Mental
Health Association in New York State, Inc. |
Friday Fax from Albany
BUDGET, BUDGET, BUDGET: For the first time in over two decades, there is some chance that New York may actually have an on time, April 1st, budget. Early in the week, the Senate and Assembly agreed to begin holding Conference Committees to try to iron out their respective differences on how to proceed with changes to the Governor’s budget proposal. These conference committees have proven successful elsewhere and on other issues here in New York, bringing together the two sides. Similar attempts at Budget Conference Committees have been tried in past with limited success. After a General Conference Committee meeting, presided over by Senate Majority Leader Joseph Bruno and Assembly Speaker Sheldon Silver, there have been several Conference Committee meetings on select areas of the budget. Of most significance to our members are the meetings that have taken place at the Mental Hygiene table and continue to take place at the Health and Aging table. The Joint Assembly and Senate Mental Hygiene Committee met on Wednesday and Thursday, chaired by Assemblyman Peter Rivera and Senator Thomas Morahan. From MHANYS’ perspective, the most important resolution that came out of these discussions was to revisit the $7.7 million that was cut from the Local Assistance budget last year. These cuts have already impacted many of the community providers, including several of the MHAs. On Wednesday, the Committee agreed to restore $4.3 million of last year’s $7.7 million cut. If ultimately approved as part of the budget, we will have to work closely with OMH and the counties to highlight the importance of insuring that funding goes back to many of the MHAs and other community providers who were left most vulnerable by the cuts. It has been our priority to restore that funding and we are appreciative of the members of the Mental Hygiene Conference Committee for partially restoring this funding. Other agreements reached at the Mental Hygiene table include:
On Thursday, the Mental Hygiene Committee met again to deal with issues left unaddressed on Wednesday, including the proposed closure of Middletown PC in 2006 and the proposed merger of the Commission on Quality of Care for the Mentally Disabled and the Office of the Advocate for Persons with Disabilities. Regarding the closure of Middletown PC, the committee decided to reject the proposal to close the facility as part of the budget. Citing a lack of details on how the closure would be accomplished and the impact it would have on the catchment area in Orange and Sullivan Counties, the Committee requested that OMH provide the legislature with such additional details by May 4th, at which time, the legislature would revisit the proposal to close Middletown PC independent of the budget process. We continue to advocate for half of the funding estimated from the closure (total funding of $7 million) be utilized by community providers in those areas, as opposed to all of it being used by state operated programs. In addition, although the Committee initially had agreed to approve the merger of the CQC and the Office of the Advocate for Persons with Disabilities, they decided to defer that decision to the General Conference Committee, chaired by Senator Bruno and Speaker Silver, due to discrepancies in information and understanding. MHANYS has been on record as supporting the proposed merger as we believe combining these resources would provide additional quality in oversight of services for people with all types of disabilities. Lastly, the Committee also agreed to transfer responsibility and oversight of compulsive gambling services and programs from OMH to the Office of Alcoholism and Substance Abuse Services (OASAS). At the Health and Aging Conference Committee, chaired by Senator Kemp Hannon and Assemblymember Richard Gottfried, there has been no final decision made regarding issues of greatest concerns to our members, including the proposed elimination of mental health services under Family Health Plus, the implementation of a Preferred Drug Program, and the elimination of funding for psychological services under Medicaid. After going to Washington, D.C. to meet with Health and Human Services Secretary Michael Leavitt, Governor Pataki returned to Albany on Wednesday to announce an additional $1.5B in Medicaid funds from the Federal government over the next three years (article enclosed). Information about the details are limited though we have heard that they might be putting aside the $1.5B discussion until after the budget.
Without further details, it is unclear as to what will be necessary for the state to secure this funding, including the elimination of mental health services under Family Health Plus and cuts to psychological services. It will now be a wait-and-see approach to see how this will play out in the current budget negotiations. As the Governor specifically mentions the Preferred Drug Program (above), and the legislature appears to be more receptive to the proposal that in years past, we remain very concerned that a Preferred Drug Program could be enacted this year. We continue to voice our strong opposition, especially in regard to the creation of the Clinical Drug Review Program which would create a separate PDP within the PDP, allowing the language the carves out certain medications including atypical anti-psychotics and anti-depressants to effectively be sidestepped.
