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

Friday Fax from Albany

Governor’s Budget Proposal Scrutinized by Legislature: Last week marked the beginning of the 2004-2005 budget negotiation period, as the Senate and Assembly held joint hearings to gain input from advocates and lobbyists regarding the Governor’s Executive budget proposal, which was released two weeks ago. As was detailed in a previous Friday Fax, there are several proposals included in the Governor’s budget that would affect individuals with mental illness in New York. On Tuesday and Wednesday of this week, MHANYS testified at both the Joint Legislative Budget Hearings on Health and Medicaid, and Mental Hygiene.

At the Mental Hygiene hearing on Wednesday, the Commissioners of the Office of Mental Health (OMH), Office of Mental Retardation and Developmental Disabilities, and the Office of Alcoholism and Substance Abuse Services were first to testify, detailing the points of the Executive budget proposal as they relate to populations their respective offices serve. Sharon Carpinello, Acting Commissioner of OMH provided the Legislators gathered with the details of the budget proposal, including the proposed closure of Middletown Psychiatric Center, the Commission on Psychiatric Center Closures, changes to Reinvestment, and many other points that were detailed in a previous edition of the Friday Fax. Then followed the questioning.

Assemblyman Peter Rivera began questioning Acting OMH Commissioner Sharon Carpinello with a series of questions on a range of issues, including: the necessity of maintaining waiting lists for individuals seeking mental health services; the relationship OMH has with the Department of Correctional Services in ensuring inmates with mental illness receive appropriate treatment; the location of the 20 children’s inpatient beds cited for closure; the budget reduction for local assistance that will only affect non-clinical services which are “less critical”; the Commission on Psychiatric Center Closures, and; the lack of continued funding for the 2000 bed promise made in last year’s budget.

Senator Thomas Libous then followed Assemblyman Rivera with a series of comments and questions that included: his displeasure with OMH failure to follow the law with regard to closure of psychiatric facilities and his subsequent skepticism regarding the Commission on Psychiatric Center Closures; his displeasure with the lack of funding currently in Reinvestment and his support for securing Reinvestment funds for communities affected by closure; the proposed cut to local assistance; the need to address the crisis in funding for children’s services; the current implementation of PROS and the need for a trend factor, and; the collaboration between the OMH and the Office of Alcoholism and Substance Abuse Services in treating those with a dual mental health/chemical dependency diagnosis.

Other Senators and Assemblymembers questioned the Commissioners on a variety of issues, many of them following up on points raised by Assemblyman Rivera and Senator Libous. After the Commissioners testified, organizations such as MHANYS presented comments on the Governor’s budget proposal. Following are a few highlights from the testimony MHANYS presented at both hearings in the limited time permitted.

Excerpts from MHANYS’ testimony to the Joint Budget Hearings of the New York State Senate and Assembly On Health

(Read complete testimony.)

“ . . . the Mental Health Association in New York State (MHANYS) is deeply concerned about many of the proposed cuts to the Medicaid system in this year’s budget. As part of the Medicaid Matters Coalition, we agree with the positions outlined by this organization in regard to the protection of Child Health Plus, Family Health Plus, and several of the other Medicaid issues of vital concern to individuals living with mental illness, as well as their families and other support networks.”

“The primary issue I would like to discuss with you today is the pending threat of a Preferred Drug Program (PDP) within Medicaid. MHANYS has stood up repeatedly, with over 20 other organizations, to oppose the implementation of a Preferred Drug List (PDL), supplemental rebates, and prior authorization (PA). These programs place restrictions upon the medications that individuals living with mental illness may receive; taking control of this vital decision out of the hands of doctors and their patients and placing it instead in the hands of individuals who may be up to 350 miles away, and ignorant of their personal health care needs.”

“Many have argued that this is not even a fight that MHANYS should be holding. They have argued that the mental health community’s medications are exempted. This legislation exempts only atypical anti-psychotics, anti-depressants, anti-retrovirals, and anti-rejection medications for organ transplantation. However, individuals with mental illness have a 50% co-morbidity rate. That is, 50% of the people on Medicaid with mental health needs also have a chronic physical ailment. It does my organization no good if our members have their mental illness treated, only to die later of congenital heart failure or diabetes. Further, medications for bi-polar disorder, anxiety disorders, and other crippling mental illnesses are not included in this list. Only by exempting the person with the chronic condition, and not the pills they are taking, can we begin to address the consumer protections that would be necessary for even a basic bill. This provision, as it currently exists, is unacceptable at any level.

