Mental Health Association in New York State, Inc.
(Publication Archives)

Friday Fax from Albany

NIMBY vs. NOMBY: Any time an organization tries to site a new program, particularly residential, for people living with mental illnesses, NIMBY (Not In My Back Yard) rears its head. People from throughout the community, usually lacking sufficient understanding of the program, understanding of those to be served or other attributes of the planned service will rally against the proposed site, making the argument that they don’t want it in their community. Largely founded in misguided fear and ignorance, NIMBY has untracked many a worthy program or residence.

NOMBY is a much lesser known phenomenon. An acronym for Not Out of My Back Yard, NOMBY is a similar, albeit more educated and compassionate response to proposed dismantling of services or facilities. This year, as in 2001, Governor Pataki has proposed the closure of state run psychiatric centers around our state. And in the communities that fear new and greater gaps in the mental health services available, NOMBY is the first and most visceral reaction.

The demarcation line in the MHA movement around proposed closures is best explained in terms of NOMBY. Virtually all of our MHAs, as well as MHANYS, believe that the size of the infrastructure of the state run psychiatric hospital system exceeds the demand and required capacity. Downsizing is warranted, and utilizing the funds saved to improve (dare we even say develop) the system of community-based care is universally supported. Where we divide is the question of which community is going to lose their facility.

Over the years, the role of psychiatric hospitals has evolved. Although the residential buildings remain large, each facility actually serves many times more people on an outpatient basis than inpatient. They have become the core of intensive mental health services for their communities, as well as their large catchment areas. Communities fear that the closing of the facility will lead to a drop in access to inpatient beds, outpatient services, and continuity of care. And, in the absence of a plan, history continually bears out those fears as justified.

First and foremost, it is important to note that Deinstitutionalization, long a rallying cry for mental health advocates, has never included a plan. That, at least in part explains how the same percentage of the population that occupied state hospitals in the 1950s is numerically equivalent to the percentage living with mental illnesses caught in the criminal justice system today – 0.3%.

More recently, we need look no further than the closing of Gowanda psychiatric center a decade ago. Today, people in that community will tell you that the county jail is the largest psychiatric hospital in the county, there are substantial gaps in housing and services, and that Buffalo is too far for many people to go to see, and advocate for, their loved ones who are hospitalized with critical mental health care needs.

Understanding NOMBY is what has brought MHANYS to its position regarding the proposed closures Governor Pataki has put forward. We agree that the infrastructure is too large, and that services can be provided more effectively and cooperatively in the community. But we cannot support closures in the absence of an overarching plan, for what happened in Gowanda will happen elsewhere unless the planning and systems change is completed.

NMHA Legislative Alerts:

US Senate Health Panel Must Take Up Parity Bill
Grassroots: Urge Committee Members to Press for "Markup"

To win passage of parity legislation this year, it is critical that the US Senate Committee on Health, Education, Labor, and Pensions (the "Health committee") take early action on the Senator Paul Wellstone Mental Health Equitable Treatment Act, S. 486. Advocates must press their senators, and particularly those who are members of the Health Committee, to push the chairman to "mark up" the parity bill very soon.

The members of the US Senate Health Committee must hear from constituents urging them to press the chairman to “mark-up” the Wellstone parity bill. For us in New York, Senator Hillary Clinton should be contacted, thanked for cosponsoring the parity legislation, and urged to push for a ‘mark up’ of the Wellstone mental health parity bill (S.486).

Please call Senator Clinton in both her New York offices and Washington office, using the Parity Hotline 1-866 PARITY4 (1-866-727-4894). The message is: "I'm a constituent, calling to urge Senator Clinton to push for a 'markup' of the Wellstone mental health parity bill (S. 486). It's really vital to pass this bill to end insurance discrimination against people who have mental disorders."

Congress Considering Deep Medicaid and Mental Health Cuts
Contact Members of Congress Now to Avoid a Funding Crisis Ahead!

The House and Senate are completing work on a budget plan that lays the groundwork for what could lead to deep, long-term cuts in federal mental health funding. The House of Representatives has already passed a plan that would slash Medicaid spending by some $93 billion over the next ten years, and, next year alone, would cut $53 million in mental health funding from the Substance Abuse and Mental Health Services Administration as part of a $1.4 billion across-the-board program reduction. The House proposed these deep cuts to offset the huge revenue loss its adoption of the President's tax-cut proposal would trigger. Although the Senate has yet to complete work on its version of a budget resolution, it has adopted a number of helpful amendments, including temporary fiscal relief for the states and their Medicaid programs, and increased funding for public health programs.

With development of the budget resolution on a very fast track, and the risk that major cuts proposed by the House could be adopted soon, it is critical to voice concerns immediately. Grassroots advocates must register immediate, profound concern to head off a real crisis.

