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September 15, 2006 SENATE TO PASS TIMOTHY’S LAW TODAY! Tom O’Clair invites Timothy’s Law supporters to join him at the Capitol today to watch from the gallery as the NYS Senate passes Timothy’s Law. Timothy’s
Law supporters will be gathering at 1:30 in the Senate Lobby on
the 3rd Floor of the NYS Capitol. IN THE NEWS: A
Chance for Parity - The State Senate May Pass Timothy's Law, which
Grants Access to Mental Health Care. Editorial After years of debate and delay, it now appears the Legislature is close to embracing the principle of equal health coverage, or parity, for physical and mental illnesses. All that is needed now is for the state Senate, which returns to Albany this week, to support Timothy's Law. The Assembly, which has long supported mental health parity, could follow suit later this year. How encouraging. Timothy's Law is named after Timothy O'Clair of Schenectady County, who committed suicide in 2001 after his parents' health insurance for their son's mental illness had run out and they had relinquished custody so he could continue to receive treatment. Opponents have long argued that mandating mental health coverage will drive up premiums and make heath coverage too expensive for many employers, particularly small businesses, and that more workers will be left uninsured. Supporters of Timothy's Law estimate premium increases of 1 to 2 percent, while opponents have argued it would be much higher. But the experiences in other states and in Washington, D.C., suggest that parity is affordable. For example, in 1998 President Clinton issued a directive providing parity coverage for 9 million federal workers. To date, there is no indication that government health care costs have risen dramatically as a result. Many states have had similar experiences. In 2000, California adopted parity, and as yet costs have remained manageable. Indeed, according to The San Jose Mercury News, premiums have risen just 1 percent. Nor have the 35 other states with parity reported soaring costs. Besides cost, there is the issue of how society views mental illness. As supporters of Timothy's Law have long argued, no one would suggest denying coverage for diseases like cancer, or expensive treatments like bypass surgeries and organ transplants. Yet opponents argue that mental health care can be drawn out and prohibitively expensive. In truth, many forms of mental illness can be treated with prescription drugs that are far less costly than chronic physical illnesses. Four years ago, President Bush embraced parity, no doubt out of his own personal experience of having witnessed his mother, former First Lady Barbara Bush, suffer the paralyzing effects of depression after her 3-year-old daughter died of leukemia. But until there is a national parity bill, the states -- including New York -- must do the right thing and take the lead. And do it now.
When we last checked in with the New York Legislature, the members were doing their best to capitalize the "D" in dysfunctional. Spring was in full bloom and the lawmakers were finishing another regular session highlighted by more fiscal gimmickry, more fiscal pork-barreling, and hardly any movement on the big issues confounding New York state, including finding a new and improved method for funding public schools. Today marks Round II, as the Senate returns to "action" for a quick, after-primaries session. Set your expectations low, as hard decisions are unlikely with voters starting to pay attention to all those nasty political mailers and commercials, and be thankful that the agenda, as far as we can discern, doesn't include a surprise pay raise — a story line that gained some fleeting currency in our Albany bureau earlier this year. We hold out hope, nonetheless, that the Albany gathering will offer more than just another opportunity for the lawmakers to stretch their legs, exercise their appetites and reconnect with favored lobbyists. If all goes according to script, the Senate will follow through with the leaders' previously announced plan to give final legislative passage of Timothy's Law, the mental-health parity initiative, requiring employers that offer health benefits to provide a minimum level of mental-health services as part of that coverage. Timothy O'Clair was a Schenectady boy whose parents were forced to turn him over to the state to get better care because their own insurance was inadequate. His father, Thomas O'Clair of Rotterdam, has been a one-man lobbying brigade, lending his son's name to the cause. Timothy died in 2001 — a passing that could make a difference in the quality of life of untold New Yorkers now doing without needed mental-health services. The Senate should close the deal. The Senate lawmakers could find further redemption, and shock voters and editorial writers