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MHANYS 2009 Legislative Agenda
Proposed Budget-Related Items:
Legislative Actions:
Issue: The governor plans to cut the state portion of the Supplemental Security Income (SSI) Benefit. SSI provides cash assistance to the aged, blind and disabled, and is administered by the Social Security Administration. New York provides an optional state supplement, which it has not increased in over 20 years. The federal benefit itself is adjusted annually to keep pace with inflationary trends. The budget reduces the 2009 state benefit for SSI recipients living in the community by $24 for individuals and $28 for couples per month. The governor’s budget briefs justify the reduction given this year’s federal portion increase of 5.8 percent. The governor’s proposal would bring the state’s supplement down to $63 for an individual living alone; $8.91 less than the 1986 level. For people unable to work because of a disability, SSI is their total monthly income through which all daily living expenses must be met, including the basics of shelter, food and out-of-pocket medical expenses. Although the federal government has determined an inflationary trend factor of 5.8 percent, New York is proposing to apply a negative 28 percent “deflationary” trend. This proposal is grossly out of step with current economic realities of people with disabilities trying to maintain the most basic, subsistence lifestyle. Ideally, New York would match the federal trend factor adjustment, recognizing the steady increases in living costs each year. But advocates have worked with futility at winning any increase in the $87 state supplement for over 20 years. Now the governor wants to lower it to $63. This is unacceptable. Recommendation(s):
Issue: Establishing Mental Health Parity through the passage of Timothy’s Law represents an historic landmark in the advancement of mental health treatment access. Due to Timothy’s Law, much of the landscape has changed for the positive for hundreds of thousand of New Yorkers with psychiatric disabilities as well as for their loved ones. In December of this year, this legislation is proposed to sunset. As proven over the last two years, the fears of employers and insurers of skyrocketing rates have been completely unfounded. All concerns about the legislation have been addressed and the first two years of implementation have been very successful. There is no reason not to make this law permanent. We need your support and leadership to insure that Timothy’s Law becomes permanent. While making the law permanent we also need to expand its coverage in two critical areas. Unfortunately, Post-Traumatic Stress Disorder (PTSD) is not included among the biologically based illnesses that are covered under the new law. The exclusion of PTSD negatively impacts returning veterans, children and adults who have suffered sexual abuse and many others who have developed this illness due to trauma. PTSD is marked by clear biological changes as well as psychological symptoms. Recommendation(s):
Issue: The 2009 -10 Executive Budget recommends $427 million in cuts to Mental Hygiene that would be achieved through a number of provisions including the deferring of planned cost of living adjustments (COLAs) for mental health workers for one year. This is a critical issue because the failure to help mental health workers keep pace with inflationary trends negatively impacts the recruitment and retention of a quality workforce, and by extension a mentally healthy New York. Specifically, the governor proposes to eliminate the planned 5.6 percent 2009-10 Cost-of-Living Adjustments (COLAs) for human service providers. It is expected that approximately 5,500 providers statewide will be impacted by this action representing a $93 million cut in the salaries of the lowest paid tier of the mental health workforce. Successful recruitment and retention of qualified mental health care staff requires that employers be able to offer wages at least commensurate with entry-level, service industries. Their work is difficult, stressful and highly necessary. A reasonable cost of living adjustment for mental health workers has been neglected for far too long to halt this important COLA at this juncture. Recommendation(s): MHANYS urges the Legislature to reject this delay and assure that the originally planned-for COLA be restored. Funding from the stimulus package can be utilized to restore the COLA for Mental Health (approximately $55 million). Rights of Families with Psychiatric Disabilities Issue: The Mental Health Association in New York State (MHANYS) working to change New York’s child custody law to eliminate provisions that discriminate against parents with psychiatric disabilities. New York State Social Services Law (SSL), subdivision 4 of §384-b includes four grounds for permanently terminating parental rights. Those grounds are:
MHANYS strongly opposes 384-b(4)(c) because:
Historically, parents with psychiatric disabilities have faced enormous societal biases concerning their fitness to maintain parental relationships. These biases continue to pervade the legal process. Stigmatizing attitudes and beliefs are at the root of discriminatory policies. We, as a state, cannot hope to eliminate these attitudes when the foundational structure of our laws perpetuates this manner of viewing people with disabilities. MHANYS is urging the New York State Legislature to remove this and other discriminatory provisions in our laws. Recommendation(s): Support S.2835(Huntley), which would eliminate paragraph (c) of SSL §384-b (4) and all of Subdivision (6) of SSL §384-b and effectively put an end to this discriminatory law.
