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August 29, 2006 SAVE THE DATESSeptember
14, 2006 October
26, 2006 MHANYS 2006 Fall Conference Speakers and workshops will take place from 9 a.m. to 4 p.m. Featuring bestselling author of Lincoln’s Melancholy, Joshua Wolf Shenk. This event will take place at the Wolf Road Marriott Hotel in Albany.
SENATE EXPECTED TO RETURN TO ALBANY SEPTEMBER 15TH: With the Senate’s anticipated fall return scheduled to take place in just three weeks, mental health advocates are hoping that the Senate will capitalize on this opportunity to address a number of issues of importance to New Yorkers living with psychiatric disabilities. We are hopeful that the Senate will take this opportunity to pass the agreed upon version of Timothy’s Law that they reached with the Assembly at the end of the Legislative Session in June. At this time, the Assembly has not publicized any anticipated date of return to take up this important measure, as well as many others. Therefore, we are encouraging everyone to contact their Senator before the Senate returns to Albany as they are expected to on September 15th. Please tell your Senator that you want them to pass Timothy’s Law. Also,
please tell your Senator to override Governor Pataki’s vetoes
of the legislation to: You can contact your Senator’s office by calling the Senate switchboard at 518-455-2800 and asking to be connected with your Senator’s office. LAST CALL FOR MHANYS MEDIA AWARDS NOMINATIONS: Have you seen a newspaper or magazine article in the past year that does an excellent job of addressing a pertinent mental health issue or helping to dispel the many myths surrounding mental illness? Or, perhaps you’ve seen on television or heard on the radio a broadcast on a recent mental health issue that you’ve been impressed with? If so, we want to know about it. MHANYS has extended the deadline for the 2006 MHANYS Media Awards nominations to September 1st, leaving just 2 days in which to submit nominations you think are worthy of being considered. All article(s) and websites must have been published, and programs or announcements aired between June 1, 2005 and May 31, 2006. Anyone interested in nominating a newspaper article, television segment or radio broadcast for outstanding coverage of mental health issues should fill out this nomination form or contact Melissa Ramirez at infocenter@mhanys.org or 800 766-6177. End
Isolation of Mentally Ill. Editorial It's not too late for New York to end the inhumane practice of locking mentally ill inmates in solitary confinement. Gov. George Pataki recently vetoed a bill that would have placed seriously mentally ill inmates in secure residential treatment programs when they can't control their behavior. Currently, the behavioral problems are handled by locking inmates in disciplinary units, commonly referred to as "the box," for up to 23 hours a day, indefinitely. This occurs even when their behavior may have been caused by their symptoms. This wrongheaded approach has gone on long enough in New York. State lawmakers should vote to override the veto when they return to session later this year. The bill was passed 61-0 in the Senate and 133-6 in the Assembly. If lawmakers truly are committed to properly treating the mentally ill, and improving working conditions for correction officers and others inside the state's prisons, they won't hesitate to buck the governor. The deinstitutionalization of the mental health system over several decades has led to the state's prisons becoming de facto psychiatric centers. An estimated 8,000 inmates, or 12 percent of the state's prison population, are seriously mentally ill. But they represent 23 percent of the inmates in solitary confinement. The problem is not unique to New York. ILLNESS PLAYS ROLE IN BENHAVIOR Pataki said the disciplinary units are needed to protect other inmates and staff from those "unwilling to adhere to even the most minimum levels of civilized behavior." But the governor misses the point — for these inmates much of the behavior is difficult to control due to their illness. Isolation is counterproductive for these inmates, triggering attempts to kill or injure themselves. Those actions prompt even longer stays in the box. The situation also makes for a less safe environment for those working in the facilities. The legislation had the support of the union representing correction officers. Many of those working in prisons are unprepared for dealing with the mentally ill. The bill would provide annual training for all correctional staff, with an emphasis on those working in the residential treatment programs. Pataki also questioned the estimated cost of the legislation — which his administration put at up to $380 million for constructing, and up to $131 million a year to run, a residential treatment center. But the costs of not approving the legislation — the cost of time lost by injured staff, the cost of defending litigation by inmates and the cost in lives — are too great. Concerns raised by Pataki can be overcome. But the way the state deals with mentally ill prisoners must change. State lawmakers need to make it happen. Veto
of Needed Reform, Would've Protected Mentally Ill Prisoners.
