Problems at NYS CQC and P&A Programs

The NYS Commission on Quality of Care (CQC) is supposed to be an outside monitor of the quality of care received by people with mental illness in New York State. They accomplish some of their work through administering the Protection and Advocacy Program (P&A). Following is our testimony to be given at hearings on Feb. 2

CQC has failed to act on the most important issues.
They focus exclusively on quality of care and ignore lack of care

P&A has focused on preventing care and illegal lobbying

Issues

NYS is Short 4,311 psychiatric Hospital Beds needed to treat the Most Seriously Ill– NYS has 5% of the beds it had in 1955. 5,269 private and public beds are available, but at minium 9,580 are needed meaning there is a shortage or 4,311 beds. In addition, many of the 5,296 are for sexually violent predators and patients involuntarily committed meaning even fewer available for people who need it. In spite of this massive unmet need of beds for people with serious mental illness, the NYS Office of Mental Health continues closing beds and CQC and P&A do nothing.

4,000 Seriously Mentally Ill NYers are Incarcerated Because OMH Refused to Treat them. In NYS you are more likely to be incarcerated for mental illness than hospitalized. Riker's Island is state's largest psych hospital. Marcy State Psychiatric Hospital was turned into a jail with some of same people in it. Of 92K NYS prisoners, 15% (14K) are mentally ill. But there are only 12K patients in all hospitals. While OMH transfers mentally ill to prisons and jails, CQC does nothing.

Number of Homeless Mentally Ill skyrocketing: 38 percent of discharges from a NYS hospital had “no known address” six months later. 96.6 percent of homeless going to Bellevue for treatment had a previous psychiatric hospitalization. CQC does nothing about the skyrocketing homelessness among mentally ill

$665 million of OMH budget (1/3) wasted per Dr. Llloyd Sederer: “Thus, taken together, $665...was spent, perhaps unnecessarily, on people with mental disorders, principally for the serious medical illnesses that they frequently suffer.” In spite of this waste, the NYS CQC and P&A Program do nothing.

NYS Office of Mental Health ignores most seriously ill. OMH serves 650,000. Only 3,600 are seriously mentally ill individuals in state hospitals and 1,871 are in assisted outpatient treatment programs. Maybe 100K are in other programs that help seriously mentally ill. Due to mission-creep, the majority of people OMH serves are not the seriously ill. OMH policies transfer the seriously ill to shelters, prisons, jails and morgues. CQC and P&A do nothing. They acquiesces to the mission-creep and OMH that puts the seriously ill at danger.

OMH impeding execution of Kendra’s Law OMH tells hospitals wanting to enroll patients in Kendra’s Law that there is a long wait for beds, thereby giving hospitals an incentive to release patients without needed treatment. OMH funds the organizations that oppose AOT, opposes making AOT permanent. CQC and P&A support the opposition to the program that has reduced hospitalization, arrest, incarceration, suicides and homelessness among mentally ill.

No oversight of PAIMI – NYS P&A Programs are have taken on legally impermissible responsibilities, have violated congressional mandates against lobbying and have sometimes even lobbied against laws that would benefit mental health consumers. Ex.NYSLPI lobbied against Kendra’s Law, used P&A funds to create a false report alleging racism which forced OMH to have an independent report done which found their report false. P&A has brought suits to make it more difficult for docs to get medical records, and has engaged in other prohibited anti-treatment activities. CQC renews their contracts year after year.

Failure to investigate systemic failures OMH refuses to correct. Andrea Peyser did an article on how Steve Muccio at P.E.O.P.L.E. was being paid to act as a representative payee for a client to ensure the client did not go off medications and on illegal drugs. At a conference attended by NYS OMH Commissioner Michael Hogan, Mr. Muccio bragged that he gave the client all the money so the client could buy drugs. When this was brought to CQC attention, they referred it to Commissioner Hogan who never responded


Recommendations

Change Law so CQC reports to Legislature not Governor.
There is a conflict of interest when the agency charged with monitoring OMH reports to the person responsible for hiring the commissioner.

CQC should focus on the most seriously ill and issues important to them
CQC focuses on those treated by OMH. But most seriously mentally ill are refused treatment by OMH and get it in shelters, jails and prisons, so CQC should focus on seriously ill independently of whether or not OMH does.

Change law so CQC focuses on lack of care, not just the quality of care delivered by mental health department
Most people with serious mental illness do not receive treatment from OMH. OMH through unbenign neglect, transfers them to shelters, prisons, jails and morgues.

Reform P&A
1. Audit to see if they are engaged in prohibited lobbying activities, end contracts with those that are, and prohibit them from bidding again.
2. Open the contracts to public bidding so NAMI and other groups concerned about treatment delivery can compete for the funds

Propose Eliminating OMH and Merging it with DOH
Putting OMH within DOH will help eliminate the $665 million Sederer says is wasted and could help end mission creep and refocus the department on the most seriously ill. This could be done in concert with the SAGE Commission

Propose OMH use the NIMH Definition of Serious Mental Illness and focus efforts on this population.
To end mission-creep, OMH should be forced to focus at least 80% of its expenditures on those with the most severe mental illnesses. By using the existing NIMH definition, we could eliminate the politics of coming up with their own definition.

Focus on what is happening to the most seriously ill (incarceration, homelessness) rather than the quality of care OMH delivers to the few seriously ill they treat

Investigate impediments to Laura’s Law put in place by OMH

Highlight the dearth of psychiatric hospital beds for the most seriously ill.

Additional Reading. This is a fantastic law journal article on how the Protection and Advocacy Program inhibits people with serious mental illness from receiving care.