Glenn Liebman, CEO
Mental Health Association in New York State, Inc.

testimony to

JOINT BUDGET HEARINGS OF THE NEW YORK STATE SENATE AND ASSEMBLY - MENTAL HEALTH, MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

January 26, 2005

Thank you very much, Chairmen Johnson and Farrell, for providing us with the opportunity to weigh in regarding Governor Pataki’s 2005-06 Executive budget proposal. I would also like to thank Mental Health Committee Chair Peter Rivera and welcome Senator Thomas Morahan to his new role as Chair of the Senate Committee on Mental Health and Developmental Disabilities.

The Mental Health Association in New York State is comprised of 32 affiliated organizations across the state, representing 54 counties. Our agencies range in size and budget, serving the community largely for purposes of training and educating the public about mental health issues. Some of our agencies also provide mental health services in the community. The Mental Health Association movement has a long and rich history of being recognized as an organization dedicated to promoting mental health and recovery by encouraging consumer empowerment, overcoming discrimination, and raising public awareness with education, advocacy, and public information.

In many previous years, MHANYS has come before you to express concern over portions of the Governor’s proposed budget. We have premised our remarks on a lack of planning for the creation of a comprehensive system of community-based care. Specifically, MHANYS has opposed some changes the Governor has suggested (such as significant adult inpatient facility closures, consolidation of children’s facilities, and discontinued Reinvestment funding for community-based programs) due to the absence of planning for the near and long term future of the mental health system.

Last year, MHANYS came before you to applaud the Governor for taking significant steps toward the development of comprehensive planning for the future of the mental health system. This was demonstrated in the Office of Mental Health’s release of a substantive Statewide Comprehensive Plan for Mental Health Services released in conjunction with the budget, the proposed bi-partisan facility closure commission, and a long term extension of the law we know as Reinvestment. This year’s budget represents more of a mixed bag for those of us in the mental health community.

There are parts of the budget that are very positive. For example, the supported housing rate increase for downstate programs is long overdue and well-deserved. Though this increase does not dramatically close the gap between the cost of housing downstate and the ability of recipients and housing providers to pay out-of-pocket, it is a good step in moving towards more affordable rates and should be enhanced in future years.

In addition, we are also appreciative that there will be an additional 600 supported housing beds available this year and funding for additional housing in the pipeline, based on prior budgets. We thank all of you in the legislature and the Governor for continuing that funding.

At the same time, while these commitments are appreciated, we must state unequivocally that there is still a great unmet need for housing in the community. Priority populations, such as adult home residents with psychiatric disabilities, individuals with mental illness coming out of the criminal justice system, people who are homeless and have a mental illness, and aging family members with loved ones living at home should all have the ability to live in their own communities. We will continue to make housing one of our major priorities until appropriate levels of housing for all priority populations in the mental health community are met.

Also, the enhanced rate for clinics serving individuals with psychiatric disabilities is greatly appreciated.

It is with regard to the issue of planning that we are concerned with the Governor’s attempts to close Middletown Psychiatric Center (PC) again this year in the absence of adequate planning for the future of mental health services in Orange and Sullivan counties. With 19 psychiatric facilities in New York State housing just over 4000 people, where just an additional five psychiatric facilities housed over 90,000 in the 1950s, we understand the need to provide more efficient state-operated inpatient services. However, the process for facility closures must be done in a planful way with all the stakeholders at the table.

While the Governor’s proposal calls for closing Middletown PC in 2006, providing an additional year in between the proposal and the close date which provides a more realistic time frame, it remains unclear whether a mechanism designed to ensure local stakeholder input will accompany this proposal, like that in the Governor’s proposed Commission on Psychiatric Center Closures from last year. Such a process would require realistic and demonstrable time frames and should be examined in conjunction with all other factors pertaining to the state’s mental health system. Similar to last year’s budget, we would recommend the establishment of a Commission, with representation from recipients, family members, advocates, counties, unions, and all other stakeholders, to examine all issues pertaining to the future of the mental health system, including psychiatric center consolidation. The future of Middletown PC should be examined in this context as well. Also, if Middletown Psychiatric Center closes in 2006 than the formula for distribution of the money should change. Currently, the proposal is for all $7 million to be distributed to state operated programs in the Orange/Sullivan area. We think that the formula should change to reflect the role of community provider. Half of the $7 million should be dedicated to community providers in those counties.