Editorial Solitary confinement for 23 hours a day, sometimes for years on end, is no way to treat mentally ill people - even those who are prisoners. That's why it's so disappointing that Gov. George Pataki vetoed a bill that would have put an end to the use of disciplinary segregation for mentally ill inmates who break prison rules. The legislature should override the veto if it returns to Albany before Election Day. Failing that, proponents should introduce the bill again next year, when a new governor could mean new life for the much-needed reform. Prisons have become mental-health facilities of last resort. People with psychiatric problems often land behind bars when their aberrant behavior crosses the line into criminality. That's a problem for the sick and for prison officials whose job is to keep order. Psychiatric treatment behind bars has been expanded, as Pataki said in his veto message. But the mentally ill, by definition, find it hard to control their behavior. When they break the rules, the official response is still too often punitive isolation. The vetoed legislation would require psychiatric treatment and more appropriate in-prison housing units for disturbed inmates. Pataki expressed concern that the bill's language is too broad, that it would cover inmates who are not seriously ill and divert money that would otherwise be spent to care for inmates more in need of treatment. Those problems are not insurmountable. Mentally ill inmates often deteriorate in isolation, leading to more infractions, more solitary confinement, more deterioration and, in some tragic cases, even suicide. New York can do better.
We do not believe that those who have broken the law, been found guilty by their peers and sentenced to prison should be coddled. Prison is not supposed to be a "fun" place; it is a means to protect society from those who would do it harm. Originally, prison was to serve as a time of rehabilitation with the goal being that once released, former prisoners could again take their rightful place in society having learned valuable lessons that would make that possible. Prison is no longer looked upon as a place where inmates can be rehabilitated. That said, however, prisons must still be humane. Last week, Gov. George Pataki was blasted -- and rightfully so -- for vetoing a measure to end the practice of punishing seriously mentally ill prisoners by throwing them into solitary confinement for up to 23 hours every day. It is estimated that 8,000 inmates -- about 12 percent of the state's prison population -- are seriously mentally ill. Shockingly, however, mentally ill inmates make up 23 percent of the prisoners in solitary confinement. With the governor's veto, New York State becomes one of the few remaining that treats the severely mentally ill in this manner. Manhattan Democratic Sen. Thomas Duane, one of the many critics of the governor's veto, said there is ample evidence that mentally disturbed prisoners "usually deteriorate rapidly and sometimes mutilate themselves or take their own lives when placed in solitary confinement." According to a study conducted by the Correctional Association of New York State, and cited by Mr. Thomas and Sen. Velmanette Montgomery (D-Brooklyn), 53 percent of inmates with mental illness in solitary confinement attempted suicide, while 40 percent committed acts of self-mutilation. "Besides being inhumane, placing a mentally ill inmate in solitary confinement makes a bad situation worse," Sen. Montgomery said. "It creates prisoners who are more disruptive, more disturbed and more likely to hurt themselves or others." In addition, studies reveal that mentally ill prisoners who survive solitary confinement also cost the state more money, because they often experience a cycle of mental deterioration requiring costly in-patient care in a psychiatric hospital. The two senators, who co-chair the Senate Democratic Task Force on Criminal Justice Reform, also criticized Mr. Pataki for ignoring the overwhelming support the bill received, including from mental health advocates and correction officers. The measure passed in the Senate 61-0 and in the Assembly 133-6. The measure would have provided corrections officers with the training they need to better handle mentally disturbed prisoners. It would have also helped mentally ill prisoners receive proper treatment and medication. "Without the treatment or the medication they need to control their illnesses, mentally ill inmates --when released from prison -- will often present a danger to the community and end up reincarcerated," warned Mr. Duane. It appears now that his veto might lead to a court case. Several federal courts have ruled that such practices and methods are cruel and unusual punishment. Ms. Montgomery said, "I was hoping it wouldn't take a lawsuit to end this inhumane practice in New York. I expected the governor to end this practice. It is a tragedy that he has not." We agree.
