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
February
7, 2007
Introduction
Thank you Assembly member Farrell, Senator Johnson and Committee
Chairs Senator Morahan and Assembly member Rivera and other members
of the committee.
My
name is Glenn Liebman and I am the CEO of the Mental Health Association
in New York State (MHANYS). The mission of our organization is
to advocate for positive transformation of the mental health system
and to educate the public about mental health related issues.
We have a very strong network made up of over thirty affiliates
across New York State that represents 54 of the state’s
62 counties. Many of our affiliates provide community based mental
health services in their region of the state.
We
have long held the belief that you cannot have good health without
mental health. Over twenty percent of the nation’s population
has a mental illness. Yet, due to stigma, lack of awareness and
a system that often provides fragmented care, many people do not
seek any services even when they are in desperate need.
We
must create a system that transcends our existing system of care.
We have to incorporate ‘best practices’ into models
of care. There have often been barriers in place that make it
difficult to take existing research and move it into practice.
Our jobs both in and out of government is to work collaboratively
to eliminate those barriers and create models of care that are
evidenced-based and that fulfill the recovery needs of people
with psychiatric disabilities.
We
are very hopeful that with the Spitzer administration we are moving
in a very positive direction. The appointment of Michael Hogan
as Commissioner of Mental Health is a very good sign. He has a
nationwide reputation for helping to transform systems of care
as he did successfully in Ohio. We are very appreciative of the
innovative initiatives from the past several years but we are
hopeful with Commissioner Hogan that there will be a much more
extensive transformation of the mental health system.
We
are also very hopeful because of all your leadership and support
for the passage of Timothy’s Law. This will have a positive
impact for millions of New Yorkers and would have never come about
with out the leadership of the Legislature. We thank you very
much for your help.
HOUSING
This
year’s executive budget is one that we are very supportive
of in many ways especially as it relates to housing, which has
long been a major priority of our organization.
We
applaud Governor Spitzer’s commitment to housing and his
proposal to add 1,000 new supported housing beds and 1,000 new
congregate care beds. MHANYS is a member of several statewide
coalitions of organizations, including The Campaign for Mental
Health Housing, which calls for 35,000 units of housing over the
next ten years. Governor Spitzer’s proposal represents a
major step in that direction. We are also pleased to see that
this housing is for both congregate care and for supported housing.
It is important that recipients of mental health services have
options in terms of their housing needs.
One
of the populations of people who have been identified as possibly
needing alternative housing options are adult home residents.
Recently, the Office of Mental Health released the results of
a case study that found approximately 500 adult home residents
were appropriate for more independent housing. In light of this
report and the words of many adult home residents who are rallying
today in Albany, we join with other members of the Campaign to
earmark 500 of the 2000 beds for residents of adult homes. We
also strongly advocate for geriatric individuals with mental health
needs be included in this priority population.
In
addition, we are very pleased that there is continued funding
for the New York/New York III agreement and new funding and to
enhance staffing in Community Residential Programs and Family
Based Treatment Programs.
There
is also $6.3 million in new funding to handle increased rent and
utility costs in the third year of a three year increase in stipends
for Supported Housing.
These
are all significant initiatives that will help enhance the lives
of people with psychiatric disabilities.
Recommendation:
•
To insure that there is priority access for 500 of the 2000 units
of housing for adult home residents.
•
To continue to explore ways to insure greater housing for priority
populations including the needs of family members with mental
illness living at home with aging family members and for the geriatric
population.
•
To develop a comprehensive response to identify the housing needs
of individuals with psychiatric disabilities
COMMUNITY SERVICES
We
are appreciative that the administration has called for the continuation
of a 2.5% COLA for mental health workers. However, this three
year 2.5% COLA will not dramatically improve the ability of community
mental health providers to recruit and retain qualified staff.
As we said last year when we were fighting for a larger COLA,
“this is a good first step but what we need is a quantum
leap”
We
need to keep our work force in place. The most frequently voiced
concern by our members is the ability to have funding to keep
a quality work force in place in the mental health system. It
was true many years ago and it is true that community mental health
agencies lose staff because McDonalds pays better than many direct
care workers in the mental health system. We have to continue
to change that paradigm.
