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April 21, 2008
MHANYS May 1 Spring Reception and Fundraiser—Less then Two Weeks Away Register today at www.mhanys.org With less then two weeks till our May 1 Reception, we are continuing to have more and more people register for the event. We hope that you will join us. The event is taking place on May 1 at the State Room in Albany from 6 p.m. till 9 p.m. Our keynote speaker is David Kaczynski, a well known Social Activist, who is the brother of the Unabomber Ted Kaczynski. David details his relationship with his brother and discusses the criminal justice system as it effects people with psychiatric disabilities. His message is ultimately one of hope and healing. As with the tradition that was started from last year, we have several silent auction basket items again this year. Among the items for auction are:
Spend a night with a wonderful speaker, great food, friends and auction items--All for a very important cause in helping to end the stigma of mental illness.
Adult Home Housing Futures Meeting On Thursday April 17th, the first meeting of the Housing Futures Committee of the Adult Home Work Group was held. This Group was established by the Governor’s Office this past February. I was asked by the committee chairs, Gary O’Brien and Bob Melby of the Commission on Quality of Care, to provide what MHANYS saw as the major issues regarding adult home reform for people with psychiatric disabilities. My remarks are listed below: Thank you very much for the opportunity to speak today. The Mental Health Association in New York State is comprised of 30 affiliates across New York State representing 53 different counties. Most of our members provide community based mental health services as well as educational and training programs.. At the state level, we are very involved with many different advocacy issues ranging from Timothy’s Law, to workforce, housing and many other significant mental health issues. We are also very involved in adult home reform. MHANYS is an active member of the New York State Coalition on Adult Home Reform. My comments today are based on my experience both as the CEO of MHANYS and in my former job as the Director of Adult Home Special Projects at the New York State Department of Health. I would like to thank Gary O’Brien and Bob Melby for the opportunity to speak this morning. I want to make clear from the start that this discussion is not about housing for people with psychiatric disability versus those who are elderly. It is ultimately about the need for more innovative and affordable housing options for everyone. But that said, the needs and desire for more independent housing for many people with psychiatric disabilities in adult homes are of crisis proportion as they have been for several years. There have been some positive changes in recent years regarding enforcement issues and quality of life issues. There are also adult homes that are much better than others and we should not generalize in regard to homes and operators. I have been to many adult homes over the years and seen some good operators running excellent homes but I have also seemed some awful homes with operators who have no right being in this business. However, of the 12,000 individuals with psychiatric disabilities in adult homes, there are thousands who strive for more independent settings. We know this for several reasons. We know that anecdotally from the residents of the homes that we meet, from the numerous residents interviewed and affiliated with the Coalition for Instituionalized and Aged Disabled (CIAD) and from some of the survey data that was shared over the years from the assessments done by New York Presbyterian. Also, as an aside, in order to have a serious discussion of the housing needs of adult home residents, the data from the adult home assessments should and must be shared. Proper planning for housing is only enhanced by the information from this report. Over the last several years, many adult home residents have been unable to move because of the lack of available housing. Though they have become a priority population in the SPOA process, this has not translated into more housing for adult home residents Conditions, though better than in the past, continue to be unfit for many people. 200 to 300 people with psychiatric disabilities living in this kind of residential setting are not a suitable living arrangement for many people. Interaction with the various providers as we know from the CQC layering report is filled with lack of coordinated, timely and appropriate care. Medication administration continues to be a major issue in homes as well. Having independent case managers in adult homes is a significant step forward in getting the necessary services to enhance individual quality of life as is funding for ENABLE grants. However, at the end of the day, it is really about finding the most appropriate setting for adult home residents with psychiatric disabilities. That is why I hold hope for this group. When I think of future models, I think of Pollack Gardens. Pollack Gardens was a wonderful collaboration between state agencies and housing providers. I believe it is the closest we have seen to an evidenced based best housing practice. There was a multitude of funding streams utilized to insure that the adult home that closed was converted to CR/SRO Housing. Having been involved in the conception of the program, it was not brain surgery; it was a willingness by several people inside and outside government to work together. Great credit is due to many folks but especially Ralph Fasano of CONCERN on Long Island and Bob Melby of the Commission of Quality of Care for being the leaders in showing that this model is achievable. It is significant that the Paterson administration has put $20 million in funding into an adult home conversion project. More models like this are necessary across the state but a necessary component is that adult home residents currently living in the home has first priority when these beds are converted. In addition, we have been asking for several years that 25% of new beds in the mental health system be dedicated to adult home residents with psychiatric disabilities. As I mentioned earlier, few and far between are new beds dedicated to adult home residents. We have always heard that adult home residents are less of a priority because they have a roof over their head but in many cases it is a collapsed roof. In my mind, adult home reform for individuals with psychiatric disabilities is about a progression. In the first step, residents through independent case managers and peers are able to develop and implement treatment plans that foster independence. These case managers should also be trained to discuss the various housing options available in the community for adult home residents. The second step is that based on the treatment plans of the residents, ENALBE Funding can be utilized to provide needs necessary for independence (i.e.---budgeting skills, ADL Skills, employment and education resources, etc.) and recovery in the community. The third step is to move to a housing model program more geared to the independent needs of the adult home resident--A housing unit that provides an opportunity for recovery in an atmosphere of dignity and respect My great hope is that our combined work will help to develop the kind of innovative housing models that would make the third step a reality for adult home residents. Thank you for the opportunity to speak today.
