Showing posts with label New York State. Show all posts
Showing posts with label New York State. Show all posts

Monday, February 22, 2016

NYS Needs Kendra's Law & Psychiatric Hospitals. Don't let mental health industry close them

The two trade associations representing NYS mental health providers (NYAPRS and MHA) are having their annual rally in Albany tomorrow (Tue. 2/23). We OPPOSE their attempts to move mental health spending away from the 5% who are the most seriously mentally ill and towards the higher functioning. Their proposals to end Kendra’s Law and close state psychiatric hospitals puts patients, police, and public at needless risk. We will be in Albany on Tuesday to oppose raiding services that treat the seriously mentally ill.

1. Support making Kendra’s Law Permanent and Stronger. (S-04722/A01275).

While NAMI/NYS supports this, the trade associations do not. Kendra’s Law is NY’s most successful program for the most seriously mentally ill. It allows judges to order someone who already accumulated multiple episodes of arrest, violence, incarceration or needless hospitalization to stay in six months of mandated and monitored treatment while they continue to live free in the community. It is only available to those who already refused to accept voluntary treatment that was made available to them. It also allows judges to order community programs to accept these individuals into their programs. Kendra’s Law is proven to reduce arrest, violence, hospitalization and incarceration in 80% range each, cut costs to taxpayers and reduce stigma. 81% of those in it said it helped them get well and stay well.
S04722/A01275 make Kendra’s Law permanent, ensure court orders are reviewed before expiring, requires community directors to take reports from family members about loved ones who might benefit, and lowers cost by allowing patients to voluntarily stipulate to Kendra’s Law orders. The NYS Assoc. of Chiefs of Police support.

2. Oppose Closing more Psychiatric Hospital Beds.

The trade associations are supporting Gov. Cuomo’s budget proposal to close 225 more psychiatric beds that serve the seriously mentally ill. We oppose. The trade associations look at these beds as a bank account and want them closed so the savings can be given to their member organizations. But there are two problems with that. NYS is short at least 4,000 psychiatric hospital beds even if we had perfect community programs. So closing hospitals guarantees the sickest will not receive treatment. Secondly, even when some savings are given to community programs, they refuse to use them to provide actual treatment to the same adults who are being discharged from hospitals. Instead the funds are used on wasteful sideshows like educating the public, fighting ‘stigma’, identifying the asymptomatic, or funding programs with no evidence of efficacy. As a result, NYS has more mentally ill incarcerated than hospitalized. The percentage of prisoners in NYC jails with mental illness shot up 30% between 2010 and 2014.
We do support increasing housing options, but first we must increase those that provide 24/7 onsite support (group homes), versus the independent housing options supported by the trade associations that serve the higher functioning.

Monday, June 24, 2013

Anti Stigma Effort Fortunately Fails in New York State

We are happy to report that the effort to get a donation check-off put on NYS Tax forms (A5953) to encourage people to make a donation to 'stigma' did not pass and the legislative season is over.

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

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.

Thursday, November 1, 2012

NYS Office of Mental Health: The wrong response to Hurricane Sandy

Whenever a tragedy like Hurricane Sandy strikes, the New York State Office of Mental Health (OMH) calls up mental health workers en masse and assigns them to do counseling for those affected by the tragedy. The problem is, they’re not needed, rarely do any good, are expensive, and take resources away from where they are truly needed: helping the most seriously mentally ill.

Monday, October 22, 2012

NYS OMH Commissioner Leaving: Good News for NYS

Last week we wrote on a NYS Inspector General Report proving the NYS Office of Mental Health (OMH) falsifies discharge plans of people with mental illness in order to kick them out of the hospital.

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

An investigation by acting New York State Inspector General Catherine Leahy Scott found officials at Kingsboro Psychiatric Center allowed the release of mentally ill patients without a required discharge plan and then directed staff to cover it up. In this particular case, Kingsboro discharged a mentally ill woman to a street corner near a shelter. (Read Full Report or Summary)
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


NYS is currently holding hearings and accepting write in testimony on how to comply with the Supreme Court decision, Olmstead v. L.C. That decision held that Title II of the ADA requires services for persons with mental illness be provided in the “most integrated setting appropriate to the needs of the disabled, considering available resources". 

We believe that using Kendra's Law more can help accomplish that because it is proven to reduce the use of more restrictive settings like incarceration and inpatient commitment. Unfortunately, those who scheduled the hearings did not schedule any hearings in jails, prisons, or psychiatric hospitals, the three most restrictive settings. As a result, the testimony they are likely to hear will not reflect the thoughts of persons in the most restrictive settings, the professionals who provide care for them or their families.

