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

Friday Fax from Albany

Sharon Carpinello Nominated by Governor for Appointment as OMH Commissioner: This week, Office of Mental Health (OMH) Acting Commissioner Sharon Carpinello was nominated by Governor Pataki to become the next Commissioner of OMH. If confirmed by the Senate, Carpinello would become the first woman to lead NY’s Office of Mental Health. In light of the leadership Acting Commissioner Carpinello has shown over the past several months on the issue of planning, MHANYS believes Carpinello would make an excellent successor to former Commissioner Jim Stone.

Assembly’s Mental Hygiene Task Force Committee Meets: MHANYS has been an active member of the Assembly’s Mental Hygiene Task Force since Assembly Mental Health Committee Chair Peter Rivera created it last year. As a member of the Task Force’s subcommittee on Intergovernmental Organization & Strategic Planning, MHANYS took part in the first meeting of the subcommittee on Wednesday, with various advocacy groups, county government officials and Assembly staff present.

Much of Wednesday’s discussion focused on the need for improved intergovernmental cooperation, both horizontally and vertically, so that all levels of government and appropriate government agencies work better together.

Several suggestions were made regarding planning mechanisms, and the underlying need for both needs and capacity assessments. There was general consensus that one of the greatest deficiencies with the current law is the lack of accountability.

MHANYS representatives suggested that certain tools of accountability, like wait lists and community-driven utilization data, should be made mandatory. According to the local officials present, OMH's Single Point of Accountability (SPOA) system already requires the derivation of this data at the local level, but there is no requirement for OMH to use it in its planning process.

MHANYS is currently working with the National Mental Health Association to identify assessment and data collection mechanisms being used in other states.

More information on the progress of the subcommittee and the Task Force, as a whole, will be forthcoming as the process moves forward.

The Fate of Middletown: On the same day as the Assembly’s Mental Hygiene Task Force subcommittee meeting, news of both the Senate’s and Assembly’s rejection of the Governor’s proposed closure of Middletown Psychiatric Center broke. Additionally, the Senate also indicated its rejection of the Governor’s proposal to create a Commission on Psychiatric Center Closings. See “Psych center rescued” from the Middletown Times Herald Record in the In the News section.

As one of the most outspoken and visible advocacy organizations on the issue of planning over the past several years, MHANYS contends that it is inappropriate to close any psychiatric facilities in the absence of a plan. Instead, we have argued that Middletown PC should remain open so that it can be examined, just as all state-operated psychiatric centers would, should the Commission on Psychiatric Center Closings be approved by the legislature.

It is important to note here that MHANYS and many other mental health advocacy organizations are pleased by the Governor’s proposal as a first step toward examining the future of New York’s mental health system. However, should any such Commission be created, it’s scope should be expanded to comprehensively look at the impact psychiatric center closures would have on the delivery of mental health services in a community and how such an absence would be filled. Furthermore, such a Commission must represent all stakeholders and seek out input from everyone that would be affected by any such closures, and incorporated into the larger planning process.

Timothy’s Law: Two major events in support of Timothy’s Law have been planned. First, is a March 9th Call-In in support of Timothy’s Law. Then, a notice for the Rally on the steps of the NYS Capitol follows, which will take place on the anniversary of Timothy O’Clair’s suicide – March 16th.

PHONE-IN FOR
TIMOTHY’S LAW

Tuesday, March 9th

Call the NYS Senate switchboard at (518) 455-2800.

Ask to be connected to your Senator and tell them, “No one should die because of insurance restrictions! Please ask Senator Bruno to bring Timothy’s Law (S.5329/A.8301) to the floor for a vote, NOW!”

THEN,

Call the Senate switchboard again, ask to be connected with Senate Majority Leader Bruno’s office ask him to “Please bring Timothy’s Law to the floor for a vote, NOW!”

For more information on Timothy’s Law events, go to www.mhanys.org/timothyslaw or by joining Timothy’s Team at http://mail.kilakwa.net/mailman/listinfo/timothysteam_kilakwa.net for periodic e-mail updates.