TIMOTHY’S LAW VIGIL: Wednesday, March 16th, was the anniversary of Timothy O’Clair’s death by suicide. Timothy’s Law advocates spent a good portion of the day at the Capitol circulating remembrance cards to legislators and staff. In addition, at 4:00, many supporters joined Tom O’Clair in the Capitol for a brief vigil in memory of Timothy. While no legislators were specifically invited, when word of mouth got to Senate Minority Leader David Patterson, he immediately joined Tom and Timothy’s Law supporters. In addition, as Speaker Silver was returning to his office, he happened upon the vigil and remained with us, standing in silence for several moments to remember the tragic loss of Timothy O’Clair.
MHASC LOBBY DAY: As had been advertised in previous editions of the Friday Fax from Albany, members of the Mental Health Alternatives to Solitary Confinement coalition convened in Albany on Monday to continue our push to eliminate the use of solitary confinement for inmates with mental health needs. Joined by former inmates confined to SHUs and family members of those lost to suicide in SHUs, we held an impassioned press conference at which the pleas for reform of the way in which inmates with mental illness are treated. After the press conference, advocates went to meet with members of the legislature to ask for their support in sponsoring this bill. Following are two articles detailing our efforts on Monday. In addition to Timothy O’Clair, Wednesday was also the anniversary of Jesse McCann’s death by suicide in ‘The Box.’ Four years ago this week, our system’s failure to adequately deal with the mental health needs of two boys was made glaringly clear. It is our hope that we can prevent such tragic losses from occurring in the future through improvements in our system of mental health care through passage of Timothy’s Law and elimination of solitary confinement for inmates with mental illness.
MHANYS’ ONLINE ADVOCACY: Budget - Please take just a minute to send your Senator and Assemblymember an e-mail regarding the Governor’s 2005-06 proposed budget using MHANYS’ Online Advocacy at http://www.mhanys.org/policy/advbudget.htm. Urge your representatives to reject proposals that would negatively impact individuals with mental health needs in New York. Preferred Drug Program - In addition, we have also provided you with an opportunity to urge your Senator and Assemblymember to reject the Governor’s proposed Preferred Drug Program (PDP). You may send your legislators an e-mail, detailing the problems with the PDP at http://www.mhanys.org/policy/advpld.htm. If you’re unsure of who your Senator and/or Assemblymember are, simply enter your address in the Board of Elections search page at http://map01.elections.state.ny.us/boe/main.asp. May is Mental Health Awareness MonthSecond Annual Walk for Mental HealthWeek of May 14 – May 20, 2005 In November of 2004, several advocates from across the state walked 122 miles in support of Timothy's Law. The walk went from Warwick, NY to Albany, NY and culminated in a rally of more than than 600 individuals gathered for Mental Health Parity. This year, two advocates involved in the Walk for Timothy’s Law in Memory of Robin Jane Desrats, Ann Berardinelli of Families with Bi-Polar Children, and Ali Zimmerman, an employee of Independent Living, Inc., are planning an annual Walk for Mental Heath during May is Mental Health Month. During the week of May 1st through the 20th, they will be getting walkers from each county to participate in a relay-type walk from the four corners of the state, converging on Albany on the 20th. If you are interested in participating, please contact Ann or Alexandra - e-mail the Walk Committee at mentalhealth_walkers@yahoo.com, or call Ann at (845) 566-0810 or Ali at (845) 703-1042 and they will connect you with the agency coordinating the walk in your region. IN THE NEWS: Medicaid
Waiver Stalls Budget Talks. By Karen DeWitt Senate and Assembly Leaders say they'll work through the weekend to try to come up with a budget agreement that they can take to Governor Pataki. Lawmakers applauded when the leaders of the joint conference committee on local government assistance told a panel led by Assembly Speaker Sheldon Silver and Senate Leader Joe Bruno that they had finished their work early. Senator Hugh Farley, a Republican from Schenectady, wore a green tie, as did Assemblyman Robert Sweeney, a Democrat from Eastern Long Island, to mark the day of celebration for Irish-Americans. "With my co-chairman, my fellow Irishman, on St. Patrick's Day you can be sure that we had no disagreement," Farley said. State lawmakers may consider an agreement on even a small portion of the budget a major accomplishment after 20 years of missed deadlines, and a record late completion date last year of August 11th. But many hurdles remain if there is to be a full budget in place by April 1st. Negotiations in the joint conference committee on health came to a halt, after Assembly Democrats said there