In the News: ASSEMBLY STANDING COMMITTEE ON MENTAL HEALTH,MENTAL RETARDATION AND DEVELOPMENTAL DISABLITIES ASSEMBLY STANDING COMMITTEE ON AGING NOTICE OF PUBLIC HEARING Assembly Hearing Room 19th Floor 250 Broadway New York, NY Friday April 25, 2008 10:00 AM ORAL TESTIMONY BY INVITATION ONLY SUBJECT: Assessing the Comprehensive Geriatric Mental Health Act PURPOSE: To ascertain the status of work done by groups that were funded under the program, and by relevant state agencies. Currently, there are an estimated 6 million American seniors with depression and only 10% of them are getting treatment. Untreated mental conditions can lead to disability, exacerbate symptoms of other illnesses, lead to premature death, and result in suicide. The suicide rate among elderly men is the highest among all age groups. The elderly are twice as likely to commit suicide as teenagers. As the 78 million baby boomers retire, increased health care costs including mental health care costs, will shift to the states. Currently, states provide mental health services through their state Medicaid match and through state general revenue funded mental health programs for a variety of populations including the elderly. In 2000, $14 billion in state funding was spent on mental health services. The need for services is increasing daily. In 2005, New York State passed landmark legislation to address the criticial issue of geriatric mental health care. In addition to the enacted legislation, to date there has been $2 million appropriated for demonstration projects designed to meet the needs of elderly New Yorkers suffering from mental illness. The Assembly Standing Committee on Mental Health, Mental Retardation and Developmental Disabilities and the Assembly Standing Committee on Aging are holding this public hearing to determine the status of the mandates included in the legislation, in regard to the requirements placed on state agencies to begin to better address geriatric mental health issues; to learn how the funds appropriated have been spent by grantees; and what outcomes there have been. Please see the reverse side for a list of subjects to which witnesses may direct their testimony, and for a description of the bills which will be discussed at the hearing. Persons wishing to present pertinent testimony to the Committees at the above hearing should complete and return the enclosed reply form as soon as possible. It is important that the reply form be fully completed and returned so that persons may be notified in the event of emergency postponement or cancellation. Oral testimony will be limited to 5 minutes in duration. In preparing the order of witnesses, the Committee will attempt to accommodate individual requests to speak at particular times in view of special circumstances. These requests should be made on the attached reply form or communicated to Committee staff as early as possible. In the absence of a request, witnesses will be scheduled in the order in which reply forms are postmarked. Ten copies of any prepared testimony should be submitted at the hearing registration desk. The Committees would appreciate advance receipt of prepared statements. In order to further publicize these hearings, please inform interested parties and organizations of the Committees' interest in hearing testimony from all sources. In order to meet the needs of those who may have a disability, the Assembly, in accordance with its policy of non-discrimination on the basis of disability, as well as the 1990 Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with disabilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities. Peter Rivera Member of Assembly Chairman Committee on Mental Health, Mental Retardation and Developmental Disabilities Jeffrey Dinowitz Member of Assembly Chairman Committee on Aging
SELECTED ISSUES TO WHICH WITNESSES MAY DIRECT THEIR TESTIMONY: 1. A number of agencies have received grants from the state to implement sections of the Comprehensive Geriatric Mental Health Act. What types of services have these grants paid for? 2. How many seniors have been served thus far by these demonstration projects, and what types of mental health issues have they presented? 3. The Act mandates that local mental health plans identify and address the mental health needs of older adults. Has this been extensively accomplished and what needs have been identified and addressed? 4. The Act also requires the Office of Mental Health to support planning and improve quality of care for older adults with mental disorders. What has OMH done to meet this requirement? 5. This Act also creates an Interagency Council on Geriatric Mental Health to be responsible for developing, on an ongoing basis, an interagency plan for addressing the needs of older adults with mental disorders. How has the Council begun to address the needs of seniors with mental health issues? 