Mental
Health Association in New York State, Inc. |
Friday Fax from Albany
LEGISLATURE LEFT ALBANY, BUT RUMORS ABOUT THEIR RETURN CIRCULATE: Albany is a much quieter town these days with lobbyists and public policy wonks taking some much needed time off. However, rumors are being confirmed in the Albany Times Union that at least the Senate, and perhaps the Assembly, may return in late July. The issues they may address upon their return are unclear at this point, but there is talk of addressing unfinished casino legislation and pay raises for themselves. Only time will tell. In the mean time, there were many articles that mentioned Timothy’s Law as one of the issues left undone during this year’s session, one of which follows in the In The News section.
RELEASE OF REPORT FROM THE CORRECTIONAL ASSOCIATION OF NEW YORK STATE: Recently, the Correctional Association of New York State released a report about the lack of adequate mental health services in the New York State prison system. Our comments regarding the report appear in an article in the June 26th edition of Mental Health Weekly, which follows below in the In The News section. DEPRESSION AND BIPOLAR SUPPORT ALLIANCE (DBSA) CONFERENCE: DATE:
Saturday, September 10, 2005 Conference Breakout Sessions Will Include:
In
addition to educational sessions, DBSA conferences offer patients and
family members the opportunity to network with one another and to share
their strength and hope. COALITION FOR THE HOMELESS SEEKS SENIOR POLICY ANALYST: Coalition for the Homeless’ advertisement. THE COALITION FOR THE HOMELESS seeks Senior Policy Analyst for Albany office. Senior Policy Analyst assists in monitoring, assessing, and informing the legislative and administrative processes of State government on matters of concern to the Coalition. Also performs legal and empirical research, drafts legislation and supporting materials, writes and delivers testimony or comments in response to legislative or administrative proposals, analyzes policy and budget issues, and participates in strategy and message development for the Coalition’s advocacy/public policy agenda, litigation, and various campaigns as well as tracks policy developments in the Legislature and in State agencies. Salary commensurate with experience. B.A./B.S. in political science, public administration, related discipline required. Advanced degree in related discipline preferred. 3 yrs of recent experience with New York State legislative processes required. Direct public policy analysis experience strongly preferred. Knowledge of and commitment to principles of legislative representation and lobbying essential. Ability to work on deadline and to communicate effectively, both orally and in writing, required. Ability to perform multiple tasks and work independently and as a team member essential. Familiarity with State housing and other social services programs strongly desired with knowledge of the interaction among State, local, and Federal policies helpful. Advocacy, public relations, organizing, campaigns, or government experience related to homelessness, housing, and poverty/welfare issues preferred. Send RESUME with COVER LETTER via EMAIL to prai@cfthomeless.org. No telephone inquiries please. Persons of color and formerly homeless individuals encouraged to apply. EOE.
IN THE NEWS: New
York Report Cites Inadequate MH Services, Treatment for Inmates. Approximately 7,500 or 11 percent of New York inmates suffer from mental illness, with about half of these inmates suffering from a major mental health disorder, such as schizophrenia or bipolar disorder, according to a report released this month by the Correctional Association of New York. According to the report, about 11 percent of the total prison population have been identified as needing mental health services (i.e., medication, counseling or both). Outpatient and limited inpatient services are provided to inmates by the New York State Office of Mental Health (OMH). For this report, a total of 301 prisoners were surveyed at nine correctional facilities, including seven maximum-security prisons and one medium-security facility. The report, State of the Prisons 2002-2003: Conditions of Confinement in 14 New York State Correctional Facilities, finds that in New York's prisons, inmates with mental illness struggle with victimization by staff and other inmates, have difficulties complying with their medication regimens, and frequently violate prison rules as a result of their mental illness. The report notes that although there are some model programs and well-run facilities in the state prison system, there are many troubling problems that require state policymakers' attention. Specifically, the system fails to meet the needs of the majority of inmates with mental illness. Disciplinary confinement is overused, harsh and sometimes ineffective and there are too few programs in which inmates can learn and engage in constructive activities. (The report indicates that some specific practices, personnel and conditions may have changed since the time of the individual visits in 2002 and 2003). "The goal of the prison report is to advocate for a more humane prison system and promote remedies at the policy level," Shayna Kessler, project associate of the Prison Visiting Project, told MHW. The report states that correction officers lack the training needed to work effectively with inmates with mental