NYAPRS Note: With yesterday’s final session of OMH Acting Commissioner Kristin Woodlock’s statewide listening tour in Ogdensburg, OMH and the Cuomo Administration will now turn their attention to finalizing plans to reconfigure the state’s state operated inpatient and outpatient systems to improve care while reducing avoidable costs. Woodlock ended her straightforward, heartfelt presentation (see a version at http://www.omh.ny.gov/omhweb/excellence/com_message.html) by letting attendees know that, given the legislature’s requirement that the state announce state hospital downsizing/reconfiguration plans a year in advance of taking action, OMH will make its recommendations known next week.
Woodlock provided more details of a developing vision for a smaller number of regional Centers of Excellence that the state is considering, a vision that has been informed by forum attendees and via public comments (see http://www.omh.ny.gov/omhweb/excellence/comments_event.html).
A good view of that emerging vision can be found at http://www.omh.ny.gov/omhweb/excellence/possibilities.html.
See below for NYAPRS testimony that I delivered at yesterday’s Listening Session at St Lawrence Psychiatric Center in Ogdensburg.
Psych Center Awaits Its Fate
by Julie Grant North Country Public Radio May 16, 2013
The state plans to decide next week which mental health hospitals it's going to close, and which will be chosen as "regional centers of excellence." That's the word from New York's Acting Commissioner for Mental Health. Kristin Woodlock wrapped up her "listening tour" of hospitals around the state in Ogdensburg on Wednesday.
More than 300 people packed the St. Lawrence Psychiatric Center's meeting room, as state mental health commissioner Kristin Woodlock explained that New York has too many mental health hospitals: 24. Compared with 8 in Texas, 5 in California, and 4 in New Jersey.
She says that's about to change.
"What I see is a smaller footprint for our hospitals. I see us having less inpatient. And I'd like to see that inpatient really make that shift, from safety net, from that asylum history we have, and sort of grow off that into best in nation care."
Woodlock says New York must move toward smaller community-based outpatient programs, and create regional centers of excellence. Even after Woodlock's 40 minute speech, it's still unclear exactly what such a center would be.
"First and foremost, whatever we come up with is going to have be good for the people that we serve and their families."
So, the why five full days? I have to play with the cards that I have, just like all of you.
But there were doubts in the audience. When it was the community's turn to talk, many, like John Burke, mentioned that the next nearest mental health hospital is in Syracuse, more than 120 miles away from this impoverished, rural area. He says that's not good for patients or their families.
"To have good outcomes, you have to have families able to drive and see their loved ones."
Assembly member Adie Russell reminded the state that it snowed here just last week. She says it's already hard enough for patients to get the care they need.
"Adding over 100 miles of travel in one direction to the next closest state facility, presents not only additional financial hardship to the patient, or Medicaid transportation costs, it may not be safe or appropriate for someone to drive or ride that distance."
Russell expressed doubts that closing hospitals has anything to do with helping patient care.
"Unfortunately, knowing the current financial challenges to our state, we are concerned this consolidation is being used as a convenient claim of improved services that will ultimately result in a net reduction of services, and reduced utilization resulting from the additional barriers to obtaining treatment."
Commissioner Woodlock says this question has come up at many stops on the Office of Mental Health's listening tour of state hospitals.
"You know is this all about making the OMH budget work, about making the state budget work? and it's not. That's a piece to this..."
But Woodlock says there are bigger pieces, such as national health care reform. She says mental health coverage must shift from fee for service to managed care in the next year. Government reimbursements to hospitals will be based less on the services they provide, and more on patient outcomes.
St. Lawrence County administrator Karen St. Hilaire is among those who want the Ogdensburg hospital to get on the bandwagon.
"I believe that we are ready in this region to be a part of helping you to create those centers of excellence that you want. I believe all those component parts are here. We are ready to do everything we can to strengthen those, because we believe we can be that specialized center that you want. We'd like to help you fulfill your vision."
Ogdensburg leaders talked about the huge range of services the hospital provides, for adults, children, sexual offenders, and others. Family of patients spoke about the excellence of care. Leaders from Clarkson and St. Lawrence Universities talked about the hospital's collaborations with their programs and students.
Commissioner Woodlock says Ogdensburg is the final stop on her listening tour. Now her team has until May 20 to make its decisions. Not much time.
"So, the why five full days? I have to play with the cards that I have, just like all of you."
NYAPRS Testimony at May 15 OMH Listening Session at St Lawrence PC
Thanks Acting Commissioner Woodlock, state and local officials and attendees for this opportunity to speak today on themes that are so very important to the members of my community…..and for accommodating my getting back to participate and speak at noon at today’s Mental Health Walk in Watertown.
A state hospital is a fitting place for my remarks today as I began my recovery in a hospital, began my work in this field in a state hospital and have worked since to help people leave and avoid returning to hospitals through the provision of recovery centered policies and services.
