2011 NYS Advocacy Priorities
Click Here for a copy of NYAPRS' February 15th Legislative Day Book
Click Here for a copy of NYAPRS' March 2nd Mental Hygiene Budget Testimony to the NYS Legislature
Testimony Before the NYS Legislative
Joint Fiscal Committees
Mental Hygiene Budget Hearing
March 2, 2011
Presented by
Harvey Rosenthal, Executive Director
New York Association of Psychiatric Rehabilitation Services
On Behalf of NYAPRS Members and
The NYAPRS Public Policy Committee
Co-Chairs: Ray Schwartz, Carla Rabinowitz
NYAPRS Board of Directors
President Douglas Hovey
The New York Association of Psychiatric Rehabilitation Services represents a statewide partnership of 40,000 New Yorkers who use and/or provide community mental health services who are dedicated to improving services and social conditions for people with psychiatric disabilities
I’d like to thank the chairs and members of the respective committees for this opportunity to present to you the concerns of the thousands of New Yorkers represented by the New York Association of Psychiatric Rehabilitation Services. NYAPRS is a unique statewide partnership of New Yorkers with psychiatric disabilities and the community mental health professionals who support them in over 100 community-based mental health agencies from every corner of the state.
I'm Harvey Rosenthal, NYAPRS Executive Director. The following testimony that I will present incorporates the direct input of many hundreds of NYAPRS members who gathered at local forums that were conducted this past fall and winter in localities across the state including Amityville, Binghamton, Buffalo, Carmel, New York City, Syracuse, Westport and White Plains.
You may have seen our members out in great evidence last February 15th. Throughout that day, the Capitol was filled with over 800 orange-hatted New Yorkers with psychiatric disabilities and the community mental health staff who support them came to urge their state legislators and Administration officials to advance policies promoting their recovery, rehabilitation and rights.
State mental health policy is a very personal matter for our NYAPRS community. Many of our members, our board members, our staff and I all share a common personal journey of recovery from a psychiatric disability. We believe this strengthens our ability to speak to you on behalf of the thousands of New Yorkers with psychiatric disabilities and their supporters that we represent.
Our community greets this year’s Executive proposal with the following reactions and recommendations.
Support Regional Managed Behavioral Health Care Coordination Initiative
New Yorkers with mental health, substance use and medical conditions require more active, engaging and better coordinated care that both promotes their health and recovery and reduces costly and avoidable ER and hospital stays. While many of those visits are to treat medical conditions, a majority of these individuals are not well engaged by health plans and medical practitioners, preferring to ‘come into care’ offered by behavioral health services.
NYAPRS and 40 other statewide and regional behavioral health advocacy groups have successfully advocated with the Governor’s Medicaid Redesign Team for behavioral health care to remain ”carved out” from being turned over to health plan management and instead be put under a specialty form of managed care called ‘behavioral health organizations’ that are more experienced with our community and much more supportive of recovery and peer services. Under this proposal, BHOs will operate regionally for the next two years, improving the integration and coordination of behavioral health care and link it to needed healthcare, housing and local supports in ways that will also reduce avoidable inpatient costs. Eventually, this will evolve into a fully integrated managed behavioral and physical health design.
Recommendation: On behalf of NYAPRS and as a Steering Committee member of Medicaid Matters, we support the Regional Managed Behavioral Health Care Coordination Initiative
Deep Cuts to Community Mental Health Services
The 2011 Executive Budget proposal cuts $27 million from our community mental health services safety net, including direct hits on several Medicaid mental health programs like continuing day treatment and children’s Clinic Plus programs.
Built into this is a continuation of last year’s 1.1% across the board cuts for all community programs. This cut also includes a currently unspecified drop in state aid for local mental health services, details of which are to be determined locally. For the third year in a row, it withholds a previously promised cost of living increase for our hard working dedicated nonprofit community workforce.
The budget also imposes a systemic freeze on new housing programs, except for long overdue supported housing services for adult home residents. However, those units have themselves been put on hold due to a recent stay of a federal court’s ruling requiring community placements for adult home residents with psychiatric disabilities (see below).
This is not the time to cut the community safety net on which some of our most vulnerable New Yorkers rely. We urge state legislators to restore these cuts and suggest several strategies below to redirect savings from state operated service reductions to maintain our commitment to “protect the safety net!”