illness and vacancies in mental health staff cause serious gaps in services. Whereas residential treatment programs can provide a supportive environment that facilitates treatment compliance and minimizes conflicts, the capacity of these programs need to be significantly expanded to meet the real needs of the current prison population. Because of the limited number of residential treatment programs, most inmates with mental illness are housed with the general prison population in maximum-security facilities, where mental health services are woefully insufficient, the report states. Treatment Treatment for mental illness is extremely scarce, according to the report. Medication supplemented by brief consultations with clinical staff is the primary and often only form of mental health care for general population inmates. Resource constraints limit the availability of individual and group therapy for most general population inmates in New York. Given the limited mental health resources in the general population, inmates often do not come to the attention of mental health staff until they become so mentally impaired that they require hospitalization or end up in solitary confinement for violating prison rules. According to the report, some superintendents, when asked about the lack of intervention in these kinds of cases, expressed frustration at having to manage so many inmates who, in their opinion, belong in mental hospitals rather than prison. The leading criticism among correction officers concerning mental health services was the lack of training provided to frontline officers. The New York State prison system has two types of residential care units for inmates who have been identified as "victim prone": The Intermediate Care Program (ICP) for inmates with chronic mental illness and the Special Needs Unit (SNU) for developmentally disabled inmates with IQs of 70 or less. "The Intermediate Care Programs located in 11 correctional facilities throughout the state, offer a therapeutic, safe environment and access to a range of mental health services," said Kessler. "Inmates can access individual counseling, their rates of medication compliance are high and the units are staffed by individuals who are generally sensitive to their needs. "Inmates repeatedly cycle between Central New York Psychiatric Center and the prisons, particularly inmates in Special Housing Units (SHU), said Kessler. The psychiatric center is a hospital with 189 beds for Department of Correctional Services inmates, who have significantly de-compensated and are in need of crisis treatment," said Kessler. Its limited capacity prevents it from providing long-term care and 65 percent of inmates are re-admitted to the hospital within a year after they are returned to correctional facilities, said Kessler. The hospital began treating Department of Correctional Services inmates in 1981 when the prison population was approximately 24,000. "Although the prison population has grown to 64,000 today, a 166 percent increase since the psychiatric center opened, its capacity has remained unchanged," said Kessler. Advocates weigh in The prison report by the Correctional Association is a "mixed bag," Glenn Liebman, chief executive of the Mental Health Association in New York State (MHANYS), told MHW. "On the positive side, the state should be recognized for doing some good things," said Liebman, who cited the Central New York Psychiatric Center as a state of the art model for recognizing individuals in prison with mental illness. "They focus on an individual's recovery," said Liebman. "They look at people with serious and persistent mental illness (SPMI) as people as opposed to people in a prison system. They've done a very good job. Their ingrained philosophy is that individuals can recover from mental illness." However, there still are a lot of issues out there, including the pervasive stigma of mental illness, said Liebman. "The number one issue in the prison system for people with mental illness is stigma," said Liebman. "There's stigma out there right now in the general population - it's manifested sevenfold in the prison system." Liebman added, "Inmates are reluctant to admit to mental illness because of the stigma." There should be more funding for training for correctional officers to learn more about mental illness, said Liebman. "They don't have a real understanding of mental illness." There should also be more funding for clinical workers, such as psychologists, social workers and psychiatrists, said Liebman. The understanding of co-occurring disorders within the prison population is also crucial, said Liebman. "A large population of people in prison who have mental illness also have a cooccurring substance abuse [condition]. There must be ways to provide better treatment to recognize the needs of co-occurring disorders and more resources dedicated to residential treatment," said Liebman. "Like all issues, this is very complicated," said Liebman. "There's a growing recognition by the state of these issues." Well over one-half of the prison population has mental illness and a co-occurring substance abuse issue, said Liebman. "As long as we keep people in separate silos, that's not going to work. You have to integrate services," he said. According to the report, nearly every prison visited had an insufficient number of meaningful programs. Waiting lists for educational, vocational