In an effort to stop the repeated cycling of mentally ill people through courts and prisons, some states are setting up special courts for the mentally ill. The goal of judges, prosecutors and attorneys is to get treatment, housing and other kinds of support for the defendants. Proponents say the new approach is more effective -- and cheaper -- than other options. There are no national standards for mental health court policies. But there is an emerging consensus in favor of them. At a conference of state chief justices last January, representatives from all 50 states adopted a resolution endorsing the concept of mental health courts. And the Justice Department has allocated money to create more of them There are more than 120 mental health courts across the United States. They aren't distributed evenly. Ohio has 30, for example, while other states have none One argument in favor of the courts has to do with money. While critics questions that a program that incorporates housing, counseling, medication, and employment assistance can be cheaper than standard prisons, Ohio Supreme Court Justice Evelyn Stratton has an answer. Stratton, who led the drive for mental health courts in her state, says the statistics are actually very dramatic. In Ohio, keeping someone in the mental health program costs taxpayers $30 a day, all-inclusive. But, "If you put them in prison, it's $60," Stratton says. "If you put them in a mental hospital, it's $451 a day. And if you put them in a general hospital it's $1,500 a day. Supporters of mental health courts don't fit any one political or ideological profile. In Cincinnati, Judge Michael Sage is a former prosecutor. He calls himself a bedrock conservative, and he says nobody has ever argued that he's soft on crime. "I make the argument when I have opposition, what is the right thing to do?" Sage says. "And the right thing to do is to put them in this program and treat them. And to hopefully make sure they don't end up back on the streets committing crimes and doing the same things they were doing before. One of the men being treated in Sage's program keeps a list of things he's grateful for each day as part of his therapy. When he showed up in court for his check-in, his case manager asked what was on his list that day. The client replied: Having a judge who understands mental illness.
(Note: This article was also published in The Poughkeepsie Journal on August 27, 2006, titled “Mental illness issues grow- Companies offer help for stressed”) At first, it seemed as if little things were going wrong. Bonnie Harris forgot about sales appointments; she couldn't recall colleagues' names. But as her job in sales became more stressful, Harris developed intense mood swings and moments of terror. She saw psychiatrists, who prescribed various medications, but the drugs only made things worse, she says. At one point, she tried to throw herself out of a window. It wasn't until Harris, an earlier victim of violent crime, was diagnosed with post-traumatic stress disorder (PTSD) that she began to recover with the help of therapy and meditation. But through her entire 1991 episode, she kept working, trying to camouflage what was going on. "I went to work every day. I was a top salesperson, working 60-hour weeks," says Harris, 44. "Co-workers knew I was moody, but no one knew how bad it was. You don't tell people at work that you have this mental illness. It's so shameful." Today, Harris runs her own firm, Wax Marketing, in St. Paul and knows how to manage PTSD when symptoms creep up. Despite its stigma, a growing number of employers and employees are addressing a topic that has long been taboo: mental illness in the workplace. Employees' emotional health, a topic that once seemed incongruous with the survival-of-the-fittest corporate arena, is getting attention as a real bottom-line issue. Employers are beefing up mental health services as new research shows the staggering cost of mood disorders — depression, anxiety and panic disorder, bipolar disorder, schizophrenia and obsessive-compulsive disorder — can have on businesses. For example: •High costs. Untreated mental illness costs the USA $105 billion in lost productivity each year, with U.S. employers footing up to $44 billion of the bill, according to the National Mental Health Association, an Alexandria, Va.