Amend Sex Offender Legislation Issue: We are well aware of our existing budget deficit and the impact it will have to our entire state, but instead of just advocating for more funding in difficult times, we have also identified a funding stream that will help defray the cost of restoring initiatives that have been cut. Specifically, we are referring to the Sex Offender Legislation that was signed into law by former Governor Spitzer. This legislation is costing New York over $50 million a year to house less then 200 sex offenders in psychiatric facilities. The annual price of housing a committed sex offender averages more than $200,000, compared with about $35,000 a year for keeping someone in prison, because of the higher costs for programs, treatment and supervised freedoms. We have long opposed this legislation because sex offenders should not be housed in psychiatric facilities. Instead, offenders could be housed on the grounds of correctional facilities. The public would be better protected and the state would save a great deal of money (that can go to community based care) by not having to construct new facilities and beds on the grounds of psychiatric facilities for this specific population. Recommendation(s): We urge the Legislature to revisit the Sex Offender Program and end the practice of housing sex offenders in state psychiatric facilities. To house offenders on the grounds of correctional facilities saves the state money and also provides greater protection to the community. It is a common sense approach that should be embraced.
Issue: Safe, decent and affordable housing is a critical component of recovery from mental illness, and is foundational in a person’s life for establishing stability and independence. Access to good housing is a fundamental problem for many people with psychiatric disabilities. The limited supply of very-low-income housing, the rising cost of rental market housing and discrimination leave these individuals with few, if any, choices for appropriate housing. Although all would agree that actual housing need exceeds currently proposed remedies, there remains no reasonable measure to direct policymaking and prioritize the use of finite resources. A comprehensive and rational approach for addressing the need for mental health housing will ultimately depend on some means of estimating the true scope and nature of this problem. A sound housing policy and plan for people with psychiatric disabilities should be informed and directed by a realistic understanding of the true need. Tracking the number of people with mental illness who are in need of appropriate housing seems like a reasonable place to begin. Maintaining a registry of housing need is not merely a means of assessing volume, but would provide invaluable information about where housing is needed and in what format. Recommendation(s):
Issue: Stigmatization of people with mental disorders has persisted throughout history. It is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, and/or avoidance. Stigma leads others to avoid living, socializing or working with, renting to, or employing people with mental disorders, especially severe disorders such as schizophrenia. Stigma reduces patients’ access to resources and opportunities (e.g., housing, jobs) and leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking, and wanting to pay for, care. In its most overt and egregious form, stigma results in outright discrimination and abuse. More tragically, it deprives people of their dignity and interferes with their full participation in society. For someone with a mental illness, the consequences of stigma can be devastating — in some cases, worse than the illness itself. Some of the harmful effects of stigma include:
Recommendation(s): Support the reintroduction of S.8662 (Morahan)/A 6826-A (Rivera P), which would establish a gift for eliminating the stigma relating to mental illness on personal income tax returns. The bill would also establish the mental illness anti-stigma fund into which such gifts shall be deposited and directs the monies in such fund be used by the Office of Mental Health (OMH) to provide grants to organizations dedicated to eliminating the stigma attached to mental illness and those with mental health needs.
