NYAPRS Decries Criminalization, Testifies on NYS Budget Proposal

NYAPRS Note: Following is a copy of our testimony at this week’s Legislative mental hygiene budget hearing, which:

decries the defamatory, discriminatory media coverage and criminalizing public policies that are based on unsupported connections between violence and psychiatric diagnoses and urges lawmakers to speak out against such coverage and carefully examine such policies
expresses gratitude for sparing the mental health safety net from cuts and housing increases and calls for cost of living increases
strongly supports state hospital downsizing plans but urges an increase in the formula to reinvest savings in the community from 20 to 50%
expresses support for Medicaid reinvestments in community recovery initiatives and looks to future increases
ensures that the integration of mental health, addiction and medical services in new managed care designs gets maximal stakeholder input via additional meetings of the MRT’s Behavioral Health Work Group and that the consolidation of Medicaid has strong OMH guidance and stakeholder input
insists on a strong prescriber prevails protection to ensure open access to anti-psychotic medications and
seeks to ensure that adult home and prison mental health reform monitoring is an adequately funded priority for the new Justice Center

Once the budget is approved, it will up to state agency leaders to help us best understand how it will be implemented and the expected impact on our community. Come hear Medicaid Director Jason Helgerson, OMH Acting Commissioner Kristin Woodlock and OASAS Commission Arlene Gonzalez-Sanchez at NYAPRS’ April 25-6 Annual Executive Seminar in Albany. See program and registration details at https://registration.nyaprs.org/.

Testimony Before the NYS Legislative Joint Fiscal Committees

Mental Hygiene Budget Hearing

February 27, 2013

Presented by Harvey Rosenthal Executive Director

New York Association of Psychiatric Rehabilitation Services

On Behalf of NYAPRS Members and The NYAPRS Public Policy Committee

Co-Chairs: Ray Schwartz, Carla Rabinowitz

NYAPRS Board of Directors

Maura Kelley, Steve Coe Co-Presidents

I’d like to welcome our new mental health committee chairs and thank them and the other members of the mental hygiene and finance committees for this opportunity to present to you the concerns of the thousands of New Yorkers represented by the New York Association of Psychiatric Rehabilitation Services. NYAPRS is a unique statewide partnership of New Yorkers with psychiatric disabilities and the community mental health professionals who support them in over 100 community-based mental health agencies from every corner of the state.

I’m Harvey Rosenthal, NYAPRS Executive Director. The following testimony that I will present incorporates the direct input of many hundreds of NYAPRS members who gathered at local forums that were conducted this past fall and winter in localities across the state.

State mental health policy is a very personal matter for our NYAPRS community. Most of our members, board members, our staff and I all share a common personal journey of mental health recovery. We believe this strengthens our ability to speak to you on behalf of the thousands of New Yorkers with psychiatric disabilities and their supporters that we represent.

You may have seen our orange capped NYAPRS members out in droves last January 29^th, urging state legislators and Administration officials to advance policies promoting their recovery, rehabilitation and rights. I’ve attached some examples of media coverage of those efforts in my materials today:

I’d like to begin my comments by focusing on the other side of media coverage, the horrific kind our community has endured in the past few months. In almost 40 years of work as a community service worker and advocate for people with psychiatric disabilities, I have never seen the level of outrageous vitriol and demonization that we have experienced in the wake of several recent violent tragedies in Newtown and in New York City.

These tragedies are especially abhorrent to those of us in the mental health community, particularly since studies have shown that people with mental illness are 12 timesmore likelyto be victims of violence, and no more likely to be violent unless, like the general public, they are substance abusers.

Nonetheless, horrific acts of violence are often wrongly associated with mental illnesses, often because the motivations for them seem unfathomable…and they end up getting sensationalized front page coverage.

The most egregious examples of this kind of coverage can be found in the New York Post, which over the past few months has published articles entitled “Here Come the Crazies,” “Beware: 11,000 Psychotics on the Streets” and “Scoop the Nuts”, all enclosed in my testimony before you:

Such coverage has also been periodically found in the Daily News, which ironically found that an estimated 5 of 494 New York City murders in 2007 were committed by people with mental illnesses. You can be sure that those five tragedies stayed on the front page for weeks in stark contrast to the other 489.

This kind of coverage vilifies conditions that1 in 5 Americans share. It’s the sort of profiling that used to be the fate of most racial or religious groups…but is no longer acceptable for them because those groups and good minded citizens demanded an end to these virtual lynchings.

It has also clearly become a key strategy in diverting attention away from gun control and was particularly evident in the words used by the NRA’s Wayne LaPierre as he called us “monsters” and “lunatics” just three weeks after Congress overwhelmingly voted to ban the word “lunatic” from federal laws.

The stark truth is that the public doesn’t need protection from people diagnosed with mental illnesses, it is we who need protection from these kinds of outrageous mischaracterizations that assail our dignity, our rights and privacy protections…and from the rush to enact laws that provide false solutions to appease public fears.