In
addition, we have to look for alternative ways, including new
funding streams, to help fund existing community based mental
health programs. These programs frequently provide the most appropriate
quality services at minimal expense. They have also been targeted
for cuts in recent years. Without these programs in place, many
individuals with psychiatric disabilities would end up homeless,
in emergency rooms or in jails and prisons. This is devastating
for the individual and costly to the taxpayers. We look forward
to working with all of you to increase funding for community based
mental health services and recognizing that this should be a priority
in mental health.
Recommendation:
•
Increase the 2.5% COLA for mental health workers and make the
COLA permanent
•
Reprioritize funding from the existing mental health system to
insure that there is greater funding priority for community-based
programs that provide the most recovery based care at the least
expense to taxpayers.
CHILDREN’S
SERVICES
The
members of our organization run many children mental health programs.
The percentage of children with mental health need is at a staggering
20%. As with the adult system of care, there must be greater recognition
of the needs of children in the mental health system.
We
are pleased that Governor Spitzer has continued the commitment
to funding Home and Community Based Waiver Slots for 180 new slots
for this year. This program has proven itself as a very effective
and efficient way in which to address mental health needs in children.
We
are also very pleased to see that the Achieving the Promise Program
which funds Child and Family Clinic Plus programs, continues to
be funded as part of the Governor’s proposal. This program
was designed to help create over 400,000 new mental health assessments
in schools and bring about early detection of mental illness in
children.
With
the increased identification of mental health needs come increased
capacity issues. Part of the ‘promise’ of this program
should be to insure that there are appropriate community placements
and additional school personnel trained to work with this population
of students.
Recommendation:
•
Additional funding for Home and Community Based Waivers slots
for children with mental heath needs
•
Increased funding to pay for additional mental health professionals
in school settings and in community programs
PRISON MENTAL HEALTH SERVICES
We
applaud Governor Spitzer for proceeding with targeted investments
to expand and enhance services to prisoners with mental illness
which features the development of specialized residential mental
health programs. One of the major efforts of the mental health
community has been to eliminate the use of 23-hour solitary confinement
in Special Housing Units (SHUs) for prisoners with psychiatric
disabilities—an effort that was vetoed by Governor Pataki
last year.
There
is $2 million in this year’s budget for an expansion of
mental health services (this annualizes to $9 million) in prisons,
combined with Capital funding to create alternatives to Special
Housing Units for prisoners with psychiatric disabilities. This
is an important acknowledgement of the need to improve upon the
mental health services within the correctional system---a system
that has seen a seemingly endless increase in the number of people
with psychiatric disabilities in recent years. This practice must
end and this funding to create residential programs in prisons
will be a significant positive step.
FACILTY CLOSURES
We
know that there are no proposed facility closures in this year’s
budget. However, we are pleased to see the language from the Executive
regarding the ‘right sizing’ of the current institutional
service system. MHANYS and other mental health advocates believe
that inpatient mental health services can be delivered in a more
efficient manner, which will allow for full reinvestment of saved
resources in community-based mental health care aimed at preventing
people from needing inpatient services. As part of the transformation
of the mental health system, we must work with all stakeholders
to develop a plan for better serving people with severe mental
health needs without causing undue harm in the process.
Recommendation:
•
Bring all stakeholders together to discuss strategies regarding
the downsizing of the inpatient state psychiatric hospital system.
Such discussions should not impact the existing number of beds
currently in the state psychiatric hospitals.
•
Insure that any efficiencies in funding found through capital
closure and operational costs must be utilized for community based
services. We believe that this would be a new style reinvestment
that would create greater funding capacity in the community and
in turn help better coordinate the planning process.
CO-OCCURRING DISORDERS
We
support Governor Spitzer’s proposal to fund $4 million in
demonstration projects for co-occurring disorders. Well over 50%
of people with a mental illness also have a co-occurring addiction
disorder. It jumps to over 80% for the forensics population. Unfortunately,
the way the system currently operates is that there are parallel
systems of care for both mental health services and addiction
disorders. Instead, there should be integrated treatment for mental
health and addiction disorders.
We
have to incentivize providers to create a better system of care
through funding evidence based best practices including integrated
treatment services for people with co-occurring disorders. This
funding should help support creation of demonstration projects
that can be identified as best practices for integrated treatment.
In addition, we should utilize this funding to encourage core
competencies for practitioners in the field.
SEXUAL
OFFENDERS
This
year’s proposed budget calls for $19.2 million ($46 million
annualized) to house sex offenders in the state’s inpatient
mental health system.
