January 16, 2007

SAVE THE DATE
MARCH 14TH – MHANYS LEGISLATIVE CONFERENCE

PUBLIC POLICY DISCUSSION IN KINGSTON, JANUARY 24TH: The Kingston public policy discussion, originally scheduled to take place in December, will be held on January 24th. Details follow below.

Mental Health Association in Ulster County
Is Hosting A
Hudson Valley Region
DISCUSSION OF MENTAL HEALTH POLICY ISSUES IN NEW YORK STATE

January 24, 2007
3:00 – 5:00 p.m.
MHA in Ulster County’s Clifford Beers Center
300 Aaron Court (across from Hannaford shopping plaza), Kingston, NY

All are welcome. Please RSVP to Tree McElhinney at tmcelhinney@mhainulster.com or 845-339-9090 x115.

MENTAL HEALTH HOUSING RALLY IN ALBANY ON JANUARY 23RD: More than 1300 people are presently signed up to participate in what appears will be one of the largest mental health rallies in recent years. Everyone is encourage to join us to make this event as successful as possible and send a message to the Spitzer Administration and the Legislature that housing matters!

Tuesday, January 23, 2007
10:30am-4pm
In “The Well” (1st Floor) of the Legislative Office Building, Albany

Participants must register at www.campaign4housing.org, call (518) 465-7330 or e-mail marcyw@lobbywr.com.

MHANYS’ BOARD APPROVES 2007 LEGISLATIVE AGENDA: At MHANYS’ Board Meeting on Friday, January 12th, the Board voted to approve the following as the 2007 Legislative Agenda for the Mental Health Association in New York State.

Mental Health Association in New York State, Inc.

2007 Legislative Agenda

Housing

Issue: The lack of available and affordable housing for people with mental health needs is prevalent in urban, suburban and rural communities throughout New York State. Many could transition to much less restrictive and less expensive alternatives if such options were made available. The priority populations for transition include homeless individuals and those in homeless shelters, those who currently live in adult homes that are in deplorable conditions, individuals with psychiatric disabilities living at home with aging parents, and individuals transitioning from the criminal justice system. Additional capacity in existing housing models and development of new housing models are necessary, especially for these identified priority populations.

Action: 1) Create a waiting list of people with psychiatric disabilities in need of housing or in need of alternative housing, to appropriately assess the need; 2) Invest in additional, affordable housing for priority populations to provide individuals with the opportunity to recover from mental illness; 3) Enact recommendations of the New York State Coalition on Adult Home Reform to improve conditions in adult homes and develop alternative housing options for adult home residents, and; 4) Make more housing affordable through stipends and financial assistance.

Sexual Offender Management

Issue: Currently, NYS has not implemented a comprehensive approach to sexual offender management, resulting in a piecemeal system that is marginally successful in reducing the prevalence of sexual crimes. Many have called for enactment of a solitary approach to prevent sexual offenders who have served their sentence from being released to the community by “civilly committing” them to state psychiatric centers. However, current civil commitment proposals would: 1) Jeopardize the safety of current psychiatric center patients and others in the mental health system; 2) Drain enormous resources ($200,000+ per offender per year) from the mental health system and the legal system statutorily responsible for representing people with mental health needs, and; 3) Further stigmatize those living with psychiatric disabilities. Civil commitment laws expend enormous resources on a tiny percentage of sexual offenders, doing very little to reduce the number of offenses that take place.

Action: Instead, NYS must focus on enacting a comprehensive approach aimed at ensuring the public’s safety by preventing sexual violence from taking place and effectively managing offenders to prevent them from offending again. Professionals in sex offender treatment and those representing the victims of sexual violence call for the establishment of a state agency to organize the state’s current efforts to curtail sexual violence, being ultimately responsible for education, prevention, treatment, monitoring, supervision, and if necessary, civil commitment for a tiny percentage of offenders for whom earlier efforts have been unsuccessful. Any civil commitment program would need to protect the safety of those in the mental health system and the resources dedicated to serving those individuals.

Criminal Justice System Reform

Issue: Individuals with psychiatric disabilities have become more and more involved with the criminal justice system. This is, in part, due to the failure to properly fund community-based mental health services that provide individuals living with psychiatric disabilities the services they need to remain healthy and stable. We continue to see individuals with mental illnesses entering court rooms, sometimes as a result of behavior caused by their untreated or under-treated disability. And when individuals with psychiatric disabilities do end up in prison or jail, many are inappropriately placed into solitary confinement/special housing units (SHU), often times as a result of behavior directly caused by their untreated or under-treated mental illness. Placement in SHU is not therapeutic and often times results in fostering or furthering mental deterioration.

Action: NYS must make take steps to avoid incarcerating people with psychiatric disabilities through innovative alternatives to incarceration, including development of additional mental health courts. With regard to the treatment of prisoners, NYS must ban the use solitary confinement for inmates with mental health needs.

