Mental Health Association in New York State

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

Testimony to

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

January 25, 2006

Introduction:
Thank you very much Senator Johnson and Assemblymember Farrell and Mental Health Chairs, Assemblymember Rivera and Senator Morahan for providing us with an opportunity to present our thoughts on Governor Pataki’s ‘06-07’ executive budget proposal.

The Mental Health Association in New York State, Inc. is comprised of 30 affiliates across New York State representing 54 counties. Our members provide education and training to the community about mental illness. Many of our members also provide mental health services to their community. These community programs include housing, peer run programs, jail diversion, school based prevention programs, case management, trainings on co-occurring substance abuse and mental illness services, crisis lines, emergency services and a variety of other programs as well.

We also advocate for positive changes in the mental health system. To that end, this year’s budget represents the best budget proposal we have seen in several years. Though we still have concerns that we will voice, we are pleased by the enhanced funding for children’s services, additional housing through a New York/New York III agreement, a Cost of Living Adjustment (COLA) for direct care workers, funding for suicide prevention, resources for those with co-occurring disorders and funding for the Geriatric Mental Health Act, signed into law last year by Governor Pataki. We would like to thank Governor Pataki and Commissioner Carpinello for putting such an emphasis on areas that have been under funded in the past.

Children’s Mental Health Services

Of great significance to us is the funding for children’s mental health services. According to the recently released report from the Federal government on School Mental Health Services, one-fifth of the children and adolescents in the country experience the signs and symptoms of a mental health problem in the course of a year. Despite these large numbers, there is a disconnect between the onset of a mental illness in childhood and initial contact with treatment professionals.

According to the National Co morbidity Survey Replication Preliminary Findings, the median duration of delay in manifestation of an anxiety disorder and the first treatment contact is an average of ten years. The average age for initial onset of an anxiety disorder is 11 years old. Largely because in the past, there was limited funding for assessments and referrals, thousands of younger New Yorkers had early signs of undiagnosed mental illness that went untreated. For bipolar disorder, it is six years between manifestation of the symptoms and first treatment contact. This is a public policy failure. Ultimately, many of these children with undiagnosed mental illness will end up as part of the adult mental health system, many for the rest of their lives.

That is why we are supportive of the initiative by the Office of Mental Health to provide funding for the early recognition of emotional disturbances in children. The evidence is overwhelming, through evidence-based practices, that early intervention and identification does reduce the severity and length of mental illness. Having the ability to screen 400,000 children and assess 76,000 children, as proposed in the budget, will greatly enhance the ability of clinicians to identify an illness at its early stages and provide the necessary resources to provide the best treatment for those children with an identifiable mental illness. Parents, family members, and children’s mental health advocates have long pointed to the need for additional resources for screening and treatment for children with mental health needs. This is excellent step forward and we are strongly supportive of this initiative.

MHANYS is also part of the New York Children’s Action Network (NYCAN), which recently wrote to Senator Johnson and Assemblymember Farrell requesting that a Children's Budget Hearing be incorporated into the annual budget hearings. Children are New York's most important resource and investments in our children are the most worthwhile investments we can make. Their needs are of concern to all of us which is why we ask the Assembly and Senate to hold a Children's Budget Hearing to focus attention on the dollars New York spends on children. We believe New York CAN and must do more for children and families.

Cost of Living Increase for Community Mental Health Workforce

We are also supportive of a 2.5 percent COLA for residential and several non-residential providers. Many of our members would be among those who would be receiving this COLA. Ever since funding for reinvestment has dried up, the lifeline for new funding for community providers has dried up as well. In recent years, we have fought cuts of $7.7 million two years ago and $3.9 million last year. We thank the legislature very much for restoring $4.3 million that was cut from the $7.7 million in last year’s budget.

Many of those cuts were to the services that are integral to recipients of mental health services living in the community. Due to the multiple cuts over the years and increases in health insurance, heating and rental space, it has become exceptionally difficult for providers to keep running quality programs and keep qualified workers.

It is only through dedication, commitment and the belief in the recovery of individuals with mental illness that staff working for community providers are staying in the field and not moving to higher paying jobs (i.e. fast food) in the service industry.