I have outlined here numerous ways in which the PDP proposed by the Governor in his Executive Budget is flawed. However, I would like to again stress that, in the opinion of MHANYS; the only good PDP is no PDP. We recognize that steps have to be taken to begin to curb the cost of pharmaceuticals within the Medicaid program; but do not believe that limiting recipients access to those pharmaceuticals is the proper response. There are other alternatives which would save money while preserving access, and we would be happy to work with you in investigating these alternatives further. One such alternative is the concept of poly-pharmacy – identifying and reviewing individuals who are filling Medicaid prescriptions far in excess of the average for those with similar diagnoses. This is a concept that has been enacted in many states, most successfully Massachusetts. It not only saves the state millions, it does so in a manner that promotes the best clinical science and helps to identify and reduce fraud. And while poly-pharmacy efforts are most often targeted at mental health, experience dictates that there are many people receiving multiple medications for physical health ailments – from chronic pain to heart disease and blood pressure. Addressing the issue of over-prescription of medication may lead to better health care and lower costs. An added benefit of poly-pharmacy review might also be uncovering Medicaid fraud, at both the provider and consumer level. This is but one of many options that can be pursued further.”

Excerpts from MHANYS’ testimony to the Joint Budget Hearings of the New York State Senate and Assembly on Mental Health, Mental Retardation and Developmental Disabilities

(Read complete testimony.)

“This year, the Governor has taken a significant step toward the development of a comprehensive system of mental healthcare. Both in his budget itself, and in documents issued concurrently with it, the Governor’s Executive Budget Proposal makes progress in the effort to plan for future mental health services. And MHANYS would like to thank the Governor for listening to our requests, and those of our colleagues, in working toward a plan.

The Governor’s proposed budget, inclusive of a bi-partisan facility closure commission, a long term extension of the law we know as Reinvestment, and an effort at more fully complying with the planning requirements of § 5.07 of the Mental Hygiene Law, demonstrates an Executive Branch commitment to planning not seen since the days of Governor Hugh Carey.”

“Of course, the Governor’s proposed budget does have it shortfalls. We look forward to working with the legislature to address them. Perhaps most prominent is the Governor’s proposal to close the Middletown Psychiatric Center at the same time he proposes to create a Commission to look into closing State Psychiatric Centers. Both have a completion date of April 1, 2005.

MHANYS believes this can best be described in terms of ‘putting the closure in front of the horse’. We recommend, consistent with our existing position regarding no major changes in the absence of a plan, that Middletown be included in the Commission’s evaluation of psychiatric centers, just as all others would.

MHANYS also believes that the proposed Commission itself, while a significant step in the right direction, may require some modifications. First, we are concerned that the Commission will rely on OMH determined census needs for the facilities, and does not include community-based needs and assessment. Without ascertaining the broad-based need for mental health treatment in these communities, those numbers may be inaccurate.

We are concerned, as well, that the proposal includes no requirements to ensure that all stakeholders are represented on the Commission, and to ensure that all constituencies are represented, such provisions must be made.

Additionally, MHANYS is concerned that the Commission’s duties may be short-sighted. Recognizing that determining state inpatient bed needs will require broad assessment, the Commission becomes a perfect opportunity to develop and approve a comprehensive plan for a system of community-based care. The planning function might include having the Commission hold hearings, review and approve the 5 year services and the 3 year capital plan submitted by OMH before the Commission’s members are discharged from their duties.

What is the impact of limiting such a Commission to determining which facilities to close? We need look no further than the experience of the Plattsburgh area and the military base to see what closure without a plan can do.”

MHANYS Releases 2004 Legislative Agenda: This week, MHANYS Board of Directors approved the following as MHANYS’ 2004 Legislative Agenda.

Mental Health Association
in New York State, Inc.

2004 Legislative Agenda

Parity: End health insurance discrimination by enacting parity in coverage for mental health and chemical dependency as is provided for other health services

• Enact Timothy’s Law

Plan: New York must establish a planning process that includes all involved stakeholders, in all communities throughout the state, so that the system of mental health care is capable of meeting the ever-changing needs of all children and adults with mental illnesses. The system must:

• Assess existing infrastructure and services, and service needs
• Develop services capable of meeting individualized needs
• Consistently assess the need for existing services through oversight and develop services to address any unmet needs
• Ensure the availability and affordability of safe, quality housing
• Eliminate gaps in services that create barriers to recovery by causing people to unnecessarily ‘fall through the cracks’
• Maintain a workforce appropriately trained and compensated to consistently delivery quality services

