NYAPRS Note: While we are still sifting through the ambitious set of mental health related proposals that Governor Hochul advanced yesterday in her State of the State to address what she called “New York’s mental health crisis,” we also greatly appreciated her reference to the state’s “workforce crisis.” Increasing services without increasing base funding for our very hard pressed workers will not allow these bold proposal to succeed. These views are shared by Senate Mental Health Committee Chair Samra Brouk, who told Spectrum News yesterday that “the thing I’m concerned about is none of this is going to be possible if we don’t have a workforce.”
NYAPRS and our colleagues are urging the Governor to include a desperately needed COLA tied to the Consumer Price Index-U at 8.5% (July 2022) in the SFY 2023-24 Executive budget proposal. In addition, a $500 million rate increase for unrestricted flexible funding is needed to make up for decades of underfunding for mental health and substance use disorder services, supports and the workforce. More later today.
Advocates Cautiously Optimistic About Hochul’s $1B Mental Health Plan
JACQUELINE NEBER Crain’s Health Pluse January 11, 2023
Tuesday morning Gov. Kathy Hochul revealed a $1 billion, multiple-year mental health investment plan and discussed the plan in her State of the State address.
The plan includes increasing inpatient psychiatric treatment capacity by 1,000 beds, creating 3,500 units for New Yorkers with mental illnesses, expanding outpatient services and increasing insurance coverage. Advocates expressed optimism towards the investment, but questioned whether it’s enough to fully address the severity of the issues New Yorkers face.
These proposals, Hochul said during her speech, would address New York’s chronic underinvestment in mental health care and current barriers to access, including long waits for beds, a lack of appointments and insurance coverage.
“We have underinvested in mental health care for so long and allowed the situation to become so dire that it also has become a public safety crisis as well,” she said.
The plan will direct community hospitals to open up 850 inpatient psychiatric beds. During the pandemic, hospitals were allowed to make operational changes that allowed them to move psychiatric beds “offline” or out of service. Now, these beds will be brought back into service, and the state Office of Mental Health will be able to fine these hospitals up to $2,000 per day if they don’t comply with the number of beds outlined in their operating certificates.
Additionally, the state will open 150 new adult beds in state psychiatric hospitals–including 100 in the city alone–in addition to the 50 open beds Hochul announced last November.
Leaders of advocacy organizations across the mental health care space had mixed reactions to Hochul’s plan on Tuesday. Jody Rudin, the chief executive of the Institute for Community Living which serves about 13,000 New Yorkers with behavioral health challenges, disabilities and those experiencing homelessness each year, said the governor’s plan is encouraging.
“It feels like we as a society have not lived the full promise of deinstitutionalization over the last century in terms of having a robust community-based system of care for people who are mentally ill,” she said. “This is historic in that context. It takes programs that are evidence based, like ACT and CTI and multidisciplinary teams that will meet people where they are…and work with them in a really person centered way on whatever their needs are.”
Ruth Lowenkron, the director of the disability justice program at New York Lawyers for the Public Interest, said she applauds the planned expansion of outpatient services. But those services being voluntary is key to the disability community, she said.
“Forced outpatient commitments…is not a service,” she said.
Her comments echo criticism of Mayor Eric Adams’ plan to address mental health announced in November, which include a directive that re-emphasizes that police, emergency medical professionals and outreach workers are authorized under existing state law to involuntarily transport patients to hospitals who seem to be unable to meet their own basic needs.
Advocates have called Adams’ plan unconstitutional and unacceptable; he has said his plan is tailored and will not violate laws.
The governor will also make a capital investment to fund 3,500 new residential units for New Yorkers living with mental illness. Those will include 500 community residence single-room occupancy units tol house and provide services to people with serious mental illness, 900 transitional units for people moving into community-based living, 600 licensed apartment units for people who need some services to live in their communities and 1,500 supportive housing units for people with serious mental illness. The supportive housing units include scattered-site rentals and new construction or renovation that will be completed over the next five years.
Lowenkron praised Hochul’s commitment to creating 3,500 units of housing, but said that more are needed, especially since 900 proposed units are transitional, not permanent.
Hochul’s plan also includes measures for increased accountability for admissions and discharges. Hospitals will be required to “responsibly admit patients in need of care” with new evaluation standards and increased state oversight. Emergency departments and inpatient providers must discharge high-risk, high-need New Yorkers into immediately-available services such as housing or job support. And outpatient programs must provide immediate and ongoing appointments for high-risk patients during the discharge process.
Beyond these requirements for programs and hospitals, 50 new Critical Time Intervention teams of workers will be created to help patients transition into services after discharge as well.
These policy changes and investments address the continuum of care issues that were highlighted by a Crain’s investigation which found that many hospitals do not admit seriously mentally ill patients, instead bouncing them out of emergency rooms with prescriptions in a cycle referred to as the institutional circuit.
Moreover, Crain’s has found that more than 1,000 New Yorkers are on waiting lists for community programs for serious mental illness, highlighting a need for better connection between inpatient and outpatient services and increased capacity.
