I have a sister in law with a serious mental illness and want to thank and congratulate Governor Cuomo for issuing Executive Order 84on Friday creating a cabinet level committee to help move persons with mental illness out of segregated institutional care and back into the community. (Olmstead v. LC.,) But I fear the way the committee is currently constituted, it lacks the expertise to do the job correctly and may do more harm than good.
Too many members have expertise in mental health and none have it in criminal justice.
The policies and procedures used by the New York State mental health system to keep persons with mental illness out of hospitals are often the exact same ones that send them to prisons. The result is higher costs for the state and more people institutionalized—the opposite of what the Governor is trying to achieve.
The policies and procedures used by the New York State mental health system to keep persons with mental illness out of hospitals are often the exact same ones that send them to prisons. The result is higher costs for the state and more people institutionalized—the opposite of what the Governor is trying to achieve.
For example, New York State Office of Mental Health (OMH) has done a good job of what they euphemistically refer to as “reducing inpatient census”. They simply locked the front door of hospitals, opened the back, discharged patients sicker and quicker, and called the unfilled prescription they gave them a ‘discharge plan’. From the Office of Mental Health perspective this was a huge success. Fewer persons were hospitalized, and OMH costs went down.
But from a state perspective—and from the perspective of a family member who doesn’t want to visit his relative in jail--this was a failure. Many of these same individuals wound up incarcerated--some for acting out while psychotic, some for minor crimes, and others for becoming a “mentally ill killer on rampage” headline. Governor Cuomo needs criminal justice representation on this committee so the policies it comes up with reduce overall institutionalization and overall costs, not just transfer costs and people from mental health to criminal justice.
Another example: NYS OMH research shows Kendra’s Law—which allows courts to order historically violent patients to stay in treatment as a condition of living in the community—has reduced violence, 83% and incarceration, 87%. Our own research estimated Kendra’s Law saved New York $73 million in incarceration costs and has the potential to save $200 million. Kendra’s Law helps the most seriously ill live safely in the community rather than behind bars. But OMH has refused to support it or close loopholes in it that allow persons with mental illness to march themselves into jail. Again, allowing mentally ill to become psychotic and divert themselves to jail may result in fewer institutionalizations within the mental health system, but it results in more institutionalization, longer institutionalization—and aways in a more expensive, restrictive and cruel setting: prisons and jails.
The last Commissioner of the New York State Office of Mental Health bragged about ‘transforming’ the focus of OMH from treating serious mental illness to improving mental health. The mental health community applauded, even as the most difficult patients were offloaded to criminal justice. As a result of this policy change, there are now 15,000 mentally ill New Yorkers incarcerated, compared to only 4,000 in state hospitals. This is cruel to people with mental illness and expensive for the state. Hopefully Cuomo will appoint a new commissioner who will reverse this trend towards ignoring the most seriously ill.
In the meantime, Governor Cuomo should put many more police, sheriffs, judges, corrections officials, and district attorneys on the commission so he can look at overall costs and consequences and not just those limited to the mental health system. There is simply no way to reduce the institutionalization of persons with mental illness while ignoring the elephant in the room: jails and prisons.
****
DJ Jaffe is Executive Director of Mental Illness Policy Org., a non-profit think-tank that provides media and policymakers unbiased information on serious mental illness (not mental health).
