Alliance Update: At the top of each year, the Mental Health Weekly seeks comments from mental health about their chief concerns for the coming year. See below for contrasting views seeking an expansion in the use of innovative recovery and choice-focused advances from the Alliance’s Harvey Rosenthal and the National Coalition for Mental Health Recovery Jospeh Rogers as opposed to a push for an expansion of coercive Assisted Outpatient Treatment measures from E. Fuller Torrey, as well as a call for more funding for community based services from CEO of the New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA) Inc. Deborah Wentz. Rogers also put out a call to reject former President Trump’s stated plans to expand the use of institutions.
Readers Bracing For Funding Needs, AOT Issues, Politics In 2024
Valerie A Canady | Mental Health Weekly | December 29, 2023
Editor’s note: For the first issue of the year, we asked our readers about their most pressing challenges and opportunities awaiting them in 2024. Here are some comments we received. More to come next week.
Fuller Torrey, M.D., associate director of research at the Stanley Medical Research Institute and founder of the Treatment Advocacy Center:
The Treatment Advocacy Center (TAC) looks forward to the challenges of the coming year. Assisted outpatient treatment (AOT) is now available in 47 states. We hope to also make it available in Massachusetts, Connecticut, and Maryland. Among the 653,000 homeless individuals in the U.S., a disproportionate number suffer from serious mental illnesses. We hope that additional mayors and governors will follow the leadership of [New York City] Mayor Eric Adams and California Gov. Gavin Newsom in focusing clinical services, including AOT, on this population. AOT is especially effective for homeless individuals who have schizophrenia and other psychoses and are unaware of their own illness. We hope that [the federal Substance Abuse and Mental Health Services Administration] SAMHSA will continue funding AOT programs and will put more emphasis on data collection and program evaluation.
Each year, approximately 600,000 people are released from federal and state prisons and another nine million are released from local jails. This includes a disproportionate number of individuals with serious mental illnesses. This is another group for which AOT is especially effective, often in combination with the use of clozapine and long-acting injectable antipsychotics. We hope that in 2024 mayors and governors will provide leadership in focusing attention on this groups’ need for treatment. When they do so, it will provide rich dividends in lowering rates of re-incarceration and psychiatric rehospitalization.
Harvey Rosenthal, CEO of the Alliance for Rights and Recovery (formerly NYAPRS):
Across the nation, state policymakers are faced with two competing strategies to address the challenges faced by ever growing numbers of unhoused, isolated and distressed individuals. Some states are looking backwards and expanding their use of coercive approaches like mandated outpatient treatment orders (sometimes called AOT), broadening criteria to involuntarily commit more people to local hospitals and rebuilding state hospital facilities.
On the other side, some are making major investments in a continuum of voluntary community service models. These include successful INSET model peer-led engagement and support teams for folks who otherwise would be placed on AOT orders; peer-led crisis respite, stabilization and drop-in alternatives to emergency rooms and hospitals; and the use of mental health/EMT non-police first responder teams.
Opening more hospital beds will only increase the number of failed discharge plans. We should instead ensure access to people who can walk alongside you to make a successful transition back to the community (peer bridgers), a place to live that will accept you regardless of your condition (Housing First and Safe Haven Beds) and a place to go (recovery centers and clubhouses).
At the same time, we are heartened by the establishment of SAMHSA’s new Office of Recovery that we know will take numerous measures to see that recovery is the expectation for all.
Debra L. Wentz, Ph.D., president and CEO of the New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA) Inc. and executive director of the New Jersey Mental Health Institute:
The challenges and opportunities the New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA) faces in 2024 are significant. As Congress remains divided with the possibility of severe potential budget cuts and the deadline for spending any remaining COVID relief funds approaches, New Jersey is facing shortfalls for its current and next fiscal year according to forecasted revenues. These budgetary threats are occurring at the same time [that] New Jersey is preparing to transition many behavioral health services to managed care, which will come with administrative, cash flow and staffing burdens as providers work to enter networks, have all staff credentialed and increase the demands on their billing staff and systems. Opportunities still abound, however, given the continued state and federal focus on mental health and substance use treatment and the bipartisan support for enhanced services and access. NJAMHAA will build on the current visibility, momentum and successes of recent years to address workforce challenges with its 2024 advocacy campaign, “Diverse Faces: All Are Worthy of Full Investment.” NJAMHAA is requesting significant investment in behavioral health rates and contracts, as well as increased funding for loan redemption and recruitment and retention bonuses and will be continuing its efforts for stronger parity enforcement.
Joseph Rogers, founder and executive director, National Mental Health Consumers’ Self-Help Clearinghouse:
As 2024 begins, one enormous challenge the mental health field must wrestle with is the chaos in Congress, where the deep division between the aisles, and the fact that the Republican party has been hijacked by its radical right wing, have led to a stalemate, so that there is little hope of legislative remedies to address the overwhelming problems we face. Also, we cannot dismiss the fear that, despite his numerous criminal indictments, the former president [Donald Trump] may be re-elected in November. If that happens, his stated plans to bring back mental institutions and get rid of the Affordable Care Act will only be a small part of the terrible damage he may cause throughout the U.S. and the world.
But we must sustain our hope that, despite the many obstacles we face, we can use every opportunity to work together “to advocate for a recovery-focused mental health system that prevents crisis, protects rights, and promotes social justice, wellness, economic empowerment, and social inclusion,” as the National Coalition for Mental Health Recovery has described as its overarching priority. And we must continue to fight for programs such as Housing First and other community-based alternatives, such as peer-run crisis respites