Rhode Island’s largest psychiatric – and substance abuse treatment center: The ACI, by the numbers

Last week, a spokesperson for the Rhode Island Adult Correctional Institutions (ACI), Kaitlyn Bouchard gave some startling statistics during a radio interview – common information for some, but revealing for others. As the month of May, Mental Health Awareness Month, comes to an end, these statistics are especially poignant, for several reasons. The interview was one of several done by radio hosts throughout the month of May to recognize Mental Health Month.

According to Bouchard (and confirmed with the ACI), the ACI is Rhode Island’s largest psychiatric treatment center – and the state’s largest substance abuse treatment facility. And – between 44 and 48 percent of the ACI population is on psychiatric meds (anti-psychotics, etc.).

When asked if there was a reason she could cite as to how this changed throughout the years, and has gotten to this point she said, with a great deal of surety – “the deinstitutionalization pattern and the closure of the “IMH”.

The IMH was the inpatient psychiatric facility on the grounds of the Pastore Complex known as the Institute for Mental Health.

We went to the ACI to confirm Bouchard’s facts and to ask for more of a drill down of statistics. Here is what we learned:

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From J.R. Ventura (Jhomphry Ventura), Chief of Information & Public Relations Officer

“Yes, all those are facts…” [about the ACI being both the largest psychiatric treatment center – and the state’s largest substance abuse treatment facility. This is something seen across the nation with the largest psychiatric treatment provider in the country being the California Penal System and the largest single treatment provider being Cook County Jail in Chicago.

Also, 7-10% of our population being SPMI [Severe and Persistent Mental Illness, a clinical diagnosis], and we also have 35%-40% receiving mental Health counseling. There may be overlap between those that are seeing psychiatry and also in mental Health counseling, and we consider SPMI to usually need both.”

As of today, there are 174 SPMI patients in custody with a census as of this moment of 2,349. As of today, by facility:

[As of] May 22, 2023: 174 SPMI with census of 2,349

• HS (High Security) – 20 (80- 7 in RTU [Residential Treatment Unit])
• ISC (Intake Service Center) – 63 (826)
• MAX – 16 (316)
• MED – 47 (825)
• MIN – 9 (177)
• WF (Women’s Facility) – 13 (124)

As of Jan 9th, 2023, the date of most recent complete review of the behavioral health caseload, we had a census on that date of 2,303 and the following clinical caseloads:

169 total SPMI, or 7.34% 

1,015 in active psych treatment, or 44.1%

693 in MH counseling, or 30.1%

When we factor in MAT (Medically assisted treatment [suboxone, methadone]) services for the substance abuse component, we also were able to provide the numbers of individuals involved with mental health as defined by SPMI, or on the psychiatry caseload, or on the clinical therapy caseload or on MAT, without double-counting anyone (as patients may be on more than one caseload, causing overlap).

This data is as follows by facility with the number receiving one of the 3 services, the facility census and the percentage of the facility receiving psych, clinical therapy and MAT treatment services:

ISC 419/813 = 52%

MIN 61/142 = 43%

MED 458/853 = 54%

MAX 185/305 = 61%

HSC 66/81 = 81%

WF1 95/114 = 83%

Overall = 1284/2308 = 56% of the incarcerated persons housed at the RI Department of Corrections were receiving either psychiatric treatment, clinical therapy, or MAT treatment. 

As for staffing: The Behavioral Health Unit consists of thirteen (13) qualified mental health professionals including LICSWs, LMHCs and master’s level clinicians under the supervision of a Clinical Director and a Clinical Supervisor. These qualified mental health professionals are assigned to facilities, and the number of staff assigned to each facility is based upon the population and needs of that facility. 

We operate a Residential Treatment Unit (RTU) that provides specialized clinical services to the severely and persistently mentally ill who require a higher level of care and this Unit has intensive group and individual therapy. A psychiatric occupational therapist provides specialized services to patients housed in the RTU as well as housed at the High Security Center. 

The Behavioral Health Clinicians provide on-site clinical treatment services seven (7) days per week on first and second shift. Twenty-four hour on-call emergency coverage is provided for additional clinical support. 

Evidence-based treatment interventions are employed by all QMHPS with mental health services available for all incarcerated persons who require them at any point in their incarceration. Individual therapy and group programming are provided based on level of clinical need presented by each patient. 

PSYCHIATRY SERVICES:

Rhode Island Hospital Department of Psychiatry has provided services to the jailed and sentenced population at the R.I. Dept. of Corrections (RIDOC) since 2006. Daily (Monday-Friday) on-site evaluations and treatment services are provided as well as at least one weekend clinic at the Intake Service Center and on-call services 24/7 including weekend and holidays.

