NYAPRS Note: The NYS Office of Mental Health recently released the Statewide Comprehensive Plan for Mental Health Services 2012-2016 (5.07 Plan). This plan is now posted on the OMH website at
This plan is perhaps the most detailed and important one in many years, laying out a blueprint for how to support the recovery, wellness and community integration of New Yorkers with psychiatric disabilities and transform, integrate and make accountable the services they receive.
It begins with a visionary summary from OMH Commissioner Mike Hogan, who after a long and storied career serving as Commissioner for 3 states and chairing the President’s Mental Health Commission, is retiring this Friday.
In the summary below, Mike offers a view that we are currently moving from a "casualty model" of mental health care that waits for problems to arise and then offers expensive and extensive treatment in inpatient settings” to “an early intervention and coordinated care model that promotes wellness and aims to prevent the need for more extensive and expensive treatment through increased community based services with the capacity to meet the needs.”
Thanks to Mike’s great leadership, he leaves behind an environment that has well moved from symptom management to recovery and from hospital to community, that has recognized the critical importance of and expanded housing, employment and peer support in advancing that recovery and that will integrate mental health, addiction and medical care in coordinated ways that will hopefully turn around the pattern where so many of us die 25 years ahead of our time. He also leaves us with an emerging ‘First Episode’ capability to improve the response to young people in distress in ways that will promote hope and recovery…rather than the life of patienthood previous systems regularly promoted.
We will greatly miss Mike, not only for the prominent, visible ways he promoted these reforms but for the more subtle, hidden ways he protected us from wayward policies and damaging cuts to our community safety nets.
He leaves us with an exhortation to speak up and out during this extraordinary time of unprecedented change…to ensure that our voices are heard: “Be an agent for change. Get involved with the changes taking place. Decisions about the future delivery of mental health services are being made every day, throughout the year, and can only benefit from every stakeholder's involvement.”
New York State Office of Mental Health
Statewide Comprehensive Plan
Introduction from Commissioner Hogan
The Office of Mental Health's (OMH) core purposes, programs and mission have emerged from a nearly 175-year history of care to New Yorkers with serious mental illness, dating from the establishment of the New York State Lunatic Asylum in 1843. New York State's mental health system remains largely based on this "legacy system" of psychiatric institutions, with New York State continuing to operate nearly 10% of the nation's state-operated psychiatric centers (PCs) - more than twice as many as the next largest state - with many more inpatient psychiatric beds than comparable states.
However, today, the vast majority of mental health services are now delivered in the community. While New York State once provided inpatient mental health services to more than 90,000 New Yorkers in the 1950s - constituting the vast majority of mental health care at the time - the current census of OMH-operated PCs is now less than 4,000; the remaining estimated 710,000 New Yorkers receiving OMH-funded or -operated services do so in the community.
The core mission of OMH remains management of the mental health safety net for New Yorkers with the most serious mental illnesses, yet that core mission and OMH's functions are rapidly evolving, with multiple forces for change. Development of community-based alternatives to institutions has been robust.
However, care provided by these community alternatives has not been managed - not because of an absence of good leaders, but because there has been no single point of accountability at the community level. Counties, providers, health plans and OMH all played a role. This has resulted in poor outcomes for individuals, resulting from the lack of continuity and integration - and subsequently it has led to high costs as well. Like nearly all states, New York State turned to Medicaid to pay for community-based mental health care; however, Medicaid's coverage of mental health services has been uneven, often services were contorted to assure coverage, and care was"siloed." Until the Medicaid Redesign Team's recommendation to move to behavioral health managed care, there was no possibility of fixed accountability.
The absence of accountable systems meant that people with mental illness frequently "fell through the cracks," sometimes simply ending up in emergency rooms again and again, but sometimes with spectacularly tragic results - including suicide. The MRT vision and plan of "care management for all" allows New York State the opportunity to redefine the core OMH safety net mission, and to right-size OMH services. The biggest mental health challenge in a generation lies just ahead - getting the move to care management right.
