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

Friday Fax from Albany

PROS UPDATE: As part of the process by which the Office of Mental Health (OMH) must go about implementing regulations for the Personalized Recovery Oriented Services (PROS) program, they must accept comments from the public prior to the implementation of those regulations. For general information about the PROS program, you can visit OMH’s website at http://www.omh.state.ny.us/omhweb/pros/.

MHANYS submitted comments to OMH based on the various comments we’ve received from affiliates and additional items (including stronger grievance procedures and pro-active advisory boards). Following is an excerpt from the comments MHANYS submitted to OMH earlier this week.

“Due to the differences in the size, operating budgets and structures of the MHA affiliates in New York State, there are a varying degree of reactions to PROS programs. Several of the MHAs have voiced enthusiasm about the hope that PROS offers through a strong array of service categories and enhanced rates that will help provide both a more individualized and coordinated recovery, orientation for recipients. Others have voiced concern that PROS will force programs that have long provided creative rehab strategies to now be forced into more of a medicalized model of care and in turn have to develop new and time consuming record keeping processes.

CHOICE

One of our overarching concerns is that PROS will create larger entities that will envelop smaller providers (including some of the smaller MHAs who have a history of quality services in their community) thereby limiting the choice of recipients. In areas of the state that now offer an array of choices regarding Clubhouses, IPRT programs, etc; we are concerned that recipient choice will be minimized after implementation of PROS. We urge the Office of Mental Health to work closely with the Local Government Units (LGUs) and local provider to insure that there continue to be an array of community services available to meet recipient needs.

SERVICE CATEGORIES

The Office of Mental Health has put together an impressive array of service categories. Of particular significance are categories related to basic living skills and community living exploration. One of the priority areas for services must be the opportunity to enhance the Activities of Daily Living (ADL) Skills for many recipients of services. Many individuals in the mental health system have not had the opportunity to learn even the most basic of living skills. This greatly hinders the ability of individuals to move to more independent setting. The hope of PROS is that individuals will be able to move forward in their lives through enhanced vocational skills, more education and movement towards independent setting as they continue to recover. The best way to enhance that ability is by helping to provide the ADL skills necessary to move forward. The ability to enhance ADL skills training is an integral component of any service plan.

ASSESSMENT TOOL

Regarding assessment tools, we would be interested in finding out what assessment tools will be utilized in the creation of a treatment plan for individuals in PROS programs. Will it be one of the existing assessment tools (i.e.—Basis 28) or a hybrid of several tools?

We are pleased that in addition to the general assessment tool, there is also a vocational assessment. According to the proposed regulations, the priorities as set forth by the goals of intensive rehabilitation include assisting individuals in attaining specific life roles including independent housing and education. Based on those priorities, it would be consistent to also include separate assessments on housing and education. We don’t advocate an overly cumbersome assessment process but we do think before establishment of a treatment plan that the recipient has the opportunity to have strength based assessment highlighted by the overarching goals of housing, employment and education.

GRIEVANCE PROCEDURES

We agree that each PROS governing body must have written policies and procedures describing a grievance procedure. It is stated in the proposed regulations that there must be a process in place enabling individuals to request review by the Office of Mental Health when resolution is not satisfactory. Though we agree with that statement, we are concerned that recipients will not be told about this unless they take the time to review the governing body’s grievance procedures themselves.

To more strongly get out the word about the grievance process for recipients, we recommend that:

1. Upon recipient orientation, the PROS program designated staff person must provide a written copy of the grievance procedure to the recipient which includes a toll free phone number to contact the Office of Mental Health in situations where grievances could not be resolved internally.
2. Grievance procedures must be prominently displayed in the facility.
3. Any grievances put forward by recipient in local PROS program must be shared with their local PROS advisory board.

We also recommend that there be an individual/individuals identified at the Office of Mental Health who will be the contact people for any issues related to grievances or any other complaints related to PROS.

Regarding notice of rights to each individual upon admission to a PROS program, we recommend that the notice not only include OMH, CQC, PAMI and NAMI, but also include the statewide number for the Information and Referral Line of the Mental Health Association in New York State (1-800-766-6177).

ADVISORY COMMITTEE

We agree that there has to be strong recipient participation in governing bodies through advisory boards. However, we have concerns that these advisory boards will provide little impact in governance of the PROS programs.