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No one should die because of insurance restrictions!

Join hundreds of supporters of Timothy’s Law (S.5329/A.8301) on the steps of the New York State Capitol, and then meet with
Legislators to ask them to pass the bill.

11:30 - Rally at Capitol Steps 1:00 to 3:00 - Legislative Visits We plan to have buses from Buffalo, Binghamton, Syracuse, Westchester, New York City and Long Island.

Information on transportation to the rally will be available at www.mhanys.org/timothyslaw or by joining Timothy’s Team at http://mail.kilakwa.net/mailman/listinfo/timothysteam_kilakwa.net for periodic e-mail updates.

Please contact Debbi Davis at the Mental Health Association in New York State to register for the Rally in Albany for Timothy’s Law, and to coordinate transportation to the rally in Albany.

Debbi Davis: (518) 434-0439 ext. 17 or ddavis@mhanys.org

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MHANYS and Samaritans Suicide Prevention Center
2004 Legislative Conference

Date: Monday, March 22, 2004

Location: Room 711-A, Legislative Office Building, Albany, NY

Time: 8:30 – 12:00 Noon, individual meetings afterward

Mental Health Association in New York State and
Samaritans Suicide Prevention Center
Legislative Conference

March 22, 2004
Room 711-A
Legislative Office Building

REGISTRATION FORM

Name ____________________________________________________________

Organization ______________________________________________________

Address __________________________________________________________

City ______________________________ State _________ Zip _____________

Phone _____________________________Fax ___________________________

E-Mail___________________________________________________________

Number of Attendees: ____________

Names of Attendees:

__________________________ ___________________________

__________________________ ___________________________

__________________________ ___________________________

__________________________ ___________________________

FAX OR E-MAIL TO:
Michael Seereiter, Director of Public Policy
MHANYS
194 Washington Avenue, Suite 415
Albany, NY 12210
FAX: (518) 427-8676
mseereiter@mhanys.org

In the News: Several articles of interest appeared in newspapers across the state this week on a variety of issues.

The first two articles, both from The Daily Star, out of Oneonta, NY, demonstrate the incredible momentum and strength Timothy’s Law currently enjoys. The first article discusses, at length, the current debate going on regarding Timothy’s Law, and the efforts currently underway in opposition to the bill. The second is one of the strongest editorials we seen in support of Timothy’s Law to date, published just 3 days later.

Next is an editorial in The Journal News of Westchester that discusses the recent NYS Court of Appeals case upholding Kendra’s Law, and calls for the passage of Timothy’s Law.

Also editorializing on the Kendra’s Law decision was the NY Post, in which they included some terribly stigmatizing language about individuals with mental illness. Please note the very end of their editorial where they state that the Court’s decision is “an important step in protecting society from the mentally ill.”

Lastly is the Times Herald Record article about the Middletown Psychiatric Center.

Timothy's Law spurs debate on health costs. By Amy L. Ashbridge
The Daily Star,February 23, 2004

Mental illness would be covered under proposal

Businesses, legislators and mental illness advocacy groups are battling over equal health coverage for mental illness this legislative session.

On Feb. 2, multiple small-business representatives from the area sent a letter to Assemblyman Bill Magee, D-Nelson, asking him to reject Timothy's Law, a state mandate for mental-health parity.

"Why would the small businessmen be against it?" asked Beth Strong from the Alliance for the Mentally Ill in Oneonta.

In the letter, the writers say unfunded mandates, like Timothy's Law, represent 12 percent of health-insurance premiums.

"It's not necessarily that we're against mental-health parity," said Rob Robinson, president and chief executive officer of the Otsego County Chamber.

Previous unfunded health-care mandates include the Women's Health & Wellness Act of 2002, the Health Care Reform Act of 2000 — which set up the Healthy NY program for those who work, but don't have insurance — and the Women's Health and Cancer Rights Act of 1997.

"There has to be a chance for the private employer to catch their breath to pay for health care," Robinson said. If the state passes the mandate, insurance companies will pass the costs along to employers, he said.

