After a tumultuous few months, the mental health system in Maine will have new life breathed into it in the person of Robert Jay Harper, a former patient advocate with the Disability Rights Center, who was recently named acting superintendent at the Riverview Psychiatric Center, the state-run mental health hospital in Augusta.
The hospital lost accreditation in October, losing nearly $20 million dollars in federal funding from the Centers for Medicare and Medicaid Services (CMS) after surveyors found issues with safety and patient rights. The system has had a number of concerns raised about procedure and safety over the years, including a lawsuit in 1989 that led to the creation of a consent decree that is still in effect today.
Under Harper’s leadership, the state hopes that the federal funding will soon be reinstated and the former mental health advocate will bring new direction to the embattled system, one that will last well beyond his time in the leadership role.
Harper spoke with New England Psychologist’s Catherine Robertson Souter about his new position, his goals and what he sees for the future of the facility and for the future of the mental health system in the state.
Q: How did your career path, which has included advocacy as well as state government positions, lead you to this role?
A: My basic background is in strategic planning, measurement, performance budgeting and contracting, what we call performance management skills.
I was an administrator at Danvers State Hospital in Massachusetts and came to Maine as the director of Adult Community Mental Health. I went back to get a Master’s degree in psychology and was hired by the Disability Rights Center which were the advocates but also the plaintiffs in the consent decree case.
I had retired from the advocacy role and the Commissioner asked me to come in for some discussion about some things I thought were going on, sort of an extended exit interview. I was asked to come back and be acting superintendent and try to implement some of the ideas we had talked about. My retirement lasted 70 days.
So I came here as an advocate but I honestly think that one of the ways that I have always viewed the concept of service is basically advocacy. You are trying to keep people whole and deal with who they are and institutions should not be running around fixing people or making them normal but rather allow the person to prescribe their own direction.
Q: You are “acting” superintendent only. How long do you plan to be there?
A: The challenge is how to stay in an organization long enough to have an effect and establish a sense of continuity and then decide whether and when it is time to leave.
I did indicate to the Commissioner that at some point I really would like to retire.
Q: Basically, Commissioner Mayhew brought you on board because you were able to look at the system from the other side and bring a different perspective?
A: Getting people at the table and feeling empowered to speak and how they experience the situation both doctors and patients is the way you get the real view of the health of the organization and the depth of its resources in order to make a change.
And we are making pretty significant changes here, going from a well-established, medically driven model with the classic type of ancillary services around it and then saying that we are going to be very recovery focused, holistically from the perspective of the patient. People are not used to, in the psychiatric field, patients dictating what their choices are going to be and honoring their choice of saying, “I am not wanting to do medication at this point of time. What else can I do?”
I think of it as more the way we are going as a society. I think we are moving the community psychiatric discussion into what has become more of a mainstream discussion in the medical field.
My sense is that the hospital was beginning to move in that direction. But my charge was to hit the ground running and we are moving pretty quickly.
Q: Is that your main focus or is it about getting the federal funding reinstated?
A: I think it is all one package. It is problematic for us to get ready for CMS to come back and re-certify us and get the funding back and then to go do something different with this recovery model. The solution to recertification is that we move quite overtly into the recovery model and that we pay much more heightened attention to issues around client rights. Coming from the advocate role, I am hypersensitive to that and can cue up on those issues very quickly.
Q: How did we get here that, in 2014, we are re-writing the whole system?
A: I think part of it is an organizational environment and philosophy. The thing I am finding most interesting here, and a challenge for me, is to say to people, “When you make a change think about it in terms of what you are trying to accomplish and tell me how you are going to measure the results.”
I think that is what caused some of the problems; we kind of just continued on and things just slowly got away and we didn’t have our own set of traffic lights saying, “Stop here, make a turn.”
Q: How do you set the facility up so the forward momentum keeps going, especially if you are not going to be there for the next 20 years?
A: First of all, we have performance measures built right into the organization and everybody starts asking the question, “How do I measure if I am making a difference?” Think of it as an investment. I have public funds and I’m trying to get value for what I put in here so how do I measure that I get a good rate of return?
I think once that culture change occurs and hopefully it drills down deep enough into the organization that everyone thinks that way, whether it is a one-on-one interaction or at a unit level or whatever, that will be a better management and treatment culture overall.
Q: Finally, congratulations on your new position. It must be an exciting, if demanding, role to step into.
A: I have always known that these are very dedicated people that are fun to be working with. And the clients are very caring people who are facing psychiatric challenges. In fact, there is not really much difference. We all have same goals: we want quality of life, to have fun in our life, to find friends and partners, to find a job that makes us feel worthwhile from a social perspective.
I have always felt at home with whatever side of the facility I am working in and right now, I am having fun and I’m trying to get people here to lighten up a little bit. I think one of the problems is that after you go through a number of events, you start looking for the next shoe to drop. I keep saying, “If it is going to drop, it is going to drop and there is nothing you can do about it except do your best.” Your best means you have to be positive and enquiring and learning oriented and do it that way.
By Catherine Robertson Souter