Recommendation: Restore community mental health cuts with funds derived from state services reductions.
Close State Hospitals, Reinvest Portion of the Savings
The budget recommends a 10% cut to state operated mental health services. New York is particularly poised to take that reduction as we operate 27 state psychiatric hospitals, almost 7 times the national average (4) and 4 more than the next highest two states combined (Texas (12) and Virginia (11) per 2008 data available from NASMHPD (the National Association of State Mental Hygiene Program Directors (see attached).
Further, New York houses fewer individuals per campus than other similar states; e.g. 2008 NASMPHD data indicated that California housed 5,188 individuals in 5 hospitals, Ohio housed 5,926 in 7 facilities in contract to New York’s housing 5,282 individuals in 27 facilities.
New York topped the nation in cost for state hospitals, coming in at $1.2 billion, totaling more than the combined total of other top states Pennsylvania (#3 at $511 million and New Jersey (#4 at $502 million).
We have 17 adult facilities, each of which was originally constructed to serve thousands of inpatients. Most currently house and serve only around 100 individuals.
In 1994, the legislature approved the Community Mental Health Reinvestment Act which authorized the closure of 5 state hospitals and redirected a portion of the savings into boosting community mental health services.
Recommendation: This is the time to do another major round of Reinvestment-driven state hospital closures that will yield considerable savings to the state, while also maintaining if not strengthening the community services safety net that will need to be firmly in place to accommodate former hospital patients and the increasing number of ‘high needs high cost’ Medicaid beneficiaries that are a big focus of Medicaid reform.
Privatize State Operated Community Residences
According to our friends at the Association for Community Living, the state can save significant dollars within the residential system of care for people with psychiatric disabilities in ways that can sustain that same system at current or higher levels of funding by turning State Operated Community Residences (SOCRs) over to much lower cost Not-for-Profits (NFPs).
The OMH funded residential system is vital to New York because it cares for people with multiple diagnoses who require more extensive levels of support, without which they would join the ranks of the highest users of Medicaid. Housing instability is almost always tied to mental and medical instability for groups with serious, complex needs and so, investments in adequate housing save lives and dollars for New York.
New York State has operated a two-tiered system for years, operating more costly state operated community residential programs at the same time it has developed a vital sector of community residences run effectively and affordably by nonprofits.
An ACL report indicates that the state could save approximately $35 million in personal services alone if it transferred the operation of the 1,546 state operated community to the private nonprofit sector. There would likely be additional savings in OTPS related to food and food preparation, linen service, cleaning, etc.
Recommendation: Privatize State Operated Community Residential Programs.
Maximize Peer Services
One of the most promising, effective and affordable innovations in modern mental health care are peer-run services, which are run by individuals with psychiatric disabilities who are trained to provide quality support and service to their peers. Peer-run services have been in development for the past three decades and recommended time and again in important national reports including the 2003 Presidential Mental Health Commissions and the 1999 Surgeon General’s Report on Mental Health.
Peer run services are developing an impressive body of evidence around their capacity to help “high cost high needs” individuals with mental health and related conditions to improve their engagement and participation in treatment, health care outcomes and diminished use of avoidable and costly emergency and inpatient services.
Peer services are demonstrating a crucially important and timely culturally competent role in helping New York’s health care system address and succeed at engaging our most challenging “high cost high needs” Medicaid recipients. Further, they are a comparatively low cost approach that yields extraordinary returns: a peer wellness coach earning $37,500 annually can produce that much in averting avoidable ER and inpatient stays in less than a month!
Recommendations:
- Peer operated services should, as has been the case for previous years, be exempt from local budget cuts.
- New York should carefully consider Medicaid reimbursement for peer services, in consultation with leading peer groups like the Coalition to Promote the Integrity of Peer Support in New York State.
- It should also require managed health and behavioral healthcare organizations to contractually include such peer services in their benefit packages.
Housing Set-Asides Prioritized for People with Psychiatric Disabilities
A safe, affordable home is the number one concern of mental health recipients. And research has proven that housing with supports is a key to recovery. Unfortunately, mental health recipients are able to access only a small percentage of the units financed by New York State. In 2010, for example, despite set asides and favorable scoring advantages, only 16% of the 1,600 units developed with low income housing tax credits went to people with special needs.