You can send your own thoughts on how to serve people with mental illness in the least restrictive, most integrated settings to raymond.l.pierce@opwdd.ny.gov echoing the below to or fill out the form at http://www3.opwdd.ny.gov/wp/wp_catalogz2414.jsp . You can learn more about Kendra's Law at http://kendras-law.org

Testimony of DJ Jaffe

NYS Olmstead Implementation Plan Public Hearing
August 21, 2012

NYS is required to make greater use Kendra’s Law to ensure individuals with mental illness receive treatment in the most integrated setting as required by Olmstead v. LC

Failure to use Kendra’s Law could create liabilities for the state and localities.

 “It is a common phenomenon that a patient functions well with medication, yet, because of the mental illness itself, lacks the discipline or capacity to follow the regime the medication requires.” . (Olmstead V. L. C. (98-536) 527 U.S. 581 (1999))

It must be remembered, for the person with severe mental illness who has no treatment the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our own powers to describe.... (Olmstead V. L. C. (98-536) 527 U.S. 581 (1999))



1. New Yorkers with serious mental illness are not living in most integrated setting
    • 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.

2. The problem is not lack of “available resources.” NY has “available resources”

            * NYS spends in excess of $3 billion on mental health
            * Individuals with serious mental illness are largely excluded from OMH programs especially if they lack the ability to volunteer. The seriously ill go to the end of the line while worried well go to front.
            * OMH has never improved services for the most seriously ill, absent a court order.
            * $665 million of OMH budget (1/3) wasted per Dr. Llloyd Sederer: “Thus, taken together, $665 of the $814 (more than 80 percent!) was spent, perhaps unnecessarily, on people with mental disorders, principally for the serious medical illnesses that they frequently suffer.”
             * OMH refuses to focus existing resources on the 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. 

OMH policies transfer the seriously ill to shelters, prisons and jails in violation of Olmstead.

3. Kendra's Law research shows it can help people live in the least restrictive most integrated setting

Once enrolled in Kendra’s Law
·  77% fewer experienced psychiatric hospitalization
·  On average, AOT recipients' length of hospitalization was reduced 56% from pre-AOT levels.
·  83% fewer experienced arrest
·  87% fewer experienced incarceration.
March 2005 N.Y. State Office of Mental Health “Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment. “

·      Individuals who received court ordered treatment in addition to enhanced community services spent 57 percent less time in psychiatric hospitals than individuals who received only enhanced services.
·      Individuals who had both court ordered treatment and enhanced services spent only six weeks in the hospital, compared to 14 weeks for those who did not receive court orders.
1998 Policy Research Associates, Inc. Research study of the New York City involuntary outpatient commitment pilot program.

Patients given mandatory outpatient treatment - who were more violent to begin with - were nevertheless four times less likely than members of the control group to perpetrate serious violence after undergoing treatment.
February 2010 Columbia University. Phelan, Sinkewicz, Castille and Link. Effectiveness and Outcomes of Assisted Outpatient Treatment in New York State Psychiatric Services, Vol 61. No 2

For those who received AOT the odds of any arrest were 2.66 times greater and the odds of arrest for a violent offense 8.61 times greater before AOT than they were in the period during and shortly after AOT. The group never receiving AOT had nearly double the odds of arrest compared with the AOT group in the period during and shortly after assignment.
March 2005 N.Y. State Office of Mental Health “Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment. “

(AOT) improves likelihood that providers will serve seriously mentally ill: It is also important to recognize that the AOT order exerts a critical effect on service providers stimulating their efforts to prioritize care for AOT recipients.
June 2009 D Swartz, MS, Swanson, JW, Steadman, HJ, Robbins, PC and Monahan J. New York State Assisted Outpatient Treatment Program Evaluation. Duke University School of Medicine, Durham, NC, June, 2009

Providers of both transitional and permanent housing generally report that outpatient commitment help clients abide by the rules of the residence. More importantly, they often indicate that the court order helps clients to take medication and accept psychiatric services.
1999 NYC Dept. of Mental Health, Mental Retardation and Alcoholism Services. H. Telson, R. Glickstein, M. Trujillo, Report of the Bellevue Hospital Center Outpatient Commitment Pilot


Research in numerous other states support the proposition that AOT enables individuals with serious mental illness to live in the least restrictive most integrated setting.

To be compliant with Olmstead, NY must make greater use of Kendra’s Law. To offer humane care for the most seriously ill NY should make use of Kendra’s Law.

 To learn more, visit http://kendras-law.org




[i] http://www.huffingtonpost.com/lloyd-i-sederer-md/patient-care-managing-high-need_b_8134

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.

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

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 PAIMINYS 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.