The mental health safety net requires more than treatment services, however. Supports such as housing, supports provided by peers, and assistance gaining employment are needed as well. New York State is now positioned to address the needs of this modern mental health safety net:
1) care management for individuals in Medicaid will allow re-balancing from costly hospital services to community treatment, with modest reinvestment in supports;
2) OMH efforts, combined with the MRT Supported Housing initiative can help close the gap in affordable housing availability for people with mental illness;
3) leveraging New York State's historic Ticket To Work agreement with the Social Security Administration will create opportunities to offer competitive employment opportunities to many people with disabilities.
Yet, even with these advances, the safety net will also require efforts to assure adequate provisions for mental health care in other systems, such as corrections, children's services, and especially primary health care. The movement of mental health care into mainstream health plans and primary settings will necessitate a significant improvement in the ability to address mental health needs in primary health care.
These settings have traditionally remained largely ill-equipped to this task, in fact, leading in part to the overdevelopment of institutional mental health care, along with the failure to apply early interventions that reduced the severity and duration of such disabling conditions. Now, most people with mental illness not only are not in hospitals, but they are not in specialty mental health settings, like those funded and operated by OMH. Psychiatrists write less than 1/3 of the prescriptions for psychiatric medications.
The average nine-year gap between when an individual first experiences a mental illness and when they first begin receiving care demonstrates many missed opportunities. The majority of these opportunities for early intervention occur in primary care settings, but identification and treatment or referral for treatment is far too rare. Managed care for intensive mental health services must be coupled with improved integration with mainstream managed care, and especially with improved detection and treatment of mild-to-moderate mental health problems in primary care. This will require investment, supports, and standards.
In collaboration with the Department of Health, OMH will offer focused and structured support to mainstream health care to provide services to people who need moderate levels of mental health treatment. Additionally, OMH is developing a First Episode Psychosis (FEP) capability to detect potentially disabling psychotic illness early, and to support young people in their families as they learn to manage these conditions in a fashion that will not lead to lifelong disability.
The public mental health safety net is perhaps in the final stages of a generation-long transition from the institutionally dominated system of another era. We are moving beyond the "casualty model" of mental health care that waits for problems to arise and then offers expensive and extensive treatment in inpatient settings. OMH is moving to an early intervention and coordinated care model that promotes wellness and aims to prevent the need for more extensive and expensive treatment through increased community based services with the capacity to meet the needs.
At the same time, we must redouble our commitment to assure adequate care for those who need it most, including people whose illness can block the recognition that they need help. The initiatives and efforts discussed in this document are profound changes from the past and will serve as catalysts to accelerate the movement from a mental health safety net focused on inpatient care - which too often has done more to perpetuate long-term disability than prevent it - toward community-based services that are focused on recovery, but never forgets those for whom recovery has not yet begun. These changes will help OMH fundamentally redefine priorities - moving away from long-term treatment toward supporting people in achieving independence, improved community functioning and substantially better lives.
This year's OMH Statewide Comprehensive Plan (2012-2016) serves as a guide to the efforts that will move mental health services toward a more prevention- and recovery-oriented system of services and supports. In this document, you will read about several key initiatives that are centerpieces of 0MH's efforts to bring about such change:
In addition, these seven featured efforts are complemented by additional initiatives that further illustrate OMH's shift toward overall improvement in the quality of the lives of people with mental health conditions. These efforts are reflective of an inevitable evolution of the mental health system. These changes are inevitable as they represent the "right thing to do" to help people experiencing symptoms of mental illness lead more fulfilling lives. In that regard, these initiatives take on an unprecedented level of importance, as their successful implementation will further that inevitable evolution.
While our system's ability to help people achieve recovery has improved dramatically, there is still much to be done. Collectively, these efforts provide stakeholders an unprecedented opportunity to shape the future of mental health services and supports.
Change and improvement is not just a top-down proposition. The history of mental health is full of innovations led by individuals, and community and voluntary organizations. Be an agent for change. Get involved with the changes taking place. Decisions about the future delivery of mental health services are being made every day, throughout the year, and can only benefit from every stakeholder's involvement.