-based non-profit. •Threat of litigation. Federal guidelines issued in 1997 explain how employers can make accommodations for employees with serious mood disorders. Those who don't make accommodations, such as changing an employee's work hours, could be sued. The guidelines are further explanations of the Americans with Disabilities Act, issued by the Equal Employment Opportunity Commission. In fiscal 2004, the EEOC took in $469,000 in financial settlements for employees who complained that they'd been discriminated against because of their depression: 889 cases were filed. By 2005, that amount ballooned to more than $3 million, and there were 1,005 cases filed in that fiscal year. "There is a greater understanding among employers about these issues," says Chris Kuczynski, assistant legal counsel with the EEOC. Cases filed under the Disabilities Act have become easier to win as the public becomes more aware of mental health issues. •More emphasis on employer help. A number of employers are enhancing mental health coverage or programs. The number of firms with employee-assistance programs, which often provide on-call counselors and referrals, has climbed from 68% in 2001 to 71% this year, according to the Society for Human Resource Management. Seven in 10 offer mental health insurance. Eighteen percent have grief-recovery programs, up from 12% in 2002. General Motors' program provides U.S. employees with unlimited access to telephone counseling with a trained mental health professional and up to three face-to-face counseling sessions at no charge. GM also helps managers with what to do if an employee has personal issues. COVERAGE LAGS But companies' mental health coverage often lags behind coverage for physical ailments. Health plans may restrict the number of times an employee can see a mental health provider, for example. Americans battling depression with limited access to mental health care could face bills of $18,000 annually to cover health-related expenses due to their condition, according to the National Alliance on Mental Illness. Those with limited access were four times as likely to quit their jobs. In recent years, famous business and entertainment leaders have given a public face to mental health issues. 60 Minutes' Mike Wallace and newspaper humorist Art Buchwald shared that they've fought depression. Actress Brooke Shields documented her postpartum depression. Actress Ashley Judd revealed she went to a treatment facility for depression and other emotional problems. But despite the attention, some employees with mental health issues say they still struggle with how to tell managers what's going on. Sara Kobiela, 26, of Livonia, Mich., has a master's degree in social work but has struggled to keep jobs because of a depression so severe it left her unable to care for herself or do little more than sleep. She has held a variety of jobs, such as file clerk at a medical office and waitress. At her waitress job, she says her supervisor was very supportive and allowed her to take some time off and return after a depressive episode. But she has just started a new job as an intake counselor at a mental health outpatient center and has so far told only one other person about her struggle. She is on anti-depressants and other medication to help with depressive episodes. She is waiting for insurance to kick in so she can seek out a mental health practitioner. "You don't want to tell employers, but you need that support at work," says Kobiela, who lives on her own with three cats. "I get very overwhelmed and frustrated at work, but I can put on this front. But I think it's a huge stigma in the workplace." She says she fears breaking down at work. "When I get depressed, going through the motions of my day, I hate my life, but work is the one thing I can do. You can't be friendly with co-workers (so you worry) they think, 'What's wrong with her, why is she so unfriendly?' ... You don't want to get a label." 'The working wounded' Like Kobiela, many of those with mental illnesses are younger: Mental illness is highest among those 15 to 44, says Joseph Calabrese, a psychiatry professor at Case Western Reserve University and director of the mood disorders program at the University of Cleveland. Depression ranks at the top. Mental health problems can erode work performance and lead to absenteeism. "These people go to work, but they're the working wounded," Calabrese says. In many cases, those with mood disorders qualify for employment protections under the federal Americans with Disabilities Act, which means employers must make accommodations to help with work. In order for a mood disorder to be a disability, it must limit a major life activity, such as an employee's ability to sleep or take care of himself or herself. Some types of accommodations have included allowing employees to work from home, modifying supervisory methods, reassigning them or changing a work schedule. But employers can ask for documentation of mental illness to be sure a disorder is legitimate, and they can argue whether that disorder is truly a disability under the ADA. Traits such as irritability or chronic lateness are considered behaviors, not mental impairments requiring accommodations. Employers don't have to make accommodations if doing so would impose an undue hardship, and they cannot retain an employee if that worker poses a direct threat. Lucinda DuToit, director of human resources at Digineer, a technology consulting firm in Minneapolis, says the shift from ignoring to acknowledging mental illness has come as employers become more aware of the link between personal and professional lives. She also says employers stand to gain valued loyalty from these workers if they make the