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February 29, 2008Mental
Health Association In New York State (MHANYS) We are less then two weeks away from the MHANYS Legislative Breakfast. It is a great opportunity to talk about the issues of significance to our members and colleagues across New York State. We hope that you will be able to attend. To date, the list of confirmed speakers includes:
Among the other highlights include presentations from our members and other experts across New York State on many of the major mental health issues. In addition, we will be presenting an award to our friend and colleague Mike Attwell, the recently retired head of the Mental Hygiene Bureau for the Division of the Budget. Date and Location:
For more information, contact John Richter at jrichter@mhanys.org or Bob Corliss at bcorliss@mhanys.org Issues Update for Legislative Day Please see our policy page for the major issues we will be talking about at our Legislative Day. We look forward to talking about the issues in greater detail including the call for the addition of $2.5 million in the budget to begin the process of implementing health care enhancements for direct care workers as well as funding for the geriatric mental health act, employment programs, the restoration of funding for the anti-depressant carve out in the Medicaid Preferred Drug Program and other significant issues. We will also be talking about important legislative issues such as the expansion of Timothy’s Law to include Post Traumatic Stress Disorder, securing legislative approval for 25% of future bed expansion to be utilized specifically for adult home residents, The Housing Wait List Bill and legislation that would eliminate a mental illness diagnosis as a criteria for custodial relinquishment.
Memo of Support for the Health Care Enhancement Bill As we reference a few weeks ago, Senator Morahan has introduced a bill that would create a Health Care Enhancement for direct care staff in mental health programs. We continue to track this bill. Listed below is our memo of support on this issue. We urge you to send a memo of support on this bill to your individual Senator. If you would like information on contacting your individual Senator, please e-mail me at gliebman@mhanys.org
Memorandum of Support S 6768 By Senator Morahan An Act to amend the mental hygiene law, in relation to establishing an employee health care enhancement program The Mental Health Association in New York State strongly supports S.6768, the Health Care Enhancement Bill. This legislation would allow for funding to subsidize the health insurance cost for direct care staff in mental health programs. Direct care staffs in the developmental disabilities programs have received stipends for several years to underwrite the cost of their health insurance. Yet, during this same time period, there have been no health care enhancements for direct care staff in mental health programs. These enhancements are clearly deserved in the mental retardation and developmental disability field but they are equally as necessary in mental health. We support this legislation for several reasons:
The Mental Health Association in a not-for-profit mental health agency with 30 affiliates across New York State representing 53 counties. The organization’s mission is to advocate for community based mental health services and for the positive transformation of the mental health system. In addition, MHANYS and our affiliates provide trainings and educational programs on mental health related issues.
In The News NYS
Office of Mental Health Awarded $1.9 Million Grant to Research and
Pilot ACT Step-Down Approaches OMH Commissioner Michael Hogan, Ph.D., said, “This grant builds on New York’s commitment to providing evidence-based and recovery-oriented practices in mental health. People can and do recover from serious mental illness. Recovery is usually not ‘cure,’ but a personal process of overcoming illness and disability. Therefore developing programs that provide good, flexible services for people who are ready to move beyond assertive community treatment will help consumers in their recovery journey.” “The Bristol-Myers Squibb Foundation is pleased to partner with the New York State Office of Mental Health, and we believe this initiative will provide the chance for innovations in mental health services to be explored and evaluated,” said John Damonti, president of the Bristol-Myers Squibb Foundation. ACT is one of six evidence-based practices for serious mental illness endorsed by the federal government and the National Association of State Mental Health Program Directors. ACT provides improved consumer outcomes, and is cost effective when delivered to high-need individuals, reducing episodes of hospitalization and increasing successful life in the community. OMH has implemented 78 ACT teams since 2003. The ACT model was developed decades ago to provide a community based alternative to long term institutional care. The very first ACT team was a team of doctors, nurses and other staff who moved out of Mendota State Hospital with the patients they cared for. As a “hospital without walls”, ACT was conceived as a life-long service that helped to promote community integration. Dr. Robert Drake, Professor of Psychiatry at Dartmouth and a national leader in ACT and evidence-based practices said, “The mental health service system has changed dramatically since the 1970s, and so has our understanding of recovery for people with mental illness. Many elements of the ACT model have not been well specified, including the use of recovery enhancing practices, and step-down or graduation of clients. This grant offers the best opportunity we are likely to have to study new models of transitioning individuals in to the community.” Specific goals of the project are to develop and pilot transitional approaches for ACT step-down/graduation based on clinical evidence and consumer needs; to identify and promote changes in regulations and policies needed to support ACT step-down/graduation approaches; and to develop a training package to support wide scale dissemination. The last two years of the five-year grant will focus on developing sustaining mechanisms and disseminating the approaches studied. Dr. Lloyd Sederer, OMH Medical Director, said, “This innovative project will incorporate recovery and community integration goals into assertive community treatment to ensure that services are targeted to consumers’ needs over time. It will enhance the flexibility of New York State’s continuum of services for those with serious mental illness.” The project calls for extensive collaboration among stakeholders, including state and local government, national experts, researchers, consumers, agency leadership, and clinicians. Dr. Jeffrey Lieberman, Director of the New York State Psychiatric Institute, said, “This project is a wonderful example of the public-academic partnership that the recently established Columbia University/NYSPI Division of Mental Health Services and Policy Research is charged to support. We look forward to collaborating in all phases of the project, and believe that it will inform public mental health services not only in New York State but nationwide as well.”