6. The Comprehensive Geriatric Mental Health Act further requires that the Commission on Quality of Care conduct a study within two years to determine the adequacy of services for older adults with mental illnesses at facilities regulated by the Office of Mental Health or the Department of Health. Has this study been completed, and if so what were the findings? 7. The Act also stipulates that all state bodies that address long-term care or aging issues include stakeholders knowledgeable about geriatric mental health. What steps have the relevant state bodies taken to address such issues? 8. The Act also requires that the Office of Mental Health, Department of Health, Office for the Aging, and the Department of Education jointly develop programs to assure that there will be a well-trained geriatric mental health workforce as the population of older adults increases. Have such workforce development plans been met?
Advocates
Want Mandatory Health Insurance Coverage for Posttraumatic Stress
Disorder The number of soldiers returning home from war with mental health problems is among the reasons advocates in Albany last week were pushing for an expansion of Timothy’s Law. A coalition of mental health advocacy groups calling themselves the Timothy’s Law Campaign are lobbying the Legislature to broaden the scope of the legislation, which was signed into law by Gov. George E. Pataki in December 2006 to mandate parity in the private insurance industry’s coverage of physical and mental health illnesses. The campaign wants an amendment that would include posttraumatic stress disorder among the biologically based mental illnesses Timothy’s Law requires insurance companies provide coverage for. The amendment (A.10078/S.6818) is being sponsored by the chairmen of the Senate and Assembly’s mental health committees: Sen. Thomas Morahan, R,C,I,WF-New City, and Assemblyman Peter Rivera, D-Bronx, who met with the coalition in Albany last week to speak about the importance of coverage for posttraumatic stress disorder. “Timothy’s Law has significantly advanced access to mental health treatment,” said Morohan. “However, the exclusion of posttraumatic stress disorder negatively impacts returning veterans, children and adults who have suffered sexual abuse and trauma,” he said. “This is a great first step to expanding Timothy’s Law to a population who needs it,” said Rivera. The assemblyman said the amendment could help society deal with the problems suffered by troops returning home from Iraq. Timothy’s Law was named for Timothy O’Clair, who in 2001 committed suicide at the age of 12 after his parents reached the limit on what their insurance carrier would cover for their son’s treatments. Timothy’s Law covers major depression, bipolar disorder, schizophrenia (psychotic) disorders, delusional disorders, panic disorder, obsessive-compulsive disorders, anorexia and bulimia. The proposed amendment would add posttraumatic stress disorder to the list. The campaign argues that posttraumatic stress disorder was not originally included into Timothy’s Law, even though its inclusion was proposed, due to the belief that treatment for soldiers would be covered under benefits they receive from the U.S. Department of Veterans Affairs. But only 35 percent of veterans seek help from Veterans Affairs, according to John Javis, chairman of the Veterans Health Alliance of Long Island. Javis said veterans are reluctant to seek help from the federal agency for a number of reasons, including a concern that information about their mental health problems will wind up on their personal records. And Javis said there are also problems with access because the agency’s office hours usually conflict with veterans’ work schedules and because they might have to travel long distances to get to an office. Javis also said women may be reluctant to visit a Veterans Affairs facility because of sexual abuse experiences that may have taken place during their time of service, making them fearful of personal interactions. The coalition said for individuals in the acute phases of posttraumatic stress disorder, the base mental health benefit required by Timothy’s Law might not cover all of their treatment needs. The proposed amendment would cover treatment past the currently mandated 20 outpatient and 30 inpatient visits for insured individuals and cover all treatment for posttraumatic stress disorder sufferers, even if they are only in an acute phase of the condition, when more intensive inpatient and outpatient treatment is medically necessary to help the person reach a state of stability. According to Shelly Nortz, deputy executive director for policy at the Coalition for the Homeless, there are about 20,000 to 25,000 people in New York who would be covered by the amendment. Nortz estimated it would cost insurance companies an additional $500,000 annually should the amendment pass. The amount is so small, she explained, because few people require treatment past the 30 inpatient visits