necessary accommodations. "There's much more of an understanding of mental illness. In the past, it was just, "We'll see you, bye,' " DuToit says. "Now it's, 'We'll get you help.' " But some employees also have filed lawsuits saying that it's the workplace that caused, or added to, their mental health stress. THE WORKPLACE ITSELF Southwest Airlines employees sometimes pull pranks on co-workers once they've passed their probationary period. But customer-service agent Marcie Fuerschbach says this joke went too far. At the end of her probation at her job in Albuquerque, co-workers got police officers to handcuff her in a mock arrest. By the time she was in on the joke, she was crying and scared, according to the lawsuit she filed. Later that day, found crying in the bathroom, Fuerschbach was sent home. She says she had to see a psychologist and was treated for post-traumatic stress disorder. She settled her case out of court with police. She lost her case against Southwest. Southwest spokesman Ed Stewart says, "It was so unfortunate it was taken the way it was, because that was not the intent. Everybody learned from it." But Fuerschbach, who still has the same job, says she is taking Lexapro, which is used for treating depression and anxiety. "I figured it was real. I thought for sure it wasn't a joke," says Fuerschbach, 48. "It was torture. I was shaking and crying. I was just shocked, handcuffed behind my back. I couldn't work after that." MENTAL
HEALTH VETO Gov. George Pataki vetoed a bill yesterday that mental health advocates had lobbied for heavily. The legislation would have let the state Office of Mental Health work with local communities to identify and track the number of adults with serious mental illnesses who are waiting for supportive housing and to create a monthly statewide waiting list. The Mental Health Housing Waiting List bill (A-2895a), sponsored by state Sen. Thomas Morahan and Assemblyman Peter Rivera, had been passed unanimously by both houses of the Legislature. The New York State Campaign for Mental Health Housing is pushing for lawmakers to override the veto. The state has not conducted a needs assessment of its mental health housing stock in more than 10 years. SENATE
SESSION The state Senate has scheduled a special session Sept. 15 to confirm Gov. George Pataki’s nomination of Judge Eugene Pigott to fill an upcoming vacancy on the Court of Appeals, a Senate spokesman confirms. The chamber is likely to add more agenda items. The spokesman says one likely topic is Timothy’s Law, which would create parity in health care coverage for mental illness. The Assembly and Senate agreed on compromise language just before the Legislature’s summer break but did not have time to vote.
Gov. George Pataki’s veto of legislation to return the burden of proof in special education hearings to school districts strikes a heavy blow against New York state’s most vulnerable families and their children. The legislation attempted to reverse the impact of a last November’s U.S. Supreme Court’s ruling in Schaffer vs. Weast that swept away more than three decades of public policy in New York and other states. In effect, the decision stated that in the absence of a state law to the contrary, parents of children with disabilities, not school districts, must bear the burden of proof in disputes over their child’s education. Up until Schaffer, the burden of proof in New York had been on school districts. New York based its pre-Schaffer policy on the overwhelming legal, informational and personnel resources any school district brings to bear against a parent. Giving school districts the burden of proof provided a more level playing field. Had Governor Pataki signed, instead of vetoed this bill, he would have restored a three-decades-old status quo. For working and poor families, without the resources to hire an attorney or who rely on public interest lawyers stretched to the breaking point, placement of the burden of proof is critical. Nearly 40 organizations argued that saddling these parents with the burden of proof robs them of any semblance of meaningful due process in disputes over their child’s federal right to a free and appropriate public education. Imagine, someone living paycheck to paycheck, certainly a poor person, perhaps a mechanic or tradesman or fireman or cop. Imagine them trying to protect their disabled child’s right to an appropriate public education by single-handedly presenting evidence, cross-examining witnesses and making legal arguments against a school districts specialized attorneys, They won’t stand a chance. On the other hand, nothing will change for parents who have the money to “buy” the right to an appropriate public education by hiring an attorney. Thanks to the veto, this right belongs to those who can pay for it. Through phone calls and e-mails, thousands of parents, advocates and family members across New York pleaded this case to the governor, urging him to sign the bill. But Governor Pataki didn’t listen. Instead, on July 26, he vetoed