Meanwhile, Hochul’s plan involves expanded outpatient services which seek to widen care access. The plan will add 12 comprehensive psychiatric emergency programs throughout the state; 42 Assertive Community Treatment teams (22 in the city) which will offer high intensity mobile services; 26 Certified Community Behavioral Health Clinics for walk-in behavioral health care, including substance use disorder treatment; Eight Safe Options Support teams (five in the city) to do outreach work; 20 expanded-capacity Article 31 mental health clinics; and Health Home Plus care management.
The governor also plans to prohibit insurance companies from denying adult and child patients access to medically necessary high-need, acute and crisis mental health services.
The New York State Conference of Blue Cross and Blue Shield Plans released a statement on that part of the proposal, saying that the further coverage of mental health services could drive up the costs of coverage.
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Kathy Hochul Proposes $1 Billion in New Funding for Mental Health
The New York Governor Also Calls For 3,500 Housing Units To Prevent Homelessness
New York has underinvested in mental-health care
By Jimmy Vielkind Wall Street Journal January 10, 2023
ALBANY, N.Y.—New York Gov. Kathy Hochul said Tuesday she would seek to add 1,000 hospital beds for psychiatric patients and stimulate additional housing production, pitching both priorities as solutions to help address homelessness and population loss.
The hospital-bed proposal was part of a call for $1 billion in new funding on mental health. And for housing, she proposed letting state officials approve residential developments if localities drag their feet.
The Democratic governor unveiled both proposals during a speech to state lawmakers at the capitol following her election last year. The goal is to increase public safety and ensure affordability, Ms. Hochul said. Public safety was a major issue in her race against Republican Lee Zeldin, whom she defeated in a contest for governor that was tighter than expected.
“If New Yorkers don’t feel safe in their communities, if they can’t afford to buy a home or pay the rent—the dream remains out of reach,” she said.
The governor said production of more housing was the centerpiece of making the state a more affordable place to live. More than half of residents in New York City, the Hudson Valley and on Long Island pay more than 30% of their income for rent, state officials said, and the state has added 1.2 million jobs in the last decade but just 400,000 housing units.
At the same time, homelessness has increased in New York City to 67,880 as of this week from about 50,000 in January of 2013, according to the city’s Department of Homeless Services. New York lost 220,000 residents in the year that ended July 1, the Census Bureau said, which is more than any other state.
In New York City, only 58 percent of adults with suspected serious psychological distress reported they were able to receive needed counseling or medication, according to a 2021 city report. Mentally ill people living on the streets have contributed to a declining sense of public safety, Ms. Hochul said.
The mental health proposals were met with applause during her speech from lawmakers in both parties and complemented plans by New York City Mayor Eric Adams to reduce homelessness by moving individuals from the street into institutional settings. The Democratic mayor last year announced a plan that would lead to more involuntary commitment of individuals who are found to be unable to care for themselves. Mr. Adams has described a “mental health crisis” among the city’s homeless population amid concerns about safety and disorder in the city.
Legislators who represent suburban areas like Long Island said they objected to the potential loss of local control over zoning and development. Progressive Democrats said they were concerned about the potential revival of a tax incentive for affordable-housing development that they said was essentially a giveaway to developers.
Ms. Hochul also proposed indexing the state minimum wage—currently at $14.20 in upstate areas and $15 in and around New York City—to inflation. She also said she would seek further changes to the state’s controversial bail law, which prohibits cash bail for most misdemeanor and nonviolent felonies.
More details will be released later this month when the governor proposes a $200 billion-plus budget. She said Tuesday she would not raise income taxes in the coming fiscal year. The state projects it will run a roughly $2 billion net surplus in the current fiscal year, which Ms. Hochul has placed in reserve.
The new funding would pay for 3,500 housing units for people with mental illnesses who are at risk of becoming homeless. That figure includes 1,500 supportive housing units, to be completed over five years, for seriously ill people.
The state already planned to spend about $5.5 billion on mental hygiene through several agencies in the fiscal year that begins April 1, according to its most recent fiscal plan. The additional funding increase would be phased in over multiple years, a representative for the governor said.
Harvey Rosenthal of the New York Association of Psychiatric Rehabilitation Services, a patient advocacy group, praised the investment—particularly in supportive housing.
“While more beds may get some people off the streets for a few days or even weeks, beds alone will not substantially improve people’s health and lives, nor help them break the cycle of repeat relapses and readmission, unless we move away from the failed discharge policies of the past,” he said.
Ms. Hochul said she hopes to quickly increase the number of inpatient psychiatric beds by forcing private hospitals to reactivate capacity that has been shut down because of staffing issues. The state has 7,471 psychiatric beds now—a 20% decrease from 2014 levels. If hospitals don’t redirect staff to bring beds online, they could face fines of $2,000 per bed, a day, state officials said.
A spokesman for the Greater New York Hospital Association, a trade group, said it hoped to work with the state. An important variable in meeting the state’s goal is the continuing nurses strike affecting the Mount Sinai and Montefiore health systems, the spokesman said….