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August 11, 2006 URGENT! CALLS TO GOVERNOR PATAKI NEEDED: PLEASE CALL OR E-MAIL GOVERNOR PATAKI TO TELL HIM TO SIGN LEGISLATION TO ‘BOOT THE SHU’ AND TO ESTABLISH MENTAL HEALTH HOUSING WAITING LIST Phone: E-mail:
Wednesday,
August 16, 2006 $100
per person Additional information and RSVP at http://www.foundationofadvocacymh.org
IN THE NEWS: New
Depression Findings Could Alter Treatments. By Benedict
Carey
In one, government researchers found that an injection of a powerful anesthetic drug dissolved feelings of despair in a small group of severely depressed patients in a matter of hours, and that the effect lasted for up to a week in some participants. Doctors cautioned that the study was very small, and that the drug, ketamine, is a tightly controlled substance sometimes used as a club drug that can cause hallucinations, confusion and dangerous reactions, especially when ingested in unknown doses. In the other, psychiatrists in New York found evidence that antidepressant drugs significantly increased the risk that some children and adolescents would attempt or commit suicide. Doctors have debated this risk for years, but the authors of the study were skeptical of it, and their report may sway others. Both studies are being published in The Archives of General Psychiatry. In the first study, Dr. Carlos A. Zarate of the National Institute of Mental Health led a team of researchers who treated 18 chronically depressed men and women with the anesthetic ketamine. Five participants recovered from depression in the first day and were still significantly improved a week later. Most patients also received a placebo treatment during the study, an injection of saline solution, and showed no improvement. Dr. Zarate said experimenting with novel approaches was crucial because the current crop of antidepressant drugs worked slowly and weakly, if at all, for millions of patients. Ketamine affects the brain in a way entirely different from drugs like Prozac, and it has shown some antidepressant effects in animal studies. It had not been tried for depression in humans. “What the study tells us is that we can break this sound barrier, in effect, and get an almost immediate response that we cannot get with other drugs,” Dr. Zarate said. Ketamine is not approved for depression, and it has a checkered past in psychiatric research. The drug often induces hallucinations, like whispering voices and light trails, and researchers used it in the 1990’s to induce psychotic reactions in people with schizophrenia — an experiment widely criticized as unethical. Dr. Zarate said that neither doctors nor patients should use it for depression outside of carefully controlled research settings and that the results of the current trial should be considered suggestive. “This drug should be seen as a tool for understanding what mechanisms might be involved in rapid relief,” and not as a treatment, Dr. Zarate said. The study of suicide risk, led by Dr. Mark Olfson of Columbia University and the New York State Psychiatric Institute, was based on an analysis of Medicaid records of more than 4,400 people who were hospitalized for depression in 1999 and 2000. The researchers found no link between the antidepressant drugs and suicidal behavior in depressed patients 19 or older. But children and adolescents in the study who were taking antidepressants were about 50 percent more likely than those not on the drugs to try to kill themselves. And they were about 15 times as likely as those not on the medications to complete the act, although the number of suicides was too small to draw definitive conclusions, the authors cautioned. In addition, there could be differences between the two groups that the Medicaid records didn’t reveal: the children who received the drugs may have been more severely ill, skewing the results, they said. In 2004, the Food and Drug Administration required strong warnings on the labels of antidepressant drugs alerting parents and doctors of a possible suicide risk in some children. Since then many psychiatrists have been skeptical of the suicide link. “I was surprised by what we found,” Dr. Olfson said. “I set out thinking we’d find that the drugs” significantly reduced suicide risk. The findings may prompt researchers to look at which children are most at risk, rather than continuing to debate whether the risk exists, he said.