the bill. The veto message is sadly specious. It states that “opponents of the bill are concerned that putting the burden of proof on school districts would result in a substantial increase in the number of administrative and judicial appeals… (resulting) in increased litigation costs.” An increase since when? Since 1975? That’s the year special education began in New York state. That’s how long the burden of proof has been on the school districts. But the veto message was written as if the last three decades never occurred. Further, in this year’s state budget, the governor didn’t take a dime’s worth of saving based on parents assuming the burden of proof. Hence, if the burden is shifted back to districts, no savings are lost. If this veto should somehow save a pittance in litigation, it will be at the expense of denying a basic right to children from families without the means to pay for it. Further, the veto says that putting the burden of proof on districts creates a “legal presumption” that a child’s educational plan is invalid. In reality of course, an education plan is not invalid until it is successfully challenged. Perhaps that’s why proponents of this argument didn’t think to raise it for the last 30 years. Finally, the veto quotes the state Education Department as advising that signing the bill would be premature because the re may be a national rule on burden of proof coming any minute, with new federal special education regulations. No one hears of that excuse before the veto message and, not surprisingly, with the regulations finally out, there is not national rule. Working and poor parents don’t deserve this treatment. They live a nightmare trying to get their child appropriate services. The bill the governor vetoes would not have made that nightmare any better, but it would have kept it from getting much worse. The governor forgot about a constituency he has been admirably sensitive to during his 12 years in office. It’s a share that he chose to approach the conclusion of his tenure in office on a note like this. Mark Brandt is executive director of NYSARC, Inc. (formerly the New York State Association for Retarded Children).
Medicaid has been getting a bum rap. New York's taxpayers and homeowners are more familiar with the cost of Medicaid than its important purpose. Allow me to speak in defense of Medicaid. Medicaid was created as part of the "Great Society" program established under President Lyndon Johnson. The purpose of Medicaid was to provide health care to those too poor to pay for it. Medicaid is funded by both the state and the federal government and is managed separately by each state. The people primarily served by this government-funded health insurance are the working poor, seniors, children and the disabled. At face value, Medicaid's purpose is difficult not to support. The main reason Medicaid has been getting a bad rap, in New York at least, is the increasing burden it's having on local property taxpayers. Year after year, taxpayers have seen their property taxes increase at a double-digit rate. This is because much of the cost of Medicaid has been placed on the 62 counties in New York State, making this an "unfunded mandate" on the counties. And according to most, the cost to New York counties isn't coming down anytime soon. However, the cost of health care also continues to increase each year, and until the health care industry is regulated properly, these increases will be the norm. It was first reported in the Post-Standard that Excellus Health Plan members had to increase their premium payments by double digits last year. But what's more disturbing is that in the same year that Excellus' unregulated rates increased, the company enjoyed a record profit of $198 million, with overall revenues of $4.43 billion. The problemswith Medicaid are not simple. As the New York Times reported last year in a three-part expose, there is significant fraud in New York's Medicaid system. According to the Times, "many experts say that it is likely that at least 10 percent and probably more of New York Medicaid dollars are stolen or wasted." The current Medicaid system costs $44.5 billion, meaning $4.45 billion might be spent on waste and fraud. This issue needs to be addressed. But if indiscriminate cuts are made, the majority of legitimate Medicaid recipients could be left with no health care alternative. State leaders must tackle this issue head on. Consider the words of President Johnson when he announced the creation of the Great Society programs: "There are those timid souls who say this battle cannot be won; that we are condemned to a soulless wealth. I do not agree. We have the power to shape the civilization that we want. But we need your will, your labor, your hearts, if we are to build that kind of society." Joe Rossi is political director of SEIU Local 200 United. To contribute to "Rethinking Albany," contact state editor Paul Riede at 470-2138 or e-mail him at priede@syracuse.com
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