December 15, 2006

CALLS NEEDED TO GOVERNOR PATAKI TO URGE HIM TO SIGN TIMOTHY’S LAW: Governor Pataki technically has until December 26th to sign or veto Timothy’s Law, however indications suggest that he will take action sooner rather than later.

Therefore, we are asking everyone to take immediate action to help enact Timothy’s Law:

CALL
• Call Governor Pataki (if you already called, call again
and every day until the bill is signed) at 518-474-1041.
• Reach out personally to three other people and ask them to call the Governor.
• Ask those three people to enlist three more people to call the Governor.
FAX
• Fax the attached first page of the bill to Governor Pataki at 518-474-8099.
E-MAIL
• Email: Go to www.timothyslaw.org, click on the “Get Involved” tab and follow the instructions from there, or go directly to http://161.11.121.121/govemail.

Letters should be addressed to
Governor George E. Pataki
State Capitol
Albany, NY 12224.

IN THE NEWS:

Legislature Ends Special Session with Deal on Mental Health Treatment Bill - Pact on sex offender confinement is elusive.
Poughkeepsie Journal, December 14, 2006
By Yancey Roy and Cara Matthews

ALBANY — A special legislative session Wednesday consisted of closed-door meetings and idle lawmakers hanging around the Capitol — but no agreements on sex offenders, charter schools or even pay raises for legislators.

The one piece of legislation that passed was a measure to mandate more insurance coverage for mental-health treatment. The Democrat-led Assembly voted unanimously to approve the measure, called "Timothy's Law," to follow through on an agreement it reached with the Republican-controlled Senate last spring.

Assemblyman Paul Tonko, D-Amsterdam, Montgomery County, said the bill, if signed by Gov. George Pataki, will be a "major step forward" for people with mental illness and will help employers too through increases in worker productivity.

A spokesman for Pataki had no immediate comment.

Lawmakers were ready to leave the Capitol without a deal on the issue Pataki called them back to the Capitol to do: pass a measure to keep sexual predators confined to psychiatric hospitals after they complete their prison terms.

"Right now we have no civil-confinement law, so you potentially have sexual predators coming out of jail, out on the street, who belong in treatment," said Senate Majority Leader Joseph Bruno, R-Brunswick, Rensselaer County.

The lawmakers did make one important decision by failing to act: a report that calls for closing nine hospitals and 4,100 hospital beds and 3,100 nursing-home beds will take effect Jan. 1. The closings take effect automatically unless the Legislature votes to block them.

Lawmakers did not adopt an issue at the top of the list for some lawmakers: their first pay raise in eight years. Base pay is $79,500 a year.

"Our members expressed that they wouldn't be extorted," said Assembly Speaker Sheldon Silver, D-Manhattan, about the possibility Pataki would OK a pay raise in return for approving an expansion in the number of charter schools or other issues he wanted.

State Assemblyman Thomas Kirwan, R-Newburgh, said the pay raise issue never came up and neither did civil confinement. The special session cost taxpayers $60,000, Kirwan said.

"I think our reputation as the most dysfunctional legislature in the country, if not the galaxy, remains intact," Kirwan said, adding he would not support a pay raise.

Bruno said the Senate won't return to the Capitol before the end of the year, meaning a pay raise is off the table for at least two years. But Silver said lawmakers could be back before New Year's. Lawmakers spent much of the day waiting and meeting behind closed doors.

The Senate confirmed a number of Pataki nominations to various regional and state boards and also some new judges, including Lt. Gov. Mary Donahue as a Court of Claims judge.

The Assembly Fulfills a Spring Promise, Backs Timothy's Law
The Journal News, Editorial, December 15, 2006

The good news from the Legislature's special session is that the lawmakers could not agree upon who was extorting from whom and, therefore, failed to vote themselves a legislative pay raise. The bad news is, even at their current and inflated wage, the lawmakers could barely manage a lick of work.

There was no agreement on civil confinement - a last-ditch effort under Gov. Pataki to confine still-dangerous sex offenders in psychiatric hospitals after they have completed their prison sentences; Pataki had enacted a confinement program by fiat, a move recently rejected by New York's highest court. The Assembly and the Senate have been unable to agree on enabling legislation that is true both to their rhetoric and due process.

