Removing stigma: A name change for RI's behavioral health system

Contributed by Ed Allard, FRN Communications Representative

Craig Stenning, Director of the newly renamed 
Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals 

In March of 2009, Rhode Island Governor Donald L. Carcieri congratulated Craig Stenning for his unanimous confirmation by the Rhode Island State Senate as Director of the Department of Mental Health, Retardation, and Hospitals (MHRH). Mr. Stenning had been serving as Acting Director of MHRH since June of 2008.

“Craig has served the public with great distinction throughout his entire career,” said Governor Carcieri. “As the founder of the CODAC Treatment Centers, Craig changed the way we care for and treat individuals with substance abuse and mental health issues. His commitment and passion to improving the lives of others is inspiring.”

Earlier that same month, Governor Carcieri had joined forces with the Special Olympics and Best Buddies to ban the word “retard” from everyday speech. Designating March 3, 2009, as “Spread the Word to End the Word Day,” Governor Carcieri and Mr. Stenning then began the process of renaming MHRH, removing the “R-word” from the Department’s name. “The stigma and misunderstanding of intellectual and developmental disabilities is an ongoing challenge,” said Mr. Stenning in a news release about the desire for the name change, “which is why the Department supports the need to remove the word from our official Department name.”

Fast forward to July 2010. The Department of Mental Health, Retardation, and Hospitals introduced itself on the World Wide Web as the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH). As quoted on the Department’s new website, Mr. Stenning states, “the name change continues our fight against the stigmatization of people with developmental disabilities, mental illness, and substance use disorders and addictions.”

Mr. Stenning began his state career in January 2000 as the first Executive Director of Behavioral Healthcare Services. Prior to joining state government, Mr. Stenning began his professional career in 1969 as Director of the Cranston Law Enforcement Planning Agency. In 1971, he started CODAC Treatment Centers, and served as its CEO for 28 years as it became the state’s largest outpatient program. His work in substance abuse treatment and prevention has earned him numerous state and national awards, including the prestigious Nyswander/Dole Award for outstanding contributions in substance abuse treatment at the national level. (Rhode Island Government website)

Earlier this summer, Ed Allard, FHR Communications Representative, had the opportunity to interview Director Stenning. “Mr. Stenning has a long history of service to the community,” Ed said. “I was interested in finding out his philosophy on being a community provider over the past three decades. I was not surprised to hear that Mr. Stenning has always put the consumer first, and wondered, ‘How does this work out in the community? How does it affect individuals rather than spread sheets?’”

Ongoing budget cuts to the Department by the State of Rhode Island, amounting to between three and eight percent per year, have certainly presented challenges to keeping the consumer first; however, Mr. Stenning noted, “with every problem there is an opportunity.” “In years past, we made the effort to look at every dollar, to make cuts that would not affect programs and services. Later, as this became more and more challenging, we used other approaches,” said Mr. Stenning. Under Mr. Stenning’s leadership, the Department acquired a number of large federal grants to fill in some of the gaps, so as not to disrupt services. He stated his goal was to see to it that we served just as many people despite budget cuts. “Maybe everybody doesn’t get a Lexus,” he said. “But they do get a Ford.”

“We did the really difficult work of looking, in-depth, at how the money was being spent out in the community to see if we could reform the way we spend. The goal was to make sure that no matter who walked through the door of an agency, they would receive the appropriate level of service to meet their needs,” said Mr. Stenning. “We’ve basically been trying to reform the safety net given the dollars we have, as opposed to just cutting rates or cutting off eligibility. We have not adopted an ‘it’s our way or no way’ attitude.”

Budget cuts are not the only negative aspect to the everyday operations of the BHDDH. “I think when economic conditions get difficult, issues of stigma get more entrenched,” said Mr. Stenning, referring to the topic of stigma in the world of mental health and disabilities. “More and more often today there is a lack of acceptance for individuals with disabilities who have legitimate needs. In its worst form, I hear some people say that it is some kind of life choice made by these individuals. Part of my job is to continue to fight against stigma and educate as to the need for services, despite the sometimes high cost associated with treatment.”

“We’re not a benefits system like Welfare or Food Stamps,” he continued. “We are a service delivery system, meaning that you receive services if you need them, and you don’t receive services if you don’t need them. It’s not something you become ‘eligible’ for.”

Throughout his lengthy career, Mr. Stenning has advocated the move to a recovery-based model in behavioral health. “The idea is that people change, they do recover, and the service system needs to change with that.” A recovery model allows for hopes and dreams. “There are a lot of subtle things connected to recovery,” said Mr. Stenning. “Self-determination, empowerment, and choice are powerful tools in living a healthy life.”

Feeling that it is wasteful to give people a regimen of treatment if, after that treatment the individual has no place to live and nothing meaningful to do for employment or education, Mr. Stenning and the Department invested in the “Housing First” approach. “A discharge plan to a shelter is not a discharge plan. It is not treatment and it often leads to a repeated cycle of hospitalizations and homelessness,” he said. The “Housing First” approach allows people on the path to recovery to find safety in the simple basic need of having a roof over their head.

According to Mr. Stenning, this approach has a 70% success rate at getting people engaged in treatment, at a cost of $8,000 less per person, receiving that treatment. At present, the “Housing First” approach has led to 120 units of housing in the state, and has given housing vouchers for initial deposits to 670 people. His staff is currently working on an “Employment First” model.

Another milestone of pride for Mr. Stenning includes his involvement in the Department’s behavioral health disaster team, created in 2000 by former Director A. Kathryn Power. At present, the team has 450 members and is purely voluntary. “No one gets extra pay for the work,” he said. “It’s part of what we do and probably some of the best work that we do. After a disaster, there’s an emotional aftermath, the human aspect is often overlooked.” The team provided treatment within the community following September 11, 2001, the Station nightclub fire, and, most recently, with the massive flooding Rhode Island experienced earlier this year.

With its new name, Mr. Stenning intends to keep the momentum moving forward. “Some have discussed merging our Department with other systems such as Welfare,” he said. “This concerns me. Much of what we do is unique, and we should not compress our services into a benefits system. We are a service system, and part of the way I keep my own mental health in my role as Director is to get out of the office and into the community to visit with people, including those receiving our services, as well as the staff members that work so hard on the consumer’s behalf. Any time I can do that, it is a better day for me. The staff and the consumers serve as an uplifting reminder as to why I got into this line of work.”

The Department is planning a public celebration in recognition of its name change later this year.