On-site clinical coverage is provided on a weekly basis as well as HIPAA compliant telehealth visits as an adjunct to on-site treatment. 

Court services for the purpose of seeking Petitions for Instructions and Civil Court Certifications are provided for patients in the provider’s care as necessary. 

Clinical coverage is determined for each facility based upon level of need and population served. As of April 1, 2023, there are 88 clinic hours per week across all facilities, broken down as follows:

• Intake Service Center- forty-eight (48) clinic hours per week with one additional 4 hour clinic once per month on a weekend day for one week with 52 hours of clinic coverage. 
• Minimum-  four (4) clinic hours per week
• Medium- sixteen (16) clinic hours per week
• Maximum- four (4) clinic hours per week
• High Security- eight (8) eight clinic hours per week
• Women’s – eight (8) clinic hours per week

The current staffing for the psychiatry contract consists of a full-time PCNS who provides forty (40) hours per week of clinical services to the Intake Service Center; four psychiatrists, three of whom provide eight (8) hours per week of clinical coverage and one who provide twenty (20) hours per week of clinical coverage. A Forensic Fellowship program with Lifespan and Eleanor Slater Hospital provides two forensic psychiatry fellows per year who each provide eight (8) clinic hours per week. Additional providers conduct a rotation for weekend clinic coverage for four (4) hours on one weekend day and all providers are in a rotation for on-call coverage.

We thank the RI DOC’s Ventura for this complete and detailed breakdown.

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Deinstitutionalization Timeline:

According to the BHDDH website, here are some relevant dates and how services were moved –

1960: Governor John Notte formulated a plan to place the General Hospital and State Hospital for Mental Disease under one Superintendent, creating a “Medical Center.”

1962: The General Hospital and State Hospital for Mental Disease merged to become the Rhode Island Medical Center. Both facilities were accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 1963.

1963: Barry Hall was rededicated.

1967: The Medical Center was divided into The Center General Hospital and Institute of Mental Health. Both hospitals were administered by a new State department; Department of Mental Health, Retardation, and Hospitals (MHRH).

1970: Through deinstitutionalization, many hospital residents from the General Hospital and Zambarano (as well as patients at the Institute of Mental Health) were discharged and placed in “community settings.”

1970: Deinstitutionalization of the Ladd Center was in progress. Overwhelmingly, bond issues passed for the State to purchase and renovate homes in the community for developmentally disabled citizens

1977: The Institute for Mental Health was divided into nine units to deal with specific regions, and categories of patients.

1980: In addition to treatment and counseling, community services for persons with mental illness expanded to include residential services, employment programs and other services.

1986: On July 30, Governor Edward DiPrete announces his intention to close the Joseph H. Ladd School.

1994: The last five residents of the Ladd Center moved into group homes, and the institution closed.

1994: The Institute of Mental Health, the Center General Hospital and the Zambarano Memorial Hospital united to become the Eleanor Slater Hospital. Hospital psychiatric services were provided at the Adult Psychiatric Services Unit, as well as the Psychogeriatric Unit of the hospital. Admissions were streamlined to include individuals in need of long term, hospital-level care.

2000: The Division of Substance Abuse was transferred to MHRH from the RI Department of Health. Mental health services and substance abuse services merged to form the Division of Behavioral Healthcare.

More deinstitutionalization

One of the keys to closing of the Institute of Mental Health was a multi-part series by the Providence Journal. The public outrage demanded a revamping to long-term institutionalized care. As the IMH was eventually closed, day programs such as the New England Fellowship for Rehabilitation Alternatives opened that allows both group homestyle housing and places for people to go during the day. Day programs included medication monitoring, counseling, job skill training, socialization, and assistance with food preparation and daily life skills. As the day programs closed, the chronically mentally ill and those addicted to drugs were now on the street or depending on social service programs centered around housing and economic need, not mental health or substance use support. Also key were a series of Community Mental Health Centers where people could go for support services.

Office of Mental Health Advocate

The Office of the Mental Health Advocate was created in 1975 when the Mental Health Law of Rhode
Island was revised to reflect the national movement toward deinstitutionalization of mentally ill
individuals and protection of civil, legal and liberty interests. This movement, begun in the 1950s,
became a centerpiece of public policy in the 1970s after the United States Supreme Court declared that
all states must provide Constitutional Due Process and legal counsel to individuals subjected to
involuntary hospitalization. The statute authorizing the Mental Health Advocate is codified in R.I.
General Laws § 40.1-5-13 through § 40.1-5-25

The agency’s mission is to ensure the legal, civil, and special rights of people with mental illness in Rhode Island. To protect the liberty interests and treatment rights of individuals subjected to involuntary commitment and to the involuntary administration of medication in psychiatric facilities, including penal inmates.