There also was no agreement on charter schools either; in 1998, Pataki used a legislative salary hike as the carrot to induce - "extort" works just as well - lawmakers' support for charters. The thinking this time around was that the same quid pro quo could re-emerge. No deal. "Our members expressed that they wouldn't be extorted," said Assembly Speaker Sheldon Silver, D-Manhattan.

That would reflect a change in policy; Pataki pointed the finger at Silver, accusing him of demanding approval of a permanent mechanism for raising lawmaker pay, based upon the cost of living. We can assume the topic is not dead. There has been talk of raising legislators' base pay from $79,000 to more than $90,000.

The Wednesday session wasn't all bickering. Fulfilling a spring promise, the Assembly gave final legislative approval to a version of the long-debated Timothy's Law, which mandates more insurance coverage for mental-health treatment. Under the measure, insurers have to provide coverage for a host of mental-health conditions, and allow a minimum of 20 outpatient visits and 30 inpatient treatment days a year. Copayments and deductibles would have to be comparable to those for physical aliments.

The state would pay the extra cost for premiums - estimates have varied - for employers with fewer than 50 workers, lessening the blow to business. The legislation is named in honor of the late Timothy O'Clair of Schenectady, who committed suicide in 2001 as his family struggled to provide him mental-health treatment. He was 12. His namesake bill is far from perfect, even after years of wrangling. But it would move New York closer to the health mainstream, as some three-dozen states already have such mental-health "parity" laws. Pataki should see to it that New York makes the leap.

Group Warns Cost of 'Timothy's Law' Unknown as Bill Passes Assembly
The Business Review (Albany), December 14, 2006

Gov. George Pataki is being urged to veto a bill that would add another mandate to health insurance policies written in New York state.

The state Assembly gave final approval to the bill, dubbed by supporters as "Timothy's Law," during an otherwise unproductive special session held by lawmakers on Wednesday. Pataki blasted the Democrat-dominated Assembly Thursday for failing to vote on a bill that would allow civil commitment of sex offenders considered at high risk of committing other sex crimes when their criminal sentences have been served.

SSA, a small-business membership group in Schoharie, said it is still unclear what the Mental Health Parity bill will cost businesses which provide health insurance for their employees.

"Lawmakers have failed to tell us what this mandate will cost, proving that we truly need a mandate review commission to make sure that they're not passing mandates that will ultimately make health insurance too costly for those who can least afford it," said Chris Koetzle, SSA's vice president of membership and marketing.

The legislation requires coverage for treatment of mental illness, including eating disorders. Under a compromise that helped earn the legislation passage earlier this year in the state Senate, coverage for substance abuse treatments were taken out of the bill.

The measure says businesses with 50 or fewer employees would be given relief by the state under a method to be determined by the state's insurance superintendent.

Sign Timothy's Law - The Assembly follows up on Senate approval of mental health parity legislation.
Albany Times Union, Editorial, December 15, 2006

While Wednesday's one-day legislative session was generally unproductive, one key measure was addressed when the Assembly passed Timothy's Law. The vote followed Senate approval in early September, and sent the measure to Gov. Pataki, who has 10 days to sign it into law.

He shouldn't wait. He should sign it now.

Timothy's Law is named after Timothy O'Clair, the Schenectady County 12-year-old who committed suicide in 2001 after his parents' health insurance coverage for his mental illness had run out and they had relinquished custody so he might continue to receive treatment.

Timothy's tragic death sparked a statewide debate over health insurance coverage in general, but in particular the imbalance between coverage for physical and mental illnesses. Supporters of Timothy's Law argued that disorders of the brain should not be considered any different than physical illnesses, such as heart or kidney disease, that often take years to heal and require expensive care.

Opponents, however, insisted that requiring mental health parity would be a burden for many employers, particularly small businesses, and that more workers would be left without coverage. At the same time, supporters contended that premiums would rise only 1 percent to 2 percent.