Please modify the following letter as you see fit and fax it to your senators' and representatives' offices at the earliest opportunity:

/ /03

 

The Honorable ________

 

Dear (Senator or Representative, as pertinent] ________:

On behalf of the Mental Health Association of _________, I am writing to raise our deep concerns about the House-passed fiscal year 2004 budget resolution, and to urge you to oppose any cuts to the Medicaid program as part of that budget resolution. We also ask you to prevent cuts to any other federal programs that provide supports and services to people who have or are at risk of developing mental illnesses or substance abuse disorders.

Among its very troublesome provisions, the House-passed budget resolution requires that Medicaid be cut by more than $90 billion over the next decade. The impact of such cuts must be understood in light of a mental health system that the President's mental health commission has already described as being in crisis, and in light of the growing dimensions of that crisis, as states grapple with record budget deficits. Cuts in Medicaid would take a particularly heavy toll on people with mental illnesses because that vital safety net program currently funds approximately 50 percent of state and local spending on mental health care. Cutting Medicaid, and "block granting" it, as the resolution proposes, would put millions of people who have mental illnesses and depend on Medicaid at increased risk of becoming homeless, institutionalized, involved with the criminal justice system, or perhaps of taking their own lives. It is vital that the final budget resolution plan provide for increased federal support for the states and their Medicaid programs, as is called for in the Senate budget plan.

We also urge you o to oppose across-the-board cuts in the House budget plan, which would slash mental health funding by $53 million, and shrink funding for the supports and services people who have mental illness or substance use disorders desperately need. Please ensure that the final budget resolution provides the higher funding allocations provided for in the Senate budget resolution.

What the budget debate has clearly highlighted is the fact that this country simply cannot afford the more than $1 trillion in tax reduction proposed in the House budget plan. Deep sustained tax cuts would profoundly reduce the federal government's capacity to meet pressing mental health, social service and public health needs. These must remain a national priority.

We urge you to inform conferees of our views, and to oppose the final budget resolution if it requires cuts in Medicaid or other mental health funding.

Sincerely,

NYAPRS’ To Host Events on PROS for NYAPRS’ Members:

RECOVERY REPORT:
Special 'PROS' Edition

To: NYAPRS Members March 21, 2003

From: Harvey Rosenthal Executive Director

Re: OMH's PROS Proposal Continues to Take Shape;
Come to Special NYAPRS' Member Meeting with OMH in Albany on April 11;
NYAPRS to Host Biweekly Member Teleconferences on PROS;
NYAPRS Launches Series of Local PROS Forums;
NYAPRS' Annual Conference to Feature Special Day, Track on PROS

In response to the growing interest and controversy over OMH's new Medicaid outpatient license, termed "PROS' (Personalized Recovery Oriented Services), NYAPRS has planned a number of ways for our members and friends to stay informed, have input and prepare for the broad array of changes required by the proposal.

According to the NYS Office of Mental Health, PROS is a "comprehensive (new) recovery model that integrates treatment, support and rehabilitation". PROS as proposed will replace IPRT, existing vocational programs, clubs, and on-site rehabilitation programs with a new license option for providers of these services. PROS providers will bill Medicaid for rehabilitation and recovery oriented services. In addition, there is an option to include
Continuing Day treatment programs under the license.

In the News:

Bottom line: plan riles. Dozens speak against shutting Hutchings, other centers. By Amy Hsuan
The Syracuse Post-Standard, March 21, 2003

Of the 51 people who spoke Thursday at an Assembly hearing on Gov. George Pataki's plan to close Hutchings Psychiatric Center, just a few - including one state Office of Mental Health official - voiced support for the idea.

That official's testimony was greeted by jeers.

More than 200 people attended the Assembly Mental Health Committee hearing in the Onondaga County Legislature chambers at the county courthouse. Most of those who attended oppose the plan to shut Hutchings, which the Pataki administration says would save the financially strapped state $6.6 million. The governor also plans to close Elmira Psychiatric Center and three other centers Downstate.

Two state employees' union won a court order Wednesday temporarily halting the state's preparations to shut down the centers. A hearing will be held on the issue April 2.

One proponent of the shutdown was Al Holmes, deputy commissioner of the state's Office of Mental Health.

He acknowledged that the closing of Hutchings was "strictly a bottom-line" decision that calculated the number of empty beds and the cost of services into a savings for the state. He cited new drugs as having decreased the number of inpatients over the years, making for more beds than patients.

But he was unable to give specific answers to some questions posed by the committee.
When asked how many child psychiatrists were employed at Mohawk Valley Psychiatric Center in Utica, where Hutchings patients would be treated, Holmes said he didn't know, but that he expected there was at least one.