Budget

Issue:
Readjustment of State Funding - Presently the Office of Mental Health Budget (OMH) spends approximately $5 billion annually, more than 50% of which goes to maintain approximately 4,000 beds of inpatient care. However, OMH serves more than 600,000 people annually, leaving less than 50% of those resources for the vast majority of those in need of mental health services.
Local Assistance - In previous years, inconsistent funding and cuts to local assistance have damaged the ability of community-based mental health providers to consistently provide quality mental health services.
COLA - Recruitment and retention of quality direct care mental health staff has become more and more difficult, primarily due to very low compensation.

Action:
Readjustment of State Funding - NYS should evaluate the entire system of mental health care to determine if there are efficiencies that can be made. Any savings that are captured must be directed into community-based care, where the vast majority of individuals receive mental health services.
Local Assistance - Maintain existing funding for community-based providers and improve upon these quality services through increases in local assistance funding.
COLA – Additional funding is necessary to ensure that employers can hire and retain qualified direct care staff who play an integral role in the process of recovery from mental illness.

Co-Occurring Disorders

Issue: In addition to their psychiatric disabilities, over half of the individuals in the public mental health system also have a co-occurring addiction disorder, while still others have a co-occurring developmental disability/mental retardation. Unfortunately, the present parallel systems of care provide little-to-no coordination in treating these individuals, often times denying responsibility for particular individuals with such co-occurring disorders.

Action: New York must create a more integrated system of treatment, which is recognized as an evidence-based best practice. Current regulations and discreet funding streams must be changed to accomplish this goal. Budgetary and regulatory barriers that hamper the coordination of care must be broken down. In addition, a dual licensure certification process should be considered to allow for greater opportunity to create integrated treatment programs and work with colleges to create a dual certification mental health/addictions disorders degree track in New York (much like that which has been successfully implemented in Connecticut).

Employment

Issue: Recovery has finally become a core component of all mental health services. Employment plays a significant role in enhancing recovery, contributing to overall life satisfaction, and integrating people within their community. However, the current unemployment rate amongst people with psychiatric disabilities remains at least at 85% as it has been for many years now, while employment rates for those with other disabilities has dropped in recent years.

Action: Additional funding must be provided for supported employment - a proven, evidence-based best practice – as well as vocational rehabilitation to help facilitate competitive, integrated employment. Concerning employers, more must be to done to educate and promote various tax incentives available to their business, such as the Work Opportunity Tax Credit and Empire Zones, for hiring people with disabilities. Promotion and publicity of existing incentives and programs, such as the Medicaid Buy-In and Ticket to Work, are necessary to educate people with disabilities about returning to work without losing their benefits. Lastly, improved coordination and adequate funding must be provided to state agencies responsible for promoting workforce development for people living with disabilities.

Access to Services and Treatment

Issue: Ensuring that individuals living with psychiatric disabilities have access to services and treatments is an essential component of achieving recovery from mental illness. While well-intentioned, some government proposals and actions effectively restrict access to the services and treatments that allow individuals living with mental health needs to remain healthy and stable, especially with regard to medications.
Medicare Part D – As part of the Medicare Modernization Act enacted in 2006, dual eligible individuals (those on both Medicaid and Medicare) must now get their prescription medications through Medicare. The state’s efforts to provide a ‘wrap-around’ benefit have proven effective at ensuring that those who face difficulties accessing medications are not denied their medications. However, the requirement that dual eligibles must pay co-payments to access medications under Medicare (which was previously not mandatory for those who couldn’t afford co-payments under Medicaid) is exceptionally onerous on some individuals and effectively prevents them from getting the medications they need to remain healthy and stable.
Preferred Drug Program – As part of the previously enacted Preferred Drug Program under Medicaid, safeguards were included to ensure that mental health medications would remain available to those who need them. In addition, physicians were guaranteed the final say regarding which medication their patient would be prescribed. Attempts in previous years to eliminate these safeguards were unsuccessful due to MHANYS and other’s advocacy.

Action:
Medicare Part D: 1) Provide permanent ‘wrap around’ Medicaid coverage for dual eligibles experiencing difficulties getting their medications from their Medicare Part D plan; 2) Cover co-payments for those dual eligibles unable to afford the mandatory co-payments required by Medicare.
Preferred Drug Program: Ensure that safeguards in the Preferred Drug Program remain to preserve open access to mental health medications and to retain the physician’s ability to make the final determination regarding medications prescribed to a Medicaid patient.

Transition Issues

Issue: Individuals 16-25 years old with psychiatric disabilities appear to be falling through cracks in the mental health system as they attempt to transition from systems of care for children into the community as adults. As a result, many do not want to engage in mental health or other services intended to help them. As a result, these individuals end up involved with the criminal justice system, homeless, or in other undesirable situations.

Action: NYS must have a strength-based, individual-centered assessment that identifies choices regarding education and employment. For those young adults, transition planning must begin at an early age, far before high school. There must be greater emphasis on post-school outcomes aimed at providing the greatest opportunity for productivity and independence. Case management programs can be very helpful in making a successful transition to college, vocational training or employment. Lastly, youth must be at the forefront in developing one-stop programs/drop-in centers and other programs dedicated to providing adolescents and young adults with an opportunity to work with their peers.