While we can't celebrate it as a law yet, Timothy's Law may just become that, after an agreement was reached in Albany between the Senate and Assembly in late June. Timothy's Law is a bill that would provide parity in insurance coverage for mental illnesses. This agreement is expected to be acted on officially once the Legislature reconvenes. “After four and a half years, it is gratifying to see the Legislature coming together and recognizing the difficulties confronting families who need mental health insurance coverage. I look forward to the day when Timothy's Law is the law, and I urge this bill to be finalized as soon as possible,” said Thomas O'Clair, Timothy's father after the agreement was reached. Timothy's Law was named after Timothy O'Clair, who hung himself in March of 2001 at the age of 12. His parents spent nearly five years trying to seek the necessary supports and services for his emotional disorder without success. The O'Clair's had health insurance through Thomas O'Clair's job with the New York State Thruway Authority. Their policy only allowed 20 outpatient visits per year for the psychiatrist and psychologist combined. Initially their physical health and mental health insurance co-payments were $10 per visit; however mental health visits became $35 each after just a few visits. As the family used up their coverage, they had to begin to pay for all appointments. Additionally, they found themselves having to pay for his extended hospitalization stays. The Timothy's Law Campaign announced the agreement. “The agreement requires health insurance policies sold in New York state, not exempt under Federal law, to provide at least 30 inpatient days and 20 outpatient visits for mental health treatment. Perhaps more importantly, co-payments for accessing such services will be equalized with other co-payments for physical health needs included in a policy. This will bring to an end the exorbitant co-payments, often in excess of $50 per visit, commonly required to access mental health services. Affected insurance plans will have to cover conditions in a manner comparable to the insurance state employees and state legislators have access to under the Empire Plan. Small employers of 50 or fewer employees will be held harmless from any potential premium increases,” the Web site reported. The agreement would also require insurance companies to fully cover treatment of biologically based mental illnesses including bipolar disorder, major depression, panic disorder, obsessive-compulsive disorder, anorexia, bulimia, schizophrenia/psychotic disorders, attentiondeficit/ hyperactivity disorders, disruptive behavioral disorders and pervasive developmental disorders. Small employers would have the option to purchase this same coverage. It should be noted that when Assembly bill 2312-A went up for a vote in the Assembly this past March, 134 Assembly members voted for it, nine voted against it. Of our Assembly members, only Assemblyman Gary Finch voted in the affirmative. Both Assemblymen Brian Kolb and Bob Oaks voted against it. This is only an agreement, so celebration for healthcare parity might be premature. We'll let you know once the Legislature reconvenes if this agreement becomes official and Timothy's Law is voted on and then signed by the governor. Amanda Derby is the housing advocate for Options for Independence
Advocates for the mentally ill on Tuesday urged Gov. George Pataki to sign legislation they said would help people get the services and housing they need. Steven Coe, chairman of a coalition of community groups, the New York State Campaign for Mental Health Housing, said the state needs to work with local groups to create an updated waiting list of those mentally ill adults in need of housing. At a news conference with other supporters of the Community Mental Health Housing Waiting List Bill, Coe said the state Office of Mental Health has opposed the legislation. Critics, Coe said, have raised fears that too many people would get on the list and that it might spur lawsuits. He and other advocates said the concerns are unwarranted. They cited a 2001 University of Pennsylvania study as demonstrating that supportive housing is "the solution that pays for itself' because of the higher costs of leaving people homeless and untreated. Creating the list would not itself be costly, said David Seay, executive director of the National Alliance on Mental Illness' state chapter. If, as others claim, there is enough housing, there would be no additional cost, he said. Scott Reif, a spokesman for Pataki, said the bill was one of more than 300 delivered to the Governor from the Legislature on Aug. 4. As is customary, Reif declined to comment on whether the governor would sign or veto it but said action on all of the bills is expected on the last possible day, Aug. 16. Jill Daniels, spokeswoman for OMH, said its policy is not to comment on pending legislation. Antonia Lasicki, executive director of the Clifton Park-based statewide advocacy group Association for Community Living, said the population of state psychiatric centers has declined from 93,000 40 years ago to 4,000 today. About 25,000 people are in appropriate "mental health housing," she said, mostly run by nonprofit agencies, where they can get needed support and be helped to recover from their mental illness. But, she and other advocates said, many thousands of others arc homeless, in jails, prisons or general hospital psychiatric units from which they will be released, staying with aging family members or in "adult homes" run for profit. The latter category, Lasicki said, often means "flophouses." Advocates at the news conference included two people who have suffered from mental illness, Gary Levin and Shavon Jackson, who said they needed supportive housing in order to be able to learn to live independently. Jackson, a youth advocate for the Mental Health Association of New York City, said, "Soon I will be maintaining my own home, paying bills and living a life just like anyone else."