Protecting Access: Ensure that individuals living with mental illness have access to the medications and treatment they want and need

• Prescription Drugs in Medicaid
• Electroconvulsive Therapy Patient Protections

Prison and Jail Reform: Prevent individuals with mental illnesses from becoming involved or further involved with the criminal justice system due to inappropriate treatment, and ensure appropriate post-release support

• Medicaid Coverage When Leaving Jails, Prisons & Hospitals
• Eliminate Solitary Confinement for Inmates with Mental Illnesses
• Reform of the “Not Guilty by Reason of Insanity” Defense

In the News: Four articles are attached to this week’s Friday Fax, which deal directly with all four of the major issue areas included in MHANYS 2004 Legislative Agenda, which was just discussed.

• 1st (Parity) - An editorial that includes commentary that expresses much of the frustration many advocates feel with regard to Timothy’s Law
• 2nd (Plan) - An article that discusses the proposed closure of Middletown Psychiatric Center and the Commission on Psychiatric Center Closures
• 3rd (Protecting Access) - An article detailing the debate over the appropriateness of antidepressant use regarding children
• 4th (Prison and Jail Reform) - An article about the efforts of the Mental Health Alternatives to Solitary Confinement (MHASC) Coalition, of which MHANYS is an active member, to put an end to the use of solitary confinement for inmates with mental illness.

The Capitol is like the movie Groundhog Day. By James V. Franco
Troy Record, February 5, 2004

From the Capitol, a deja view

In the movie, Bill Murray plays a weatherman sent to Punxsutawney, Pa., to cover Phil the groundhog and report on whether Phil sees his shadow, which means six more weeks of winter, or not. Somehow, Murray gets caught up in a weird time warp and relives Feb. 2 over and over and over again.

It's kind of like that around here, too.

Now that the pomp and circumstance of the governor's State of the State and budget presentations are over, and session is rolling along, you can't help but have, as Yogi Berra said, "Deja vu all over again."

County officials are screaming for mandate relief, just like last year. Everyone in the Capitol is promising it, just like last year.

The elderly are screaming for lower prescription drug costs and everyone is promising them, just like last year.

Tom O'Clare brought his son Timothy's wagon full of petitions to state Senate Majority Leader Joseph Bruno urging him to support mental health insurance parity, just like last year. Timothy O'Clare was a mentally ill 14-year-old boy who hung himself because he could not, in part, get the proper treatment. Bruno has refused to put it to a vote.

The Senate passed budget reform, just like last year. The Assembly will, too, just like last year. And the two bills are just as far apart this year as they were last year.

Everyone is saying the budget will be done on time, just like they did last year at this time. We'll see where we are on April 1, but my guess is it will be just like last year - and the 18 consecutive years before that.

The Legislature will have been in session 11 days before it takes a much-needed and well-earned week off, just like last year.

Hospitals are screaming for relief, just like last year. And, according to the Healthcare Association of New York State, the entire system is "on the brink," just like last year.

The Assembly passed its version of a bill that would force clergy to report instances of abuse. But Assemblyman Jack McEneny and Sen. Stephen Saland can't get together and pass the same bill, just like last year.

Budget hearings are going on before various legislative committees, just like last year, but we all know the final budget will be determined by Bruno, Gov. George E. Pataki and Assembly Speaker Sheldon Silver behind closed doors, just like two years ago.

I know, it's not like last year, when the Legislature voted to override 119 of Pataki's vetoes. There are exceptions to every rule.

There is a deficit this year, though, just like last year, and yet the budget will grow again, just as it did last year.

Leaders have pledged "no new taxes" this year, but Pataki proposed to raise a host of fees. Early indications are the Legislature will go along with them, so it will be the same as last year, when the final budget did include tax increases.

Education spending, always a touchy subject, will be harder to deal with this year than in years past because of the court mandated reform of how aid is distributed. A little different than last year, but certainly not any better.

Rockefeller Drug Law reform is still on the table, campaign finance reform is too, and so is Medicaid reform ... just like last year.

In the movie, Bill Murray woke up on Feb. 2 every morning for more than 30 days. The weather was the same, the people were generally the same and the general scenarios were the same. He lost it for a while. He indulged in booze and bad food and drove off a cliff, killing himself only to wake up again on Feb. 2. He punched people, stole money and got tossed in jail.

Finally, frustrated and depressed and nearly crazy, Murray did things a little differently, got his life in order and woke up on Feb. 3.

My guess is I will be able to write this same exact column next year.