alike, by getting behind Assembly-backed reforms aimed at closing loopholes that have permitted campaign funds to be used for so much more than attack advertisements and commercials, including personal-car leases and seemingly endless tours of Manhattan restaurants. In May, New York Public Interest Research Group said that the Albany crew has one of the weakest laws regarding personal use of campaign funds; 30 states have tougher laws. Pending legislation would also ban gifts from lobbyists, ban honoraria to lawmakers, limit so-called "pay to play" contributions from contractors and other campaign donors, toughen reporting requirements for public officers, and mandate ethics training for lobbyists, the governor, legislators, legislative employees, and state agency officers and employees. "By far, it's not perfect," Blair Horner of NYPIRG told the Editorial Board, speaking of the Assembly-backed initiative, but he called it a starting point for substantive discussions between the two chambers — that is if the Senate takes up the measure. "At least they (the Assembly) put something out." The Senate should follow the Assembly's lead, faster than Majority Leader Joseph Bruno can say Jack Abramoff. Enough said. If the Senate cannot defy low expectations and attend to its own ethics, it should still take action to address ethical lapses in the prescription drug trade, by forcing doctors to disclose honoraria, meals and other freebies extended to them by drug companies — shedding light on a practice blamed for increasing drug demand and creating artificial markets. Stanford University's medical school recently banned all free pens, mugs, stationery, lunches and other gifts from drug suppliers. Once more, the Senate should get on board with the Assembly. While on the same topic, the Senate should waste little time getting behind another Assembly-backed bill, this one requiring bulk purchases for all drugs earmarked for public health programs, taking advantage of the state's enormous purchasing power to get lower prices. Think Wal-Mart, but for buying drugs. Go ahead ask: How come New York doesn't do this already? Albany needs to stop being Albany.
But mental disorders, ranging from depression to bipolar disorder to alcoholism, have long been stigmatized and underestimated. For many health insurance plans, the result is fuller coverage for physical ailments. Not so for federal employees who participate in the Federal Employees Health Benefits Program, which is run by the Office of Personnel Management and offers dozens of insurance options for its 8.5 million participants. Since 2001, OPM has required FEHBP providers to offer equal benefits coverage for mental and physical ailments. That means participants pay the same deductibles, co-insurance and co-payments for both categories of illness. They also can make the same number of outpatient or inpatient visits. Five years later, researchers have concluded that parity not only resulted in improved insurance coverage for mental illness, but did so without a significant increase in total costs for the providers. A March study published in the New England Journal of Medicine found that in five of seven FEHBP plans examined, the amount participants spent on mental health care decreased about $13.82 to $87.06 between 1999 and 2002. But they found no significant increase in total spending by providers on mental health. Earlier studies found small increases in costs when mental health parity began, but they were comparing plans before and after parity took effect. This study compared plans with and without parity over the same time period, eliminating external factors for a greater use of mental health treatment. "What we found is it's a really good thing we had a comparison plan," said Howard Goldman, a University of Maryland psychiatry professor who led the study. "It didn't go up any faster than in the nonparity plan. It was a big deal from a research point of view." Part of the controlled costs stem from OPM's encouragement that providers manage their mental health care. That means insurance companies can require participants to use a select group of practitioners within their network, get prior authorization for treatment and follow a set treatment plan. In the Blue Cross Blue Shield standard federal plan, participants must get approval before they can receive any inpatient or outpatient mental health treatment. For in-network medical providers, there is a maximum of 25 visits a year and practitioners must provide a treatment plan by the ninth outpatient visit. There is a $15 co-pay for each visit to social workers, psychologists or psychiatrists. Inpatient visits have a $100 co-pay. Legislation has been introduced multiple times to extend the level of parity granted in the federal program to private sector insurance plans, but has never passed.