Here in Buffalo, a dedicated group of people is trying hard to improve the lot of local veterans—especially those who may have slipped through the cracks of the sprawling VA healthcare system—by mobilizing a veterans assistance network that consists of local courts and community-based service providers. And with any luck, next week they’ll have the opportunity to show the rest of the nation how to do it when Crisis Services hosts a conference entitled “The Impact of War: Community Mental Health Responds to Returning Combat Veterans.” The conference, which will run from Tuesday through Thursday, is an attempt to build on the success of the recently founded Buffalo Veterans Court. The Veterans Court, viewed as the first of its kind in the country, held its first sesssion January 15, with the noble mission of intercepting troubled veterans before they could become mired in our imperfect, overwhelmed justice system. The court is the brainchild of Western New York Veterans Project co-founders David Mann and Jack O’Connor, who saw that many returning veterans, particularly combat veterans, had problems readjusting to civilian life and weren’t being well-served by the traditional court system. In fact, according to Henry Pirowski, project director for City Court, 323 veterans entered the local criminal justice system between January 2006 and June of 2007, for charges ranging from loitering and begging to disorderly conduct, petit larceny and domestic violence. “But jail’s not the answer,” says Pirowski. “Nobody gets helped by going to jail.” And getting help is the key, according to Pirowski. While their problems are myriad and include Post Traumatic Stess Disorder (PTSD) and other psychiatric problems, substance abuse and problems with violence, many of them don’t seek out help of their own accord. “Many of these folks have a warrior’s mentality,” Pirowski says. “They have these ideas like ‘treatment is for the weak’ or ‘I can take care of this on my own.’ As a result, things can get out of hand for them rather quickly.” Pirowski would know, being a former Marine himself. And, nationally, the stats back him up. Take post-traumatic stress disorder (PTSD), for example. While estimates suggest that between 12 to 20 percent of all veterans suffer from PTSD, only 52,000 veterans of Operation Enduring Freedom and Operation Iraqi Freedom have been treated for PTSD by the VA—or roughly three percent of troops deployed. Many factors play into the soldiers’ silence. According to Mann, a lieutenant in the Buffalo Police Department, “If they’re active duty, they just won’t go to the military if they’re having any kind of problem, for fear of damaging their military careers. And with these multiple deployments, we can expect that a lot of them are having problems.” Some veterans undoubtedly end up getting in trouble, and that’s how they wind up at Veterans Court on a Tuesday afternoon, standing before Judge Robert Russell. The court is set up to help meet the special needs of troubled veterans, not only by sparing them jail time or probation but by connecting them with veteran mentors who, in turn, help enroll them in community-based programs that offer the kind of counseling that can help turn their lives around. John Rudy, an Army veteran, is one of the nearly 20 volunteer mentors in Veterans Court. “I think that there’s an instant rapport when a veteran talks to another veteran,” he says. A supervisor and former counselor in the New York State Division of Veterans Affairs, Rudy says his own 23-year-old son is a combat-wounded veteran. “You go through something like that and you’re changed forever. There’s no getting away from that—they are changed forever. It’s just a matter of trying to get them help when they’re young versus what we see on the other end of the spectrum where there are guys whose whole lives have been messed up.” Besides talking to them and referring them to services, the mentors—whose backgrounds include mental health experience, VA healthcare experience and work in various veterans affairs organizations—find them safe, stable housing if they’re homeless (a 1999 report showed that 23 percent of America’s homeless are veterans), and get them into education and job training programs at Erie Community College. In its first six weeks, the Veterans Court has already taken on and is actively handling 27 cases, most of which involve nonviolent substance abusers who also have some kind of psychiatric disorder. The word “active” is important to what the court does. The vets are judicially monitored, which means they return to the court every week. “Judge Russell knows exactly what they’re doing,” says Pirowski, “he knows when they’re doing it and how they’re doing it. It’s the most stringent form of community supervision there is.” They receive urine tests three times a week, visit their case manager twice a week and are rigorously breathalyzed. But, most important, their needs are met. They get counseling and a clean record rather than a long rap sheet. “Make no mistake on this,” Pirowski says. “It would be easier for these guys to go to jail and do their time. It’s not a soft on crime thing at all. They’re under strict community supervision and they’re