and treatment programs were uniformly long, staff vacancies caused the unnecessary suspension of courses and materials and equipment were often outdated. Moreover, inmates throughout the system stated that one of the major changes they would like to see in their prisons is the addition of more programs. Housing units Legislation introduced that would require the state to provide humane mental health treatment alternatives to special housing units referred to by advocates as "the box" remains stalled in the Senate Corrections and in the Assembly Rules committees, according to advocates. The bill, S.2207/A.3926, would end the placement of inmates with severe mental illness in special housing units (SHUs) and place them instead in residential treatment programs. It would also provide for additional training for staff to develop skills to safety and effectively work with inmates with mental illness. Inmates in SHUs are locked up for 23 hours a day with severely limited access to social interaction, natural light or enriching activities. "We believe this is incredibly inhumane," said Lauri Cole, executive director of the New York State Council for Community Behavioral Healthcare. "When an inmate with a mental illness exhibits symptoms of his/her illness, he or she should be offered treatment - not locked away and punished for exhibiting symptoms of a real illness." "Properly treating inmates with mental illness is not just humane, it will create a safer prison environment for staff and inmates and save the state valuable resources," added Kessler. "We are hopeful that the legislation will pass next year as it has bipartisan support and the support of the Correction Officers' union," said Kessler. "In spite of widespread support for the legislation, the bill was stalled because of an unrelated amendment that was attached to it that slowed its progress." The Correctional Association of New York is a privately funded, nonprofit organization that conducts research, policy analysis and advocacy on pressing criminal justice issues. The report was conducted by the Prison Visiting Committee, the arm of the Correction Association that visits prisons throughout the state and advocates for policies for inmates, correction staff and the society at large. Prison advocacy group calls for expanded MH services The report by the Correctional Association of New York, State of the Prisons 2002-2003: Conditions of Confinement in 14 New York State Correctional Facilities, recommended expanding services for inmates with mental illness, including the need to:
A copy of the report is available at www.correctionalassociation.org.
N.Y.
Advocates Disappointed over Parity, Other Unresolved Issues. Mental health advocates are disappointed that New York lawmakers have left unresolved the passage of Timothy's Law, the state.s parity bill, and legislation that would end the placement of inmates with severe mental illness in special housing units. New York lawmakers ended their session last week. Timothy's Law Campaign is a grassroots effort aimed to end discriminatory practices by health insurers and the health maintenance organizations (HMOs) with regard to the treatment of mental illness and substance abuse disorders. Concerns have been raised that enacting Timothy's Law would drive up the cost of insurance premiums for small employers. The campaign, in an effort to address the concerns of small business owners in New York state, updated the proposed legislation. The legislation would now offer all employers with 50 or fewer employees, including sole proprietors, the option to purchase full parity benefits at a comparable price. The
legislation would also eliminate arbitrary exclusions based on "Timothy's Law will probably not happen," Glenn Liebman, chief executive of the Mental Health Association in New York State (MHANYS), told MHW. "We were told it's done for the year. Our chances at this point are very, very minimal. Our goal remains to do everything we can to get Timothy's Law passed." "Of course we are all disappointed that in the end there was no deal," Lauri Cole, executive director of the New York State Council for Community Behavioral Healthcare, told MHW. "Having said this, we are not going away on this issue. We are in this for as long as it takes. We have a long-term game plan and an unwavering commitment to secure meaningful parity legislation in this state. We intend to come back stronger and more vital in the days ahead." Cole added, "This year our statewide campaign experienced unprecedented cooperation and cohesion among all of the stakeholders and grassroots advocates. We were unified and incredibly productive. The fight for Timothy's Law has everything to do with basic fairness and equity and the understanding that substance abuse and mental health related disorders are no different from any other physical disease. "When an employee with a mental or chemical dependence problem goes untreated we all pay a price," said Cole. "Small businesses pay a steep price when they fail to assure that their employees get the treatment they need. Without early intervention (in substance or mental health issues) we often see a downward spiral in the performance of that employee resulting in higher absenteeism and a less effective worker. It is in every business owners best interest to assure that his employees have access to affordable behavioral healthcare."