MHANYS has been part of a coalition of advocates who would like to see a 10 percent increase across the board for community mental health programs. The Governor’s 2.5 percent increase is a good first step, but we need a quantum leap just to keep qualified individuals working in community mental health programs.

We hope to work with all of you this year to enhance the funding for the COLA and to make the COLA permanent. In addition, we support the addition of ten million dollars for the many service providers who have been cut over the last two years. Many of these program cuts have gone to transportation programs, family support and respite program, peer run programs and multicultural initiatives.

Without this funding, programs that have proven effective for recipients of psychiatric disabilities will either be greatly reduced or eliminated altogether. We do not believe that anyone wants to see that happen or witness the disastrous consequences of a poorly funded community mental health system.

Housing

We are very pleased by the state’s commitment to a New York/New York III agreement in housing. 9000 units of housing over a 10 year period represents a historic commitment to housing for people with psychiatric disabilities. Approximately 5500 of these units will be dedicated to individuals with psychiatric disabilities. Both the Governor and Mayor Bloomberg deserve a great deal of credit for this agreement.

However, we all know that there is a great deal of work ahead for us in creating more housing capacity for individuals with psychiatric disabilities. This agreement does not include housing for individuals coming from corrections settings, those who want to move out of adult homes and those with psychiatric disabilities who are living at home with elderly parents.

Also, housing for people with mental illness is at crisis level across the state. We need similar agreements in Long Island, Central New York, the Hudson River Region and in Western New York. We also urge passage of legislation that provides for a housing waiting list that identifies the need for housing in the community for people with psychiatric disabilities, similar to that which presently exists for people served through the Office of Mental Retardation and Developmental Disabilities. Without an identified need, it becomes very difficult to provide proper planning for residential placement.

Lastly, we were pleased to see the Governor’s proposal also included additional funding for supported housing programs. Supported housing is an important component of the housing continuum that allows people with mental health needs to begin living independently, laying the groundwork for even more independent living in the future.

Adult Homes

In regard to housing, 12,000 individuals in New York with a psychiatric disabilities remain in adult homes, many of whom would like the opportunity, and have the capability, to live in a less restrictive setting. In the previous two years, the state has allocated $10 million each year for adult home residents, which included independent case management services and funding for quality of life initiatives for residents. In addition, we remain very appreciative of your work last year in creating an SSI increase for adult home residents.

Unfortunately, this year, there appears to be a glaring omission in funding for adult home residents. We urge the legislature to add funding for essential adult home services that would be utilized to insure that residents of adult homes live as independently as possible either in the homes or in other placements in the community. In addition, there must be funding in place for much needed legal and lay advocacy and air conditioning in the adult homes. This population must not be forgotten.

Geriatric Mental Health Act, Suicide Prevention
and Co-occurring Disorders

Other initiatives we are pleased with in the budget include funding for the Geriatric Mental Health Act, an important recognition of the elderly and their growing mental health concerns, more funding for suicide prevention and also additional funding for co-occurring disorders. One of the most significant problems in today’s mental health system is for individuals who have both a mental illness and substance abuse issue. Recent estimates suggest that over 50% of people with psychiatric disabilities also have a co-occurring substance abuse disorder. One of the evidence-based practices in mental health is integrated treatment for this population. We are pleased to see funding in the budget that is earmarked for this program, which we hope will lead to better recovery rates for those with co-occurring disorders.

Civil Commitment of Sexual Offenders

One area we are still gravely concerned about is the housing of sexual offenders in OMH run facilities. We have consistently voiced our opposition to the housing of sexual offenders in psychiatric facilities. First and foremost, the facilities and services provided by the Office of Mental Health are designed to be therapeutic environments where individuals can be helped in the recovery process from serious mental illness, such as schizophrenia, major depressive disorder, and bipolar disorder. It is not a system intended to serve as lock down wards for sexual offenders.

Safety Issues - Individuals with mental illness living in the community are 12 times more likely to be the victims of violence than the general population. We would have serious safety concerns about the population of individuals with psychiatric disabilities, who are even more vulnerable than those in the community, being housed amongst sexual offenders.

