After retiring from a long and successful career as a healthcare executive, Richard Charest accepted the position of Director of the RI Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH) in June, 2021. In this interview, BHDDH Director Richard Charest discusses his vision for prevention in Rhode Island, some of the ways that Rhode Island prevention providers are currently helping BHDDH to address pressing behavioral health challenges, and his commitment to supporting a strong prevention infrastructure in order to develop, maintain, and ensure a solid foundation for prevention work across the state.
In June 2021, you accepted the position of Director of the RI Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH). Could you start by telling us a bit about your professional background and what led you to this role?
I received a Bachelor of Science in Pharmacy from Northeastern University and a Master of Business Administration in Health Care Administration from Bryant University. My career as a healthcare executive spans many years, leading not-for-profit and for-profit community hospitals with tertiary programs, as well as a for-profit specialty hospital and a private equity healthcare company. These experiences have given me a diverse management background with extensive turn-around experience.
After a successful career, which included the turnaround of Landmark Medical Center from insolvency in 2014, I retired in 2017. Governor Dan McKee approached me to help with the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, and, wanting to give back, I accepted. I was confirmed by the Senate in June 2021.
What are some of the key priorities for BHDDH under your direction?
BHDDH provides and supports services for people with mental health and substance use conditions, people with developmental disabilities, and people who need care in the state hospital system, which is known as Eleanor Slater Hospital. Our efforts impact many people and we deal with a wide range of concerns every day.
In our Division of Behavioral Healthcare, one of our priorities is to expand the availability of community-based mental health services. A big part of this is to transition from a Community Mental Health Center model of care to a Certified Community Behavioral Health Center model, which will enhance our ability to provide behavioral healthcare in community-based settings by ensuring access to integrated and evidence-based mental health and addiction services. This will better serve the people who need help and will reduce the number of people needing state hospital services.
In our Division of Developmental Disabilities, we continue to address issues raised in the 2014 Consent Decree. The Consent Decree requires the state to take specific steps to improve services for individuals with developmental disabilities, including services for integrated day activities and supported employment. We have made progress, but there is more work to do and there are targets that we must meet by 2024.
At Eleanor Slater Hospital, there has been tremendous change since my arrival at BHDDH one year ago, and there will be more as we continue to ensure the hospital has everything it needs to provide the best treatment and care for the Rhode Islanders who need its services. The hospital’s first priorities are patient care and patient safety, and toward that end, we have addressed many longstanding issues in areas ranging from patient care to policies to maintenance of buildings and facilities. We are also seeking final approval to relicense the Roosevelt Benton facility as a standalone psychiatric hospital. The Benton facility now operates as part of Eleanor Slater, but under a separate license, it will be subject to standards and regulations more appropriate for a psychiatric hospital. Operating Benton under a separate license will also better position Eleanor Slater Hospital to seek federal reimbursements that can help cover the cost of patient care. Beyond these efforts, we are also planning for the future of the hospital. The FY23 state budget approved by lawmakers includes $170 million in capital investments over the next several years, as recommended by Governor McKee. This plan includes new construction and renovations, as well the procurement of an electronic medical records system.
Could you tell us a bit about your vision for prevention in Rhode Island?
Our goal is to promote the use of evidence-based programs, policies and practices that will help to prevent the onset of substance use disorder; prevent the use, misuse and first use of substances; and promote healthy lifestyles and well-being among individuals, families and communities, among people of all ages. This involves the work of people across a wide range of state and local stakeholder groups, with BHDDH providing resources and leadership to help with these efforts. Our prevention strategies, endorsed by the Center for Substance Use Prevention, include information sharing; prevention education; social and recreational events that exclude substance use; problem identification and referral; community-based prevention services; and “environmental approaches” that limit product advertising and provide training for retailers and adults, with the aim of preventing substances from getting into the hands of youth and individuals under the legal age.
What do you think are some of the most pressing behavioral health challenges in Rhode Island right now? How can prevention providers within the community help you and BHDDH to address these challenges?