Psych center savings? By John Milgrim
Times Herald Record, February 5, 2004

Closing would produce $6.9M for mental health, state OMH says

Albany – Closing the Middletown Psychiatric Center will leave the state with enough money to nearly double the amount spent on community-based mental health programs in Orange and Sullivan counties, the acting state mental health commissioner said yesterday.

Sharon Carpinello, acting commissioner of the state Office of Mental Health, said the state will save about $6.9 million each year by closing the center. Pataki's proposed budget includes returning half of those savings to the communities now most closely served by the center.

The Pataki administration's plan to return money to the community has left some thinking it might now make it an easier sell to close the 100-year-old center.

"The precedent he [Gov. George Pataki] made is breaking the stalemate," said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitative Services.

"That is a step in the right direction," said state Sen. John Bonacic, R-C-Mount Hope, who, twice before, helped fend off the administration's plans to close the facility.

"If it's in the cards that Middletown has to close, so be it, but I want it done fairly and competitively," Bonacic said, adding that all of the $6.9 million in savings should be returned to community services.

State-operated community mental health services in Orange and Sullivan, such as group homes, clinics and other facilities, currently cost New York about $3.7 million, Carpinello said. The reinvestment from the psychiatric center's closing would mean an additional $3.4 million, she said.

Rosenthal said that plan is similar to the "responsible downsizing" of the state's psychiatric centers for which the psychiatric services association has been pushing.

In previous budgets, Middletown was named along with several other centers as favored sites for closure. This year, however, Pataki singled out Middletown for closure and left it to a new panel to decide other centers that should be closed.

Bonacic said that panel should decide Middletown's fate, too.

Carpinello said the case for closing Middletown is so compelling that it should be used as a model for deciding what other facilities to shut.

The state can't justify spending $28 million to bring the center up to date, especially when it can only house 115 patients, she said.

Carpinello also noted that the 27 miles from Middletown to Rockland Psychiatric Center, where many of the patients would likely be moved, is not that far.

Stronger Warning Urged on Antidepressants for Teenagers. By Erica Goode
New York Times, February 3, 2004

BETHESDA, Md., Feb. 2 — A scientific advisory panel urged the Food and Drug Administration on Monday to issue stronger warnings to doctors now about the possible risks to children of a newer generation of antidepressant drugs, rather than wait until the agency's review of the drugs was completed.

"Our sense is that we would like in the interim for the F.D.A. to go ahead and issue stronger warning indications to clinicians" about the chance that the antidepressants might be linked to suicidal thinking and behavior, hostility or other forms of violent behavior, said Dr. Matthew Rudorfer, a scientist at the National Institute of Mental Health and the chairman of the F.D.A. advisory committee.

Dr. Rudorfer said such a warning would not discourage doctors from using the antidepressants but would alert them to warning signs that a drug might be having harmful effects.

The recommendation came at the end of an emotional daylong public hearing on the issue. Most of the antidepressants belong to the class known as selective serotonin reuptake inhibitors, or S.S.R.I's.

Dr. Thomas Laughren, the team leader for the F.D.A.'s division of neuropharmacological drug products, said that the agency took the panel's recommendation "very seriously" and that it would probably issue such a warning "sooner rather later."

Along with experts who testified at the hearing, the panel listened to parent after parent, and children, who stepped up to the microphone to tell stories of suffering and loss. A father spoke of his 13-year-old son who hanged himself from a closet hook after starting on an antidepressant. A teenager said that after a few weeks on the drugs he took a hunting rifle to school and threatened his classmates. He had no memory of his actions, he said, and woke up afterward in a juvenile detention center.

One mother asked, "How many more people have to die before a warning gets issued?"

Other parents said the antidepressants had helped their children enormously and saved many other children's lives.

"I shudder to think of their plight if these medications were not available," said a mother whose son suffers from manic-depression.

Dr. Rudorfer said the committee was struck by the fact that in some cases described at the hearing doctors had seemingly prescribed antidepressants casually and failed to monitor the children closely while they were taking them.

"We were all concerned about the stories we heard," Dr. Rudorfer said, noting that the drugs were "very powerful but also potentially very effective."

In December, British drug regulators told doctors to stop writing new prescriptions for children under 18 for six newer antidepressants because the potential risks outweighed benefits. Use of the drugs might still be warranted in some cases, the regulators said, and they exempted Prozac from the order.

The F.D.A. has been conducting its own review of the safety and effectiveness of the antidepressants, but has not yet taken action to stiffen warning labels or restrict use of the drugs. Officials from the agency said the investigation would probably not be completed until summer and that another public hearing would be held before then.