To strengthen the advisory board’s role, we urge that:

1. There be a minimum of four meetings a year with the Governing Body and the advisory board.
2. Minutes from these meeting must be kept and made available to the public
3. Advisory board must include a minimum of two recipients and should also include other stakeholders including family members and local advocates
4. Minimum of two meetings a year with PROS advisory board and their regional office of the Office of Mental Health.

FINANCING

Many of our affiliate members have voiced concerns about the use of reinvestment funding to help finance the PROS programs. The original intent of reinvestment was to insure that there was new funding available for local programs with the strong involvement of the mental health sub-committees of the Community Services Board. With the implementation of PROS, we are concerned about this funding stream. Many of the MHAs have relied on reinvestment and local assistance funding to finance their community based programming. With the recent cut in funding for local assistance combined with the use of reinvestment to help fund PROS, our members are very concerned about the funding for the programs that have run successfully in the community for many years. Even with the implementation of PROS, local assistance and reinvestment must continue to be identified as viable and continuous funding streams for other community based programs.

In addition, the reinvestment planning process continues to be imperiled by PROS. The reinvestment planning process empowered recipients and families to participate in the decision making for locally funded programs. With the continued dissolution of reinvestment, this planning mechanism will be greatly weakened.

PUBLIC MEETINGS

There are several counties working with OMH in the implementation of the PROS program. It will be important for the other counties, recipients, local providers, other stakeholders and advocates to find out information about county implementation. We urge OMH to have regional forums in the five OMH regional offices and include resource material that has been helpful in implementation in those areas that have begun PROS implementation. All interested individuals should be allowed to attend in their areas.

In addition, we recommend there be a statewide PROS advisory group that will meet quarterly with the New York State Office of Mental Health. This group will be comprised of recipients, family members, providers, county officials, advocates, local PROS governing board members and local PROS advisory board members.

SUMMARY

In regard to our concerns about PROS, we are mindful of the recipients of services and their individual recovery with priorities that include independent housing, vocational training and education. That is why we are urging modifications in PROS that include,

1. Additional Recipient Choice,
2. Assessments that include separate measures for education and housing,
3. Stronger grievance provisions with more public information sharing,
4. Stronger consumer representation in advisory committees,
5. Viable funding to insure other community based funded programs, besides PROS, that enhance individual recovery,
6. Public meetings with strong stakeholder participation."

SAVE THE DATE – MAY 3rd, SPECIAL SCREENING OF MAANGAMIZI

Join the Mental Health Association in New York State (MHANYS) at the Spectrum 8 Theatres on 290 Delaware Ave. in Albany at 7:00 p.m. on May 3 for the Capital District premiere of Maangamizi. Producer/Director Ron Mulvihill will speak about the film at the reception to follow.

Proceeds from this special screening go to support MHANYS. For more information about this event, or to purchase tickets, call (518) 434-0439 ext. 20. Tickets are $35 for regular admission (includes $25 charitable contribution to MHANYS), $10 students/seniors, and free for mental health consumers.

For full details about the event, including a brief synopsis of the film, see the Maamgamizi flyer.

SAMARITANS SUICIDE PREVENTION CENTER'S
7th Annual HOPE Candlelight Vigil

Thursday, May 19, 2005, 6:00-9:00 P.M.

When you are sorrowful look again in your heart,
and you shall see that in truth you are weeping
for that which has been your delight. ~Kahlil Gibran

On May 19th, Samaritans Suicide Prevention Center will hold its 7th annual candlelight vigil on the steps of the NYS Capitol in Albany.

This event not only memorializes the lives that have been tragically lost to suicide (through the faces on the NYS 1998 - 2005 LifeKeeper Memory Quilts), but will also work to save future lives through sharing, courage, and the commitment to the prevention of suicide. In addition, the Vigil serves to recognize those individuals dedicated to the prevention of suicide through the Annual LifeKeeper Memory Award. This year’s LifeKeeper Awards will be presented to NYS Office of Mental Health Commissioner Sharon Carpinello and Associate Director of Clinical Operations for the Albany County Department of Mental Health, Bill Dickson.

For more information, go to http://www.timesunion.com/communities/samaritans/, e-mail sams@fcscapitalregion.org, or call (518) 689-0080.