In truth, the opponents' fears are unfounded. That has been proven by the experiences in other states with mental health parity laws. In California, which adopted parity in 2000, there has been no sharp increase in costs, and the San Jose Mercury News, analyzing the impact of the law, found that premiums rose by only 1 percent. California's experience is similar to that in the 35 other states with parity laws.

It's also similar to the experience on the federal level. In 1998, President Clinton issued a directive providing parity coverage for 9 million federal workers. Yet government health care costs have yet to rise dramatically as a result.

President Bush also supports mental health parity, in no small part because he had witnessed his own mother, former first lady Barbara Bush, suffer from depression after her 3-year-old daughter died of leukemia.

It's time, well past time, New York embraced parity as well.

If Pataki Signs Bill, Mentally Ill will Get Long-awaited Relief
Rochester Democrat and Chronicle, OP-ED, December 15, 2006
By Dr. John S. McIntrye and Pat Sine

According to the Dec. 6 issue of The Journal of the American Medical Association, a large European study demonstrated that the significant risk of postpartum mental disorders for first-time mothers remains high for up to nine months after the baby's birth.

A study last year found that in the United States, one of seven new mothers experiences depression that impairs her ability to mother. Fortunately, these depressions are very treatable. Unfortunately, at times tragically, many of these women do not receive treatment. One of the barriers to care that these young mothers experience is discriminatory insurance coverage for their mental illness.

Over the past two decades, 39 states have enacted some form of nondiscriminatory, (commonly called "parity") insurance coverage for the treatment of mental illness and substance use disorders — but shamefully New York has not.

However, on Wednesday, the Assembly passed the nondiscriminatory bill, Timothy's Law, named after Timothy O'Clair, a 12-year-old Schenectady boy whose suicide in 2001 was attributed in part to discriminatory mental health coverage.

Although this year's version of Timothy's Law is not perfect — substance use disorders are not included — its enactment would be a major step forward for patients with mental illnesses and their families. Timothy's Law mandates that insurance providers covering any health care services must also provide coverage for mental health and substance abuse services, and that coverage and cost must be "on par" with all other health care services covered under such policy.

The Senate has already passed this bill. Now Gov. Pataki should sign it. As the former U.S. Surgeon General Dr. David Satcher noted, "There is no health without mental health." Treatment for mental illnesses and substance use disorders should be covered by insurance just as any other illness.

Reasons for doing so are clear and convincing. The 1999 surgeon general's report on mental health concluded that mental illnesses are largely biologically based. The President's New Freedom Commission on Mental Health (2003) reported that mental illnesses constitute the leading cause of disability in the United States and other major industrialized countries. Unfortunately, the commission also noted that half of those who need mental health treatment in this country do not receive it.

Mental illnesses and substance use disorders can be reliably diagnosed, and specific treatments that are evidence-based and effective are available. The National Institute of Mental Health reports that efficacy rates for the treatment of severe mental disorders ranged from 60 percent to 80 percent, exceeding the efficacy rates for many treatments in the rest of medicine. Over the past decade, the American Psychiatric Association has published 14 evidence-based guidelines for the treatment of major mental disorders (including substance use) and these are regularly revised.

The high costs to society of untreated and undertreated mental illnesses are well-documented. Researchers at Harvard Medical School have found that workers with depression have between 1.5 and 3.2 more short-term work-disability days in a 30-day period than other workers. The 1999 surgeon general's report estimated direct business costs (lost productivity and increased use of sick leave) resulting from a lack of nondiscriminatory coverage to exceed $70 billion per year.

Nondiscriminatory coverage for the treatment of mental illnesses is not only affordable, it may save money. Perhaps the only advantage of having 39 states precede New York in enacting parity legislation is that the economic impact in these states is becoming apparent. In state after state, it has become clear that the cost of parity legislation is minimal or there have actually been savings. This has been true in large states such as California, Illinois, Texas and Massachusetts, as well as many small states. A survey of insurance carriers and health plans in New Hampshire found no indication of any change in premiums due to a parity law passed three years earlier. Four years after a parity law for state employees was implemented in North Carolina, mental health payments as a portion of total health payments decreased from 6.4 percent to 3.4 percent per year. More than a decade ago in a report to Congress, the National Mental Health Advisory Council concluded that parity coverage for severe mental illnesses would result in a net savings of $2.2 billion a year. And an independent actuarial analysis of Timothy's Law concluded that the expected employer health care costs for this nondiscriminatory coverage would rise about .8 percent.

