Mental Health Association in New York State

Come to the MHANYS Legislative Day on March 12th. For more details, e-mail John Richter at jrichter@mhanys.org

Budget Update

Yesterday was quite a day for mental health in New York. Governor Spitzer officially signed the SHU bill, the Assembly Way and Means Committee and Senate Finance Committee held their annual hearing on the mental health budget and NYAPRS and NAMI had their legislative days.

Yesterday, Commissioner Hogan, Commissioner Carpenter---Palumbo (OASAS) and Commissioner Ritter (OMRDD) all testified on the budget. This year’s mental health budget hearing was not very contentious due largely to the limited cuts and no attempted facility closures.

Commissioner Hogan did a very good job in outlining the highlights of the budget including the proposed three year COLA, housing increase, the Housing Opportunity Fund, impact of the case rate adjustment and the announcement of the Governor’s signing of the SHU bill.

Questions raised by the legislature were largely focused on the anti-depressants not being included in the preferred drug list, housing wait list bill, cultural competence issues, workforce issues, school based clinic services and ECT.

Several mental health advocacy groups testified at the hearing including MHANYS (our testimony is listed below). There were clearly common themes among the groups including:

Listed below is our testimony followed by a letter we sent to the Governor urging him to add additional funding in the budget during the 21 day amendment period. The In the News section features several articles that include MHANYS perspective on the state budget.

Glenn Liebman, CEO
Mental Health Association in New York State, Inc.

Testimony to:

SENATE FINANCE &
ASSEMBLY WAYS AND MEANS COMMITTEES

Joint Legislative Hearing - Mental Hygiene

January 29, 2008

The Mental Health Association represents 30 affiliate chapters in New York in fifty four counties. The goal of the organization is to enhance the lives of individuals with psychiatric disabilities through advocacy for community based services, positive transformation of the mental health system and education and trainings about mental health issues including the elimination of the stigma of mental illness.

We thank you very much for the opportunity to be here today and provide our testimony on Governor Spitzer’s 2008-2009 proposed Executive Budget as it relates to mental health issues.

Given the budget deficit facing New York State, we believe that the Governor’s proposed mental health budget is a very good one especially in areas of greatest concern to our organization: workforce and housing.

That said, the needs of the mental health system are vast and community based funding in New York has been under funded for many years resulting in many people with mental illness ending up in prison, jail, emergency rooms, adult homes or in homelessness. There are more people with mental illness at Rikers Island then there are in almost all of the state’s adult state psychiatric centers.

Priorities have to shift and there has to be more funding in a community based system of care that recognizes that with better funded programs, appropriate individualized treatment, better medications and a quality workforce, that people can and do recover in the community. This also saves the state money by keeping individuals in the community and not in emergency rooms and the correctional system.

Governor Spitzer and the Office of Mental Health Commissioner Michael Hogan have done an excellent job in a short time of identifying some of these issues and prioritizing specific funding but we still have a long way to go before we achieve the true promise of community mental health.

Enclosed is our budget breakdown:

Workforce Issues

This year’s proposed budget includes funding for the third year of a COLA for human service workers. In addition, the budget proposed funding for three additional years of the COLA. This is a very strong commitment from the Spitzer administration to mental health workers. We are very appreciative that the Legislature has supported the COLA in the past and we hope that you will continue your commitment by supporting the three year extension of the COLA.

However, we have to incorporate additional steps to help in the recruitment and retention of quality mental health staff. Many of those in the mental health workforce are making less than $20,000 a year. They are better off working in McDonalds or Wendy’s. Equivalent jobs in the state pay a lot better and offer a much better benefit package. Is it any wonder that many community mental health programs have turnover rates of 40% on a yearly basis? When you lose quality staff, you also lose the most important piece they provide which is the relationship that is developed between the staff and the individual with a psychiatric disability. That trust is in many ways the most significant factor in an individual’s recovery especially if it comes from a peer.

On a recent call we had regarding this issue and the various recruitment options that may be available, the best suggestion came from the director of one of the MHA clubhouse programs in Long Island, who said that the best way to retain quality staff is to “put money in their pockets.” He is absolutely right---Other incentives are great and worthwhile but when the work force is hemorrhaging, you have to put together quick funding fixes that respond to immediate needs.

