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.

New Democrat Mental Health Bill Needs to do more for Seriously Mentally Ill

Quick Rough Instant Analysis of Comprehensive Behavioral Health Reform and Recovery Act of 2016’ an alternative to HR 2646.

MentalIllness Policy Org. will be studying the bill in detail over the next day or two. In the interim, here is our instant analysis.

Statement by DJ Jaffe, Executive Director of Mental Illness Policy Org. We thank the Democrats for introducing this bill, but note that it largely ignores reforms that could help the most seriously mentally ill. It is the seriously mentally ill, not the worried-well who cause added expense and are responsible for tragedies. Congress must focus on the elephant in the room: getting treatment to the most seriously mentally ill and this bill does not.

Summary.  This bill does a better job at ‘poor mental health’ than delivering treatment to people known to have the most serious mental illnesses. It maintains most of the failures of the existing system and layers more programs on top. Some are good programs, others not.  It fails to include the most important provisions of Helping Families in Mental Health Crisis Act (HR 2646) that help people with the most serious mental illness:

• Assisted Outpatient Treatment (AOT): HR2646 bill provided $15 million for Assisted Outpatient Treatment which has been extensively independently researched and proven to reduce homelessness, arrest, incarceration in the seriously mentally ill, in 70% range[1]. This bill instead allocates $20 million to Mental Health First Aid (MHFA) which has been researched and not shown to help the mentally ill.[2] It is candy for the mental health industry.
• SAMHSA: The failure of SAMHSA to focus on serious mental illness, it’s waste, have been well-documented by Mental Illness Policy Org and the E&C, O&I Committee. HR2646 largely disbands SAMHSA. This bill calls for yet another “study”. In the interim, it empowers SAMHSA even more. While HR2646 would require the head to be an MD, this bill creates a new bureaucracy within SAMHSA “Office of Chief Medical Officer”. It seems to make SAMHSA Administrator an Asst. Sec of Mental Health.
• Hospital Care: Like, HR 2646, the bill codifies that managed care plans can pay for 15 days of hospital care for individuals in capitated payment plans. But it largely maintains the discriminatory provisions in Medicaid (IMD Exclusion), that prevent people in ‘fee for service plans’ (50% of those on Medicaid) with serious mental illness from getting hospital care when needed.[3]
• Protection and Advocacy. The bill does not reform the Protection and Advocacy Program which funds federally funded lawyers in states who work to prevent care for the most seriously ill.[4]
• HIPAA: The bill leaves HIPAA as is, but sets up procedure to create new regulations. Since the regs must work within existing legislation, they are not likely to have an effect. Families who provide care out of love to mentally ill will continue to be prevented from receiving the same info paid providers receive.

Congress can not be claiming to do mental health reform when it  ignores the most seriously mentally ill. We urge Congress to stop shunning the most seriously mentally ill.  Here are our ideas.

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[1] http://mentalillnesspolicy.org/national-studies/aotworks.pdf

[2]  http://mentalillnesspolicy.org/samhsa/mental-health-first-aid-fails.html

[3] http://mentalillnesspolicy.org/media/bestmedia/imd-exclusion-washington-post.html

[4] http://mentalillnesspolicy.org/myths/mental-health-bar.pdf

Mark Salzer who gets funds from SAMHSA supports SAMHSA

Mark Salzer, Ph.D., who is Chair of the Department of Rehabilitation Sciences at Temple University wrote a surprising oped for the Philiadelphia Inquirer. It claimed, “SAMHSA has clearly served people with serious mental illnesses” and “The elimination or curtailment of SAMHSA would be a major blow to progressive mental-health policies in the United States.”

There were no real specifics and the massive evidence documenting problems at SAMHSA shows eliminating it and transferring it’s responsibilities elsewhere would likely improve services for the most seriously mentally ill. So Mental Illness Policy Org. decided to look into what might have led Dr. Salzer come to his conclusion.

Dr. Salzer’s CV shows that he and his projects receive over $4 million directly from SAMHSA.

It is not known if this financial support from SAMHSA influenced his high opinion of SAMHSA or he really believes what he wrote. It is not known if he disclosed what most would consider a serious conflict to the editors before submitting his oped. The oped itself made no disclosure.