It’s important to view New York’s SAFE Act in the context of experts’ opinions that “the biggest risk for gun violence is possession of a gun…and there’s no evidence that the mentally ill possess guns or commit gun violence at any greater rate than the normal population.”

The SAFE Act laudably seeks to curb gun related violence but, in requiring mental health clinicians to report clients who disclose impulses to harm themselves or others for potential inclusion in a DCJS registry to cancel their gun licenses and remove their guns, it will have an unintended chilling effect of discouraging people from seeking or fully disclosing in what should be trusting therapeutic relationships.

The law is also vague about how broadly such information can be shared. We call on the legislature and the Governor to ensure that, at minimum, people’s names and private psychiatric histories are strictly restricted to gun related purposes.

We appeal to you and your colleagues to stand with us and to protect our essential civil and human rights and our dignity.

NYAPRS is also very troubled about the SAFE Act’s expansion in the use of court ordered treatment associated with Kendra’s Law. We have opposed such approaches or expansions since the law’s inception in 1999 and reject unfounded assertions that court orders rather than increased and improved services and supports are what best engages and helps at risk individuals.

Instead, we urge state legislators to redouble their support for the Governor’s Medicaid Redesign and healthcare reform measures, which will appropriately turn our systems on their head, requiring active and persistent outreach and engagement, consistent follow up and support, greatly expanded prevention, crisis and peer supports and housing and employment, and will move us to a payment system that only rewards measurably improved client outcomes.

We also strongly support the Executive’s proposal to improve the state and local response to violent incidents involving persons with mental illnesses who either harm others or are themselves harmed through the establishment of mental health incident review panels that are comprised of mental health officials and members from local law enforcement and social service agencies. We want to emphasize the panels’ mandate to investigate incidents where people with such conditions are harmed by others; given the 12 to 1 ratio mentioned earlier, proper investigations of how our community members are harmed might help in reducing violence towards us.

I’d like to also offer the following comments on how the Executive Budget proposal treats the other priority concerns of our NYAPRS community as follows:

Protect and Support the Community Mental Health Safety Net

We strongly support and appreciate the Governor’s preservation of our state’s community mental health safety net that is comprised of essential community based rehabilitation, clubhouse, residential, peer run, treatment, care management and related support services and his sparing us from damaging cuts, even as our state responds to the loss of over a billion dollars of federal Medicaid funds.

In the face of years without critically needed cost of living adjustments, we call on the Executive and Legislature to address the crisis caused by steadily increasing costs and demands without matching funding increases.

Reinvest Savings from State Hospital Downsizing to Boost Local Community Based Housing, Employment and Peer Services

According to national surveys, New York has almost 7 times the national average of state psychiatric hospitals and in doing so spends more money treating fewer people than the next few states combined. Those resources are far better used to boost community services and supports.

Accordingly, NYAPRS strongly supports OMH’s plan to reduce the number of hospitals in favor of stronger state of the art regional ‘Centers of Excellence.’

We are troubled, however, at the relatively small amount of savings that will be reinvested into boosting our community systems of care. The Executive budget proposal suggests that only 1/5 of the savings, $5 million out of $25 million this year, will be reinvested in stark contrast to the 50% formula that was required in the landmark Community Mental Health Reinvestment law this legislature approved in 1993. Given all the redoubled attention in shoring up our community mental health system, we urge legislators to return us to that original 50% formula.

Reinvestment Medicaid Savings to Enhance Medicaid Community Recovery Services and Supports

As a member of New York’s Medicaid Redesign Team, I was especially pleased to see the number of Executive proposals to redirect savings from reduced hospital and emergency services into improving community services and supports. Despite recent cuts or delays caused by the loss of federal Medicaid funds, the budget includes commitment to:

Boost integrated ‘health home’ community networks of mental health, addiction and medical care
Promote improved collaborations and co-location of behavioral health and medical care
Create upwards of $91 million in expanded community supportive housing
Expand a Medicaid Managed Care Ombuds program aimed at protecting the rights and responding to grievances of the hundreds of thousands of New Yorkers with disabilities whose care is being turned over to coordination by Medicaid health plans.
New York must keep faith with these essential measures and more properly fund them as soon as our budget circumstances allow.

Medicaid Consolidation within the Health Department

NYAPRS is very concerned that the unique needs of New Yorkers with serious mental health conditions and the adequacy and appropriateness of the care they need are not compromised by the proposed move of Medicaid services currently overseen by the Office of Mental Health to the Department of Health. We must ensure that the Office of Mental Health continue to play a very strong role in the development of Medicaid program and reimbursement/rate policies, going forward.

Strong and Clear Standards and Oversight for Integration of Behavioral Health Services into Medicaid Managed Care Plans

Starting in 2014, New York will move an estimated $2.5 billion of Medicaid mental health and addiction services from fee for service to the control of fully integrated Medicaid managed care plans.

While this may indeed improve the integration, coordination and outcomes of care for people with serious behavioral and physical health conditions, it has the possibility to erode if not evaporate community mental health supports on which hundreds of thousands of New Yorkers have come to rely.