One of our most pressing challenges is the mental health of young people. The COVID pandemic has intensified mental health struggles that were already widespread among teens. There have been significant increases in self-reports of depression and anxiety, along with more emergency room visits for mental health across the country and here in Rhode Island. Young people are bombarded with messages through the media and popular culture that can erode their sense of self-worth. Online interactions do not satisfy core needs for connection, creating feelings of loneliness, which is a key predictor for depression and suicidal ideation. Now more than ever, we need robust approaches that support the mental health of young Rhode Islanders.
One way we are addressing this is through the Student Assistance Services program, which operates in schools and provides students with easy access to services. This allows for early identification and intervention for alcohol and other drug use-related risk factors. This happens through a variety of activities, including in-school discussions about the risks associated with alcohol, marijuana, tobacco and other drugs; confidential assessments for alcohol and other drug use and other behavioral health problems; individual and group counseling for those living with a parent or caretaker with a substance use disorder; referrals to substance use or mental health treatment agencies; school-wide awareness events; and in-person and online programs for parents.
We also have seven Regional Prevention Task Force Coalitions, which strive to create a community characterized by healthy lifestyle choices and deeper understanding of the complexities of mental health and substance use. The Coalitions provide substance use prevention strategies and mental health resources, and advocate for policies that support healthy and safe communities. The Task Force Coalitions also initiate programs such as Project Sticker Shock, which provides stickers to local alcohol retailers to put on bottles of alcohol to remind buyers that providing alcohol to minors is illegal; and Media Ready, which helps middle school students analyze media messages and recognize unhealthy behavior.
Are there any prevention-specific BHDDH resources or initiatives that you would like to promote?
The Regional Prevention Task Force Coalitions hold Drug Take Back events twice a year for communities to dispose of unwanted prescription medications. The participants include the Drug Enforcement Administration, local and state police departments, tribal police, fire departments, youth and senior centers, and pharmacies, as well as BHDDH. During the October 23rd, 2021 Drug Take Back event, 3,580 pounds of unused or expired medications were collected.
Another resource is the Rhode Island Prevention Resource Center (RIPRC). RIPRC is a resource for substance misuse prevention providers, offering expertise in training, technical assistance and capacity building support. Its goals are to strengthen the capacity of prevention providers and communities to implement current, evidence-based prevention strategies; increase the number of prevention providers who participate in the Rhode Island Substance Abuse Prevention certification system; and foster collaboration between substance abuse providers and across related prevention initiatives.
Also, we offer Student Assistance programs in 31 middle schools and 39 high schools, representing 33 school districts. Master’s Degree level staff use the evidenced-based program Project SUCCESS in each school to provide students with easy access to services. This approach allows for early identification and intervention for alcohol and other drug use-related risk factors, such as drinking at an early age, poor academic performance, tardiness, absenteeism and other behavior problems.
Similarly, is there anything currently happening in the prevention world that you are excited about or would like to learn more about?
Yes, I would like to mention the Prevention Advisory Committee, which is a committee of the Governor’s Council on Behavioral Health. The Prevention Advisory Committee provides recommendations to the Governor’s Council, and those recommendations are integrated into the annual report to the Governor and into the state’s federal block grant application. The committee’s goals are to broaden the focus of substance misuse prevention efforts, integrate partnerships in prevention, reach new populations, improve evaluation and data collection, define prevention within the Affordable Care Act, eliminate health disparities and stigma around mental health and substance use disorders, and coordinate efforts across state departments and community partners. The committee is also committed to strengthening and expanding the prevention workforce in Rhode Island.
The committee members are doing great work in terms of collaboration. They recently held a statewide prevention conference in April called RI-PREVCON. RI-PREVCON 2022 focused on promoting strategies to apply an equity-based lens within collaborative prevention work. The conference was very well attended, with 149 attendees from 42 organizations.
Are there any final messages that you would like to share with prevention providers in the state?
By focusing on the integration of substance use prevention and mental health promotion across Rhode Island’s behavioral health system, BHDDH is developing a stronger infrastructure for increased coordination, collaboration and sustainability on all prevention approaches.
We are currently collecting data, through the 2022 Rhode Island Student Survey, to measure and monitor substance use prevention and mental health promotion at the municipal level. This is used to make data-driven decisions.
BHDDH is taking important steps to cultivate prevention infrastructure to develop, maintain, and ensure a solid foundation for prevention work moving forward.