"Albany has to take some drastic action. It can't be business as usual," he said. "If mental-health coverage is good social policy, it should be covered in the basic budget" proposed by Gov. George Pataki.

Dr. Joan Puritz, from Crescent Pet Lodge and Veterinary Hospital in Oneonta, said she pays $1,100 per year per full-time employee for health insurance.

Part of the problems associated with the costs for Timothy's Law could be eliminated by switching to national health care, she said.

"It wasn't that I'm against coverage for mental health," Puritz said last week. "I really believe we need more help in paying for these costs. They should have more of a plan to make sure everybody's covered."

Puritz said she has three full-time employees who receive health insurance.

"How are we going to pay for it?" she asked.

Health-insurance costs have skyrocketed to the point where it's difficult for small-business owners to afford insurance, George Hesse from Satellite Central in Oneonta said.

"People don't realize the cost of the actual insurance," Hesse said last week. "They don't have a clue what it costs."

Hesse said he pays about $2,000 per quarter for a family plan.

"It's gotten to be unaffordable," he said.

According to mental-health advocacy groups, including the National Alliance for the Mentally Ill in New York State and the New York Psychological Association, full mental-health parity would cost $1.26 per member per month.

Timothy's Law is named for Timothy O'Clair, a 12-year-old boy who committed suicide in 2001.

Thomas O'Clair, Timothy's father, said the law is necessary to protect people's lives.

"The extreme effect is they take their own lives," O'Clair said when asked what happens when people can't access mental health care. "People tend to self-medicate when they can't get the care they need."

O'Clair said he and his wife were forced to give up custody of their son to get him the care he needed. When Timothy became a ward of the state, he was eligible for Medicaid, O'Clair said.

"We exhausted everything that was available to us," O'Clair said Thursday. "We afforded him the best mental health care that we could."

Timothy committed suicide six weeks after his parents regained custody, O'Clair said.

"The first three weeks, we saw the little boy we hadn't seen in years," he said.

This state quickly deteriorated, however, and Timothy began to have violent outbursts again, his father said.

"We had to tough it out," he said.

O'Clair, from Rotterdam, said he partially blames the insurance companies and their practices for his son's death.

Parents shouldn't be forced to do what the O'Clairs did, he said.

"That shouldn't have to ever happen," O'Clair said. "They should be able to provide for their children without limitations."

Excellus BlueCross BlueShield opposes Timothy's Law because its position is that consumers should be able to choose what benefits they want to receive, according to Jeff Flood, spokesman for the company.

"We believe Timothy's Law goes a little bit too far with customers having no choice," Flood said Wednesday.

Flood said, however, BlueCross BlueShield believes people should have access to mental-health care.

"We always oppose someone else's decision to mandate a benefit," Flood said. "Individual customers should make those decisions."

The individual cost of $1.26 is questionable, Flood said.

"If they were all $1.26 a month, it wouldn't equal 20 percent," he said.

Flood said unfunded mandates contribute about 20 percent to insurance premiums.

"It's negligible," said Dr. Maria Lifrak from the New York State Psychological Association.
Lifrak serves on the association's legislative committee.

"There's a misunderstanding about the impact Timothy's Law would have on health insurance," Lifrak said last week.

Lifrak said 33 states have laws similar to Timothy's Law. About 50 million American adults have some sort of mental disorder, Lifrak said.

According to a study performed by the Milliman and Robertson Group in Texas, serious mental-illness coverage costs $3.34 for each member of a large group policy per year.

This represented 2 percent of the premium, the group found.

The same coverage cost $3.53 for small groups. The cost was 1.9 percent of the health-insurance premium.

In 2003, the federal government studied Vermont and the cost impact of its mental-health and substance-abuse parity laws.

The study found the cost of parity was 19 cents per month, and overall spending by BlueCross BlueShield of Vermont increased about 4 percent.

During the last legislative session, Timothy's Law made it through the Assembly and was held up in the Senate.

Pataki proposed a constitutional amendment in his 2004 budget address to stop any further unfunded mandates.