Recommendation: New York should set aside at least 40% of all units developed with any form of state subsidy for low income and homeless people with psychiatric disabilities.
Provide Supported Housing for Adult Home Residents
A recent federal court ruling found New York State in violation of the Americans with Disabilities Act (ADA) and the U.S. Supreme Court’s Olmstead decision by unnecessarily segregating 4,300 adult home residents with psychiatric disabilities. The court determined that adult homes are “segregated institutional settings that impede integration in the community and foster learned helplessness.”
While the state has appealed the ruling, this year’s budget contains the funds to move a first round of this group into the community with the help of peer inreach and community supported housing. A judicial panel recently imposed a stay on the state’s requirements to provide that housing until the appeal has been ruled on.
Recommendations: As a proud member of the NYS Coalition for Adult Home Reform, NYAPRS urges that the state must not require a judge’s ruling to bring justice to adult home residents with psychiatric disabilities. It should use the allocated funds to provide them just access community based mental health housing and supports that will also help them reduce their typical reliance on costlier Medicaid services.
Open Access, Increased Oversight for Medicaid Mental Health Medications
For tens of thousands of New Yorkers, a disruption in access to the appropriate psychiatric medication results in relapses that are costly in terms of both human suffering and avoidable emergency and inpatient care. At the same time, prescribing practices that don’t use evidence based medications or that use too many drugs simultaneously (polypharmacy) are demonstrating harmful effects (e.g. frequent connections to metabolic syndrome, diabetes, etc) and costing too much.
NYAPRS continues to advocate for unrestricted access to such medications to protect patient choice and care and we oppose the proposal to eliminate fee-for-service reimbursement for pharmacy and their ‘carve in’ into managed care plans.
At the same time, we urge an expansion in programs like PSYCKES, which improves psychotropic prescribing practices by red-flagging costly and health-threatening use or overuse (too many for too long) of such powerful medications, as well as increased use of electronic prescribing best practices to reduce avoidable errors.
Recommendations:
- New York should continue to promote unrestricted access to protected classes of medications like mental health drugs to protect patient choice and care by rejecting proposals to:
- eliminate vital ‘prescriber prevails’ protections.
- carve in pharmacy into Medicaid managed care plans.
- In order to improve the management of psychiatric prescription drugs and to avoid excessive Medicaid spending, the State should expand the PSYCKES quality improvement program to all community- and hospital-based mental health providers in New York State and further enhance electronic prescribing best practices that will reduce medication errors.
Fully Fund Forensic Mental Health Initiatives
Too many people with psychiatric disabilities find their way into our jails and prisons-and the numbers appear to be growing. While we advocate for stronger community mental health services and preventive services which keep persons with psychiatric disabilities from ever penetrating the criminal justice system, we are compelled to be concerned for the plight of those among us who can easily be forgotten, locked away in the state correctional system suffering with symptoms.
Many people with mental illness are not able to comply with the rules in prison and are punished with placement in disciplinary confinement (know as Special Housing Units, or SHU), subjected to 23 hours of complete isolation, poor treatment, malnutrition, and increased risk of mental deterioration.
In 2008 with the enactment of the SHU Exclusion Law, New York State made a statement that it would no longer tolerate the noxious effects of long-term solitary confinement on persons with a mental illness. The law which goes into effect in July requires the state to provide appropriate mental health assessments, keep eligible individuals out of SHU, afford them structured out-of-cell therapy and treatment on a regular basis, and assist them toward a reasonable recovery.
For the promise of the law to be realized, the OMH budget must include adequate funding for prison mental health care, including the allocated addition of a 60-bed Residential Mental Health Unit at Five Points Correctional Facility in Se. Through appropriate assessment and treatment from the outset, many imprisoned people can avoid contact with the prison disciplinary system all together. For those who are charged with infractions, OMH must be fully capable of providing the treatment alternatives required by the law.
Recommendations: As a proud member of Mental Health Alternatives to Solitary Confinement, NYAPRS strongly supports Full Funding For NYS Prison Mental Health Reforms.
Year after year, state Legislators have been tremendous partners in our joint efforts to advance the recovery, rehabilitation and rights of New Yorkers with psychiatric disabilities. I would like to thank you for your extraordinary record of support and for your help going forward once again this year.