Almost all the support, the only support, for SAMHSA seems to come from those who receive money from it or benefit from it. It is not surprising they want their sugar daddy to stay in existence. 

Following are the grants Dr. Salzer lists on his CV. Over $4 million are identified by him as coming from SAMHSA.

• Principal Investigator. Evaluation of Friends Connection. SAMHSA CMHS Consumer-Initiated Services Collaborative Agreement (SM52355; $2,267,034; 9/98-9/03).
• Principal Director. DELCO (PA) Self-Directed Care Project. Transformation Technology Transfer Initiative, SAMHSA. ($221,000; 5/1/14 – 6/30/15).
• Principal Director. Enhancing the role of Pennsylvania’s Statewide Network of Certified Peer Specialists. SAMHSA Transformation Transfer Initiative ($107,000; 1/12 – 9/12).
• Evaluation Co-Director. CABHI-States. SAMHSA States CABHI Initiative, subcontract to Mental Health Association of Southeastern PA. (1H79TI025346-01; $1,500,000; $156, 354 subcontract; 10/13 – 9/16).
• Evaluation Co-Director. Philadelphia Homeless Initiative. SAMHSA CABHI Initiative, subcontract to Mental Health Association of Southeastern PA. (TI23520; $1,500,000; $150,000 subcontract; 7/12 –6/15).
• Consultant. Infusing Peer Specialists into Pennsylvania’s Behavioral Health Crisis Services System. Transformation Technology Transfer Initiative, SAMHSA. ($221,000; 1/1/15 – 9/30/15).
• Evaluation Consultant. Certified Peer Support Specialists as Healthcare Navigators and Wellness Coaches Within Federally Qualified Health Centers. SAMHSA Transformation Transfer Initiative to Michigan ($221,000; 1/12 – 8/12).
• Evaluator and proposal consultant. Pennsylvania Statewide Consumer Network Grant. (Mary Kohut, PI). Funded by SAMHSA/CMHS (SM56338-01; $70,000; 10/1/04 – 9/30/06).
• Principal Consultant. National Mental Health Consumers’ Self-Help Clearinghouse. Funded by SAMHSA/CMHS (SM56065-01 - Joseph Rogers, PI). ($495,000; 10/1/03 – 9/30/04).
• Evaluator. Family Ties (Training, Instruction, Empowerment, and Support). Funded by PEW Foundation to Mental Health Association of Southeastern Pennsylvania ($210,000; 4/1/10 – 3/31/13)
• Evaluation Director and consultant. National Mental Health Consumers’ Self-Help Clearinghouse. Funded by SAMHSA/CMHS (Joseph Rogers, PI). ($1,200,000; 10/1/07 – 9/30/10).
• Evaluator. Keystone Pride Recovery Initiative. Funded by SAMHSA Consumer Network grant (5SMO59833-02) to the Pennsylvania Mental Health Consumers Association ($70,000; 10/10 – 9/13).

 He also does work for other entitites that get their own funds from SAMHSA. These are just a few. 

• Consultant. Promoting Olmstead in Pennsylvania. Advocates for Human Potential ($20,000; 1/12 – 9/12).
• Program Director. Philadelphia Disaster Response Network. Contract with Mental Health Association of Southeastern Pennsylvania ($22,751; 9/1/02 – 4/1/03).
• Evaluation Director and consultant. National Mental Health Consumers’ Self-Help Clearinghouse. Funded by SAMHSA/CMHS (Joseph Rogers, PI). ($1,100,000; 10/1/04 – 9/30/07).

Most of the studies which Dr. Salzer is associated with above, seem to focus on peer support. SAMHSA’s own review of the research shows: “The literature [on peer support] that does exist tends to be descriptive and lacks experimental rigor." We don't know if SAMHSA was referring to this research. SAMHSA funds other research.

The well-respected Cochrane Collaborative reviewed all the high- and low-quality data on peer support and concluded: 

Involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management.

Another study, also not by Salzer, "adds to the evidence suggesting no short-term incremental benefit (or harm) from peer services beyond usual care.” 

In spite of this research casting doubt on peer support, SAMHSA continues to fund it. Is that why SAMHSA supported researchers and consumer groups want to preserve SAMHSA?