I’m Harvey Rosenthal and my interest in these topics began in a LI hospital psychiatric ward where I was hospitalized for 6 weeks in 1970. This introduced me to a lifelong process of mental health recovery and what has come to be a long career working to support the recoveries of thousands of New Yorkers and Americans with serious psychiatric conditions.
7 years later after my hospitalization, I began in 1977 to work in a state hospital in Albany, the Capital District Psychiatric Center, first as a MHATA on an inpatient ward and eventually as a PSWA in the outpatient clinic.
I was looking for and didn’t find a system that believed in and was committed to restoration, recovery and resiliency of people like me…but instead I found a belief among state officials and hospital staff that people with these conditions would endure lifelong incapacity and patienthood, filled with expected and regular relapses and readmissions and characterized by lifelong dependency on entitlements and services.
After 7 years with the state, I moved on to run a community based rehabilitation program in Albany and saw, over the 1990’s, how people with the most challenging disabilities could be supported to return to or discover their lives, supported by the right mix of personalized recovery, rehabilitative and peer supports.
Since 1992, I have served as the executive director of the New York Association of Psychiatric Rehabilitation Services, a statewide partnership of New Yorkers with psychiatric disabilities and the providers who support them in community and state settings across New York.
NYAPRS is an advocacy organization working to promote policies and services that support the recovery, rehabilitation and rights of New Yorkers with psychiatric disabilities. I see a number of our members from the surrounding areas with us today.
We’ve also spent the last two decades training providers to believe in and develop new skills to support recovery for every individual, no matter their current appearance or functioning, and to support the move from a custodial to a recovery focused system of care.
And we have also created a number of pilot peer bridger projects that have hired and trained recovering people to help thousands of their peers to successfully transition from state and local hospitals into local communities.
During the last 21 years, NYAPRS and I have seen a steady growth in the kind of community based supports that can work so well to help people recover and restore their lives.
As an advocate, I have seen and supported passage of 1993 Community Reinvestment legislation that came to redirect and create over $200 million of critically needed community supports and services, out of an agreement between advocates, family members, legislators, unions and then Governor Mario Cuomo.
I saw those funds well used to create innovative rehabilitation and housing, employment and education, crisis and relapse prevention, children’s services and peer and family supports.
Since 2001, as a member of the state’s Most Integrated Setting Coordinating Council, I have seen the state come to recognize and move to meet its legal and ethical obligations under the Americans with Disabilities Act to support all New Yorkers with disabilities to move from institutionalized settings to live and work in the community.
As a member of the state’s Medicaid Redesign Team and the MRT’s Behavioral Health Work Group since 2010, I’m involved in plans to implement an overhaul of federal and state health and mental healthcare systems to move our systems to new designs that favor wellness and recovery, prevention and diversion, 24 intensive personalized supports and a reinvestment of Medicaid savings to ramp up community systems.
I believe we live in an age of retooling and reinvention by necessity. In order to keep with changing times, new advances and new demands, many American industries and professions have had to adapt, adjust and change what they do and how and where they do it.
This is certainly true of state operated mental health systems across the nation. Many states have reconfigured and reformed their systems to reduce reliance on hospitals and to reinvest the savings to expand community supports and services.
But New York State has lagged behind and, as a result, we spend more money on more hospitals for less people than any other state, according to data from the National Association of State Mental Hygiene Directors. Recent estimates are that we spend in the area of $350,000 per state hospital bed each year, with too much of that money going to maintain properties and grounds we no longer use or need.
If public mental health dollars are intended to help New Yorkers with psychiatric conditions in ways they need it most and in settings they belong and want to be, we must move from protecting those buildings and those jobs for jobs sake.
We can move from lagging behind the nation to leading it... with progressive plans to reform and reconfigure our services and reinvest our service dollars and to retool, retrain and redeploy our workforce. We can do this by
- Reducing the number of facilities and investing in ones that are organized to offer specialized state of the art care instead of trying to cover the state with too many buildings for too few local people and by
- Raising our approach and expertise to support shorter inpatient stays and well-coordinated and supported discharges into
- The best community system in the country that addresses unmet needs and expands underdeveloped services.
I believe that state based mental health providers have years of expertise that could be retooled and/or retrained to offer the community the innovative services consumers most need most and that taxpayers can best afford.
These can include crisis respite and diversion programs, brief intensive first episode care initiatives, hospital/nursing and adult home to community bridging services, health literacy and wellness coaching and employment and education supports.
These are what we desperately need today, not only for the hundreds of thousands we serve or should be serving now in the community but for the many hundreds of thousands more we may be asked to serve in the wake of upcoming Medicaid expansion and integrated care redesigns and finalized parity requirements to provide mental health services to all.
It’s my hope that today’s discussion will look to the future and not hang on to the past.
NYAPRS looks forward to working with all stakeholders here today to be a part of energized, progressive discussions and plans on how we can get there together. Thank you.