IN THE NEWS:

State budget of $106.5 billion hits home for poor. By Michael Gormley, Associated Press
Newsday, April 14, 2005

For many in Albany this year, Medicaid has been a dirty word.

The health care system for the poor has been blamed for threatening an on-time state budget, for driving up local property taxes, and a $1.5 billion bounty in federal money was posted as incentive to cut it.

The result is a state budget passed this month that cuts the massive and burgeoning $45 billion state-federal program by $545.7 million.

But for the poor and working poor families served by the system, the state budget isn't a question of macroeconomics. Instead, it represents a hit in their already strained wallets.

Among the changes are increases in copays, ranging from 50 cents to $5, for prescriptions, and for health care under Medicaid and the state's subsidized health care program, Family Health Plus program for the working poor. Also, less money was put into the budget than sought by the Legislature for Family Health Plus outreach.

The increased co-pays are a problem, said Harvey Rosenthal of the state Association of Psychiatric Rehabilitation Services. Dennis Poust, spokesman for New York's Catholic Conference, agrees.

"We understand the need to control the cost of the Medicaid system, but we don't think the best way to get there is by cutting access to essential services," Poust said. "These people are of very limited means, an increased copay makes a difference on whether or not you go to the doctor."

But the Legislature also restored many critical program, and other advocates agree the budget holds some positives for the poor as well.

Many of the cuts and some increases in copays, for example, are aimed not just at saving money but at improving the health care program. One of the reforms is Pataki's plan to use the state's massive buying power to lower prescription prices on a "preferred drug list." That will lower copays as well as the state's cost for prescriptions.

In addition, the state budget completed with a last-minute agreement on major items Tuesday restores or partly restores cuts called for by Pataki.

The existing cuts, meanwhile, will help the state secure a $1.5 billion federal grant brokered by Pataki as an incentive to slash Medicaid costs.

"The positive thing is there weren't a lot of cuts, but there's not a lot I could say was positive for poor people," said Hunger Action Network Executive Director Mark Dunlea, a Green Party leader. "These people are drowning and needed a life preserver. We didn't throw them bricks, but we didn't build them a boat, either."

For example, he said the state budget preserves many of the deep Social Service cuts made during the fiscal crisis after the 2001 attacks. And while this year's budget adds $350,000 in funding to food pantries, the $23 million in total funding is still less than four years ago despite the fact that demand has grown.

Sister Maureen Joyce of Catholic Charities in Albany praised the governor and Legislature for coming to agreement to use $1.1 billion in federal money under the Temporary Assistance to Needy Families program. Much of that money goes to nonprofit organizations providing services more efficiently and cheaper than a state agency could. Catholic Charities in Albany needed the money to continue operating its homeless shelter and domestic violence program.

Yet Sister Maureen said the increased health copays will hurt many of the working poor.

Under the state budget, the Medicaid copays for drugs increase to $1 from 50 cents for generics, and to $3 from $2 for brand names.

Under Family Health Plus, the drug copay increases to $3 for generics from $1 and to $6 from $3 for brand name medications. Physician and clinic visits under Family Health Plus will now carry a $5 copay. Dental visits will now also have a copay. The $5 dental copay is capped annually at $25, according to the state Division of Budget.

"You hear people say, `It's $1 to $3 or $3 to $6. People can afford that.' But you can't if you have every cent _ literally ever cent _ figured out for the rest of the month," said Sister Maureen. She said requests for emergency cash are usually to pay for prescriptions or health care.

"To have any kind of increase means they are making choices between basic necessities," she said.

Pataki and Assembly Health Committee Chairman Richard Gottfried didn't immediately comment.

Children being sent elsewhere for care. By James T. Mulder
Syracuse Post-Standard April 19, 2005

When Sheila Mevec's 15-year-old son needed to be hospitalized last month for psychiatric care, the only bed available was 150 miles away.

He spent two nights in Syracuse's psychiatric emergency room before BryLin, a private mental hospital in Buffalo, agreed to admit him.

"I wanted to really just grab him and run," said Mevec, who lives on Onondaga Hill. "I didn't know he was going to be farmed out somewhere else."

More than 100 Syracuse area youths have been farmed out to hospitals in Buffalo, Rochester, Ogdensburg, Utica and Saratoga Springs over the past year because there are not enough psychiatric beds for children and teens here.