Dr. Laughren told the advisory committee on Monday that the agency was reviewing 25 studies of nine antidepressants, involving more than 4,000 patients. The drugs under review include Prozac, which is made by Eli Lilly; Zoloft, by Pfizer; Paxil, by GlaxoSmithKline; Luvox, by Solvay; Celexa, by Forest Laboratories; Wellbutrin, by GlaxoSmithKline; Effexor, by Wyeth; Serzone, by Bristol-Myers Squibb, and Remeron, by Akzo Nobel.

He said there was "a suggestion from that data that there is a signal of something, there is an excess of something occurring." But trying to figure out what that "something" is, Dr. Laughren said, is enormously complicated.

At the hearing, Dr. Laughren and other F.D.A. officials asked the panel to advise them on several questions, including whether their plans for analyzing the existing studies of the antidepressants are adequate.

The F.D.A. has asked researchers at Columbia University to trace the data used in the drugs' clinical trials to make sure that behaviors coded in the trials as suicidal in fact represent suicidal thoughts or actions.

Parents and some psychiatrists have been critical of the F.D.A. for taking so long to investigate.

"I don't think much is going to come of this," said Jay Baadsgaard, of Yelm, Wash., whose son took the hunting rifle to school.

Some parents also say the F.D.A. is too heavily influenced by the drug industry, which heavily promotes antidepressants for a variety of psychiatric problems including depression, social phobia, anxiety disorders and obsessive-compulsive disorder.

About 11 million prescriptions for a group of newer antidepressants were written for American children under 18 in 2002, according to the F.D.A.

Some parents at the hearing, who had two minutes each to tell their stories, described how their children seemed to change abruptly after starting the drugs, becoming aggressive, suicidal or violent toward others.

But Dr. David Shaffer, a professor of psychiatry at Columbia, told the advisory panel that suicide rates among children and adolescents had declined in recent years and that the growing use of antidepressants was a possible explanation for the drop.

Advocates push to restrict use of The Box. By Paul Grondahl
Albany Times Union Thursday, February 5, 2004

Measure would keep mentally ill inmates out of special housing units

Armed with a catchy slogan and a new Assembly bill, advocates for mentally ill inmates are lobbying legislators to limit the use of special housing units, a form of solitary confinement in the state prison system.

"We're punishing people twice for being mentally ill by locking them up in SHUs. It isn't humane, and it must stop," said Assemblyman Jeffrion Aubry, D-Queens, chairman of the Corrections Committee. He has introduced a bill to abolish solitary confinement for inmates with serious mental illness.

Aubry over the last week has spoken with advocates with the New York Association of Psychiatric Rehabilitation Services (NYAPRS) and the National Alliance for the Mentally Ill of New York State (NAMI-NYS), which lobbied in Albany. Advocates wore buttons proclaiming "Boot The SHU" and waved signs with slogans such as "Think Outside The Box." In prison slang, the SHU is known as The Box.

"Assemblyman Aubry's bill has provided fresh momentum for galvanizing the different advocacy groups, some of whom have worked on this issue for years," said Robert Corliss, associate director for criminal justice for NAMI-NYS.

The state Department of Correctional Services (DOCS) uses SHUs for disciplinary cases and says the practice of the 23-hour daily confinement has reduced assaults on inmates and corrections officers.

There are 1,567 beds in 38 SHUs at maximum and medium-security prisons. The state disputes advocates' claims that SHU confinement can lead to mental illness or exacerbate existing psychological problems.

"Our goal in sending inmates to disciplinary housing is to change their behavior," DOCS Commissioner Glenn Goord said in a recent article in the department newsletter, DOCS Today.
DOCS officials declined to comment on Aubry's bill, citing a long-standing policy of not reacting to pending legislation.

Sen. Michael F. Nozzolio, R-Seneca Falls, chair of the Crime and Correction Committee, was not available for comment.

Aubry's legislation is currently a one-house bill, but advocates hope their "Boot The SHU" drive might take hold this year.

"The Box isn't treatment. It's torture. We're going to take the fight to boot the SHU to the legislators this year," said Ray Ortiz, a NYAPRS staff member and former prisoner who did time in an SHU.

Aubry praised Gov. George Pataki for asking in his proposed executive budget for an additional $6 million in the DOCS budget and an extra $7 million in the state Office of Mental Health budget for additional services to treat mentally ill prisoners.

"That's a good thing, but it's not a change in the law," Aubry said. "My concern is that they'll use the budget as a stalking-horse and the money won't last. We need a law to say that we won't put mentally ill people in SHUs."

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