Timothy’s Law

Issue: Despite steps to end discrimination in health insurance in recent years, such discrimination against those living with mental health and addiction needs continues. Inadequate treatment for mental health and addiction disorders costs US businesses hundreds of billions of dollars each year and millions of people suffer as a result.

Action: Improve upon Timothy’s Law, enacted in 2006, to completely eradicate discrimination in all health insurance through complete coverage for people, regardless of the size of their employer, particular mental health diagnoses, and to include those with addiction treatment needs.

IN THE NEWS:

The Mentally Ill, Behind Bars
The New York Times, OP-ED, January 15, 2007
By Bernard E. Harcourt

Chicago - LAST August, a prison inmate in Jackson, Mich. — someone the authorities described as “floridly psychotic” — died in his segregation cell, naked, shackled to a concrete slab, lying in his own urine, scheduled for a mental health transfer that never happened. Last month in Florida, the head of the state’s social services department resigned abruptly after having been fined $80,000 and is facing criminal contempt charges for failing to transfer severely mentally ill jail inmates to state hospitals.

Ten days ago, the Supreme Court agreed to determine when mentally ill death row inmates should be considered so deranged that their execution would be constitutionally impermissible. The case involves a 48-year-old Navy veteran who is a diagnosed schizophrenic. In the decade leading up to the crime he was hospitalized 14 times for severe mental illness.

According to a study released by the Justice Department in September, 56 percent of jail inmates in state prisons and 64 percent of inmates across the country reported mental health problems within the past year.

Though troubling, none of this should come as a surprise. Over the past 40 years, the United States dismantled a colossal mental health complex and rebuilt — bed by bed — an enormous prison. During the 20th century we exhibited a schizophrenic relationship to deviance.

After more than 50 years of stability, federal and state prison populations skyrocketed from under 200,000 persons in 1970 to more than 1.3 million in 2002. That year, our imprisonment rate rose above 600 inmates per 100,000 adults. With the inclusion of an additional 700,000 inmates in jail, we now incarcerate more than two million people — resulting in the highest incarceration number and rate in the world, five times that of Britain and 12 times that of Japan.

What few people realize, though, is that in the 1940s and ’50s we institutionalized people at even higher rates — only it was in mental hospitals and asylums. Simply put, when the data on state and county mental hospitalization rates are combined with the data on prison rates for 1928 through 2000, the imprisonment revolution of the late 20th century barely reaches the level we experienced at mid-century. Our current culture of control is by no means new.

The graph on the left — based on statistics from the federal Census Bureau, Department of Health and Human Services and Bureau of Justice Statistics — shows the aggregate rate of institutionalization per 100,000 adults in the United States from 1928 to 2000, as well as the disaggregated trend lines for mental hospitalization on the one hand and state and federal prisons on the other.

The numbers include only state and county mental hospitals. There were many more kinds of mental institutions at mid-century, ones for “mental defectives and epileptics” and the mentally retarded, psychiatric wards in veterans hospitals, as well as “psychopathic” and private mental hospitals. If we include residents of those facilities, from 1935 to 1963 the United States consistently institutionalized at rates well above 700 per 100,000 adults — with highs of 778 in 1939 and 786 in 1955. It should be clear why there is such a large proportion of mentally ill persons in our prisons: individuals who used to be tracked for mental health treatment are now getting a one-way ticket to jail.

Of course, there are important demographic differences between the two populations. In 1937, women represented 48 percent of residents in state mental hospitals. In contrast, new prison admissions have consistently been 95 percent male. Also, the mental health patients from the 1930s to the 1960s were older and whiter than prison inmates of the 1990s.

But the graph poses a number of troubling questions: Why did we diagnose deviance in such radically different ways over the course of the 20th century? Do we need to be imprisoning at such high rates, or were we right, 50 years ago, to hospitalize instead? Why were so many women hospitalized? Why have they been replaced by young black men? Have both prisons and mental hospitals included large numbers of unnecessarily incarcerated individuals?

Whatever the answers, the pendulum has swung too far — possibly off its hinges.

It would be naïve, today, to address any of these questions without also considering the impact of imprisonment on crime. One of the most reliable studies estimates that the increased prison population over the 1990s accounted for about a third of the overall drop in crime that decade.

However, prisons are not the only institutions that seem to have this effect. In a recent study, I demonstrated that the rate of institutionalization — including mental hospitals — was a far better predictor of serious violent crime from 1926 to 2000 than just prison populations. The data reveal a robust negative relationship between overall institutionalization (prisons and asylums) and homicide. Preliminary findings based on state-level panel data confirm these results.

The effect on crime may not depend on whether the institution is a mental hospital or a prison. Even from a crime-fighting perspective, then, it is time to rethink our prison and mental health policies. A lot more work must be done before proposing answers to those troubling questions. But the first step is to realize that we have been wildly erratic in our approach to deviance, mental health and the prison.

Bernard E. Harcourt, a professor of law and criminology at the University of Chicago, is the author of “Against Prediction: Profiling, Policing and Punishing in an Actuarial Age.”