we need to recognize the signs of self-harm and self-doubt. We have to try to understand how to stay hopeful and make sure that we are doing things to help us stay connected. We are adjusting to a new normal, and we need to define this new normal for ourselves so that we can better understand and prepare to deal with the emotional health issues with which we may be dealing during this time. The more we can focus on recovery, and prevention being a part of recovery, the better off we will be. At BHDDH, we see these behavioral health challenges very realistically, but I also believe that we are much more resilient and adaptive than we think. It is important that we give ourselves permission to recognize our resilience.
How can prevention providers within the community help you and BHDDH to address these challenges?
First of all, I want to thank all of the prevention providers because they are front and center doing incredible work. The Regional Prevention Coalitions and Rhode Island Student Assistance Services are doing profound work and they are so committed to prevention messaging. People sometimes have to hear something multiple times before it sticks, so I encourage prevention providers to continue regularly delivering the message that we need to prevent and promote. Additionally, prevention work is not static. There will always be another iterative problem that will arise, and we will need to target prevention messaging to address that problem. Vaping is a perfect example of this. The prevention providers have mobilized around the vaping crisis, but another behavioral health concern will eventually come about and we need to work to stay ahead of it.
The prevention providers represent what can be done in terms of strong prevention messaging. They are bringing hopeful messaging to students, helping parents guide their children through questionable decision-making periods, helping schools understand their role in prevention, and helping to inform and organize community advocates. All of this work helps the Department in actualizing our mission. Vice versa, I see my role as supporting the prevention providers. It would be wonderful to gain some additional supports for the prevention community, as resources are very limited. Prevention providers do an incredible job of identifying potential prevention programming and resources for their communities, but my job is to find financial support for these initiatives. Currently, we are working to figure out how we can use some of our substance use opioid monies to help fund prevention messaging. We also just received a SAMHSA grant to help fund our COVID-19 response efforts and we are exploring opportunities to do some prevention work through this grant. I see the Department as having a mutual relationship with prevention providers. The prevention providers are supporting the BHDDH mission, and in turn, I hope that this department is supporting them to the fullest extent possible.
Are there any messages that you would like to share with prevention providers in the state?
Prevention providers are the backbone of our healthcare system. The fact is, we need to start with prevention messaging and we should start at a very early age. At SAMHSA, we always said, “prevention works,” but we always struggled with funders asking us to tell them how it works. It is difficult to capture this type of cause and effect data, but it is necessary to illustrate how investment in prevention programs can mitigate certain outcomes. We always have to look to prevention providers to help us describe these impacts. I think we are getting a better sense of how to capture this data, but we need to be as methodical as possible, and this is something that I would like prevention providers to think about.
I value the prevention providers, and I think they need to be embedded in the healthcare system to a greater extent. We do not have enough prevention professionals sitting in medical practices or hospitals. We need more prevention professionals in the healthcare setting or in other settings so that they can inform prevention across all sectors. We need to continue expanding opportunities to ensure a higher level of prevention professional engagement in a host of different locations because prevention is worth its weight in gold.
