DN: NYC's New MH Commissioner Emphasizes Strategies to Engage People w Major MH Conditions

NYAPRS Note: There are some who believe the best way to get people with major mental health conditions help in New York City is to, following a very rare tragic event, push the image of our community as violent and one who invariably needed to be legally committed to treatment. The new NYC mental health commissioner is rightly answering those criticisms today in the Daily News emphasizing outreach and engagement, crisis response and diversion, housing and anti-stigma efforts.

How We Help The Mentally Ill: Those Claiming The City is Failing to Aid People in Serious Psychological Distress Are Just Wrong

By Dr. Oxiris Barbot  New York Daily News  March 13, 2019

There is a persistent narrative that New York City is failing people with serious mental illness. That storyline is false.

Serious mental illness affects about 4% of New Yorkers, but its impact extends to their loved ones and communities. The term is actually not a diagnosis, but an indicator that someone with a diagnosis such as major depression, schizophrenia or bipolar disorder is having a period of serious functional impairment of some major life activity.

Historically, New York City has invested lots of money and effort in combating serious mental illness; much has been written, for example, about Kendra’s Law, which provides court-ordered treatment to patients with mental illness who have difficulty staying in treatment on their own. The program has successfully reduced hospitalization, homelessness and incarceration. It serves about 2,260 individuals annually, and there has been a 28% increase in its use under Mayor de Blasio.

But Kendra’s Law is not the only solution. Nor is more hospitalization. While hospitalization might be lifesaving for some, an essential part of the city’s goal is to keep people in recovery after they leave so that they do not experience another mental health crisis.

Over the past three years, the de Blasio administration has made unprecedented investments to create and expand programs for treatment, prevention and support for people in deepest psychological need. Currently, the Health Department alone manages more than $300 million annually in funding for people with serious mental illness — a mix of city, state and federal dollars. Through ThriveNYC, we are able fill gaps that have been challenging with conventional treatment.

First, we are meeting people where they are — in communities — because that is key to engage them in care. We created a program called NYC Safe to increase interventions for the narrow population who pose a concern for violent behavior. Highly-specialized, new community and mobile treatment teams are effectively serving people who have had frequent contact with the mental health, criminal justice and homeless systems.

Among the targeted population, incarcerations and psychiatric emergency are on the decline, and from 2009 to 2016, our largest community treatment initiative saw a decrease of 30% in people in the program who reported as homeless.

Second, supportive housing makes a dramatic difference. More than any medical intervention, it keeps people with serious mental illness safe and healthy. Today, the Health Department contracts for over 8,700 units of supportive housing available to homeless individuals, and 80% of this housing is for individuals with serious mental illness. We are now well underway on our commitment to adding 15,000 more units in 15 years.

Third, like all New Yorkers, people with serious mental illness are not well served by the failed strategy of relying mostly on hospitals and acute responses. That means we have to stop caricaturing serious mental illness as only a moment on the subway or an altercation on the street.

The Health Department has innovative programs that serve as an alternative to hospitalization. For example, crisis respite centers provide community-based peer support and education. And the NYC Start program reaches people hospitalized with a first onset of psychosis so they may transition to community care; over 85% of participants attend an outpatient appointment within 30 days of hospital discharge.

These initiatives are being complemented by ThriveNYC, which adds behavioral health workers to primary care settings; clinicians in senior centers; and a helpline for anyone in need of counseling.

These initial efforts are not the last word, nor will they erase the reality of serious mental illness being neglected for so long. But they are showing us how to keep moving forward.

Barbot is commissioner of the city’s Department of Health and Mental Hygiene.

https://www.nydailynews.com/opinion/ny-oped-how-we-help-the-mentally-ill-20190312-story.html

Breaking: NYS Senate Budget Resolution Adds Some $ for COLA, Housing, CIT

The NYS Senate just released its one house state budget resolutions that adds some funds to the following mental health related items:

- Providing $9.25 million to restore the Cost of Living Adjustment effective January 1, 2020;
- Restoring $3.735 million for the Joseph Dwyer (Veteran) Peer to Peer program;
- Providing an additional $1 million to expand the Dwyer Program to additional counties, including NYC;
- Providing $3 million for additional supports and services for office of mental health housing programs;
- Providing $1.5 million for Crisis Intervention Teams;
- Providing $2 million for not for profits providing mental health services, including suicide prevention;
- Restores $400,000 and adds $100,000 for FarmNet;
- Restores $175,000 for the North Fork mental health initiative - Family Services League; and
- Restores $100,000 for the Mental Health Association of New York State to provide statewide first aid mental health training.