might be more money available than the compromise of $695 million dollars previously agreed to. Senators tried to get Assembly Health Chair Richard Gottfried, a Manhattan Democrat, to list the programs that the Assembly would be willing to give up in order to meet the spending goal, but Gottfried refused. "I'm happy to listen to your description of which items that you want to restore or you'd like to throw over the side, but I'm not prepared to enter into that exercise until I know how much I've got to throw over the side , "Gottfried said. Gottfried's response annoyed Senator George Winner, a Republican from Elmira, who said the committee had been directed by the leadership in both houses to divide up a set amount, and not add to it. "Our instructions weren't $695 (million) plus X, Y, or Z that we want to spend," Winner said. Afterward, Gottfried said the fiscal staffs of the Assembly, Senate and Governor were working on moving money around in the health care budget to find more to spend on other programs. But at the meeting of the general conference committee, chaired by the legislative leaders, Speaker Silver and Senator Bruno said that the committee would be working with the $695 million dollar figure for now. Lawmakers are also uncertain about the terms of a federal Medicaid waiver that Governor Pataki has won. Pataki announced Wednesday that he had obtained $1.5 billion dollars from the federal government, that can be used only if the state cuts Medicaid costs through closing and consolidating hospitals, driving down prescription drug costs and other savings. The governor had hoped to use the waiver agreement to convince lawmakers to go along with his plans to cut Medicaid benefits and tax hospitals and nursing homes. But Thursday, the waiver seemed to have thrown a monkey wrench into the process rather than greasing its wheels. One day after the announcement, the lawmakers say they still don't have any more information than a five- paragraph letter from federal Health and Human Services Secretary Michael Leavitt. They say they don't know exactly what the state must do in order to qualify for the one and a half billion dollars, or how the state will be limited in spending the money if it is actually awarded. Senator Bruno and Speaker Silver say they'd like to put any money from the waiver into a "locked box " to determine later how the money would be spent. The legislative leaders also say they have not yet resolved the other large portion of the state budget, education spending. They say they will meet over the weekend, with time out for religious observances, in order to meet their goal of closing down the conference committees on Monday.
Need
to change way mental illness is seen. Letter to the Editor Based on the President's New Freedom Commission report, 50 percent of Americans with serious mental illness refuse to seek treatment. One of the major reasons cited for refusing services is the stigma of mental illness. Unfortunately, this stigma gets perpetuated through many different forces. For example, recently the Vermont Teddy Bear Company rightly received a great deal of negative publicity because of its "crazy" Teddy Bear who came with his very own commitment papers. Think about recent movies or TV shows you have watched: Why are all the people with mental illness cast as either psychopaths or crazy people? Think of clothing you see -- T-shirts and sweat shirts that say "Psych Ward" and other derogatory messages about people with mental illness. Think of all the conversations where someone is referred to as looney or a nutcase. These are just a few examples of the blatant stigmas in the community regarding individuals with mental illness. Anti-stigma efforts are not a matter of being politically correct. They are about respect and dignity for the hundreds of thousands of New Yorkers with mental illness who live productive lives in the community. That is why our organization is advocating for a tax checkoff on state income tax forms that will be used to fund a public awareness campaign to end the stigma of mental illness. GLENN
LIEBMAN
Bill
would bar solitary for mentally ill inmates. By Yancey Roy, Gannett
News Service ALBANY – A bill to stop the state from putting mentally ill prisoners in solitary confinement has won a key supporter, a Finger Lakes senator with a tough law-and-order reputation. Sen. Michael Nozzolio, R-Seneca County, said he wants to look at how the state prison system uses solitary confinement – known in the system as special housing units or “the box” – to discipline inmates. He added that his main concern is the safety of guards who have to deal with mentally ill inmates. Regardless of the reason, advocates will take the support. Nozzolio is chairman of the Corrections Committee and has influence in the Republican-led Senate. The Assembly’s sponsor, Jeffrion Aubry, D-Queens, said gaining support for change is difficult “because we’re talking about a population that, quite frankly, a lot of people