Costly
limits for mental health persist - State Legislature fails to equalize
insurance benefits for treatment of emotional and physical problems. Michael knew his son was having problems. But then, in December, he found out the teen was thinking about suicide. "He told us he had been hearing voices as long as he could remember. Those voices were showing him images of him killing himself and hanging himself,'' his father said. After he revealed his suicidal thoughts, the 14-year-old spent a week at Four Winds Hospital, a psychiatric care facility in Saratoga Springs. He has been diagnosed with biploar disorder, is taking medication and goes to a psychologist for therapy. But his insurer -- the Capital District Physicians' Health Plan -- will pay for only 20 therapy sessions in all of 2005. And after four or five visits, the family is responsible for a $50 co-pay, the lion's share of the $70 hourly rate the psychologist is paid. A bill designed to remedy the situation failed in the state Legislature this year. It would have forced insurers to provide the same coverage for mental illness as they do for physical illness. Limiting sessions and mandating big co-pays are among the policies that private insurers use to limit mental health coverage, according to doctors, psychologists and other advocates. In addition, insurers' efforts to nitpick and deny requests for coverage make it hard for patients of all ages to get good care -- and for psychologists to make a living. To help him with family and school problems, Michael's son used all 20 of his allotted visits last year, before his condition worsened with talk of suicide. And now, his father fears his son could get worse again, if they can't afford to pay his therapist, Erica Ellis, after 20 visits this year. "It seems incredibly short-sighted to me,'' said Michael, who spoke to the Times Union on the condition that he be identified by first name only. "It's not a therapeutic decision. It will be based on what we can afford. It's absolutely a nightmare.'' The 20-visit limit for outpatient mental health care is standard among nearly all area health plans. Advocates have sought for years to get state lawmakers to pass a parity law to force insurers to provide the same coverage for mental health as they do for physical health care. Thirty-four other states have such laws. The bill, known as Timothy's Law, failed to pass again during the most recent legislative session, although Senate and Assembly lawmakers reportedly sought a last-minute compromise that would have exempted smaller businesses. It is named for Timothy O'Clair, a 12-year-old who killed himself in 2001 after his parents gave up custody of him so he could get publicly funded mental health care. Ellis, a psychologist with a practice in Niskayuna who treats children, teens and families, is particularly frustrated because she believes that limiting psychological care is more expensive for insurers and employers in the long run. If her patients can't afford to keep seeing her -- although she will typically offer discounted sessions -- they are more likely to get worse and end up needing care in a hospital or psychiatric institution. "That costs them a lot more,'' she pointed out. "Thousands, as opposed to hundreds.'' Psychologists report some of their colleagues are so frustrated with the policies of health plans that they are walking away from them. "Fewer and fewer people are accepting insurance,'' said Gayle Everitt, executive director of the New York State Psychological Association. Like Rudy Nydegger, a psychologist with a private practice in Schenectady. "I'm easing my way to getting completely out of it,'' said Nydegger, who is also the chief of psychology at Ellis Hospital in Schenectady."I would like to be completely free of insurance companies in the not-too-distant future.'' Insurers interfere with his work, Nydegger said. "It's very difficult when you have to develop a treatment plan consistent with the guidelines of the insurance company, as opposed to the best interest of the patient.'' Switching to a cash model has an obvious drawback: It restricts care to those who can afford to pay $50 to $70 an hour for therapy. Ironically, it could return psychology to a stereotype the profession fought for years to escape -- the idea that therapy was something only for wealthy, urban