Ultimately both houses will reconcile the differences between the Senate’s (above) and the Assembly’s (below) proposals and then meet with the Governor’s team to negotiate a final agreement.

NYAPRS will continue to advocate with both houses for our COLA, Housing and Crisis Intervention Team priorities.

Breaking: NYS Assembly Budget Resolution Funds the COLA, Housing Hike

Today, the NYS Assembly released its budget resolution that funds the Cost of Living Adjustment we’ve all worked for since the beginning of this year’s budget session, along with $10 million more for the housing rate increase.

The Assembly resolution, when negotiated with the Senate’s resolution and the Governor’s budget will form the basis for a final budget agreement to be ostensibly reached later this month.

So…we’re 33% home. Stay tuned for details about the details of the Senate’s resolution when it’s released and look for the impact of a news conference to be held next Wednesday. 

NYAPRS to Reschedule Anti-Oppressive Practice Webinar

NYAPRS Note: Due to unforeseen circumstances, part 2 of our webinar series on health equity will have to be rescheduled for either late April or early May.  To everyone who has registered for this event, we will send you a special email inviting you to register for the new date.  Everyone else, once we have our new date, we will inform you via the NYAPRS e-news.

 

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Anti-oppressive Practice is Good Practice!

Let’s Examine “the why” About Anti-oppressive Practice and Explore How to Implement It.

Date & Time TBD    

What makes anti-oppressive practice good practice and why should we adopt it for ourselves and our organizations? Now that we have a deeper understanding of oppression, racism and health inequities, join our panel as we explore their impact on our organization and our work. Let’s not just talk about anti-oppressive practice-let’s actually do it as we keep the conversation going about why to commit ourselves to anti-oppressive practice. What makes it good practice for practitioners and those who we serve and good business for our organizations?

Panelists:

Lenora Reid-Rose, MBA

Ms. Reid-Rose serves as the Director of Cultural Competence & Diversity Initiatives at Coordinated Cares Services, Inc. (CCSI), located in Rochester NY. With more than two decades of experience in the behavioral health field, she has served as a consultant and educator at the state, regional and national levels. Ms. Reid-Rose has extensive expertise in developing and implementing cultural competence assessments, training initiatives, and programs - helping agencies understand where they are on the continuum of cultural competence and then identifying critical changes in policy, practice, education, and training needed to support continued progress. She brings with her a well-established network of national experts in the field of organizational development, data analytics, and research in the areas of cultural competence and social determinants of health that she routinely taps to remain informed and knowledgeable regarding research, advances, best practices, and emerging works. 

Nancy Sung Shelton, M.A.

Nancy Sung Shelton works in the capacity of Senior Consultant, Cultural Competence & Health Equity at Coordinated Care Services, Inc. In her current role, Ms. Shelton provides an array of consultation, technical assistance, and training support to organizations, their leaders, workforce, service recipients, and stakeholders. She has more than twenty years of experience working with diverse populations in a variety of management and leadership positions.  Her work experience has included working in the Criminal Justice, Family Law, Child Protection and Advocacy, Human Services, I/DD, Behavioral and Physical Healthcare systems, as well extensive work with community-based organizations and families and youth.   Ms. Shelton is especially devoted to serving individuals who have been marginalized by society, and have been under/mis-represented and economically

James Rodriguez, Ph.D., LCSW

Jim Rodriguez is a Senior Research Scientist at the McSilver Institute for Poverty Policy and Research.  His research, training and clinical practice experience has focused on mental health services for underserved populations.  He previously worked as a clinician in the Department of Child and Adolescent Psychiatry at New York Presbyterian Hospital.  He is Adjunct Faculty at the NYU Silver School of Social Work where he currently teaches a course on anti-oppressive practice.  He is also a New York State licensed psychologist and social worker currently in private practice.

Ruth Colón-Wagner, LMSW

Ruth Colón-Wagner currently works with NYAPRS as the Director of Training & Development and has over 29 years of experience in the field of Child Welfare, Homeless Services, Employment, and the majority in Mental Health Care working with children, adults, and families.  For 12 years, Ruth served as Director of Mental Health Services and during that time, Ruth brought recovery-based, person-centered and culturally competent approaches to increase staff competency and increase client outcomes.  Ruth has worked to bring various trainings on Cultural Competency including discussions on the cultural construct in America, systemic oppression, the racial divide, realities and power of white privilege, micro aggressions and solutions for community transformation.   Ruth was trained in Undoing Racism® by The People’s Institute for Survival and Beyond.  Ruth’s other specialties includes Group Facilitation, Program Management and Compassion Fatigue.  Ruth is also certified as a Dialectical Behavioral Therapist, a Functional Family Therapist and a Life Skills Educator.  Ruth received her MSW from Hunter College School of Social Work and is licensed as a social worker in New York State.