However, Pataki has signed many previous mandates that passed the Assembly and the Senate.

Sen. James Seward, R-Milford, is chairman of the Senate's insurance committee.

"It's one more mandate on health-insurance policies," Duncan Davie, Seward's chief of staff, said Thursday. "That means added costs. That means fewer people will get health insurance. That means more people will be uninsured."

Unfunded health-insurance mandates are one reason many people can't afford health insurance, Davie said.

"New York needs to develop a plan to provide health insurance for more people, not fewer," he said.

Davie said higher costs could make health insurance prohibitively expensive for employers and employees.

If employers don't offer insurance, it can be difficult or impossible for employees to afford individual policies.

According to the Health Insurance Resource Center, a healthy, non-smoking adult in Oneonta can get an individual policy for about $213 per month.

The reported differences in costs from Timothy's Law are also a reason the bill may struggle, Davie said. He said more analysis of mandates was needed.

"A better plan is to have health insurance with fewer mandates that more people can afford," he said.

Legislators and companies need to explore more options instead of simply passing a new law, Magee said Tuesday.

"They've got some valid points," Magee said of the people who sent him the letter. "I agree with them. It would be another mandate on health care."

Magee said he didn't know what definite options could exist for people who can't afford mental-health care.

According to the Mental Health Association of New York, laws like Timothy's Law have not been costly in states where they exist.

"The increased cost of health insurance was minimal in Vermont," said Joseph Glazer, the group's president and chief executive officer. "The impact was just so low."

Glazer said when insurance companies, business owners and legislators make incorrect information available, they cloud the issue.

"We just see this as putting bad information into the community," Glazer said Wednesday.

He said Timothy's Law tries to put mental illness on an equal level with physical illness.

"It is clearly a law that seeks to end discrimination against people with mental disease," he said.

Opposition to Timothy's Law is purely about money, said Joseph Fodero, the advocacy chairman for the Alliance for the Mentally Ill in Oneonta.

"They're more interested in profits than they are in people," Fodero said of large corporations.

He said he could understand that health-insurance costs are high, but he said parity was still a necessity.

"There are a number of studies that show that this is not a huge cost," Fodero said last week.

Fodero quoted a Zogby poll as saying 81 percent of New Yorkers would be willing to pay for mental-health parity.

"There's nothing Herculean about what the cost would be if there were parity," he said. "To deny people what they need in terms of care, it's very draconian."

Insurance should cover mental health. Editorial
The Daily Star, February 26, 2004

It seems like every time we do a story about the costs of health care, someone in the story suggests the problem would disappear under national, single-payer health insurance.

We agree, but unfortunately that's not going to happen in the near future. Meanwhile, one of the problems we have to grapple with is health insurance coverage for mental illness. A proposal in the state Legislature known as Timothy's Law would mandate that health coverage include mental-health costs.

For years, we've been giving lip service to the modern understanding that mental illness is another type of health ailment. It's time our health insurance coverage caught up with that understanding and stop treating mental illness as something different.

For example, under many insurance policies, if you break a leg and go to the emergency room, you're covered. If you have a psychotic episode and have to go to a psychiatric crisis unit, you are not covered.

Timothy's Law is named for Timothy O'Clair, a 12-year-old boy who committed suicide in 2001. Thomas O'Clair, Timothy's father, said the law is necessary to protect people's lives.

"The extreme effect is they take their own lives," O'Clair said when asked what happens when people can't access mental health care. "People tend to self-medicate when they can't get the care they need."

O'Clair said he and his wife were forced to give up custody of their son to get him the care he needed. When Timothy became a ward of the state, he was eligible for Medicaid, he said.

Some business leaders oppose Timothy's Law and have asked state lawmakers to help reject the proposal. In a letter to Assemblyman Bill Magee, they said unfunded mandates, such as Timothy's Law, represent 12 percent of health-insurance premiums.

"It's not necessarily that we're against mental-health parity," said Rob Robinson, president and chief executive officer of the Otsego County Chamber.

