NYAPRS Note: Please see our statement below Governor Hochul’s historic mental health budget initiative as described below. As you’ll see, there’s a lot of good here and also several items that should be adjusted, enhanced or eliminated. Once the Governor releases the specific details of her budget proposal, our focus will turn to legislative action. At that point, NYAPRS members can have the greatest impact when we all come to Albany for our February 28th Annual Legislative Day. See below for details:
https://www.nyaprs.org/e-news-bulletins/2023/1/9/come-to-albany-feb-28-for-nyaprs-legislative-day-to-fight-for-the-cola-human-rights-housing-and-criminal-justice-reform-1
NYAPRS Policy Director Luke Sikinyi and I will be hosting 9 regional budget forums in the coming weeks. Look for details next week and please come out and give us your reactions and recommendations!
NYAPRS Hails Gov Hochul’s $1 Billion Expansion of Community Mental Health Services…
with Several Key Recommendations
Harvey Rosenthal CEO 518-527-0564
Over the past year, NYAPRS has been out front in calling for a ‘legacy-level’ investment in mental health services by NYS Governor Hochul, one that relies most specially on improved community outreach and engagement services, post hospitalization transitional and support services and access to flexible, permanent housing for people living with the most challenging mental health and social needs.
According to today’s release (see below), the Governor is making these actions a central part of her State of the State message today, calling for the creation of 3,500 new residential units and major expansions in Assertive Community Treatment teams, Community Based Clinic programs, Community Outreach Team and care managers.
We are extremely grateful to the Governor for making historic investments that far exceed actions taken by any of her predecessors in our lifetime.
The Governor will be renewing her call for community hospitals to put back online around 1,000 inpatient psychiatric beds that had previously been reallocated for COVID care and increasing pressure on them to do so. 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. Instead, we must move away from the failed discharge policies of the past and create a systemic shift to improved voluntary outreach, engagement, crisis and hospital diversion services.
In the spirit, NYAPRS enthusiastically welcomes the Governor’s historic investment in community-based housing and calls on the state to make sure that the majority of these are permanent and are operated according to the ‘Pathways Housing First’ model that accepts rather than excludes people with recurrent and often active mental health and addiction related needs, and that are linked to Assertive Community Treatment teams.
We also welcome an increase in the number and use of hospital-to-community Critical Time Intervention Teams and the wrap around dollars that they’ll be able to use to help people get better established in their community.
An important caveat about any such proposals: too often, mental health services offer episodic interventions…e.g. they may help ‘put out the fire’ but typically are gone in a few weeks to months, squandering the impact of hard-won trust in a relationship that must be in place for many months to years to promote a long lasting recovery. Quick ‘warm handoffs’ are not the answer! Recovery from a major mental illness is very hard work and requires a longtime personal commitment by the state, managed care plans and providers.
The Governor’s proposal makes no significant reference to the use of peer supporters, both around outreach and engagement efforts that can prevent relapses and readmissions and as post hospital transitional supports.
For example, peer bridgers (many of which are deployed by agencies that are operated by people in recovery), have been proven to be very effective here. NYAPRS created this peer bridger model back in the early 1990’s and, in subsequent contracts with managed care plans and hospitals, operated pilot programs that featured peer led teams of bridgers with powerful results, cutting readmissions by over 50% and saving millions of dollars, that would have otherwise been spent on avoidable hospitalizations that should be reinvested in a further expansion of community services.
Better hospital discharge plans are essential, but effective community engagement that prevents the need for such hospitalizations is far better.
In that spirit, NYAPRS urges the Governor and Legislature to back an expansion in a peer-led community engagement ‘INSET” model that gets out in front of avoidable admissions of people with major mental health challenges. A program of this kind created by NYAPRS and the MHA of Westchester County has successfully engaged 80% of a cohort of people with significant unmet needs who have previously not engaged in mental health care and support and who might have otherwise be forced into Kendra’s Law’s involuntary community treatment orders.
On that point, we are extremely pleased to see no mention of the use of coercion in the Governor’s statement. Voluntary services are always the most effective and, importantly, the most lasting impact and relationships that we can offer.
Finally, NYAPRS is opposed to the proposed expansion of beds in state psychiatric hospitals: we must not rebuild and repopulate these institutions but should focus instead on community based and operated housing and supports.
We are extremely grateful to the Governor for her commitment to improve services for New Yorkers with major mental health challenges and look forward to working closely with her Administration, the Assembly and Senate to help shape these historic investments.
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GOVERNOR HOCHUL ANNOUNCES COMPREHENSIVE PLAN TO FIX NEW YORK STATE’S CONTINUUM OF MENTAL HEALTH CARE
Transformative Plan will Increase Capacity for Inpatient Psychiatric Treatment by 1,000 Beds and Add 3,500 Housing Units Serving Individuals with Mental Illness
Governor Calls for Systemic Accountability for Mental Health Admissions and Discharges; Dramatic Expansion of Outpatient Services and Insurance Coverage
Governor Kathy Hochul today announced, as part of the 2023 State of the State, a comprehensive plan to overhaul New York’s continuum of mental health care and drastically reduce the number of individuals with unmet mental health needs throughout the state. The multi-year plan includes increasing operational capacity by 1,000 beds for inpatient psychiatric treatment, creating 3,500 units of housing to serve New Yorkers with mental illness, increasing insurance coverage for mental health services, dramatically expanding outpatient services, and creating systemic accountability for hospital admissions and discharges to better address the needs of individuals suffering with mental illness. These proposals, over time, will reflect more than $1 billion in investment in mental health.