already covered by Timothy’s Law. But the New York Health Plan Association, which represents 27 managed care health plans it says provide comprehensive health care services to nearly 6 million New Yorkers, is opposed to the proposed expansion of Timothy’s Law expansion proposal and said in a press release that the inclusion of posttraumatic stress disorder would be costly and unnecessary. “This bill appears to be a solution in search of a problem,” said Paul Macielak, Health Plan Association president. He said the majority of the proposed amendment is aimed at helping returning soldiers and survivors of the attacks of Sept. 11, 2001, who already have access to services. In addition to the cost-free health care services provided to veterans, including reservists and National Guard members, the association pointed out that in 2005, New York passed the World Trade Center disability law to “provide that any injury or illness directly related to terrorist attack on September 11, 2001, be presumptively eligible for an accidental disability.” Also noted by the association was that in the crafting of Timothy’s Law, posttraumatic stress disorder was ultimately not included in the final draft because “the Legislature made a decision to limit the scope of covered conditions specifically so as to not require coverage of every condition listed in the Diagnostic and Statistical Manual for Mental Disorders-IV” — a section of a handbook for mental health professionals that lists different categories of mental disorders and the criteria for diagnosing them. Also, the association argues that a provision of Timothy’s Law requires the state Department of Insurance and the Office of Mental Health to study the legislation’s effectiveness. “This study is to encompass two years of experience with the new law and is not scheduled to be insued until April 1, 2009. Expanding the scope of the law’s coverage to include PTSD undermines the value of a meaningful analysis,” Macielak said. Dr. Frank Dowling, a professor of psychiatry at the State University of New York at Stony Brook, said posttraumatic stress disorder is a treatable illness that develops after being witness to or victim of a traumatic event. “The event stays with them … reminders may trigger thoughts of the event,” said Dowling. Dowling said that just like depression and panic disorders, posttraumatic stress disorder is a common response to traumatic events. “It should be covered just the same,” Dowling argued. “It’s all the same spectrum and a response to the same types of events,” he said. Pat Purdie, who said she was diagnosed with posttraumatic stress disorder a year ago after being sexually abused by family members, said her abuse affected her significantly. Purdie said she has tried to take her life on more than one occasion and still experiences flashbacks, frustration and anger. She said treatment for the illness has given her a “will to live,” which Purdie said she lost after her abuse and after experiencing the symptoms of posttraumatic stress disorder. “Who wouldn’t want to add PTSD into the Timothy’s Law today?” Purdie asked. “Because without treatment, we couldn’t make it out there … I wouldn’t know where I would be today if I hadn’t gotten treatment,” she said. The Assembly’s version of the bill was referred from the Mental Health Committee to the Ways and Means Committee on March 11, and the Senate bill advanced to a third reading on Feb. 26. GOVERNOR PATERSON REQUIRES AGENCY HEADS TO IMMEDIATELY FIND SAVINGS IN NEXT YEAR’S BUDGET For
Immediate Release: April 21, 2008 Asks Commissioners to Submit Serious, Recurring and Achievable Spending Reduction Plans by May 16 Governor to Agencies: “Its Time to Get our Fiscal House in Order” Governor David A. Paterson today sent a memo to all State Agency Commissioners asking them to begin an immediate analysis to find savings in next year’s budget. The Governor requested that commissioners produce a series of savings recommendations by May 16th that are serious, achievable and recurring. Below is the text of the memo that was sent out today: To:
Agency Commissioners After your plans are submitted and approved, we need to immediately turn our attention to next year’s budget, which promises to be constructed in an even bleaker economic climate. You must use the development of these savings initiatives as an opportunity to fundamentally reevaluate your agency’s operations from top to bottom. I have an ambitious vision for our State’s finances, and these reductions are only the beginning. In
the current environment, complacency is unacceptable. We must change
the way the State does business, and start leading the nation as
an example of what is right in government. Together, we must rebuild
New York into what it once was and can be again – the Empire
State. And that starts with a better, more fiscally responsible
State budget. |
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