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Trump Proposes Big Cuts To Health, Food Stamp Programs For Poor, Elderly And Disabled

Trump Proposes Big Cuts To Health Programs For Poor, Elderly And Disabled

By Amy Goldstein and Jeff Stein  Washington Post March 11

The Trump administration is proposing a sharp slowdown in Medicaid spending as part of a broad reduction in the government’s investment in health care, calling for the public insurance for the poor to morph from an entitlement program to state block grants even after a Republican Congress rejected the idea.

The budget released by the White House on Monday also calls for a sizable reduction for Medicare, the federal insurance for older Americans that President Trump has consistently promised to protect. Most of the trims relate to changing payments to doctors and hospitals and renewing efforts to ferret out fraud and wasteful billing — oft-cited targets by presidents of both parties.

In keeping with Trump’s promise in last month’s State of the Union address to halt the spread of HIV over the next decade, the budget includes an initial installment of $291 million next year targeted to communities where the virus is continuing to infect people not getting proper treatment — the rural parts of seven states, including Mississippi; the District of Columbia; Puerto Rico and 48 hot-spot counties scattered throughout the country.

However, the spending plan would cut funding for global AIDS programs while slashing expenditures on the Centers for Disease Control and Prevention by about 10 percent.

Strategies the president and Health and Human Services Secretary Alex Azar advocate to curb the rising price of prescription drugs are part of the budget. But spending on the National Institutes of Health, a longtime favorite of lawmakers of both parties, would be reduced by $4.5 billion, with the National Cancer Institute proposed to absorb the largest chunk of that cut. Funding for pediatric cancer research, however, would increase by $50 million for the next fiscal year.

Taken together, the $87.1 billion in discretionary funding for HHS programs would be 12 percent less than in the spending plan Congress adopted for this fiscal year — although the proposal is unlikely to survive lawmakers’ scrutiny.

The idea of opening Medicaid to block grants to states — or a related idea that would create per-person funding caps — are fundamental alterations of an entitlement program run jointly by the federal government and states that began in the 1960s as part of the War on Poverty and have always provided each state a share of funding for anyone who is eligible. The budget calls for limiting the program’s growth to the pace of inflation.

Because health-care spending typically rises more swiftly than the consumer price index, tying it to the nation’s overall inflation rate would put a strong squeeze on the public insurance system that covers tens of thousands of poor, vulnerable people, some of them elderly.

The spending plan calls for a cut of nearly $1.5 trillion in Medicaid over 10 years and for $1.2 trillion to be added for the block grants or per-person caps that would start in 2021. Under the new arrangement, states would gain far more freedom to set their own rules about how to cover the poor.

The budget also would eliminate funding for Medicaid expansion under the Affordable Care Act, which has gone to about three dozen states over the past five years.

The budget does not make explicit whether the administration is asking Congress to consider converting Medicaid to a system of block grants once again — or whether it seeks to make such a switch on its own. Congressional Republicans included the idea in their failed 2017 efforts to repeal large aspects of the ACA. Opposition to block grants, including from some GOP governors who feared they would be saddled with escalating health-care costs, was a major reason behind the Senate’s inability to pass such bills.

Last year’s White House budget — an annual exercise that usually is more wish list than harbinger — also endorsed the Medicaid block grant idea, assuming it would be part of an ACA repeal. The new proposal comes as the House is in Democratic hands and even congressional Republicans have largely turned their attention away from dismantling the ACA.

Federal health officials have quietly been exploring the controversial proposal to give individual states permission to convert their Medicaid programs to block grants or a system of caps, without any change in law. Senior officials of at least one state, Utah, have said publicly they have been discussing the idea with leaders of HHS’s Centers for Medicare and Medicaid Services, and other conservative states also appear to be interested.

Matt Salo, executive director of the National Association of State Medicaid Directors, said that a proposal to give individual states permission to convert Medicaid to a block grant, “is still bouncing around in the administration.”

He said the question remains, “If state X says, ‘Hey, we want to do something different in terms of coverage, benefits, cost sharing,’ how much latitude does the administration have to grant that” in exchange for capping the federal funding?

The Trump budget also proposes to slow spending on Medicare, the federal program that gives health insurance to older Americans, by $845 billion over the next 10 years, in part by limiting fraud and abuse and payments to hospitals. During the 2016 presidential campaign, Trump said he would not cut Medicare or Social Security, the retirement program for the elderly, but his budget last year also included a proposed cut of more than $550 billion to the program.