The New York State Campaign for Mental Health Housing is urging Gov. George Pataki to sign the Mental Health Housing Waiting List bill (A-2895a) sent to him on Aug. 4. He has 10 days to sign the legislation, which has more than 125 groups supporting it. Proper
Care Needed for Mentally Ill Inmates. By Mary Beth Pfeiffer The suicides of three inmates at the federal military prison at Guantanamo Bay in June prompted an uproar among citizens concerned about the activities of the government in their name. But little public angst is expended on a more common, preventable and equally tragic kind of suicide: The ones that regularly occur in the disciplinary confinement cells of New York state prisons. A bill that would prevent many of these deaths — and provide urgently needed care for mentally ill inmates — is awaiting a signature by Gov. George Pataki. He should sign the measure, which in the long run will not only save lives but money. From 1998-2004, at least 52 New York state prisoners committed suicide while housed in isolated confinement, mostly in what are euphemistically called special housing units. That's nearly half of prison suicides among less than 10 percent of the population. Among these deaths were three local residents: James Butler, 36, and Jessica Roger, 21, both of Poughkeepsie, and Jesse McCann, 17, of Kingston, the youngest prison suicide in at least a decade. A quarter of the inmates routinely kept in these disciplinary units — which inmates call "the box" — are mentally ill, many suffering from serious disorders such as schizophrenia. The reason for this is mentally ill inmates have difficulty conforming in the rigid world of prisons, leading to disciplinary infractions and sentences to the box. Such offenses may have been committed when inmates were psychotic or otherwise unable to control their behavior. Under the bill passed by the Legislature, inmates with serious mental illness would be barred from being placed in disciplinary confinement. The prison system would also be required to set up alternative residential units for mentally ill inmates, and correction officers would be better trained in handling inmates with mental illness. If the governor signs the bill, New York would join a handful of progressive states that ban the placement of extremely ill people in isolated confinement — an overused and ultimately counterproductive form of inmate management. SOLITARY
WIDELY USED The bill passed by the Legislature will cost the state money at the outset. But mentally ill inmates are often denied parole because of poor disciplinary records in prison, costing taxpayers $32,500 for each additional year they are incarcerated. They also often leave prison in worse shape than when they went in, in large part due to long terms in isolated confinement. This increases the chance they will be unable to function when released and will ultimately return to prison. Since the 1950s, New York state has eliminated more than 80,000 beds in public mental hospitals, the outgrowth of better drugs to manage illness and court rulings in favor of patients' rights to refuse treatment. Lacking a system to take their place, prisons have become the new mental institutions of the 21st century. Until the state government figures out how to undo a half-century of failed policy, it must do the next best thing: Provide for mentally ill inmates in humane and compassionate ways.