don’t care about.” Under the bill, the state would provide more money for training for dealing with inmates with mental illness and more for mental-health services. But the key, Aubry said, would be to establish disciplinary units other than the special housing units. In solitary confinement, prisoners are isolated for 23 hours a day. Prison-rights’ advocates say about 25 percent of inmates in the units need mental-health services – the Pataki administration says it is 16 percent. Advocates also say about half of inmate suicides occur in solitary confinement. At a rally Monday, relatives of inmates who committed suicide in “the box” said the treatment is barbarous. “This system of torturing mentally ill patients is inhumane, not to mention patently illogical,” said Bryce McCann, whose 17-year-old nephew, Jesse, hanged himself in a special housing unit at Downstate Correctional Facility in Fishkill, Dutchess County. Jesse McCann, convicted of three felonies, had been diagnosed with intermittent explosive disorder, his uncle said. He tried to hang himself in the Ulster County jail before going to the state prison. Jesse McCann got into an altercation with a guard and was sent to solitary confinement. Health workers were experimenting with different medications shortly before he committed suicide. The state Corrections Department didn’t comment directly on the bill. In the past, agency officials have said they’ve increased training for working with disturbed, mentally ill inmates and that suicides have declined over the last decade, along with a drop in inmate population.
Hope
in 'The Box'. Editorial A state senator joins the effort to keep mentally ill inmates out of solitary confinement His name is state Sen. Michael Nozzolio, and he's acting like, well, a legislator. A real legislator. He, too, is concerned about the inhumane policy of placing mentally ill prison inmates in solitary confinement. So Mr. Nozzolio, a conservative Republican from Seneca County in the Finger Lakes, has lent invaluable support to a bill sponsored by Assemblyman Jeffrion Aubry, a liberal Democrat from Queens, to keep such inmates out of "The Box" and confined, when necessary, to more appropriate disciplinary housing. This injustice could be rectified, then. How unlike state government. Mr. Nozzolio could, after all, have submitted his own bill. One-house bills, as they're called, are a cheap and easy excuse for state legislators to claim the high ground and blame the other party while embracing a cause that's often worthwhile but rarely stands a chance of becoming law. They're everywhere, from budget proposals to differently worded bills that would at last require members of the clergy to report suspected cases of sexually abusing children. Common ground between Mr. Nozzolio and Mr. Aubry, and, in time, the Senate and the Assembly, could stand as an example of avoiding the inaction and one-upmanship so common to the Legislature. Mr. Nozzolio's perspective is a rather unusual one. His primary concern is how banishing mentally ill inmates to The Box affects prison guards, who are at undue risk when potentially violent offenders are mistreated this way. To others, the great cause for alarm is what such brutal punishment does to the most vulnerable of the prison population. Too often, the result is suicide. Inmate advocates say about half of prison suicides occur in The Box. The support from the prison guards that Mr. Nozzolio can bring is essential to legislation sparing mentally inmates from The Box. That's another fact of life in Albany -- the extent to which special interests can determine the fate of legislation. Without that support, the intolerable persists, with somewhere between 16 percent (the Pataki administration's estimate) and 25 percent (prisoners rights advocates' estimate) of inmates in solitary confinement in need of treatment for mental illness. To think, then, of what else could be achieved through legislating, as opposed to grandstanding.
Legislature
Rejects Plan to Close Psych Center. Gov. George Pataki's plan to shut Middletown Psychiatric Center in 2006 has been rejected by the Legislature, lawmakers said yesterday. It's unclear, however, whether the facility's door will still be open to patients after that. Assembly Speaker Sheldon Silver said last night both his house and the Republican-controlled Senate agreed to reject Pataki's closure plan. He said the administration has not yet provided a plan, as promised, detailing the potential impact of the facility's closure on patients, staff and the local community. For several years Pataki has proposed closing the facility, each time to be rejected by the Legislature. This year, however, there was less early opposition from lawmakers, mental health advocates and unions, in part because Pataki promised to reinvest the $7 million the state would save back into local community services. Exactly how that money would be spent is part of the detailed plan lawmakers have been looking for.
