Editorial: A Smart Plan To Improve Care For Mentally Ill
A Journal News Editorial July 11, 2012
New York’s new plan to overhaul mental health services is designed to modernize an outdated system of care delivery - and to save money. Those goals need not be in opposition to each other.
The plan announced Wednesday - dubbed Regional Centers for Excellence - maps a smart pathway to achieving both improved care for people with mental illness and significant cost-savings to the state.
The three-year initiative promises to redeploy cost-savings - and workers - into community-based care. A bill that would have mandated that reinvenstment of resources failed to make it to a vote last session; that is too bad. Mental health advocates, who for the most part have welcomed the Office for Mental Health’s plan, also pledge to monitor the process to ensure the shift doesn’t spell diminished services.
Advocates, program administrators and legislators must work to ensure the goal of dignified, quality care remains paramount.
A key feature of the state Office of Mental Health plan is the consolidation of 24 inpatient hospitals into 15 Regional Centers for Excellence, with more than two dozen outpatient service “hubs” run by the centers.
The Lower Hudson Valley has fared well in the process - two Centers for Excellence will grow in Orangeburg, with Rockland Psychiatric Center becoming the Lower Hudson Center for Excellence, with its own outpatient hub, and other hubs in Middletown, Poughkeepsie and Westchester County. Also, Nathan Kline Institute, known internationally for its pioneering research, will remain in Orangeburg, and serve as one of two research centers in the state.
The state’s overhaul comes amid a sea change in health care. Both the federal Patient Protection and Affordable Care Act and New York’s Timothy’s Law also demand more access to mental health care.
Other factors also push for more local outpatient care. The state’s Medicaid redesign efforts increase the use of managed care in providing mental health services. New York has also recently updated its efforts to comply with the so-called Olmstead Decision, which mandates that people with mental disabilities and illness are entitled to live in community settings, rather than institutions, whenever possible.
Our entire state and national healthcare delivery system is shifting beneath our feet, and it is our collective obligation to take this opportunity to align state psychiatric services to succeed in this rapidly changing environment,” the OMH Centers for Excellence report states. It calls the new model “a necessary business strategy for any 21st century care provider.”
New York’s system for mental health care needed updating. New York’s psychiatric hospital system sprouted in the 1840s; it’s an outdated model that most states have left behind.
Shifting resources to community-based care will help ensure people with mental illness get the kind of care they deserve, in the real world, as part of the larger community.
Hospital-based care is also costly. The state spends $1.3 billion per year on inpatient treatment for 10,000 individuals in its state-run hospitals; $5.3 billion is spent to provide outpatient care for more than 700,000 people in community-based facilities. That means 20 percent of OMH spending goes to just 1.4 percent of its clients who receive treatment in psychiatric centers.
Advocates have been generally receptive to the plan. Calling such change a “heavy lift,” Lauri Cole of the New York State Council for Community Behavioral Healthcare said in a statement: “With an oversized State hospital system, nobody wins. ... This plan appears to be a very innovative and very pragmatic approach to a very difficult issue.”
At the same time, many have expressed concern that the larger goal of quality care could play second fiddle to cost savings. In the last legislative session, Assemblywoman Aileen Gunther and state Sen. Cecilia Tkaczyk proposed the Communities of Excellence Mental Health Reinvestment Act that would mandate that a portion of the money saved from the downsizing of the state’s psychiatric hospital system be reinvested into community-based mental health services. The bill failed to come to the floor for a vote.
Indeed, the state’s promise to reinvest savings - but the lack of details on how it would be done - has concerned many advocacy groups, too. While lauding the state’s “landmark reforms,” advocacy groups, including the New York Association of Psychiatric Rehabilitation Services and the Mental Health Association of New York State, expressed concern. “We want to ensure that a significant portion of state savings from staff attrition and facility closures is reinvested into local communities to boost effective and cost effective nonprofit services,” the advocacy groups said in their joint statement.
The Centers for Excellence offers great promise for New Yorkers who are touched by mental illness. Close oversight, including legislation to ensure reinvestment of cost-savings into local communities, can help ensure that the overhaul truly lives up to its potential to deliver better quality care.