"There has to be a chance for the private employer to catch their breath to pay for health care," Robinson added. If the state passes the mandate, insurance companies will pass the costs along to employers, he said.

However, the costs of mental-health insurance coverage are not very high. According to mental-health advocacy groups, including the National Alliance for the Mentally Ill in New York State and the New York Psychological Association, full mental-health parity would cost $1.26 per member per month. Others say it could be as much as $3.53 a month.

We, too, don't like the state sending out mandates for coverage. But if insurers and employers aren't going to do what is fair, then somebody has to force them.

If health-insurance policies refused to cover heart attacks without a rider at added cost, and most policies declined to include it, we would say that maybe there needs to be a mandate. And it's likely the American Heart Association would agree.

It's time to start treating mental illness as the physical imbalance we believe it is in most cases. And that means providing the insurance coverage its sufferers deserve.

Beyond Kendra's Law. Editorial
The Journal News, February 22, 2004

The state's highest court last week upheld the constitutionality of Kendra's Law, which allows the courts, at the behest of doctors, caseworkers and family members, to order mentally ill outpatients in New York to obtain and maintain treatment.

A lawsuit that challenged the law on due process and equal-protection grounds had moved through lower courts. The Court of Appeals Tuesday affirmed the law's intent of simultaneously ensuring the health and independence of mentally ill patients, and community safety.

Yet for all their implications, the ruling and the law are but slim reeds in the morass that is the mental-health system in New York state. Far more serious issues — inadequate, unsustained funding; frequent roadblocks to care for patients; and meager innovative programs, housing options and inpatient beds — threaten mentally ill children and adults alike.

Kendra's Law took effect in 2000. It was named in memory of Kendra Webdale, who was pushed to her death from a New York City subway platform by a man with schizophrenia who had not taken his medication. But even a cursory examination of the man's case showed how inadequate his care, and options, were as he became more ill — systemic conditions that remain today.

The law is aimed at patients who are generally capable of functioning in society as long as they comply with prescribed treatment. Advocates and family members of mentally ill people themselves disagree over its benefit. Some worry that without the court-order option, mentally ill persons in decline will become a danger to themselves and others. Others object to detaining patients, for up to 72 hours in facilities for evaluation, without a hearing.

Writing the 6-0 decision, Chief Judge Judith Kaye said: "The assisted outpatient's right to refuse treatment is outweighed by the state's compelling interests in both its police and parens patriae powers,'' the latter referring to the state's guardianship role of minors and incompetent people.

Importantly, Kaye drew distinctions between Kendra's Law and earlier mental-health law and cases. While acknowledging that under Kendra's Law patients' freedom is restricted, the high court said that the detention time is minimal, and that it allows patients to participate in developing their treatment plans and affords them needed medical scrutiny.

At least 40 other states now have statutes similar to New York's. Likely, Kendra's Law will continue to be challenged on other grounds and, as unforeseen circumstances arise, may need amending by the Legislature.

But there is far more pressing work for Albany to accomplish. This session, the Legislature must commit itself to passage of Timothy's Law, also named after a victim — a 12-year-old upstate boy who committed suicide in his home after family resources, and public options for his treatment, had been exhausted.

Timothy's Law would require insurance companies to extend coverage to treatment of mental conditions on a par with physical ones. That the health insurance system is allowed to forgo or limit medical care for mental conditions is Dickensian, a cruel and prejudiced acceptance characteristic of another century, not this supposedly enlightened one.

Ironically, for the patient without full and easy access to treatment, Kendra's Law is meaningless.

The Legislature also must pass a state budget that not only maintains the state's current mental-health system but expands it. Especially needed are dollars for children's services; housing and adult-home reforms; and increased aid to localities that provide services.

A recently released analysis of Gov. George Pataki's 2004-'05 budget request cites a 5 percent — $7.7 million — cut to community mental-health services affecting crisis, rehabilitation and peer-support programs. There also is no cost-of-living adjustment for local services, a de facto cut of $16 million to localities, according to the Center for Policy and Advocacy in Manhattan.