Most importantly, eliminating discriminatory insurance policies is not only scientifically and fiscally sound, it is the right thing to do. Timothy's Law should be signed by the governor. Let's get it done and end New York's shame.

McIntyre is past president, American Psychiatric Association. E-mail him at jmcintyre@unityhealth.org. Sine is director, National Alliance on Mental Illness Rochester. E-mail her at nami@eznet.net.

Issue of Repeat Sex Offenders Left Unresolved
Newsday, December 14, 2006
By Errola A. Cockfield Jr

ALBANY - Gov. George Pataki called the state Legislature back into session yesterday to tackle the contentious issue of confining repeat sex offenders after they leave prison, but lawmakers left town without agreement.

David Catalfamo, a spokesman for Pataki, said the governor was frustrated that talks broke down between the Republican-led Senate and the Democrat-controlled Assembly. Pataki placed much of the blame on the Assembly. "It's extremely disappointing that the Assembly majority failed to act on this critical legislation," Catalfamo said.

On other fronts, lawmakers approved a new measure, Timothy's Law, to extend health insurance coverage for the mentally ill. They sidestepped the issue of pay raises and took no action on a report by a commission set up to recommend changes in the state's healthcare landscape, including possible hospital closures. Lawmakers also discussed possibly increasing the cap on charter schools, but hit roadblocks there as well.

Hoping to create momentum on the confinement of sex offenders, the Senate unanimously passed the same version of a bill it passed earlier this year. But the Assembly ignored pleas by Senate Majority Leader Joseph Bruno (R-Brunswick) to take up the measure.

Charles Carrier, a spokesman for Assembly Speaker Sheldon Silver (D-Manhattan), said talks over the issue unraveled because the Senate bill did not include a provision to track sex offenders who did not meet the criteria for confinement in psychological facilities.

"We want intensive supervision," Carrier said.

But a source within the governor's office said the Senate and Pataki reached an impasse with the Assembly because Silver sought to use a cost-of-living adjustment for his members as leverage, a charge disputed by a Silver aide. Governor-elect Eliot Spitzer issued a statement last night saying he would only support a pay raise for lawmakers if they address reforms in ethics, lobbying, campaign finance and budget issues.

State Sen. Eric Schneiderman (D-Manhattan) chided the Legislature, which returns on Jan. 3, for its gridlock. "It's really a waste of our time and the public's resources," he said.

The state Senate also approved dozens of appointments. Outgoing state Parks Commissioner Bernadette Castro was confirmed to the Long Island State Park Recreation and Historic Preservation Commission. Kevin Plunkett, a former law partner of Pataki's, was confirmed to the state Thruway Authority. And Pataki's outgoing counsel, Richard Platkin, was confirmed to a judgeship on the state Court of Claims.

A Special Place to Plead One's Case: Third Mental Health Court Opens - Some criminal cases meet with 'problem-solving justice.'
City Limits WEEKLY, Week of December 11, 2006
By Freda Moon

Miguel Fernandez stands at the podium, facing a courtroom full to near capacity. He is a small man, with a soft, boyish face framed by sparkling earrings and dark, styled hair. He starts into a speech, hastily prepared just minutes earlier. “I took a lot of things for granted,” he begins. He thanks the court. He compliments the judge. He talks about his girlfriend and his family. “I put them through hell,” he says, his voice choked as he begins to cry. He crumples some tissues and puts them back in his pocket. “I don’t need those,” he says, tears rolling down his cheeks. “Real men cry.”

The courtroom breaks into laughter.

It’s graduation day at Queens Mental Health Court, and Miguel Fernandez is the first “client” – as offenders in the city’s mental health court system are called – to complete the court’s year-long therapeutic program. Located on the third floor of the Queens Supreme Court in Kew Gardens, this specialized part of the criminal court has handled about 20 cases since opening just over a year ago. It officially celebrated its inception last week, however, to coincide with the graduation of the court’s first two clients.

