Monday, February 22, 2016
NYS Needs Kendra's Law & Psychiatric Hospitals. Don't let mental health industry close them
Monday, June 24, 2013
Anti Stigma Effort Fortunately Fails in New York State
We would support a bill to encourage donations to support services to people with serious mental illness, but opposed a check off that limits the support to fighting stigma. (By the way, we don't believe stigma exists).
According Skale's Rule:
The role of stigma in inhibiting care (if any) is inversely related to the severity of illness. Stigma may possibly inhibit some high functioning individuals from accessing care, but stigma is not why homeless psychotic people can't access care.
Tuesday, December 4, 2012
Cuomo Olmstead Commission may do more harm than good for mentally ill in New York
Thursday, November 1, 2012
NYS Office of Mental Health: The wrong response to Hurricane Sandy
Monday, October 22, 2012
NYS OMH Commissioner Leaving: Good News for NYS
This week we are happy to report that in an article posted online NYS OMH Commissioner Michael Hogan made it clear he is leaving.
This is good news. NY needs a commissioner who will focus the department on serving the sickest people, rather than the largest number of people. It is the key change needed at OMH: Send those with the most serious mental illnesses to the front of the line, rather than the back, like Hogan did.
We previously wrote Huffington Post why Michael Hogan should be fired and in Albany Times Union on how eliminating OMH could improve services for the most seriously ill. We calculated how his refusal to support one program (Kendra's Law) was costing NYS $73 million. Huffington Post writer and medical director of the New York State Office of Mental Health estimated that inefficiency in OMH was costing up to $665 million. While OMH stopped focusing on the most seriously ill and started focusing on the least, the tragedies mounted as more persons with mental illness shot others, were shot by police, or killed themselves in an effort to escape the Hell that lack of care placed them in.
Hopefully, Governor Andrew Cuomo is replacing Mr. Hogan with a commissioner who will reverse his practices and return the focus to people with serious mental illness. It won't be easy. OMH is the biggest state agency giving out billions of dollars. That tends to gain you a lot of friends interested in preserving the status quo.
Thursday, October 11, 2012
New Report: NYS Office of Mental Health Falsifies Discharge Plans for Mentally Ill
The Inspector General expanded her investigation and found the failure to see that discharged patients get appropriate care is systemic.
Wednesday, August 22, 2012
How NYS Can Comply with Olmstead & Improve Mental Illness Care
- 15,000 New Yorkers with mental illness are living in jails and prisons
- 4,000
New Yorkers with mental illness are living in state psychiatric
hospitals
- In NY you are more likely to be incarcerated
for mental illness than hospitalized.
Saturday, March 17, 2012
Recent Trends in Mental Illness
Trend: More psychiatric hospitals close. Local NAMIs start to fight back.
The trend towards closing state psychiatric hospitals in spite of a massive psychiatric hospital bed shortage is continuing in states like Massachusetts in Illinois, in Alabama, and Washington and elsewhere. NYS announced massive closures and the NY Daily News ran our op-ed in opposition. And when they tried to close a psychiatric unit at Cedar Sinai in Los Angeles, LA NAMI protested. NAMI E. Flatbush NY protested the closing of Kingsboro Psychiatric Hospital in Brooklyn. Historically, NAMIs have accepted hospital closures in return for the promise of community services that never materialize. Nice to see them not falling for it again. It would be great to see state level organizations join in.
Trend: Criminal Justice Systems are taking lead in advocating for better care for seriously mentally ill because Mental Health Departments are failing so miserably.
As a result of mental health departments taking a laissez faire attitude towards serious mental illness, there are more people incarcerated for mental illness than hospitalized. For example, the shooter of seven at Western Psychiatric Hospital turns out to have been mentally ill, known to mental health system, and left untreated. Incidents like this are causing some law enforcement officials to make getting better treatment for people with mental illness a priority, so they don't have to step in.
- American Police Beat Magazine ran a story we wrote, "Police overwhelmed by Mentally Ill", based on a survey by Police Chief Michael Biasotti.
- An Ohio Sheriff announced he is refusing to allow police to drop people with mental illness who are violent off at his jail. He wants them to get treatment instead. This was fantastic news and the first time we've ever heard something like that. MIPO supported the Sheriff .
- A sheriff in Cook County, IL has threatened to sue the mental health department to stop them from refusing to treat people with serious mental illness.
