TU: Invest in MH Reforms, Not Kendra's Law Expansion

NYAPRS Note: The Albany Times Union printed an OP ED this morning that I had titled “Invest in Cuomo’s Mental Health System Overhaul, Not Kendra’s Law Expansion.”  Below is Jaffe’s original OP ED.


Mental Health Reform Crucial

By Harvey Rosenthal, Albany Times Union Commentary   January 10, 2013


D.J. Jaffe's push to return New York to the mental health policies of the past and his tunnel vision focus on institutionalization and forced medication ("OMH needs to go back to its roots,'' Dec. 19) fails to take into account the most critical advances of the last 20 years.


Studies now show that people with even the most disabling mental illnesses can recover in the community, if they're persistently provided the right mix of modern services and ongoing supports. However, as President George W. Bush's 2003 Mental Health Commission found "the mental health services and supports they need remain fragmented, disconnected and often inadequate," presenting "barriers that all too often add to the burden of individuals, their families, and our communities."


New York was very fortunate to get the commission's chairman, Michael Hogan, to serve as state mental health commissioner for the past five years. Under Hogan's leadership, New York's mental health system received the highest grade in a national survey conducted by the National Alliance on Mental Illness, for "widespread availability of research-proven approaches to improve mental health services, ensure accountability, and promote recovery-oriented outcomes for consumers and their families."


The report lauded the state's advances in expanding housing, support and employment services, the very ''social services'' that Jaffe believes we should abandon.


After a number of highly publicized violent incidents involving individuals with mental illnesses in 2007, Hogan and Deputy New York City Mayor Linda Gibbs convened a state/city panel that created care monitoring teams to oversee improved outreach and treatment for at-risk individuals.


While these and related initiatives have improved hospital discharge planning and community follow-up services, the real answers lie beyond the mental health system alone.


It's now clear that our most vulnerable New Yorkers struggle with a mix of mental health, addiction and medical conditions that require us to mount an aggressive, highly coordinated response that cuts across state and local agency bureaucracies. It takes a strong, visionary governor to oversee a fundamental overhaul of our health and behavioral health care systems - and that's exactly what Gov. Andrew Cuomo's Medicaid reforms are rapidly moving to achieve.


These sweeping reforms are leading the nation in turning our systems on their head:

  • Integrating and co-locating medical, mental health and addiction services to ensure earlier assessments and coordinated care for both children and adults.
  • Moving the focus from clinic offices to aggressive community outreach, engagement and follow-up.
  • Emphasizing relapse prevention and real-time crisis responses.
  • Requiring closely coordinated hospital discharge hand-offs to community providers.
  • Implementing electronic health care record systems that will ensure real-time patient information to all providers.


Most of all, it changes the way providers get paid, moving from rewarding the number of times people are seen to measurable improvements in their stability and self-care.


New York's Medicaid reforms appropriately require a shift in focus and funding from hospital to community, a formula we should continue to apply to our mental health hospital system.


National data is clear that New York has far more state hospitals serving fewer people for more money than any other state. These resources are far better spent in the community, most notably to improve our woefully poor record of services to people of color, who make up the highest proportion of those in prisons, jails and homeless shelters.


Jaffe is right that we should stop dumping the failures of our mental health systems on the courts and cops. That's why we shouldn't spend another $100 million to expand Kendra's Law court mandated care program.


Instead, we should accelerate the pace of the governor's hard-hitting reforms, which are already paid for, relying on community transfers of funding from avoidable ER and hospital visits.


Rosenthal is executive director of the New York Association of Psychiatric Rehabilitation Services and a member of the state's Medicaid redesign team.





OMH needs to go back to its roots

By D.J. JAFFE, Commentary

Published 10:31 pm, Tuesday, December 18, 2012

The Office of Mental Health is the largest state agency, with a budget of over $3 billion, yet it has no commissioner.

Gov. Andrew Cuomo has not announced a replacement for Michael Hogan, who recently left the job after five years of "transforming" OMH from an organization that treated the most seriously ill to one now focused on "improving the mental health of all New Yorkers."

Cuomo should appoint a commissioner who will undo that transformation and return OMH to its roots: helping the most seriously ill.

Hogan's transformation effort was successful. There are more bullying brochures, anti-stigma efforts and "how to reduce stress" programs than ever. But the cost was to abandon the most seriously mentally ill to jails, prisons and shelters, where they cost taxpayers more.

Today, 15,000 seriously mentally ill New Yorkers are being incarcerated, largely because less than 4,000 are receiving hospital services. Police are being forced to step in where the mental health system no longer treads. This puts police, public and patients at risk.

The new commissioner should want to work closely with police, sheriffs, courts, and corrections on reducing the number of mentally ill criminalized. The policies that allow OMH to close hospitals and fail to provide aftercare often have the impact of turning patients into prisoners. While this looks like a success for OMH - their budget is reduced - it increases cost for the governor, who now has to fund services behind bars. As a result of OMH failures, rather than just providing treatment for serious mental illness, the state is now forced to fund police, sheriffs, courts, corrections, parole and probation programs, plus provide food shelter and clothing to those OMHs neglect caused to be incarcerated.

To return OMH to its proper focus, Cuomo should choose a commissioner who has extensive experience helping people with serious mental illness. New York used to have a requirement that the commissioner be a medical doctor because medical doctors are more likely to understand the consequences of lack of treatment.

This was waived to allow Ph.D.s to serve and suddenly OMH was helping people get better grades, saving marriages, and ending poverty. Serious mental illness went out and social services came in.

The new commissioner should want to treat the seriously mentally ill rather than relegate them to a sideshow.

The new commissioner should believe in, champion and expand the use of Kendra's Law. OMH research shows Kendra's Law - by allowing courts to require certain historically dangerous, hospitalized, or incarcerated mentally ill to stay in treatment as a condition of staying in the community - reduced homelessness, hospitalization, arrest and incarceration over 70 perfect each. It also saves money because it commits the mental health system to do what it has failed to do voluntarily: serve the most seriously ill.

Many in the mental health industry will howl if Cuomo does this. Returning OMH to its original function of helping the most seriously ill will require them to abandon social services to others and start helping more symptomatic patients. But the governor's obligation should be to the most seriously mentally ill New Yorkers and to taxpayers - not to the mental health industry, which is happy to feed on taxpayer dollars.

D.J. Jaffe is executive director of Mental Illness Policy Org., a nonprofit think tank on serious mental illness.