It’s been more than ten years since New York State has conducted a needs assessment on housing and services available to those with mental illnesses. In that time, we’ve taken positive steps to address what we can only estimate is a growing need for a safe, affordable housing with adequate support services, like job training and counseling, for people with mental illnesses. For example, under the governor’s watch, the New York – New York agreements are making it possible for the state, New York City, and non-profit agencies to work together to create additional housing units for homeless people with mental illness. These and other initiatives are helping to reduce the number of people with mental illnesses that are in and out of homeless shelters, hospitals, emergency rooms, and jails. Despite these successes, New York has no method of tracking its progress so that we can use proven models to make the wisest investment of state funds. A statewide Mental Health Housing Waiting List law would bridge this gap. Governor Pataki has such a bill on his desk. Bill A.2895-A/ S. 3653-A, which we co-sponsored, would allow us to build on recent successes, furnish the state, counties, and local housing providers with a roadmap for smart planning, and do the right thing for those with mental illnesses and their families. The governor should move quickly to sign this bill into law. The bill calls for the New York State Office of Mental Health to collect data from around the state on the number of people who have applied and waiting for housing. They would then publish the data monthly so that we can identify and track what works, what’s needed, and where to target state funds. This common-sense legislation is long overdue. The bill has the support of New York City Mayor Bloomberg, the New York State Conference of Local Mental Hygiene Directors, and a coalition of over sixty mental health providers, consumers, family members, housing developers, social policy experts, and legal rights organizations. There is no doubt that safe, affordable supportive housing increase chances of recovery for people with mental health illness. President Bush’s New Freedom Commission on Mental Health states that the lack of decent, safe, affordable and integrated housing is one of the most significant barriers to full participation in community life for those with mental illnesses. With proper planning and an adequate supply of community housing with supports, we reduce the number of homeless people with mental illnesses on our streets and provide them with an opportunity to live productive lives. We assure a home for children with mental health illnesses who are aging out of foster care. We provide peace-of-mind to families who worry loved ones suffering from mental illnesses will have no place in the world when they’re gone. And we keep those with mental illnesses from being shuffled between shelters, hospitals, and jails. We also save money and assure a smart investment of state funds. For example, studies have shown that the cost of leaving people homeless and relying on emergency interventions is far more expensive that redirecting funds toward community-based housing and services that increase chances for recovery. The fact is, by putting in place long-term planning tool for decent, appropriate housing for people with mental illnesses, we do a great service to those who suffer from mental illnesses, to their families, and to our communities as a whole. Without a means of tracking what works statewide, we are forced to target state dollars in a way that is neither the most responsible, not the most effective. Other agencies, like the Office of Mental Retardation and Developmental Disabilities conduct annual needs assessment and maintain waiting lists. In fact, their data resulted in the nationally renowned New York Cares Housing Program for the developmentally disabled. With this legislation, New York State has the opportunity to create a similar successful program for people with mental illnesses. New York has come a long way in the effort to provide needed housing for people with mental illnesses. Let’s build on these efforts with the tools we need to wisely now and into the future. It’s time for the governor to take the next step and sign out Mental Health Waiting List legislation into law. Note: The writers are chairs of respectively New York State Senate and Assembly Mental Health Committees
I agree wholeheartedly with your recent editorial calling on the governor to quickly sign legislation banning the inhumane treatment of prison inmates with mental illnesses ("End the cruelty" July 30). At the same time he is signing into law a bill to end the cruel punishment of prisoners with mental illnesses, he should put his signature on A-2895a (Mental Health Housing Waiting List), which is also about to be sent to him for action. The bill encourages the use of housing with supportive services as an alternative to prison, emergency services, and homelessness for those with mental illnesses. Safe, affordable housing with support services, such as job training and counseling, has been proven to increase the rate of recovery for people with mental illnesses. The bill calls on the state Office of Mental Health to work with local communities to develop and publish a monthly list of people with mental illnesses who are waiting for housing that meets their needs. It's been more than a decade since a needs assessment has been conducted in this area to gauge our progress and document what works. This law would create a necessary planning tool to meet the basic needs of our mentally ill citizens. County mental health directors have unanimously endorsed this bill, citing the need for "... access to accurate information on the number of seriously mentally ill adults on waiting lists for specialized housing in their jurisdictions. This legislation is an important step in facilitating the reporting of, compilation of, and dissemination of such information." Both of these bills would result in common-sense laws that assure people with mental illnesses are treated in the most humane and cost-effective way possible. The governor should sign them both into law. STEVE
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