In December, we had a unique opportunity to meet with several of our members to elicit opinions on issues of significance to the MHA’s and to the mental health community. In each of these forums, individuals identified concerns about transitional planning from school based mental health services to the adult mental health system as well as general concerns about school mental health services.

To help respond to these issues, I had the opportunity today to present testimony to the State Education Commissioner’s Advisory Panel on Special Education.

The full text is listed below and it includes our recommendations for helping to make school based mental health services more accessible to children with emotional disturbances. In addition, the proposal in the OMH Budget to enhance funding for children’s services by providing 400,000 additional screenings will greatly enhance accessibility.

I would especially like to thank Marcia Feuer of the Nassau MHA for all her help in working with us on transition planning.

Feedback on this issue is greatly appreciated.

Glenn Liebman, CEO
Mental Health Association in New York State, Inc.

testimony to:

State Education Department's Commissioner's Advisory Panel on Special Education

January 25, 2005

Introduction:
I would like to thank the Members of the Commissioner’s Advisory Panel for providing me with the opportunity to present on issues of concern to those of us in the mental health community. My name is Glenn Liebman and I am the CEO of the Mental Health Association in New York State. Our organization has 30 affiliates statewide representing 54 of the state’s 62 counties. Our organization’s mission is to promote mental health and recovery, encourage empowerment in mental health services for mental health service recipients, eliminate discrimination and raise public awareness with education, advocacy, equality and opportunity for all.

According to the Surgeon General’s 1999 report on mental health, one fifth of the children and adolescents in the country experience the signs and symptoms of mental health problems in the course of a year. More recently, the President’s New Freedom Commission report which came out in 2004 recommended the initiation of a national effort to promote early intervention for children identified to be at risk for mental disorders and to identify strategies to appropriately serve children with mental health problems.

Our organization recently held public policy forums throughout the state regarding issues of greatest concern to each community. At each of the forums, one of the issues brought to our attention concerned children with emotional disorders transitioning into the adult mental health system. This is clearly an issue that has risen to prominence in recent years.

My presentation is broken down into four categories—A) Transition Planning, B) Individualized Education Plans, C) Co-occurring Mental Illness and Substance Abuse Disorders Among School Aged Children, D) Recommendations for Change

Transition Planning

We are very appreciative of the work being done by the State Education Department and the Commissioner’s Advisory Panel on transition planning. However, based on the comments that we have received from our membership, we still have a long way to go.

Transitioning into the adult mental health system after high school is difficult especially if there is not a transition plan in place for someone identified with a special need. The transition plan for many high school seniors with serious emotional disorders typically does not even begin till half way through their senior year. Often the plan only includes a referral to VESID after graduation. VESID counselors are frequently overwhelmed by the number of referrals on their caseloads.

As part of a transition plan, there must be a greater emphasis on school and work. There is little more disheartening than to identify people in high school with serious emotional disorders (SED) who become part of the adult mental health system without any emphasis on employment or education. When I served as the Program Director for Adult Home Initiatives at the New York State Department of Health, we held forums with residents of many homes who had a psychiatric disability. It was clear that many of the younger residents of adult homes we spoke with were interested in furthering their education through college, trade schools, vocational training, computer science trainings and a whole host of other initiatives that would be appropriate for anyone of a similar age.

The planning process must begin well in advance of six months before graduation and must recognize that many students drop out before they are seniors in high school. Plans must include an earlier assessment and referral process recognizing the myriad needs of children with mental health needs and most importantly must emphasize education and employment.

In addition, we would ask the Commissioner’s Advisory Panel (CAP) if any data was available from districts regarding what particular transition plans are occurring (i.e. referrals to VESID, paid or unpaid employment, etc.). Also, we would like to identify what SED and CAP perceive as best practices and person centered planning for individuals identified in the transition planning process?

Individualized Education Plans (IEP)

We have concerns as well regarding the IEP program. Under IDEA, it is the school district’s responsibility to make sure that services are provided to insure that the student makes progress towards their IEP goals. As early as kindergarten, IEP plans are developed for children with serious emotional disorders. These plans often do not include mental health services. As the President’s New Freedom report recommends, there must be early intervention strategies for children with SED. As a result, a child who clearly needs mental health services at a young age may be denied those services simply because they are not included in their IEP plan. Parents who identify a need for mental health services in the IEP plans for their child are forced to pay out of pocket for community mental health services because if mental health services are not written into the IEP than the family has to pay for the cost of the services.

School districts have a vested interest in not writing mental health services into the IEP because it saves the district money. Family members are forced to incur the expense of paying for mental health coverage and the insurance discrimination that currently exists for mental health coverage. Without mental health parity (Timothy’s Law), parents are forced to pay escalating cost for mental health services for their loved ones. Insurance coverage will only provide coverage in most cases for twenty outpatient visits. Parents are then forced to pay the full share of services which often leads to dire consequences for parents who are unable to afford this coverage including custody relinquishment for the purposes of making their child eligible for Medicaid.

Based on the 2005 SAMSHSA report on school mental health services, “accessing services under the current system was often dependent on the financial resources of the family rather than the school system.”

From 2000-2004, OSEP found many states surveyed were not in compliance with IDEA because they failed to ensure that districts provided mental health services when appropriate. OSEP made it clear in their report that local education agencies are responsible for providing mental health services (though they can contract with community providers to deliver the services).

Co-occurring Disorders

The issue of co-occurring disorders is a very prominent one as well. There are many students especially as they transition to high school that have both a co-occurring mental illness and substance abuse problem. According to the recently produced report from SAMSHA on school mental health services in the United States, substance abuse as a major problem jumped sharply from middle school to high school. For males, it jumped from 4 percent in middle school to 34 percent in high school and for females, it rose from 3 percent of middle schools to 19 percent of high schools. Also, according to the SAMSHA report, only 43 percent of schools could provide substance abuse counseling and this service was very difficult to deliver. Substance abuse counselors account for only 3 percent of all mental health staff in schools.

One of the identified best practices in adult mental health is integrated treatment for those with a mental illness and a co-occurring substance abuse. There must be initiatives in place (including an assessment process) to help identify children with co-occurring disorders and have a treatment professional work with them. The treatment professional must have a knowledge base and skill set in both substance abuse treatment and mental health treatment.

Recommendations

We suggest the following recommendations:

I thank the members of the Commission for your time and consideration.