In this season of seemingly unrelenting anniversaries of major tragic events, the 35th anniversary of the Attica prison riot may have slipped the minds of many. However fatigued people may be of looking back at horror, the worst prison riot in American history must not be forgotten. The Attica uprising and massacre, which claimed the lives of 43 people, including 10 hostages, and resulted in 90 others being wounded, should serve as a reminder to stay vigilant about prison conditions. It was prisoner abuse and mistreatment and/or the perception of both that led to the Sept. 9, 1971, rioting. Sadly, Gov. Pataki recently vetoed legislation that took a major step toward allaying concerns about prisoner mistreatment. He said no to a reasonable proposal adopted by the Legislature that would have banned placing mentally ill inmates in solitary confinement. Never mind that an estimated 7,500 inmates suffer mental illness and that there are only 700 beds set aside for them. Because Pataki's veto was one of 70 he issued around the same time this summer, this page can only hope that he took enough time to seriously consider the impact of his action. Does he really believe that it's OK to keep mentally ill inmates in solitary confinement for 23 hours a day as a study by the Correctional Association of New York found? The association also found that a third of those inmates reported self-mutilation and more than 40 percent reported attempted suicide. Even states with reputations for being tough on crime such as Texas and Florida already have laws banning solitary confinement for mentally ill prisoners. It shouldn't have to take another prison riot and the loss of lives before New York acts responsibly. Now it's left to the state's next governor, to be elected in November, to make sure that New York doesn't repeat the mistakes of the past.
Thirty-five years ago, egregious prison conditions and inhumane treatment of Attica's inmates precipitated its infamous prison uprising. The government's violent response resulted in 39 deaths. The Correctional Association of New York, a 162-year-old organization with statutory authority to inspect state prisons, is in a unique position to assess whether conditions have improved since this tragedy. We regularly visit Attica, speak with staff and inmates, and report on conditions. Since 1971, the state has made some progress in enhancing communication between inmates and staff and in providing services and rehabilitative programs. Now, an elected Inmate Liaison Committee regularly meets with the prison administration. The prison has improved food services, is providing religious diets, has created or enhanced educational, vocational and substance abuse treatment programs, and has augmented staff providing medical and mental health care. Over this time, however, the state prison system has expanded more than fivefold, from 12,500 inmates to 63,000, and staffing levels and rehabilitative services have not kept pace. Today, too many inmates are still not engaged in programs. Complaints of inadequate medical care are commonplace. Prisons, including Attica, now confine significantly more inmates with mental illness, who often experience difficulties coping with prison due to their illness. Most disturbing is the continuing staff mistreatment of Attica inmates. Based upon our recent survey of more than 1,000 inmates in 12 prisons, staff abuse at Attica is among the worst we have seen. Nearly a quarter of the inmates we surveyed reported having a physical confrontation with staff and more than 60 percent stated they experienced verbal harassment by staff. More than one-third of the inmates reported retaliation for filing complaints, having their lights or water turned off in their cells, or their property destroyed. It seems that force and intimidation are routinely used to control the population. Although actual staff and inmate violence has diminished at Attica during the past decade, mistrust between staff and inmates still permeates the facility. With more than 80 percent of the prison population being African American or Latino, and with very few staff of color, the inevitable racial tension impedes effective communication. Although the ghosts of Attica's uprising and aftermath remain, they should not forever haunt the present. Other prisons in New York have less tension, better inmate-staff communication and greater respect between staff and inmates, all resulting in much less violence and abuse. To improve Attica, there must be more active leadership from the new executive team of the corrections department that will be appointed by the next governor, an evolution in the way staff and inmates interact, effective counseling and discipline for inmates and staff who refuse to accept change, and increased monitoring of prison violence through cameras and the department's investigative unit. With these improvements and inmates more engaged in meaningful activities, Attica would be safer and its inmates would be more successful when they are released. Unfortunately, the prison still has a long way to go to reach these goals. Beck is director, Prison Visiting Project, Correctional Association of N.Y. Contact him at info@correctionalassociation.org
Gov. Pataki's veto of a bill throws mentally ill prisoners back into the general population, which is life-threatening. They should be in mental health facilities, where they get their much needed care and treatment. To do otherwise is a step backwards into the Stone Age. In the mid 1800's, New York had a wonderful, two-term governor, William Seward. He fought fiercely to get some other inmates out of the men's prisons, because he was horrified at how they were treated. Yes, he was responsible for getting separate facilities for women, a very noble cause. Hopefully, our not-soon-enough new governor, and Congress, will have the sense to get New York out of the stone age in treatment of the mentally ill. I would be very happy. Bill
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