Medicaid
in the Cross Hairs. Editorial Everyone seems to be howling about the cost of Medicaid, and no wonder. Spending on the health care program for the poor has been exploding, up from about $200 billion in 2000 to more than $300 billion at last count. State governments, which share the costs with the federal government, were hit with the bill just as the economic downturn hit their revenues. And the Bush administration, awash in red ink, wants to cut costs. The biggest problem with Medicaid is that it has been deputized to do a lot of jobs it wasn't originally created for. Intended as a health insurance program for families on welfare and people with disabilities, Medicaid has gradually been stretched to cover for Congress's failure to deal with the millions of low-income American workers without health insurance, and the refusal of Medicare to pay for long-term nursing home care for the elderly. It's understandable that the states (and in New York, the localities, which pay for part of the program) want to control this fiscal albatross. And while this page has deep disagreements with the current budget priorities in Washington, both the White House and Congress have a responsibility to get a handle on Medicaid's rising costs. But the effort should account for three important points: Medicaid is performing a critical service that the public supports - making sure that poor children get proper medical care, that working families have health coverage and that old people get quality care. The driving force behind the recent upsurge in costs, according to an analysis by researchers at the Urban Institute, was a big increase in the number of people enrolled. The wobbly economy left more workers with incomes low enough to qualify for Medicaid and fewer employers offering affordable health coverage. That is hardly an indictment of Medicaid. The program was doing what it was meant to do, filling a gap for people in real need. There is a difference between real spending cuts and simply moving the bills into a different account book. People's health needs won't disappear just because Medicaid stops paying for treatment. People will turn instead to hospital emergency rooms, adding to the huge burden of charity care at hard-pressed medical institutions. Medicaid itself is the ultimate victim of cost shifting. A great deal of its cost is due to Medicare's failure to cover some vital services for the elderly - particularly nursing homes. As a result, people of modest means routinely impoverish themselves on nursing home bills, until they qualify for Medicaid. When Medicare begins paying for prescription drugs for the elderly, states will continue to provide the bulk of the money for coverage for the elderly poor. Congress insisted on that to keep down the cost of the new program. Despite loose talk about Medicaid providing Cadillac services when a Chevy would do, the program is extremely parsimonious in big ways. Most of its beneficiaries are in health maintenance organizations that are often shunned by better-off Americans. It typically pays hospitals and doctors far less than Medicare or private plans, making many doctors unwilling to accept Medicaid patients. Its spending per enrollee has increased more slowly than private insurance spending, and it delivers care more cheaply than a private plan. It's a pretty safe bet that few of the critics talking about overly generous benefits would be willing, in real life, to exchange health plans with a Medicaid recipient. That said, there are problems with Medicaid that need to be addressed. Sordid Medicaid mills sometimes hustle patients through at a rapid clip or charge the program for services not rendered. Middle-class people sometimes hide or transfer assets or income, often quite legally, to qualify for nursing home benefits. Many states have used outrageous accounting tricks to gain millions of dollars in federal matching funds to which they were not entitled. Such abuses can and must be curtailed, and the Bush administration deserves credit for trying. But eliminating fraud and closing loopholes will barely make a dent in the overriding problem - the inexorable rise in Medicaid costs that is restricting the ability of states to finance other vital services, such as education and transportation. In seeking to reduce the cost of Medicaid, it will be crucial to look hard at long-term care, which soaks up roughly a third of total Medicaid spending. In a rational world, those costs would be paid by Medicare, and the fact that Medicare is already in deep, deep financial trouble is no reason to continue forcing the states to pay. It is long past time for a serious national discussion about how best to handle an aging society's needs for long-term care for victims of Alzheimer's, Parkinson's and other ailments that require constant medical or custodial care beyond what the immediate family can provide. We don't argue with fiscal conservatives who say that the government should clamp down on people who shift all their assets to their children in order to make Medicaid pay for nursing home care. Citizens have a responsibility to pay their own way as much as possible. Working with the private insurance market to make sure people can get coverage for old age, and making it as automatic as buying car or home insurance, could make a big difference. Meanwhile, without a broad plan for long-term care, it would make little sense to cut deeply into Medicaid, the default funder of services needed by our aging society.
Until
next time, we remain, |