We need to do more for this workforce and that is why we applaud the leadership of Senator Thomas Morahan for sponsoring legislation that calls for the creation of health care enhancements for direct care staff in mental health programs. Senate Bill--6768

We are also appreciative of the work of Assemblyman Peter Rivera who has long been an advocate for a professional, well funded and trained workforce.

These enhancements have been in place for several years in OMRDD and the funding essentially provides a stipend to direct care staff in OMRDD programs that helps defray the cost of their health insurance (either through paying the cost of their co-pays, deductibles or creating health care accounts). In most cases, it has amounted to about a $425 stipend per person per year to help pay for health insurance costs. There is also no overhead so the money will go directly to the direct care staff.

The developmental disability workforce is deserving of these benefits but why shouldn’t the hard working direct care staff in mental health programs receive the same stipend? It is a matter of equity and fairness.

In addition, it should be relatively easy to implement through the Office of Mental Health since the several years of funding in OMRDD programs has already created a blueprint for implementation.

Recommendation:

Housing/Adult Homes

Housing has long been a priority to our membership and to mental health advocates across New York State.

Governor Spitzer has clearly heard our voices on this issue and has proposed adding 2000 units of new housing in this year’s budget, similar to what was proposed and ultimately funded in last year’s budget. We are also very enthused about the prospects of the Housing Opportunity Fund. This Fund proposed by the Governor could have long reaching positive effects for individuals with disabilities. We will be working with the administration and the legislature to insure that there are going to be specific carve outs in the Housing Opportunity Fund for individuals with mental illness.

We are also pleased to see the proposal by the administration regarding funding for adult homes being able to transition to innovative housing models in the community. These models have been successful in several parts of the state. If we can take some of the existing adult homes and turn them into homes that are responsive to the needs of people with mental illness through better conditions, individualized treatment and greater access to service than we can effectively begin to transform the system of care for adult home residents.

Recommendations:

Employment

The employment picture for people with mental illness both in New York and nationwide is dismal. In most recipient satisfaction surveys, the number one issue that people want in their lives is to be employed. Yet the unemployment rate for people with mental illness is a shocking 85%.

We have to dramatically change that number and many of our MHA members know how to do that through running successful supported employment programs. Supported employment provides direct work with employers and includes whatever resources are necessary to fulfill job responsibilities including job coaches and necessary accommodations.

In this year’s budget, the Governor has proposed taking state dollars to fund employment programs that cannot be funded with federal Medicaid dollars.

This is a terrific step but more is needed.

There must be greater outreach to the community about employment benefits including funding to provide greater information about the Medicaid Buy In, Ticket to Work, CareerZone and other opportunities. We have to also do a better job of talking to employers in Empire Development Zones and let them know about the significant federal and state tax credits that are available to them by hiring individuals with disabilities.

We also need to see innovative funding for employment for people with psychiatric disabilities through braided funded programs that have been successful in other parts of the country.

Also in many rural areas of the state, lack of transportation is a major deterrent to going to work for people with mental illness. We recommend pilot transportation programs that will include stipends to pay for transportation costs for employment for individuals with a disability.

Recommendations:

Criminal Justice

We are very appreciative that the Legislature has passed the SHU Bill and that the Governor will be signing the bill into law. This is a significant step forward in improving the treatment of individuals with mental illness in the state’s prison system.

We are also very pleased to see funding in the Commission on Quality of Care and Advocacy for Persons with Disabilities budget to help pay for the staffing of this program. We have great respect for the Commission and their oversight work. We also look forward to seeing additional funding in the budget to help pay for the behavioral health units in the state’s prisons.

It is also important to insure that there is funding in budget for jail diversion programs. Rikers Island should not be the largest psychiatric facility in New York. Programs like mental health courts and crisis intervention teams should be developed.

We maintain our opposition to the civil confinement of sex offenders in the state’s psychiatric centers. There are resources being added in this area while jail diversion programs continue to be dramatically under funded. Funding should be reprioritized for the thousands of people with mental illness in jails who should be diverted to the community as opposed to the large amount of funding dedicated to a small amount of sex offenders currently in the state’s mental health system.

Recommendation:

Geriatric Mental Health

Through the leadership of the legislature including Senator Morahan and Assemblyman Rivera as well as Michael Friedman, the Policy Director of the MHA of New York City and Westchester, the Geriatric Mental Health Act was created a few years ago.