“When it comes to protecting New Yorkers’ well-being, strengthening our mental health care system is essential and long overdue,” Governor Hochul said. “We have underinvested in mental health care for so long, and allowed the situation to become so dire, that it has become a public safety crisis, as well. This proposal marks a monumental shift to make sure no one falls through the cracks and to finally and fully meet the mental health needs of all New Yorkers.”
Governor Hochul will realign the state’s approach toward mental health with a comprehensive package of investments and policy changes aimed at transforming all parts of the mental health care continuum -from prevention to treatment to recovery. This includes:
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Increasing operational capacity for inpatient psychiatric treatment by 1,000 beds: During the COVID-19 public health emergency, the State allowed hospitals to make operational decisions that resulted in taking inpatient psychiatric beds offline, even while the operating certificate for the beds remained in place. Governor Hochul’s plan will direct Article 28 community hospitals to immediately bring 850 currently offline inpatient psychiatric beds online. New legislation will allow the state Office of Mental Health to fine Article 28 community hospitals up to $2,000 per violation per day for failing to comply with the number of psychiatric beds outlined in their operating certificate. The State will also open 150 new adult beds in state-operated psychiatric hospitals, including 100 in New York City alone, which are in addition to the 50 beds that the Governor announced last November.
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Creating 3,500 new housing units for individuals with mental illness: Governor Hochul will make a massive capital investment and provide the necessary operating funds for 3,500 new residential units serving New Yorkers with mental illness. Specifically, the plan calls for:
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500 community residence-single room occupancy units to provide housing and intensive services to individuals with serious mental illness and at the highest risk of homelessness.
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900 transitional stepdown units to help individuals transitioning from various levels of care to community-based living.
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600 licensed apartment units to serve individuals requiring an intermediate level of services to be able to live in the community.
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1,500 supportive housing units serving individuals with serious mental illness, split between scattered-site rental units that can be opened quickly and new construction or renovated facilities completed over the next five years.
Improving Admissions and Discharge Planning and Establish Systemic Accountability
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Governor Hochul is proposing a combination of policy changes and investments to create systemic accountability for admissions and discharges, including requirements that hospitals responsibly admit patients in need of care, with new comprehensive standards for evaluation and increased state-level oversight to ensure new protocols are being used effectively; emergency departments and inpatient providers discharge high-risk, high-need individuals into immediately available wraparound services; and outpatient programs to provide immediate and ongoing appointments for high-risk individuals during the discharge process. The plan also calls for the creation of 50 new Critical Time Intervention teams to provide wrap-around services for discharged patients – from housing to job supports.
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Dramatically expanding outpatient services: Governor Hochul’s plan will substantially expand a wide range of outpatient services to expand mental health care access, reduce wait times, and ensure appropriate levels of care. Specifically, the plan includes adding:
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12 comprehensive psychiatric emergency programs, providing hospital-level crisis care across New York State.
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42 Assertive Community Treatment teams to provide mobile, high intensity services to the most at-risk New Yorkers, with 22 new teams in New York City and 20 in the rest of the state.
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26 Certified Community Behavioral Health Clinics to provide walk-in, immediate integrated behavioral health care, providing both mental health and substance use disorder services for New Yorkers of all ages and insurance status, supplemented by an indigent care pool to ensure access regardless of one’s ability to pay. This will triple the number of Certified Community Behavioral Health Clinics in New York State from 13 to 39, serving approximately 200,000 New Yorkers.
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Eight Safe Options Support teams to provide outreach and connection to services for homeless populations with mental illness and substance use disorders, with five new teams in New York City and three in the rest of the state. This will build on the Safe Options Support teams introduced by Governor Hochul in last year’s State of the State that are currently in operation in New York City.
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20 expanded-capacity Article 31 mental health clinics providing care to the most vulnerable New Yorkers, which often serve as a front-door mental health service in communities across the state
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Health Home Plus care management to provide assistance as individuals with mental illness seek to access the services they need, hiring dozens of new care managers to serve individuals with serious mental illness.
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Expanding insurance coverage for mental health services: The plan will close critical gaps in insurance coverage for mental health services. This includes prohibiting insurance companies from denying access to medically necessary, high-need, acute and crisis mental health services for both adults and children, expanding commercial and Medicaid coverage of mental health services to improve the well-being and success of individuals once they leave hospitals or emergency departments. The plan will also set appointment availability and geographic accessibility standards for behavioral health services to ensure New Yorkers have access to treatment from in-network providers, and ensure access to behavioral health services whether it is delivered in-person or via telehealth.
Expanding Mental Health Services for School-aged Children
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Governor Hochul proposes expanding access to mental health services in schools by increasing Medicaid payment rates for school-based satellite clinics and school-based wraparound services, to incentivize further development of this critical care. In addition, the Governor will introduce legislation requiring commercial insurance providers to pay for school-based services at a level equal to the higher paying Medicaid rate, to ensure timely access for all children. The plan also outlines an annual investment to provide the start-up funding necessary to get new and expanded school services in operation quickly.