Those steps are unacceptable. In 1999, after Kendra Webdale's death, the Legislature rallied to pass a law that affects a relatively narrow group of mentally ill people. Now Albany can, and must, help all of them.

A Win for the Mentally Ill. Editorial
New York Post. February 22, 2004

We've had our differences with the New York Court of Appeals, but the justices of the state's highest judicial body rendered an important service last week by unanimously upholding Kendra's Law.

That's the measure, enacted in 1999, that lets interested parties get a court order to force a mentally ill patient to comply with medical treatment - including taking prescribed medication.

The state Legislature passed the law after Kendra Webdale was shoved in front of a subway train by Andrew Goldstein, a schizophrenic with a long history of violent behavior who had gone off his meds.

It's still an unsatisfying way to deal with the shutdown of state mental hospitals, which has kept thousands of mentally ill people, even potentially dangerous ones, on the streets.

This sometimes represent an immediate threat to the general public, a fact of urban life that the Court of Appeals wisely noted.

In dismissing a complaint by the lawyer for a patient forced to take medication, the court ruled: "The state's interest in immediately removing from the streets noncompliant patients previously found to be, as a result of their noncompliance, at risk of a relapse or deterioration likely to result in serious harm to themselves or others is quite strong."

Added the justices: "The outpatient's right to refuse treatment is outweighed by the state's compelling interests."

Indeed, they added, Kendra's Law - if complied with - "may enable patients who might otherwise require involuntary hospitalization to live and work freely and productively through compliace with necessary treatment."

It's difficult not to appreciate how many tragedies might have been avoided if New York had enacted a Kendra's Law even earlier, as 40 other states had done.

Kendra Webdale would likely be alive.

So would Gidone Busch, the mentally ill man gunned down by police on a Borough Park street in an incident exacerbated by his refusal to take medication.

The Court of Appeals' ruling is an important step in protecting society from the mentally ill - and those same poor souls from their own tragic demons.

Psych center rescued. By John Milgrim
Times Herald Record, February 25, 2004

Albany – State lawmakers have rejected Gov. George Pataki's plan to close the Middletown Psychiatric Center, leading legislators in both houses said yesterday.

Sen. John Bonacic, a Mount Hope Republican whose district includes the center, said the Senate's plans to keep it open were confirmed yesterday by the chairman of the Senate's Mental Health Committee, Binghamton Sen. Tom Libous.

"Closing the Middletown Psychiatric Center was never a good idea," Bonacic said. "This is a fight I have been involved with for 14 years. Protecting critical health-care services must include the protection of mental-health-care services."

Pataki's $99.8 billion budget proposal released last month included plans to shut the Middletown center and use half of the money saved to support community-based mental-health services. It was the third time in three years that Pataki has proposed the closure.

"We think all of the parties should recognize that this facility once served 3,600 patients and now serves 115, and that it would require a $27 million renovation to remain open," said Pataki administration spokesman Scott Reif.

Sharon Carpinello, acting commissioner of the state Office of Mental Health, said the state would save about $6.9 million each year by closing the center.

Assembly Mental Health Committee Chairman Peter Rivera, D-Bronx, said his house also rejected Pataki's proposal because it didn't follow legal procedures to determine whether the center should be shuttered.

"You don't make a decision to close and then go through the process," he said yesterday.

In previous budget proposals, Middletown was named along with several other centers as favored sites for closure. This year, however, Pataki singled out Middletown for closing in 2005 and left it to a new panel to decide what other centers should be closed.

Bonacic said the Senate also rejected Pataki's plans to form that panel.

"Our position is that the Legislature should retain control of the quality of mental health and we are going to make decisions on closing facilities as we deem appropriate," Bonacic said.

Also, the center employs 300 people and provides out-patient services for 700 patients, he said.

"We always have to balance the plight of the taxpayers and the benefits we are going to receive," Bonacic said.

He wouldn't rule out Pataki trying to close the center again next year, and figured it will be harder to justify keeping it open if in-house patients continue to dwindle.

"For the time being, we bought another year for the hospital," he said.

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