held to a high standard.” It’s a model that produces results. The recidivism rate for a substance abuser coming out of the Drug and Mental Health Court (also one of the first of its kind in the nation when it was started), on which the Veterans Court is based and what it’s modeled after, is a meager 17 percent after three years. Compare that to the national average of 60 to 75 percent. The Western New York Veterans Project’s work to help veterans won’t stop with the Veterans Court—that’s where next week’s conference comes in. Mann describes it as the “next step in this ongoing process.” After setting up the court, he and O’Connor met with local VA officials as well as local managed care providers to talk about the Veterans Court. “We were basically trying to get community-based services in the game of providing treatment and support for veterans,” Mann says, “and using the VA to train them on the issues that are specific to veterans.” That education, begun in September during a one-day training session, will continue at the “Impact of War” conference, where VA officials and doctors, combat veterans and military experts will get a chance to present to nearly 100 community-based service agencies. They’re also hoping that those services—Crisis Services, Child & Family Services, Jewish Family Services and many, many more—will be able to take cases from the VA, should it experience capacity problems. “So the community could probide support to the VA when they need it,” Mann says. “It’s to get the community involved in supporting the VA, and the VA more involved in educating the community, so we have a more cohesive response to the troubles faced by our veterans.” Mann continues, “All of these agencies—the Buffalo Police, the mental health agencies, certainly the addictions agencies, the domestic violence agencies—we’re all dealing with the aftermath of combat experience and trauma, but we’re just not recognizing it as such.” The conference will be a showcase for the local model, including the Veterans Court (Judge Russell and Hank Pirowski will be presenting), since William F. Feeley, the VA’s Deputy Under Secretary for Health, will be in attendance. “We’ve got a lot going on here fairly quickly,” Mann says. “So it could lead to some good things locally, but I think it will be helpful on a much broader scale, too.” Pirowski, considering his military days and reflecting on the situation of the veterans now returning from war, sums it up this way: “We used to seek and destroy, now it’s our turn to identify and assess. We need to find them and put them into the programs that will help them.” VA
Simplifies PTSD Claims for Some Veterans The Department of Veterans Affairs has scrapped a policy requiring combat veterans to verify in writing that they have witnessed or experienced a traumatic event before they can file a claim for post-traumatic stress disorder — but only if the military has already diagnosed them with PTSD. “This change provides a fairer process for veterans with service-connected PTSD,” Sen. Daniel Akaka, D-Hawaii, said in a written statement. “[It] leaves claim adjudicators more time to devote to reducing the staggering backlog of veterans’ claims.” In the past, a veteran has needed written verification — a statement from a commander or doctor, or testimony from co-workers — that he or she was involved in a traumatic situation to receive disability compensation from VA if they had not already been diagnosed by the military during a disability retirement process. But PTSD is the only condition that a veteran must “reprove” to receive disability benefits from VA. “They don’t have to reprove their diabetes,” said Mary Ellen McCarthy, special projects counsel for the Senate Veterans’ Affairs Committee. “They don’t have to reprove a leg injury. I have never seen any other condition diagnosed in service [for which] people had to reprove their injury.” The VA regulation was written at a time when the military was not diagnosing PTSD among troops, McCarthy said. She travels to VA regional offices to check the progress of veterans going through the disability claims system. Even though many of the former troops had already proven they had witnessed a traumatic event in writing as they went through the military disability retirement system, often that paperwork had been lost by the time they reached VA, McCarthy said. “It could take months to get that paperwork,” she said. That slows up the paperwork process. And the veteran has to go through the stressful process of reproving that they lived through a roadside bomb explosion or that they witnessed a friend’s death or that they killed an insurgent. “Revisiting those stressors in a non-therapeutic environment can make the diagnosis worse,” McCarthy said. Akaka said he asked VA Secretary Dr. James Peake if the rule was necessary and requested that it be removed, and Peake agreed. “I am pleased that the secretary took quick action to reverse this requirement after it was brought to his attention,” Akaka said. Peake has already informed VA regional offices of the decision, Akaka said. VA officials could not be reached for comment by press time. |
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