- The Department of Justice issued Community Policing Guidelines which endorsed AOT as a way to return treatment to mental health departments. Another announcement from DOJ is imminent.
Trend: Consumers buck consumertocracy
More and more consumers are exercising their independence and speaking out. Natasha Tracy, a great consumer blogger wrote, "Human Rights and AOT" and about non-compliance.
My favorite quote this month, was from Consumer Blogger Andrew Behrman in "Dump Stigma and Focus on Recovery" who wrote, "The stigma started with me. I initiated it. It was my own fault & result of my naivete"
The Substance Abuse and Mental Health Services Agency (SAMHSA) conducted a survey asking their largely consumer constituency what the top advances in care were over the last twenty years. Assisted Outpatient Treatment made top five. Unfortunately, SAMHSA has a habit of ignoring issues that only affect people with serious mental illness. As we wrote on Huffington Post, SAMHSA's widely quoted report on Mental Illness in America ignored 500,000 seriously mentally Ill
On the other side some government funded professional consumers ("consumertocracy") are still promoting nonsense.
- One professional consumer wrote that because there is no biological test for schizophrenia, it must not exist. That's kind of like arguing that colon cancer didn't exist before the colonscope was invented. (BTW, there is no biological test for Parkinsons either. Yet it exists.)
- Many professional consumers are using the fact that people with mental illness die earlier than others as an argument against medications. But many of these premature deaths are due to side effects of non-treatment. For example suicide, homelessness, incarceration, and lack of medical care.
- Robert Whitaker's Anatomy of an Epidemic repeated many of these arguments without any information on the other side.
In Brief
- Major study says 'art therapy' does not work for people with schizophrenia
- Scientist asks for proof that anti-stigma campaigns work
- APA Task Force Report on Outpatient Services for the Mentally Ill Involved in the Criminal Justice System argues for preserving psychiatric hospitals and using mandated outpatient treatment
- Short Sweet Video of Dr. E. Fuller Torrey on his updated book: The Insanity Offense, which includes the most comprehensive information on Jared Loughner who suffered from untreated mental illness and shot Gabrielle Giffords. (Must-reading)
- "Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill" by Mary Beth Pfeiffer is really wonderful. She shows how tiny episodes of mental illness feuled behavior can snowball and result in permanent incarceration. Two thumbs-up. (Don't confuse this with another excellent book: Pete Earley's, "Crazy: A Father's Search Through America's Mental Health Madness")
- Treatment Advocacy Center Preventable Tragedies database lets you search incidents of violence by and to people with mental illness in your own state. Powerful tool to advocate for changing laws
Around the states
California
Laura's Law and ever increasing incidents of violence by mentally ill individuals took center stage in California. A bill to Extend Laura's Law was introduced and given huge support by San Francisco Chronicle. A brilliant Sacramento Bee op-ed by psychiatrist Gary Tsai says cuts to mental health programs shift burden to law enforcement. To help people keep up, we launched a special site on Laura's Law and the Mental Health Services Act with lots of useful information. Unfortunately mental health directors, Disability Rights California, and consumer groups have formed a coalition designed to prevent people with mental illness from receiving treatment until after they become dangerous. While done in the name of 'civil rights', this results in people becoming incarcerated and losing all rights.
The other big California story is Proposition 63/Mental Health Services Act money being diverted away from serious mental illness. For instance, it is funding the opponents of Laura's Law. Mary Ann Bernard, Of counsel for Mental Illness Policy Org wrote a great piece in California Progress Report on this, and DJ Jaffe, ED of MIPO wrote a a separate story, "Proposition 63 fails to serve seriously mentally ill" in Capital Weekly.
New York
MIPO testifies that NYS Commission on Quality of Care fails mentally ill and we wrote an op-ed in New York Daily News criticizing proposed closings of psychiatric hospitals.
VA
Pete Earley on failure of Virginia mental health system
TX
Judge rules mentally ill incompetent to stand trial are being held in jail for too long before being moved to hospital
VT
Report calls for better care to prevent incarceration of mentally ill
MA
MA agrees to treat mentally ill prisoners better and revised their Civil Commitment practices.
Thank you for your support of Mental Illness Policy Org. This is a labor of love, and if you can afford it, we can use your tax-deductible donations.
Monday, January 30, 2012
Problems at NYS CQC and P&A Programs
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.