When asked how the state was planning to assist with the costs of transporting family members from Syracuse to Utica, Holmes said that while the state had done so in the past, the option had not been considered in this case.

Assemblyman William Magnarelli, D-Syracuse, said he was disappointed that the Mental Health Office appeared to focus more on money than on quality of care.

"There is no real plan for getting patients back into the community. I don't feel like I'm getting that," Magnarelli said. "I'm hearing a lot about how we're going to save money."

Most of the testimony and crowd response came from patients, employees, union leaders and medical professionals from both the Elmira and Hutchings centers. The hearing started at 10:30 a.m. and went well into the afternoon.

Speakers cited concerns over the loss of proximity to quality health care, the dangers of separating patients from family and friends and the costs of commuting to a distant center.

Such neglect of the population in need of mental health care is the result of "views (that) have made us appear to be an expendable population," said Eon West, who has been in the mental health care system in Onondaga County for 10 years.

"All things are in jeopardy if the centers close, from transitional living services, outreach to residential," West said.

Opponents of the Hutchings closure talked of the loss of more than 350 jobs and millions of dollars of annual payroll. Others spoke of Syracuse's inability to establish itself as a viable medical center without a mental health care unit, thus losing investments from outside resources.

"In order to create a medical health care powerhouse ... it is very important to us have a mental health care center," said David Mankiewicz, executive vice president of the University Hill Corp., a business development group.

Assembly members Magnarelli; Joan Christensen, D-Syracuse; Jeff Brown, R-Manlius; Will Barclay, R-Pulaski; and chairman Peter Rivera, D-Bronx, demonstrated an overwhelming support for keeping Hutchings open.

"We're talking about human lives. We're talking about people," Rivera said.

The hearing is the second in a series being held across the state on the proposed closing of five mental health care facilities statewide.

The Pataki administration says the closing of three centers - Hutchings, Elmira and Middletown - will save the state $18.2 million a year in the midst of a fiscal crisis.

Comprehensive MH Parity Proposal in N.Y. Stems from Publicized Failure
Mental Health Weekly (Reprinted from NYAPRS), March 24, 2003

A coalition of New York state mental health and substance abuse advocates expects as early as this week to see introduction of legislation that could yield behavioral health parity protections that are among the strongest in the country. Perhaps more so than with other parity bills that have been introduced around the country, this legislation will put a human face on the fight to end discrimination in health insurance benefits.

The outcome of the planned legislation, which is expected to cover chemical dependency as well as mental health and which will go beyond a “serious mental illness” approach to its mental health protections, may depend in part on efforts of the Timothy Law’s Campaign (TLC) Coalition.

The newly formed coalition has urged New York legislators to end discriminatory behavioral health coverage by adopting a law named in the memory of Timothy O’Clair, a 12-year-old Schenectady resident who committed suicide two years ago this month.

The 27-member coalition includes groups such as the Coalition of Voluntary Mental Health Agencies Inc., the National Alliance for the Mentally Ill (NAMI) of New York State, the Association for Community Living,
the New York State Psychiatric Association, physician representatives, and consumer and family groups. The advocates were joined at a news conference last week by Timothy O’Clair’s parents, Tom and Donna O’Clair, who reportedly are playing an active role in the advocacy effort.

Timothy had been diagnosed over the years with depression, attention-deficit/hyperactivity disorder, and oppositional defiant disorder. His family had difficulty accessing services for their son after they reached
inpatient and outpatient coverage limits in their family health insurance plan.

According to information released by the Mental Health Association in New York State (MHANYS), the family faced high copayments for mental health care, and said mental health treatment for their son was of a high quality but sporadic.

By the end of the fourth grade, Timothy had begun to refuse attending school. His first hospitalization occurred in 1998 after an incident in which he threw rags into the furnace of his family’s home. But according to those active in the Timothy’s Law Campaign, Timothy was hospitalized for only eight
days because his family’s insurance company would not cover a longer stay.

Following the hospitalization, the O’Clairs often pursued outpatient treatment for their son, but couldn’t access the residential care they felt he needed.

Eventually, Timothy’s parents decided to relinquish custody of their son when he required more care than their insurance would cover. He was placed in foster care in order for him to become Medicaid-eligible.

“It was the only way they could give him the services he needed,” Joe Glazer, MHANYS’s president and chief executive, whose organization hosted last week’s press conference, told MHW. “With parity you don’t have to relinquish custody for your child to get the services they need.”

Timothy committed suicide seven weeks before his 13th birthday by hanging himself in his bedroom closet.

“The O’Clair family feels if their [health insurance] coverage was not limited, Timothy would be here today,” Mathew Mathai, deputy director of the New York Association of Psychiatric Rehabilitation Services, told MHW. “They expressed that with great courage at the press conference.”