Suicide Prevention Issue: Suicide is now the third leading cause of death among young New Yorkers ages 15-24, according to the National Center for Health Statistics. Numerous studies have upheld the efficacy of suicide call-in centers at preventing suicide when call takers are properly trained. Statistical trends like these have led MHANYS to focus suicide prevention advocacy on teens and college students. The college campus setting provides an ideal academic structure for proper training to occur among students already vested in human service vocations among students pursuing human service courses of study. Since suicide is the second leading cause of death among college students, it makes sense that college campuses be equipped to provide emergency suicide hotlines for students and perhaps the larger community. Recommendation(s):
Issue: Cost-containment can at times be necessary but, should not cause us to attempt saving in areas that 1) save relatively little; 2) are counter-therapeutic for patients; and 3) can have a very costly impact. All of these criteria are met in the governor’s proposal to limit access to medication for people with psychiatric disabilities. Again this year the state Executive Budget has called for the exclusion of anti-depressants from the “carve-out” of mental health medications in the Medicaid Preferred Drug List. These budget provisions are intended to save the state money by limiting the number of anti-depressants that Medicaid will pay for to a select few. In fact this provision would only save the state $3.3 million of its $13.7 billion budget, or .0002 percent. New medications combined with expert pharmacology benefit thousands. Limiting coverage to a few medications that are “tried and true”, and work with most people, freezes medical and pharmacological advances at a point some twenty years ago. People suffering with severe mental illnesses should not be deprived of what research and technology can now provide. Limiting coverage is counter- therapeutic. New medications introduced in the last decade represent a major advance in the effective treatment of mental illnesses. Generally, the newer medications are more effective at treating various mental disorders (particularly schizophrenia and major depression), with a noticeable reduction in, or absence of, the adverse side effects often associated with the older generation medications. More specifically, newer generation drugs feature real-world effectiveness, ease of dosing, and improved safety. Timely access to the most effective drug therapies can reduce the need for inpatient treatment and minimize the disabling effects of severe illnesses and disorders, such as schizophrenia and major depressive disorder. Furthermore, the milder side effects of many of the newer medications may ensure better compliance with therapy. Together, these factors can result in marked improvement in the productivity and quality of life for both the consumer and the consumer's family. Limitations can be costly in many ways. Finally, past efforts to limit access to just a few medications have allowed for the physician to prevail in authorization denials. In reality, this provision detracts from doctor-patient face-to-face time and frustrates psychiatrists with yet another regulatory burden within the Medicaid program. Recommendation(s): MHANYS opposes cost-containment proposals that rely on limiting access to the full range of medication options currently available and shown to have added therapeutic value.
Issue: MHANYS vigorously objects to the Executive Budget’s proposal to defer the implementation date of the SHU bill an additional three years – until 2014. We also object to the proposed Article VII amendment to the original legislation that would omit approximately 50% of the SHU beds from the scope of the bill. Finally, we oppose the cutting of the minimal training included for correction officers. Last year, the State Office of Mental Health reported that the number of persons receiving mental health services in the state correctional system had grown in absolute numbers and accounted for 13.5% of the overall prison population. This occurred at a time when the overall prison population had showed a measurable decline. We also know that individuals with psychiatric disabilities have a difficult time while incarcerated and wind up in solitary confinement in special housing units in numbers far greater than their percentage of the total prison population. The social isolation and sensory deprivation associated with solitary confinement exacerbates psychiatric symptoms which can lead to psychotic decompensation, injury to self or others, and on occasion, to suicide. Arguably, locking up persons with a serious mental illness in solitary confinement, usually for extended periods of time, constitutes cruel and unusual punishment. At the very least, it represents an egregious example of deep-rooted patterns of mistreatment and neglect for the well-being of vulnerable and sick human beings. Recommendation(s): Reject the Executive Budget proposal to:
Geriatric Mental Health & Long Term Care Issue: According to the American Association of Geriatric Psychiatry, nearly 20 percent of people 55 years of age and older experience mental disorders that are not part of normal aging. Studies show, however, that mental disorders in older adults are underreported. It is estimated that only half of older adults who acknowledge mental health problems receive treatment from any health care provider, and only a fraction of those receive specialty mental health services (3 percent). This rate of utilization is lower than for any other adult age group. Intertwined with mental health are issues of chemical dependency. According to the New York State Office of Alcohol and Substance Abuse Services (OASAS), alcohol and substance abuse among the elderly is a hidden national epidemic. It is believed that about 10% of this country’s population abuses alcohol, but surveys revealed that as many as 17% of the over-65 adults have an alcohol-abuse problem. The Robert Wood Johnson Foundation suggest an escalation nationally of the approximately 1.7 million current substance dependent and abusing adults over age 50 in 2001 to 4.4 million by 2020. Of particular concern to MHANYS at this time is the high prevalence of mental illness among the elderly who also have long term care needs. A large proportion of older adults receiving, or in need of, long-term care in New York State have diagnosable behavioral disorders such as depression, anxiety disorders, psychotic conditions, or substance use problems. These conditions may or may not co-occur with dementia, most commonly Alzheimer’s disease. New York needs a process for coordinating health and mental health policy in the context of long term care reform efforts. It is critical for New York State to address the behavioral health needs of people who are receiving, who meet the criteria for receiving, or who are at-risk of needing long-term care and to address the behavioral health needs of their family caregivers. Recommendation(s): MHANYS
supports “The Behavioral Health and Long-Term Care Act of
2009”, which would establish a coordinated approach to addressing
the long term care and mental health needs of thousands of elderly
New Yorkers. |
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