The shortage was caused by last year's closing of Four Winds, a 104-bed private psychiatric hospital in Syracuse that had 64 beds for youths. The state barred Four Winds from admitting new patients on March 26, 2004, after inspectors found a lengthy list of serious operating deficiencies that threatened patient safety. The state closed the hospital for good April 30.

The closing left Syracuse with just 16 beds for youths at the state's Hutchings Psychiatric Center. To ease the shortage, Hutchings temporarily added eight beds, increasing its total to 24. Efforts to permanently solve the problem by creating a psychiatric unit for youngsters at University Hospital, which is part of SUNY Upstate Medical University, have gone nowhere.

Susan Lyons' 17-year-old son was hospitalized last month for psychiatric care at Strong Memorial Hospital in Rochester. The Onondaga Nation resident said she could not be with her son as much as she wanted to because of the distance. "I would have liked to visit him more, to be right there and be able to bring him something to eat," she said. "I just feel I wasn't able to participate as much as I would have liked."

Exporting children for inpatient psychiatric care is unacceptable, said Dr. Mantosh Dewan, chairman of Upstate's psychiatry department. "To be struggling with whatever led to their need for admission and then compounding that by going to a really far off, strange place just aggravates the child's problems," Dewan said.

Having a child hospitalized out of town makes it difficult, if not impossible, for parents to provide moral support and become involved in the treatment process, according to Sheila LeGacy, director of family support at Transitional Living Services, a Syracuse nonprofit that serves people with mental and developmental disabilities. "Being able to advocate for your family member is difficult if it takes you two hours to get there," LeGacy said.

Syracuse's Comprehensive Psychiatric Emergency Program - CPEP for short - is in charge of finding psychiatric beds for youths. CPEP, located at St. Joseph's Hospital Health Center in Syracuse, is the area's psychiatric emergency room. It's jointly operated by St. Joe's, University and Community General hospitals.

It placed 116 youths in mental hospitals outside the county between April 1, 2004, and March 29 of this year, according to Mary Bishop, executive director of CPEP. That represents about half the number of children and teens who were hospitalized.

Youngsters were rarely placed in hospitals outside the county before Four Winds closed, Bishop said. "To have this percentage, where you're looking at half the kids coming to us who need inpatient care needing to go out of town, that's an enormous jump," she said.

On average, youngsters are in CPEP 16 hours before a hospital bed is located. Some stay as long as 72 hours. Placing children takes a lot longer than it did when Four Winds was open, Bishop said. CPEP telephones hospitals across Upstate looking for openings. When a bed becomes available, CPEP arranges ambulance transportation or transports the child in its own van, with a nurse and counselor accompanying the patient, Bishop said.

Out-of-town placements upset parents, according to Bishop. "They plead with our staff to find a local bed," she said.

After Four Winds closed, University Hospital explored the possibility of establishing a psychiatric unit for youths to alleviate the shortage. The hospital was unable to find appropriate space or money for such a program, according to Dewan.

"That is a great source of aggravation to me because I do think we need it now," he said.

University Hospital is planning to build a 61-bed children's hospital as part of a six-story $118.9 million addition.

The Onondaga County Mental Health Department would like to see psychiatric beds included in the children's hospital, according to Kristin Riley, the department's deputy commissioner. Parents like the idea because it would provide an option for mentally ill children without the stigma often associated with psychiatric hospitals, she said.

"The sense is, we have this children's hospital here, it should really be all inclusive and it should include psychiatric services," Riley said.

Dewan also feels the children's hospital should have a psychiatric component, but said there's no room in the plans for such a program. "It's a done deal and construction is due to start later this year," he said. "All the space has been carefully configured."

He said Hutchings is the logical place to add more beds for youths.

Hutchings, however, has no plans to expand. The state wants to close some of its psychiatric centers. It proposed closing Hutchings in 2001 and again in 2003, but shelved the idea after the plan sparked intense opposition from families, mental health providers, Hutchings employees and elected officials.

"We're continuing to monitor the situation and nothing we've seen so far indicates a need to increase capacity," said Jill Daniels, a spokeswoman for the state Office of Mental Health which oversees Hutchings.

Sheila Mevec's experience suggests otherwise. During her son's 10-day hospitalization in Buffalo, she could only visit him once because she's a single parent with a job and two other children to care for.

"I would have gone every day if he was in Syracuse," Mevec said. "I was surprised they couldn't treat him right here."

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