Funding for this act was used to create nine demonstration projects around New York State that are being utilized to identify how best to incorporate innovative ideas into creating a better system of mental health care for the aging population. There were 68 programs that were interested in doing demonstration projects. This number clearly shows that there is a real willingness and desire for community providers to do innovative work around geriatric mental health. That momentum should continue.

We were disappointed that the administration did not find new money to add to Geriatric Mental Health so that these additional programs could be funded.

Recommendation:

Letter Sent to Governor Spitzer from MHANYS to consider adding funding to the budget during the 21 day amendment period

The Honorable Eliot Spitzer
Governor
New York State Executive Chamber
State Capitol
Albany, N.Y. 12224

You and your staff are to be commended for putting together an excellent mental health budget. We are greatly appreciative of your work on behalf of individuals with mental illness.

The support for a Cost of Living Adjustment for community programs in mental health on a long term basis as well as funding for additional housing beds including the innovative Housing Opportunity Fund are clearly highlights of the executive budget.

However, there were several important mental health initiatives that were either not added to the budget or were cut from the budget. We urge you to consider funding these programs during the twenty one day amendment process.

Throughout this past year, one of the major priorities of our organization is in the recruitment and retention of a quality workforce in mental health. In community settings, mental health workers are paid significantly less than their counterparts in state government. Also, mental health workers in the community do not receive health care enhancement stipend that are received by workers in the developmental disabilities field.

As a result, the turnover rate in many mental health programs is well over forty percent.

During this 21 day amendment period, we urge the administration to add $10 million to the budget as a down payment for health care enhancements for direct care staff in mental health programs. The enhancements will begin to create greater incentives for quality direct care staff to stay in mental health programs. Senator Thomas Morahan, the Chair of the Senate Mental Hygiene committee, recently introduced Senate Bill, S.6768, calling for health care enhancements in mental health programs.

We have attached an op-ed from the Albany Times Union detailing this initiative and how it will save the state money, help people with mental illness recover and move forward in their lives and incentivize the workforce.

In addition, we are very concerned that anti-depressant medications are no longer part of the mental health carve out in the Preferred Drug List. We are greatly concerned that without the carve out in place, many Medicaid patients would have more limited options regarding anti-depressants. As a result, our fear is that many individuals will either stop taking their medications or will take anti-depressant medication on their formulary that is not as effective clinically. This will end up costing a great deal of money to the state and taxpayers because individuals could stop taking their medications and end up in emergency rooms or in the criminal justice system.

We also urge that there be additional funding for Geriatric Mental Health. The mental health needs of this population have not been a state priority till recent years. This successful program has spawned several demonstration projects around the state geared specifically to the mental health needs of the aging population. All told, there were 68 applications for the demonstration projects and only nine were selected. It is clear from the work of these demonstration projects and the large number of applicants that there continues to be a need for a long term investment in funding for geriatric mental health and for a Center of Excellence in Geriatric Mental Health.

We hope that you are able to find additional funding in this year’s budget to fund these significant mental health initiatives.

N.Y. Mental Health Advocates Pleased with Gov’s Budget Proposal
Mental Health Weekly, January 28, 2008

New York Gov. Eliot Spitzer submitted his proposed fiscal 2008-2009 budget this month, a document that is garnering praise from many in the mental health advocacy community for its commitment to programs and services for people with psychiatric disabilities.

Spitzer’s proposal adds funding and resources to important areas for mental health consumers, said advocates, including workforce and community-based housing and prison mental health reform. The governor’s proposed budget offers 2,000 additional housing opportunities (including 1,500 supportive housing beds and funding for 500 congregate care units) for consumers with mental illness.

“There’s a lot of good news for people with psychiatric disabilities and other disabilities and the workforce that supports them in New York,” Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS), told MHW. “The governor’s budget puts its money where his focus has been — on the patients and the community,” said Rosenthal.

Rosenthal added, “In general, the administration has been very transparent and very accessible. It’s almost changed immeasurably to one of energy and purpose.”

The proposed budget will also support prison mental health reform, noted Rosenthal. Advocates, he said, are pleased that the state Assembly this month passed the SHU (segregated housing units) bill. The SHU legislation will require the state Department of Correctional Services to conduct a mental health assessment of all inmates placed in SHU confinement and periodic reassessments thereafter. Inmates diagnosed with serious mental illnesses will be removed from SHU confinement and placed in residential mental health treatment units where they will receive appropriate treatment and programming.