professionals. "It will make my services unaffordable to many who could benefit,'' Nydegger said. Area health plans say their hands are tied. MVP Health Care spokesman Gary Hughes notes that the 20-visit limit is not something the health plans came up with on their own: it was actually outlined in the HMO Act of 1973, when Congress set minimum standards for health plans. The health plans say they can only reduce co-pays or do away with limits on visits if the Legislature mandates it. Otherwise, such changes would put them at a competitive disadvantage. "It may seem like a very progressive thing to do, but the net result is that insurers would end up with costs that are much higher than the competing insurers out there,'' said Hughes. Mental health professionals aren't buying that argument. They say mental health care is at most 2 percent of health care costs, a figure the health plans don't dispute. Making it easier for the mentally ill to get a few more therapy sessions each year would add pennies to an employer's costs, they say. The $50 co-pay charged by CDPHP has drawn the most ire from area mental health professionals, who have seen patients walk away from therapy because they can't pay. Other area plans, such as MVP, have co-pays from $30 to $35 for sessions after the first five. "CDPHP provides the same level of benefits as other health plans and strives to keep costs low and affordable for consumers,'' a plan spokeswoman said in a written statement in response to questions from the Times Union. CDPHP also wrote that if a member needs more than 20 visits, "we have case managers and social workers to assist them with alternatives.'' None of the psychologists interviewed had ever heard of the insurer making any exception to its policy. One consequence of limiting talk therapy is an added dependency on medication as the sole treatment for mental illness. Pharmaceutical treatments can work wonders, especially for disorders like schizophrenia and severe depression, but the research shows definitively that patients do better when they also do talk therapy, said Beverly Lawson, a Saratoga Springs psychologist who is president of the Psychological Association of Northeastern New York. Talk therapy. goes beyond the popular stereotype, where a therapist asks a few questions and patients pour their hearts out. The therapist will usually help patients develop proven strategies so they can cope with their problems. "In some cases, talk therapy alone in the long run has a better effect,'' said Lawson. "People can learn to think differently, to manage their behaviors differently, so they have more control over what's going on.'' Mental health professionals complain that they have to constantly justify their care to the health plans. Some require written justification every four or five visits. And if the claims are denied, more time and forms are needed. When psychologists' time is squeezed, it hurts the quality of services, Ellis said. "People don't go to conferences as much as they should,'' she said. "They don't read journals as much as they should. That affects their care.'' The amount that insurers pay psychologists -- typically $60 to $70 an hour, less for government plans like New York's Child Health Plus and Medicaid -- seems like a lot. But they have to pay costs such as rent, malpractice insurance and salaries of support staff. Lawson estimates that she earns $30 an hour, at most, after she pays her expenses. The psychologists also report that the amount they are paid by insurers hasn't gone up for 10 or 20 years. Psychologists say that for many of their patients, 20 visits is plenty. But others have serious, crippling illnesses, which prevent them from having normal relationships or keeping a job or, in the most devastating scenario, cause them to harm themselves or someone else. When the 20-visit clock ticks down, the psychologists have to consult with their patients to figure out a plan: Should they try to wrap things up? Can the patient pay cash? Should they lower their fee? If a patient needs to see the therapist once a week, those visits run out as early as May. Michael fears what those limits will mean for his son. "How can we stretch the visits out?'' he wondered. "I have a 14-year-old boy, who if he's not going to get enough support through outpatient care, he's going to be hospitalized again.''