The terms by which plans are expected to incorporate and integrate these benefits and individuals, the services they are expected to offer and the outcomes by which they are judged must be explicitly clear in the state’s contracts with the plans as will the strong state oversight role that is essential to their success.

New York must re-convene the MRT’s Behavioral Health Work Group several times in the coming months to ensure that sufficient stakeholder input is incorporated into state standards and oversight of the plans, and regularly reconvene the group to monitor progress in the coming months and years.

Protect Open Access to Anti-Psychotic Medications

New Yorkers with serious mental health conditions must have access to the appropriate psychiatric medications they want and need, regardless of whether or not they are on the formularies of the 18 Medicaid health plans that now manage the pharmacy benefit.

The legislature has commendably acted to preserve this access by approving ‘prescriber prevails’ protections as regards managed care atypical anti-psychotic prescriptions. But even this form of prescriber prevails has come with another layer of bureaucratic prior authorization barriers that may undermine its intent.

The Governor seeks to repeal those protections and replace them with a developing proposal that would grant ‘goldcard’ privileges to psychiatrists and other prescribers who meet defined state standards of good practice and collaboration. Since ‘goldcard’ status eliminates prior authorization requirements and improves the quality of prescribing, NYAPRS believes this might be an acceptable alternative….provided the proposal is fully developed in the next few weeks and is immediately extended to all managed care and fee for service anti-psychotic prescriptions.

OMH Community Housing: NYAPRS strongly supports proposed 2 year allocations of 1,000 OMH supported housing units for residents of nursing homes, 3,400 beds for NYC homeless housing program and 4,000 OMH supported housing beds for adult home residents with psychiatric disabilities.

Justice Center Adult Home and Prison Mental Health Initiatives

As a member of Mental Health Alternatives to Solitary Confinement, NYAPRS members worked strenuously to see legislative passage of 2011’s SHU Exclusion Law, which requires that prisoners with serious mental illnesses who could potentially be confined in solitary confinement settings (SHU) be diverted to a residential mental health treatment unit.

A vital component of the SHU Exclusion Law is that the state monitors prison mental health care and ensures compliance with the law.

This year the Justice Center for the Protection of People with Special Needs will assume the oversight functions previously assigned to CQCAPD.

We urge state legislators to ensure that these crucial functions are not lost in CQCAPD’s incorporation within the Justice Center and to ensure that adequate funding for these crucial monitoring responsibilities is provided. The additional responsibilities imposed by the SHU Exclusion Law were expected to require at least 14 full-time employees to the task. However, only 4 staff members have been assigned to these monitoring duties over the last four years. The Justice Center’s funding must provide for additional staffing to carry out these responsibilities.

We are equally concerned that the Justice Center adequately continues the adult home monitoring responsibilities that have also been the mission of CQCAPD, to ensure that adult home residents are afforded appropriate and humane conditions and treatment.

Thank you for this opportunity to share our community’s concerns and recommendations.

^[1]Crime Victimization in Adults With Severe Mental Illness Linda A. Teplin, PhD; Gary M. McClelland, PhD; Karen M. Abram, PhD; Dana A. Weiner, PhD Arch Gen Psychiatry.2005;

² Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods Steadman, H., Mulvey, E., Monahan, J., Robbins, P., Appelbaum, P., Grisso, T., Roth, L., & Silver, E. (1998). .Archives of General Psychiatry, 55, 393-401.

http://www.nydailynews.com/opinion/curbing-madness-article-1.295260; http://en.wikipedia.org/wiki/Timeline_of_New_York_City_events,_crimes_and_disasters#Murders_by_year

3 20 percent of US adults experienced mental illness in the past year Substance Abuse and Mental Health Services Administration November 2012 report

4 Congress Overwhelmingly Votes to Ban the Word ‘Lunatic’ Time Magazine December 5, 2012

5 Mental Health Gun Laws Unlikely To Reduce Shootings Jon Hamilton National Public Radio Jan. 16, 2013

Crime Victimization in Adults With Severe Mental Illness Linda A. Teplin, PhD; Gary M. McClelland, PhD; Karen M. Abram, PhD; Dana A. Weiner, PhD Arch Gen Psychiatry.2005;

Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods Steadman, H., Mulvey, E., Monahan, J., Robbins, P., Appelbaum, P., Grisso, T., Roth, L., & Silver, E. (1998). .Archives of General Psychiatry, 55, 393-401.

http://www.nydailynews.com/opinion/curbing-madness-article-1.295260; http://en.wikipedia.org/wiki/Timeline_of_New_York_City_events,_crimes_and_disasters#Murders_by_year

20 percent of US adults experienced mental illness in the past year Substance Abuse and Mental Health Services Administration November 2012 report

Congress Overwhelmingly Votes to Ban the Word ‘Lunatic’ Time Magazine December 5, 2012

Mental Health Gun Laws Unlikely To Reduce Shootings Jon Hamilton National Public Radio Jan. 16, 2013

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