“We’re grateful for the governor’s proposed budget, said Rosenthal. “He and his administration are really listening. Their focus on community wellness, recovery and employment is extremely welcome. Overall, this really hit a lot of priorities of most groups.”

Spitzer’s proposed budget includes funding for the last year of a three-year 2.5 percent cost-of living adjustment (COLA) initiated in 2006 and then extends it for three more years. “This proposed funding is sending a tremendous message to the workforce,” said Rosenthal.

“In many ways, this budget exceeds our expectations and gains high marks from community-based providers,” said Phillip Saperia, executive director of the Coalition of Behavioral Health Agencies.

“Not only did the governor extend the cost-of-living adjustments already on the table for both mental health and chemical dependent services, but he extended them to 2012, making a concrete new commitment to the behavioral health workforce.”

It is important to ensure that the proposed funding for mental health services and programs are preserved in the budget process, said Rosenthal. A ‘Legislative Day’ is planned for this week, he noted. “We’re asking for a $2 million employment expansion in the non-Medicaid programs, like club houses. For the most part, we’re urging the legislature to accept and support all these expansions and initiatives.”

Glenn Liebman, chief executive of the Mental Health Association in New York State, told MHW he was generally pleased with the governor’s proposed budget. However, despite strong advocacy for health care enhancements for direct care workers, it did not get funded in this budget, he noted. “On the whole, we are very pleased,” Liebman said. “Gov. Spitzer has made a strong commitment to individuals with mental illness.”

He has addressed two of the association’s major priorities — the workforce and housing, said Liebman. “The funding for the third year of COLA is significant,” he added. Even more significant is the funding for COLA for an additional three years, he said. Liebman said advocates were very hopeful that the COLAs combined with the health care enhancements would help the Office of Mental Health in retaining and recruiting mental health staff.

“It is unfortunate that health care enhancements were not funded in this year’s proposed budget,” said Liebman. “We were hoping that this funding would help to defray costs for health insurance for direct care staff, which has often been a major priority for the mental health workforce.”

MHANYS is also working with the state legislature to pass health care enhancement legislation, said Liebman. Sen. Thomas P. Morahan (R-N.Y.) sponsored the health care enhancements bill (S. 6768) this month. The assembly has always been supportive of workforce issues, he said. “We’re very hopeful they would sponsor this healthcare enhancement legislation.”

Advocates would also like to see additional funding in the budget for geriatric mental health services, said Liebman. “We’re working hard to restore antidepressants as part of the carve-out for mental health medications in the preferred drug list.” Liebman added, “It’s pretty unanimous across the mental health advocacy spectrum to [provide] medication accessibility for the Medicaid population.”

The next step in the budget process is a 21-day amendment period, said Liebman. The governor has the option of adding new initiatives to the budget, he added “We’re advocating for the administration to add $10 million for health care enhancements,” Liebman said.

Spitzer Budget Proposal Earns Mostly Praise - Mental Health Plans Lauded
Schenectady Gazette, January 27, 2008
By Sara Foss

NEW YORK STATE — If people with mental illnesses are going to lead productive and successful lives, they need three things: housing, medication and employment, according to the executive director of the National Alliance on Mental Illness-New York State.

Gov. Eliot Spitzer’s proposed 2008-09 budget touches upon all three of these areas.

It increases housing for people with mental illnesses and makes a small investment in vocational training for the mentally ill, two moves that are strongly supported by mental health advocates. But the budget also looks to save money — about $18 million — by restricting the antidepressants doctors can prescribe to mentally ill patients, a proposal mental health advocates oppose.

Overall, the budget recommends $3.7 billion for the state Office of Mental Health, a $1.4 billion increase over 2007-08.

“We’re very positive about the budget, especially given the financial climate of the state,” said Glenn Liebman, CEO of the Mental Health Association of New York State. “What’s impressive about the budget, given the financial issues that have occurred this year, is that the governor has clearly identified social services, especially mental health, as a priority.”

The budget calls for 1,500 new units of supported housing — permanent housing with support services for the mentally ill — and 500 new efficiency apartments for people with mental illnesses who want more independence. It also includes capital funding to purchase adult homes for conversion into Office of Mental Health housing.

In addition, Spitzer has proposed a new $400 million Housing Opportunity Fund that would fund new affordable and supportive housing; some of this housing — the state has yet to determine how much — will be for people with mental illnesses.