MHANYS
has long maintained that housing sexual offenders in psychiatric
facilities is not an appropriate placement for several reasons
including the safety of individuals already in the psychiatric
centers, the stigma of equating people with psychiatric disabilities
with sexual offenders and the cost of such a program to the mental
health system estimated at $200,000 per person per year.
Recommendation:
•
Highlight the recommendations of the Division of Criminal Justice
Services workgroup on sexual offender management, which is about
to be released. This work group will recommend a blueprint for
comprehensive sex offender management, derived from specialists
across the state, which is expected to recommend a number of steps,
including: 1) A specialized risk assessment evaluation prior to
sentencing to assist judges in determining an appropriate prison
sentence and post-release supervision program, 2) Life-time probation
or parole for those with a life-long disorder, 3) Additional resources
for the consistently under-funded treatment programs that reduce
recidivism by 40 to 60%, 4) Support of specialized sex offender
supervision caseloads and transitional housing to provide cost-effective
community containment, 5) Education and prevention programs to
create social responsibility about safe and healthy relationships
•
As part of a comprehensive approach, civil commitment may very
well play a role for the small percentage of offenders for whom
treatment and other programs do not work. However, such an effort
should not be enacted in isolation, without the programs and initiatives
that will weed out those who do not need to be removed from our
communities.
•
Utilize the $46 million annualized as start up funding to establish
an independent state agency responsible for all aspects of sexual
offense prevention. This creates a more comprehensive approach
to dealing with all the programmatic issues regarding sex offenders.
MEDICATIONS
Having
been very involved with efforts to make the transition from Medicaid
to Medicare as smooth as possible for dual-eligible individuals
under the Medicare Modernization Act, MHANYS is very pleased that
Governor Spitzer’s budget continues the Medicaid wrap-around
benefit provided to dual eligible individuals needing atypical
antipsychotics and anti-depressant medications. However, given
the complex medical conditions of many individuals, we believe
this safety net coverage should be available for all dual eligible
individuals.
With
regard to the Medicaid Preferred Drug Program, we are pleased
that Governor Spitzer recognizes the necessity of providing an
individuals’ doctor with the final determination as to which
medication is most appropriate for that patient. However, we are
concerned about this proposal to remove anti-depressants from
the list of medications carved out of the Preferred Drug Program.
Carving out these medications would likely reduce access that
helps people with psychiatric needs remain healthy and stable
and would instead cause them to rely on more expensive and intensive
forms of care. In addition, such a policy would be inconsistent
with the continued Medicaid wrap-around the Governor recommends,
which includes coverage for anti-depressant medications.
Recommendation:
•
Extend the comprehensive Medicaid wrap-around benefits for all
dual eligible individuals.
•
Restore anti-depressants to the list of medications carved out
for the Preferred Drug Program.
GERIATRIC
MENTAL HEALTH ACT
Enacted
in 2005 and funded for the first time in 2006, there is no additional
funding in this year’s budget for Geriatric Mental Health.
Recognizing the mental health needs of the elderly population
is significant and there should be additional funding for more
demonstration projects for the geriatric population
Recommendation:
•
Add $3 million for Geriatric Mental Health Services
SUICIDE
PREVENTION
We
were pleased to see funding in last year’s population that
accompanied the NYS Suicide Prevention Plan that recognizes the
significance of this issue. While the Governor’s budget
calls for continuing funding at last year’s level, there
is no new funding in this year’s budget to expand the excellent
work aimed at preventing tragedies related to suicide.
Recommendation:
•
Add $1.5 million to suicide prevention efforts
YOUTH
IN TRANSITION
The
issue of youth in transition is a very important priority to the
membership of the Mental Health Association. There are many adolescents
with a psychiatric diagnosis who either drop out of school or
graduate from school without any transition plan in place for
their future. There are also adolescents aging out of the foster
care system and juvenile justice system that also have a mental
health diagnosis and with no transition plan in place as well.
As
a result, many adolescents with a diagnosis end up hospitalized,
homeless, or end up in jails and prisons. Some of these people
even end up as victims of homicides or suicides.
Recommendation:
•
We are requesting $500,000 from the legislature for a demonstration
project that will create a drop-in center for youth in transition
where they can work on educational, vocational and social skill
training. We propose that this demonstration project be at a Community
College where the students can serve as mentors for adolescents
who have a mental health diagnosis.