Legislative support

The discussion of parity is heating up again on the federal side as well, with last month’s introduction in both houses of Congress of comprehensive mental health parity legislation bearing the name of the late Sen. Paul Wellstone (see MHW, March 3).

New York advocates say they are encouraged by the legislative support they have received so far in both the state Assembly and Senate.

Leading proponents of the legislation are expected to include Assemblyman Paul D. Tonko, who represents the O’Clair family’s district, and Sen. Hugh T. Farley. Advocates also expect support from Senate Mental Health Committee Chairman Tom Libous and Assembly Mental Health Committee Chairman Peter M. Rivera. It was uncertain at press time as to what the formal sponsor list for
the bill would look like.

Tonko and other state lawmakers who are working on the parity bill say they intend to build significantly on the parity protections afforded in the current limited federal parity law for mental health, which prohibits
nondiscriminatory mental health coverage only in the areas of lifetime and annual coverage limits.

Working language in the legislation states, “Every policy delivered or issued for delivery in this state which provides coverage for medical or hospital care shall provide coverage for the treatment and diagnosis of mental, nervous or emotional disorders or ailments, and disorders of alcoholism, alcohol abuse, substance abuse, substance dependence or chemical dependence, however defined in such contract. Such policy shall not impose any greater limitations on such coverage than it does for physical health benefits.”

“This year since we’ve put Timothy’s name and face with it, we’re farther along than they’ve ever been able to get in previous years.”
Tom O’Clair.

Advocates say bills will be introduced in both chambers and will be identical in each. Lawmakers are currently reviewing the legislation, which advocates hope will be introduced this week.

Paige McDonald, executive director of Families Together in New York State, Inc., and chair of the Timothy’s Law Campaign Coalition, told MHW, “It’s a phenomenal coup to have the same bill in the Assembly and the Senate. All of us have worked really hard in developing the language and are really pleased with it.”

McDonald added, “New York’s legislation is very broad. It has one important piece: It’s got a person’s face. That is a real illustration of what can happen when we don’t have parity.”

Tom O’Clair told MHW that he hopes the legislation will end the stigma many families experience in the form of their unmet mental health insurance needs. “I’ve heard through members of the coalition that
it’s been roughly seven years trying to get a parity law passed,” he said. “This year since we’ve put Timothy’s name and face with it, we’re farther along than they’ve ever been able to get in previous years. That gives me hope.”

Parity study
New York advocates point to two recent studies to support their parity efforts. The first, an actuarial study by PriceWaterhouseCoopers, estimates that passage of Timothy’s Law would increase health insurance
premiums by only $1.26 per employee per month.

The Actuarial Analysis of Comprehensive Mental Health and Substance Abuse Benefits for the State of New York indicates that the proposed parity bill would not add significant overall costs for companies whose health plans include mental health and substance abuse benefits.

According to Glazer, in a survey by the Utica, N.Y.-based Zogby International Poll, 81 percent of New Yorkers said they were willing to pay the estimated $1.26 more per month to ensure full insurance coverage for mental and chemical dependency needs. “Insurance parity is cost-effective; studies support that,” he said.

Glazer added that the O’Clair family paid over $3,000 in child support to the state when Timothy was placed in foster care. “The family could have paid $8 over six months at $1.26 per month to get Timothy the help he needed,” he said.

“We have a great deal of hope that this is the year,” Glazer added.

Psychiatric workers protest plan to close hospital. By John-Henry Doucette
Times Herald Record, March 26, 2003

Middletown – Middletown Psychiatric Center employees gathered along Monhagen Avenue yesterday to protest the Pataki administration's plan to shut down the hospital, ship them out and send their patients away.

"That is the biggest sin of all," said Lucille Sorrentino, a Scotchtown nurse who has worked 19 years at the center. "My roots are here. I bought a home. My life is here, helping these patients."

The hospital has cared for mentally ill people in Orange and Sullivan counties for over a century. Its shuttering in July would kill off a large employer here and leave a hole in the system of care for some of the region's most vulnerable citizens.

It could force 370 employees to work outside Orange, and that's if those state workers remained in jobs at all, union leaders said.

County and city officials have opposed closing the center.

But such a step has been considered for years as a belt-tightening move. Gov. George Pataki announced the closure, among others in the state mental health system, in January.

With the state planning to shift workers to other state facilities, court action has stayed Pataki's hand. The Public Employees Federation filed suit because Pataki began closing the center without approval by lawmakers.

Perhaps 100 people at nearby state facilities may be displaced to make room for MPC workers, union officials said yesterday.

More than 100 patients, mostly from the general area, might be shipped to Orangeburg, about an hour's drive from Middletown.

Until next time, we remain,
Working to ensure available and accessible mental health services for all New Yorkers