“The governor has done a lot to advocate for mental health housing,” said Jill Daniels, a spokeswoman for the state Office of Mental Health. “Right now, there’s just a need for affordable housing.”

This year’s budget included 2,000 new housing units of housing for the mentally ill.

Advocates for people with mental illnesses praised the housing piece of Spitzer’s budget. Right now, they said, many people with serious mental illnesses such as bipolar disorder and schizophrenia are hospitalized, homeless, in jail or living with aging parents.

“If a person has no place to live, then their recovery has no chance of happening,” said Trix Niernberger, executive director of the National Alliance on Mental Illness-New York State.

She said the new housing proposed by Spitzer would only make a dent in the need — an estimated 40,000 mentally ill New Yorkers lack decent housing.

“There’s such a huge need that we’re very pleased [with the proposal],” she said. “But it’s not going to begin to meet the need of 40,000 people.”

She added that the number of housing units funded by the Office of Mental Health amounts to about 6.2 percent of the 600,000 New Yorkers with serious mental illnesses.

“There’s not enough housing for people with mental illnesses,” Liebman said.

NAMI-NYS also supports the creation of a mental health waiting list bill that would require the state Office of Mental Health to keep local waiting lists of people with mental illnesses who are eligible for housing with services but have not received housing with services. The group believes that this would enable the state to better determine the need for housing for the mentally ill. Niernberger said that the state Office of Mental Retardation and Developmental Disabilities maintains a waiting list for housing and that that list has worked well.

The budget also includes $800,000 to expand access to the vocational educational services provided by the state’s Personalized Recovery Oriented Services program, which helps people with severe and persistent mental illnesses attain employment and housing and improve their overall functioning.

About 85 percent of people with severe mental illnesses are unemployed, Liebman said.

“There’s some funding for employment,” he said. “We’d like to see more.”

“There’s more that we could be doing in terms of services for those with mental illnesses,” Niernberger said. “For years and years, there weren’t many opportunities, so we’re grateful, but there’s still such a dearth.”

NAMI had wanted the budget to include $500,000 for a pilot program that focuses on cognitive rehabilitation — improving the brain function of people with schizophrenia in the hopes that they’ll have an easier time finding and retaining a job.

Mental health advocates plan to fight one of the governor’s mental health proposals. This proposal would create a preferred drug list for antidepressants, meaning that doctors would only be able to prescribe the antidepressants on the preferred drug list to patients on Medicaid.

As of now, doctors can prescribe the antidepressants that they think patients need without worrying about whether the drugs are covered by Medicaid.

Advocates for the mentally ill worry that patients won’t get medication they need if a preferred drug list is adopted.

“Mental illness is diagnosed by symptoms,” Niernberger said. “We don’t always know [why people respond to a certain drug].”

She said some people may respond to one drug, but not another. And generic drugs may not be as effective, in some cases, as brand-name drugs.

Mental health advocates also lauded the budget’s investment in the mental health work force. The budget will fund the third year of a cost-of-living adjustment to the salaries of mental health human services workers, as well as a 2.5 percent cost-of-living adjustment each year through 2011-12, an investment of almost $400 million.

A better-paid work force will improve treatment and services for the mentally ill, Liebman said.

“There are a lot of issues with being able to recruit and retain quality staff in mental health,” Liebman said. “The salaries and benefits are not as good. The working conditions can be difficult. You can create the best system of care in the world, and if you don’t have anyone to implement it, it becomes very difficult to run a program.”

The Mental Health Association of New York had hoped the governor would include funding to help defray the health care costs of mental health workers in the budget.

“When you’re making $18,000 to $20,000 a year, if you get a stipend of $350 a year for co-pays and deductibles, that’s certainly very helpful,” Liebman said.

According to the state Division of Budget, the state’s mental hygiene agencies — the Office of Mental Health, Office of Mental Retardation and Developmental Disabilities and the Office of Alcoholism and Substance Abuse Services — will serve more than 1 million people in 2008-09, including 600,000 people with mental illnesses.

January 30, 2008

Budget Update

SENATE FINANCE & ASSEMBLY WAYS AND MEANS COMMITTEES

Joint Legislative Hearing - Mental Hygiene

SENATE FINANCE &
ASSEMBLY WAYS AND MEANS COMMITTEES