This year’s proposed budget would reduce the growth of various Medicare provider payments, including for care after hospitalizations, graduate medical education and hospital-owned physician clinics, according to Marc Goldwein, budget expert at the Committee for a Responsible Federal Budget. He said that with some of the Medicare “reductions” simply being moved to other parts of the budget, the cuts could be construed as between $500 billion and $600 billion.

The increasingly ambitious cuts to Medicare come at a time when many Democrats have embraced plans for expansions of Medicare, including a Medicare-for-all system that would increase federal spending on the program by as much as $30 trillion but that backers say would insure more people and reduce overall health costs.

The changes are expected to encounter fierce resistance from industry lobbying groups, and members of Congress traditionally nervous about backing cuts to health-care programs.

Charles N. “Chip” Kahn III, president of the Federation of American Hospitals, which represents more than 1,000 for-profit hospitals and health systems, said the budget “imposes arbitrary and blunt Medicare cuts. . . .The impact on care for seniors would be devastating.”

However, Howard Gleckman, a budget expert at the Tax Policy Center, a nonpartisan think tank, said: “Administrations have been proposing to do these sort of things forever, and they never happen.”

Congressional Democrats pounced swiftly, deriding the GOP president’s spending priorities.

“Instead of building a stronger, healthier nation, President Trump’s budget would take away Americans’ health care and devastate the pillars of economic security for seniors and families,” House Speaker Nancy Pelosi (D-Calif.) said in a statement.

Azar, the HHS secretary, countered in a statement: “This budget will help deliver on the President’s vision for a fiscally sustainable federal budget, a stronger economy, and a healthier America.”

https://www.washingtonpost.com/national/health-science/trump-proposes-big-cuts-to-health-programs-for-poor-elderly-and-disabled/2019/03/11/55e42a56-440c-11e9-aaf8-4512a6fe3439_story.html?noredirect=on&utm_term=.e66f6b848537

Trump 2020 budget calls for stricter work requirements, welfare reform

www.foxbusiness.com

President Trump released his fiscal 2020 budget on Monday, which – among a number of other things – called for reforming the country’s welfare programs.

Trump’s blueprint strengthens work requirements for social programs designed to help lower-income Americans – like the Supplemental Nutrition Assistance Program (SNAP, also referred to as food stamps), Medicaid and housing assistance.

Trump’s blueprint aims to strengthen work requirements for social programs designed to help lower-income Americans – like the Supplemental Nutrition Assistance Program (SNAP, also referred to as food stamps), Medicaid and housing assistance.

Able-bodied individuals between the ages of 18 and 65 will generally be required to work at least 20 hours per week in order to receive assistance, or be engaged in job training or community service, according to senior administration officials.

The proposal does contain a hardship exemption, White House officials said.

Concerning Medicaid specifically, the president wants to return the program to a “sustainable fiscal path” by instituting finance reform. That includes implementing a per capita cap or block grant.

Crop insurance would also be reduced.

Additionally, the president wants to continue his America’s Harvest Box proposal, which is a potential SNAP replacement that would provide boxes of nonperishable food items grown by U.S. farmers in place of some of their SNAP aid.

Overall welfare reform efforts are expected to generate $327 billion in revenue over the course of 10 years.

The president had backed a Republican-led effort to include stricter SNAP work requirements in a massive farm bill passed last year. However, the issue became a sticking point during Senate negotiations and was ultimately omitted from the final legislation.

Trump signed an executive order last year focusing on ways to beef up SNAP work requirements. Since the beginning of 2018, states have been allowed to implement a work requirement for Medicaid.

The budget calls for a 5 percent increase in military spending. Administration officials said the proposed budget, along with the last two budget proposals, contain more reductions in spending than any president has ever proposed. It includes trillions of dollars' worth of spending reductions.

Fox News' John Roberts contributed to this report.

https://www.foxbusiness.com/politics/trump-2020-budget-calls-for-stricter-work-requirements-for-welfare-programs  

Don't Miss 2019 NYAPRS Executive Seminar April 16-17 in Albany: Register Today!

NYAPRS Note: Don’t miss this year’s NYAPRS Executive Seminar program, entitled “Creating Value Without Compromising Our Values,” to be held on April 16-17 at the Albany Hilton. Hear how national and state agency leaders are finding a way to maintain recovery and rights focused values in the ever challenging healthcare environment. Learn about the latest advances in peer services, self-directed care, HCBS enrollment and retention, DSRIP behavioral health initiatives, Certified Community Behavioral Health Clinics and employment models. Hear how our panelists are answering the urgent call to find successful strategies that are averting fatal overdoses and suicides. Please join in this  register today at https://rms.nyaprs.org/event/?page=CiviCRM&q=civicrm/event/register&reset=1&id=30.

