Hogan Calls for Meaningful Mental Health Reform, Oversight

NYAPRS Note: Here’s a timely OP ED from former OMH Commissioner Mike Hogan who highlights improvements in our care system that are being implemented in the current move to managed care via Health and Recovery Plans. Hogan underscores the importance of integrated managed mental health care overseen by those knowledgeable and experienced in these areas, an important consideration for the state given the planned move to consolidate our Medicaid program, including those elements currently overseen by the Office of Mental Health to the Department of Health.

The state has taken some care to get input from stakeholders on its Behavioral Health Work Group, of which I am a member. Our group has given guidance around key elements like the benefit package, outcome measures, reimbursement and reinvestment and beneficiary education and rights protection. We expect to be reconvened soon to review state plans to move to managed care in 2014.

Make Reform Make Sense

By Michael F. Hogan, Commentary Albany Times Union February 4, 2013

After the mass murders in Newtown, Conn., it seemed that the nation might finally act on guns and mental health care. Proposals are starting to emerge, with a heavy focus on gun control. But urgency about mental health reform seems to have dissipated already. Surely mental health reform means more than taking gunsaway.

What should bedone?

A decade ago, I led a presidential commission appointed byGeorge W. Bushto review the mental health system. We told the president that despite the efforts of many dedicated people "the mental health system is ashambles."

It still is, but both problems and solutions are clearer a decadelater.

First, access to mental health care is usually so late that problems have too much time to fester. Mental health problems emerge on average by age 13, while the average lag to treatment is nine years. We have seen the consequences; it is time to do something about this. The Affordable Care Act brings insurance with mental health care benefits to many. But merely having insurance is not enough. Because of the stigma of seeking "mental care," people with emerging problems are unlikely to go see a mental healthprofessional.

But people will go to their doctor. Families need access to basic mental health care at their medical clinic or doctor'soffice.

A second opportunity is to improve early care for young people with more serious problems that require the attention of mental health specialists, conditions like schizophrenia. Our current approach is badlybroken.

We let people deteriorate in terror for a couple of years. When they have a "first psychotic break," they usually are briefly hospitalized. Almost always, medications take the worst of the symptoms away - within days or weeks. So then they are discharged with a referral to care and maybe a recommendation of a support group. This is woefully, stupidlydeficient.

Some have suggested that the solution to this problem is in going backward, to days when stays in mental hospitals were measured in months and years. This, too, is idiotic. There is no research to suggest it is effective. It is terriblyexpensive.

We need a modern approach to care for people with psychotic disorders, one that replaces both the asylum and the revolving door with continuous treatment like that we provide for people with chronic medical problems. Staying in school or work is encouraged - though adaptations may be needed. It is time to implement this approach, as both Australia and Great Britain havedone.

Fortunately, New York has some of the best talent in the country to lead what's known as First Episode Psychosis care. New York needs to make modest investments to develop FEP teams so that families anywhere in the state struggling with a young adult who is slipping away from sanity can get good care reasonably close tohome.

Third, the existing mental health system needs continued support and sustained attention. A reform path was developed for New York through Gov.Andrew Cuomo'sMedicaid Redesign Teamand its Behavioral Health Subcommittee, which I co-chaired.

There are two essential elements of this plan. The first is to actually manage care. Today there is no mental health system. There are hundreds of near autonomous programs - most staffed and led by incredibly dedicated people - but all essentially doing their own thing. We need a system that's accountably managed. The second signpost is to have care be managed in health plans and in state government by people who know what they are doing. This is not the time to experiment with leadership unschooled or inexperienced in mental healthcare.

The meager resources still devoted to mental health care must be preserved. Substantial new investments may not be possible in these times, but reduced investments in mental health aredangerous.

These steps are not necessarily easy, but they are sensible. What will not work is allowing what remains of the mental health system to be dissipated. Fixing it requires more than gun control, including provisions that may discourage young men who are gun owners from seeking help that theyneed.

It is time to get it right. And it ispossible.

Michael F. Hoganis the former commissioner of the stateDepartment of Mental Health.