These graduates spent the previous year in a court-mandated treatment program, requiring them to attend therapy sessions, take their medication, and show up for scheduled court appearances – sometimes as often as two or three times a month. In completing the program, they each earn a certificate to acknowledge their success, a round of applause and, from the district attorney’s office, a dismissal of the indictments against them.

The Queens mental health court is part of a growing “problem-solving justice” movement that, since the late 1990s, has been responsible for opening more than 150 mental health courts across the country, according to the U.S. Dept. of Justice. Presided over by Judge Marcia Hirsch, it is the third to open in New York City in the last five years, following similar courts in the Bronx and Brooklyn. The Criminal Justice/Mental Health Consensus Project, organized in 1999 by the Council of State Governments, describes the courts as having been “developed in response to the overrepresentation of people with mental illnesses in the criminal justice system.”

“As far as the kinds of problem-solving courts, probably the mental health court was, in many ways, the most difficult to start up and, for some people, the most controversial,” said Judge Judy Harris Kluger, the deputy chief administrative judge who oversees court reform and specialized court projects for New York state. She spoke at the opening ceremony on Dec. 6. “Because we all know, sometimes in the criminal justice system, as in the world at large, people with mental illness evoke fear in others.”

“The easy thing might be, if someone commits a crime and suffers from mental illness, to say, ‘Well, jail is the appropriate place for them to be,’” said Kluger, “but we came to realize with a lot of good thought and knowledge, that jail was not the place for most people who suffer with mental illness to be.”

Though each mental health court functions somewhat differently, they are all called “jail diversion programs” because they take offenders who would otherwise be incarcerated and divert them to community-based treatment. After clients are referred by the prosecutor’s office, they are evaluated and the court staff designs a treatment program. Some enter a residential treatment program, others live in their own homes. Before being accepted into the court, the victim of the client’s offense has to agree that the offender belongs in mental health court, instead of regular criminal court.

Some courts place limitations on the types of clients they accept. The Brooklyn mental health court, for example, does not allow felony offenders. Other mental health courts, including those in the Bronx and Queens, will consider any “appropriate” case. The Queens court has handled everything from attempted kidnappings to drug cases, trespassing to assaults.

“Mental health courts don’t let really violent people in,” said Carol Fisler, Director of Mental Health Court Programs at the Center for Court Innovation, the research and development arm of the New York state court system. “The DAs and the judges aren’t going to let people out who they think might pose a risk.”

According to a report by Human Rights Watch, there were 200,000 to 300,000 people with serious mental illness in U.S. prisons in 2003. This is about three to four times the total number of people who were treated in mental hospitals that year. Mental health courts are seen by many as an answer to the high incarceration rates among the mentally ill. But they are not unanimously well-received.

“I think it’s a bad day,” said Lisa Gitter, of the local mental health activist group Rights for Imprisoned People with Psychiatric Disabilities, in the courthouse lobby following the graduation and court opening ceremony. “It’s that cliché, something’s better than nothing. But they don’t belong in a courtroom. It’s a health issue, not a criminal issue.”

National Sheriff’s Association Executive Director Thomas N. Faust has criticized such courts for a different reason. “Failure to treat people before they enter the criminal justice system is a major reason for the increase in jail populations,” Faust wrote in a guest editorial in Corrections Today magazine. “Jail diversion programs and mental health courts are positive steps but don't address the fundamental problem: treating people before problems occur.”

Fernandez, 28, the court’s first graduate, didn’t know that he was bipolar until he was arrested last year. A resident of eastern Queens who works in the financial department of a car dealership, he was arrested last year after he went into a deli, ate a sandwich and left without paying. He was confused, he says, and didn’t realize what he was doing. When the police arrived at his home, Fernandez’s dog bit one of the officers. Fernandez was holding the dog, but did nothing to stop the animal. He was charged with assault, criminal mischief, theft, trespass and resisting arrest.

The mental health court, he said, gave him “a second chance at life.”