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MHW: N.J. Community MH Agency Partners with Legal Group

N.J. Agency Partners with Legal Group to Help SPMI patients

Mental Health Weekly March 11, 2019

Noting that medical-legal partnerships are being recognized and gaining traction as an effective and relatively low-cost intervention to improve health outcomes, a New Jersey–based mental health organization and a public interest law agency have partnered to assist patients with a serious and persistent mental illness (SPMI) in need of legal assistance before they reach a crisis point.

The medical-legal partnership between the Montclair-based Mental Health Association of Essex and Morris Inc. and the Community Health Law Project (CHLP) commenced in January and was funded with a $150,000 grant from the Healthcare Foundation of New Jersey.

The goal of the project is to address the social determinants of health of vulnerable individuals experiencing SPMI, and to collect data and outcomes to better advocate for expanded funding for medical-legal partnerships with mental health and addiction agencies, officials stated.

We noticed that legal issues cause significant stressors for our population, “Robert N. Davison, M.A., LPC, CEO of the Mental Health Association of Essex and Morris Inc., told MHW. The population with SPMI may be dealing with threats of evictions, potential loss of benefits or unresolved issues with child support and the like, he said. “

We’re embedding an attorney in our agency who will work with the homelessness case management program and an integrated case management services program, “said Davison. The attorney will work one day a week in the office and spend time during the week in the field working with a clinician to visit patients in their community. These partnerships appear to reflect a new trend, added Davison.

The embedded attorney and advocate can proactively intervene before legal problems reach a crisis point, help health care staff recognize potential health-harming legal issues, navigate system and policy barriers to health, and break the cycle of treating patient-consumers only to have them come right back because their underlying barriers to health are not being addressed, officials stated.

Early Intervention

This new concept of behavioral health organizations partnering with medical-legal partners represents a joint effort to address clients ‘problems as early as possible rather than the traditional referral to a legal entity, said Hal Garwin, Esq., executive director of the Community Health Law Project.

This type of effort is gaining more traction around the country and doing well in New Jersey, said Garwin. It will still take some time to de termine how much better it is embedding attorneys than doing it the traditional way by referrals,

he noted.

Clients with mental health or substance use disorders may find that they’ve received an eviction notice or been denied Social Security disability and be referred to a legal services provider, Garwin said. “That can be a burden on the client to call that legal services provider and make an appointment,” he said.

Garwin added, “Often the client may not get there because of their disability or they have already received a judgment [related to the eviction]. They could have been denied Social Security and missed the time needed to appeal it.”

Those are issues the CHLP will hopefully help patients with a serious and persistent mental health issue avoid, he said.

In these types of partnerships, whether or not an attorney will remain in an office for a full day depends on the program, funding and the opportunity, he said. “It varies in different places,” said Garwin. “An attorney may go out with a case manager to see clients where they are. It’s fluid.”

Other health care organizations the CHLP has partnered with include the Center for Family Services, an addiction treatment center in South Jersey and a local HIV program, Garwin noted. “We’re looking to partner with FQHC [federally qualified health center] organizations to provide similar types of services,”Garwin said.

NYAPRS Marks Retirement, Contributions of Edye Schwartz and Steve Coe at April 16th Albany Reception

NYAPRS Note: Capping decades of groundbreaking contributions and achievements, NYAPRS will be honoring and celebrating recovery champions NYAPRS’ own Edye Schwartz and Community Access’ Steve Coe as they both retire in the coming months. We’ll have a lot more to say in the coming weeks about them both but, in the meantime, mark the evening of April 16th on your calendars and be on hand for this momentous event, which will follow the first day of NYAPRS Annual Albany Executive Seminar.

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Rochester: Join NYAPRS' Ferencz, Rosenthal, Statham at MONDAY'S HCBS Peer Forum

NYAPRS Note: In collaboration with local county mental health directors, NYAPRS and our New Choices in Recovery project is hosting a series of public forums aimed at engaging, educating and encouraging eligible individuals to enroll in Health and Recovery Plans, Health Homes and Home and Community based Services!

Join Len Statham and me at NEXT MONDAY’S kick off with a forum in Rochester featuring a peer-to-peer presentation by New Choices’ David Ferencz.

Please join us and help recovering people and care managers to come together

and connect people with these life changing opportunities!

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