Funding - We believe that funding for sexual offenders should not be part of the Office of Mental Health’s budget. Instead, we are advocating for a separate funding stream, completely lined out independently in the budget. The funding for sexual offenders should not in any way, shape or form be co-mingled with the mental health budget.

Stigma - There is already an overwhelming stigma associated with people living with mental illness, often referred to in the media as “crazy” or “psychopaths.” To lump them together with sexual offenders only serves to further advance those negative stereotypes that impede the road to recovery.

Though we are somewhat mollified by the proposed housing of sexual predators at Camp Pharsalia (and that funding in the next few years for the programs would provide housing at either Central New York Psychiatric Center, which is a forensics facility, and a separate facility on the grounds of St. Lawrence Psychiatric Center), we still have concerns about OMH overseeing the housing of sexual offenders.

This also does not get to our point about the co-mingling of funding for mental health and sexual offenders. Completely separating this funding in the budget process is necessary to ensure that no siphoning off of resources otherwise dedicated for services to those with mental health needs occurs. In addition, we recommend bill language to insure that if the Office of Mental Health does end up overseeing this population of people, that an annual report on the costs associated with the confinement of sexual offenders and any impact those costs have had on the availability of resources for those with serious mental health needs.

The worst case scenario for the mental health community is that resources in the budget for community mental health services would have to compete with resources for sexual offenders in the mental health budget.

Health Issues

Two issues of concern to us that are currently in the health budget are in regard to the Governor’s attempt to roll back safeguards incorporated into last year’s Preferred Drug Program (PDP) and with regard to the implementation of Medicare Part D. Though we will get into greater detail in our Health testimony, these proposals impact people living with mental illness.

Specifically, we are concerned about the Governor’s proposal to remove the language authorizing the physician to make the final determination about which drug will be prescribed to a Medicaid patient in the Preferred Drug Plan (PDP). A physician, not a bureaucracy focused on saving money, should have the final say as to which medications are appropriate for an individual.

Also, we are concerned that by allowing cost to be a consideration in the approval of drugs under the Clinical Drug Review Program, this could have a very negative impact on those with mental health needs and the expensive drugs on which they rely.

With regard to Medicare Part D, we must develop additional strategies to insure people on both Medicare and Medicaid (dual eligibles) have access to the medications they need to remain healthy. Though we appreciate the Governor’s efforts to ensure that Medicaid is available to pay for the first few weeks of Medicare Part D when problems arise, this is just a stopgap measure. There must be a full commitment from the state to cover the co-pays for dual eligibles unable to afford these new co-pays. Without that funding in place, there will be a number of people who will stop taking medication because of the cost associated with the co-payments.

In addition, before the implementation of Medicare Part D on January 1st, advocates were assured that Medicaid would be available to cover medically necessary medications that Part D plans refused to cover. While we assumed that this coverage would remain, we were alarmed to read in the Governor’s proposal that such “wrap around” coverage would end on July 1st. Given the current lack of success in the implementation of Medicare Part D, there is little reason to believe that all issues will be ironed out by July. Therefore, we believe that the state should provide funding for this “wrap around” until March 31, 2007, which will allow for a thorough examination of any problems surrounding Part D one year after its implementation.

Summary:
There is a lot in this budget that we are very pleased with including the commitment to children with funding based on evidence-based best practices and a planning process. We are also pleased with housing through New York/New York III, a historic agreement that will have positive ramifications for years to come for individuals with psychiatric disabilities. We appreciate the dedication to funding the Geriatric Mental Health Act, suicide prevention and for services to those with co-occurring disorders. Though we are appreciative of the commitment for a 2.5 percent COLA, we need additional funding and a permanent COLA to motivate qualified individuals to continue to work in community mental health programs.

Our other major concerns involve a separation of the funding for sexual offenders, additional funding for adult home residents, reinstatement of the language safeguarding Medicaid patients in the PDP funding to pick up the cost of co-payments for dual eligibles currently enrolled in Part D, and continuation of the Medicaid “wrap around” that acts as a safety net for Part D enrollees.

We thank you very much for your time and consideration.

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