This Commission would oversee such major changes to the mental health system and be able to help ensure that funds for operation of psychiatric centers would be fully reinvested into community-based services, as was the intent of the Reinvestment legislation enacted in 1994. One of the key pieces of reinvestment was the recognition of the significance of stakeholders as symbolized by the representation of both family members and recipients sitting on the sub-committees of community services boards.

Perhaps the most troublesome aspect of the Governor’s budget proposal, as it pertains to our affiliates, is with his recommended $3.9M cut in the Aid to Localities budget. Last year, the Governor cut $7.7M from the Aid to Localities budget, which left community mental health providers, including local Mental Health Associations, severely impacted. We greatly appreciated the legislature’s efforts to partially restore that funding, despite the Governor’s subsequent veto.

The following small sampling of the impact of last year’s cut illustrates the impact on services to Mental Health Associations in communities throughout the state:

Adding a $3.9M cut to already impacted community programs will mean cutting more positions and more programs. We all know that cuts to these programs will result in greater hospitalizations, more interactions with the criminal justice system and more homelessness. Not only will these cuts have a negative impact on the recipients, but they will also have a greater cost to the taxpayers of New York State.

According to the Executive Budget, the plan to cut the Aid to Localities portion of the budget will be achieved “by reducing or eliminating funding to local mental health providers that are underperforming, delivering less cost effective services, or whose agency administration and overhead costs are higher than system-wide averages.” While it is laudable to improve the efficiency of the system, we don’t yet know the criteria for the development of such a process and most importantly, if you cut these so called ‘bad actors,’ then why not keep the $3.9M in the community system and reward the providers who are doing good work. Regardless, a combined cut of almost $12M over two years will be devastating to community programs.

We applaud the Governor’s proposal to establish a demonstration project to create 245 additional new waiver slots under the Home and Community Based Waiver program.

We also are very pleased to see a continued commitment of funding to expand mental health treatment capacity and clinical staffing for prisoners with mental illness. Additional resources will be necessary in future years to deal with this large population of people who have been ‘transinstitutionalized’ from psychiatric centers into correctional facilities.

And the proposed merger between the Commission on Quality of Care for the Mentally Disabled and the Office of the Advocate for Persons with Disabilities into the Commission on Quality of Care and Advocacy for Persons with Disabilities seems like a logical governmental efficiency that will not compromise the oversight and advocacy of CQC with regard to people living with mental illness.

While we will provide testimony at the Joint Budget Hearing on Health regarding the cuts to Medicaid, the manner in which they will impact the provision of mental health services will be very dramatic to recipients of mental health services. Cutting the mental health coverage provided under Family Health Plus is of great concern to us. As part of the Timothy’s Law Campaign, we are fighting for equal mental health coverage with physical health coverage under private insurance. The fact that coverage has never been equal is simply, discrimination, and stigmatizes individuals with mental illness. Cutting the coverage for mental health services under Family Health Plus perpetuates that discrimination.

As in previous years, we will once again be active in opposing efforts to implement a Preferred Drug Program under Medicaid in New York State. No evidence exists to suggest that any clinical improvements will be gained by implementing such a program. In addition, as individuals with mental health needs depend on drugs other than those exempted under the Governor’s proposal, a PDP will have negative effects on individuals living with mental illness.

Cuts to psychological services in inpatient settings will also have a chilling effect on those who desperately need these services. We are very concerned about the impact of these cuts to the many people with mental illness who are now living in nursing homes. Our goal is to have people live productively in the community. However, if individuals are living in an institutionalized setting such as a community hospital or nursing home, then they should not have their psychological, dental and podiatric services cut, as is proposed in the Governor’s budget.

One of the final bastions for discrimination and stigma is the perception about people living with mental illness. The media often perpetuates the images of people with mental illness as being violent and out of control. This simply is not true, and this stigma must end. In the coming session, we will be asking the legislature to support a tax check off in the New York State income tax to create a public awareness campaign to erase the stigma of mental illness.

In closing, recognizing the difficult financial times the state finds itself in, there are parts of the Governor’s budget that we greatly support, especially around housing. However, we are greatly concerned about the cuts to the Aid to Localities portion of the budget as well as the proposed cuts to Medicaid. This will have a devastating effect on recipients of mental health services in New York State if the cuts become part of the enacted budget.

Thank you very much for your consideration.