Legislature
'05: Tackling major issues, punting on others. By Michael Gormley ALBANY, N.Y. -- The New York Legislature, desperate to shed last year's label of most dysfunctional state lawmaking body in the country and avoid another voter backlash, ended its legislative session Friday well above the bar it set in past years. Yet, as in past years, the Legislature and Gov. George Pataki left many top objectives unmet from lack of agreement. One unfinished objective was the substantial strengthening of Megan's Law that allows the public to know when sex offenders move to their neighborhood. Three thousand sex offenders are still scheduled to disappear from the public registry by the end of 2006. The top prize, however, was seized March 31. The Legislature passed the first on-time state budget in 20 years. That freed lawmakers and Pataki from the annual late-budget deadlock and led to action on some issues pending for years, and action on some reform that watchdog groups feared would never become law. A scorecard includes: - The first law restricting how and when lobbyists can try to influence the awarding of state contracts. Such lobbying was at the heart of several scandals involving lobbyists influencing who received contracts that are supposed to be awarded to the lowest responsible bidder. - Further reform that will provide greater oversight and tighter regulation of the dozens of active state authorities. Although they borrow and handle hundreds of millions of dollars in public money for state purposes including maintaining upstate's Thruway and New York City's bridges and tunnels, authorities have been dogged by scandal of mismanagement and corruption. - The nation's first online price comparison between pharmacies for the 150 most commonly prescribed drugs. - A measure to ban state-funded Viagra and health care to treat erectile dysfunction of sex offenders. - Millions of dollars in money for construction and in borrowing support for New York City. A "Marshal Plan" will boost the revival of lower Manhattan, still struggling after the 2001 terrorist attacks. The new Yankee stadium project, Shea Stadium renovation and an upstate capital fund will each get $75 million in help. - A controversial law empowering pharmacists, nurses and midwives to dispense the morning-after contraceptive known by the brand name Plan B to girls and women of any age without parental consent. Senate opponents called it an abortion pill. - Lower-cost power for 300 businesses in economically depressed areas from western New York to Lower Manhattan. The companies employ 150,000 people. - A hard-line "oversight board" for the New York Racing Association, an independent group that operates Belmont, Aquaduct and Saratoga horse racing tracks on a state franchise. NYRA has been plagued by scandals of mismanagement and is under federal indictment. - Elimination of a gaping loophole in the Ethics Law that allowed state employees to end investigations against them by resigning. - Set a deadline for the release of public records sought under the state Freedom of Information Law. But even some of the top priorities of Senate Majority Leader Joseph Bruno, Assembly Speaker Sheldon Silver and Pataki were punted to a likely mini-session or for the 2006 session. Among them: - No death penalty law, after it was ruled unconstitutional by the state Court of Appeals. - No expansion of charter schools, strongly opposed by the state School Boards Association that represents traditional public schools. The limit remains 100, and there are more than 80 in place. New York City sought to convert many more of its schools and waiting lists at charter schools grow. - No casino deal for the Catskills. - No raise in state judges' pay, which hasn't increased since 1999. Lawmakers usually only raises judicial pay when they raises their own, but legislative leaders deny that's the plan. - No overhaul of campaign finance law. Monied interests and their high-priced lobbyists gain great access to influence legislation. - No overhaul of redistricting. That's the redrawing of legislative district lines every 10 years controlled by the majority of each house that gives incumbents party enrollment advantages. - No ban on gifts from lobbyists to legislators. - No substantial strengthening of Megan's Law. Proposals called lifetime registration of sex offenders and global positioning systems to make sure they don't go to schools and other areas where children could be victimized. - No Timothy's Law to require parity for mental health treatment in insurance. - No new anti-terrorism bills. Bruno and Silver called the session the most productive in memory. Pataki called it "historic." In the fall 2006 elections, voters will decide for themselves.
Mentally
ill inmates in prisons need treatment. Letter to the Editor The number of persons with a serious mental illness in U.S. jails has grown considerably in the last 15 years. A June 10 Times Union article, "Report critical of prison treatment," states that "approximately 7,500, or 11 percent, of state inmates suffer from mental illness, and half of those have a serious disorder, but there are only 700 beds in residential programs to serve this population." There is a direct correlation between the increased number of inmates with a serious mental illness and the closing of psychiatric hospitals. I am disappointed with state Department of Correctional Services spokesman James Flateau's comment that the report by the state Correctional Association isn't "worthy of a response." There are numerous reports identifying problems in the prisons including inappropriate treatment of the mentally ill, prison overcrowding, the lack of mental health services and medications for the inmates with serious mental illness, and inhumane treatment including solitary confinement. For more information on reports and how to help family members in the criminal justice system, go to http://www.naminys.org. Counties throughout this state and other states recognize the problems and are establishing mental health courts to divert defendants to mental health treatment programs. The watchdog groups, NAMI and family associations lobby for laws to protect the mentally ill and enhance the services and housing for this population. This report is worthy of a response; change is slowly under way to provide additional satellites to house and treat inmates with mental illness rather than continue with the "criminalization" of persons with mental illness. JANET
BUCK |