Saturday, April 11, 2009

The Ratings Game—How Do NY State's Mental Health Programs Rate a B?

There's good and bad in the latest NAMI national report

NY State Office of Mental Health gets a B grade from national NAMI for its operation of the mental health system in this state, and that's quite an uptick above the U it received three years ago, for “unresponsive, “ the last time the poll was taken. (see state report card for New York on website).
NAMI was most generous to award New York a B, considering its average grade awarded nationally was a D, and NAMI had to qualify its remarks about our state by saying:“Despite this high grade, all is not perfect. New York has many strengths, but it also has many problems.”
The NY State mental health commissioner, Michael Hogan, agreed, noting that “While we are gratified by a relatively good rating, we have a long way to go. The report recognizes the progress we are making in NYS to better support recovery from mental illness, but its criticism of our shortcomings is pretty accurate in my view.”
That comes with the territory. The OMH is a vast outfit with a $2.6 billion annual budget and many thousands of employees stretched over a network of state OMH hospitals and other facilities and involving some 2,500 local government and not for profit contracting agencies. It's governed by federal rules for much of its spending like Medicaid and the funding is managed by the state Health Department to a large degree. The Office of Mental Health plays second fiddle to Corrections when it comes to mental health treatment of state prisoners and it must follow Criminal Justice law and regulations for services to inmates of city and county jails.
The way that NAMI collects this data is to send a bunch of forms to the agency itself and ask it to rate itself. Then there are others to corroborate or challenge what is returned on the forms. Somehow the NAMI wits mesh this all together and come up with a report card and a grade from a thousand miles away—so you can take these surveys for what they're worth.
Even with the fairest of survey documents you might find reports like these don't tell much about the quality of the service afforded and the kind of people in charge and the net effect on the main constituents—those individuals with mental illness in all their troubled behaviors, and their families who suffer with them.
Strengths and weaknesses of our state's mental health system are pointed out in the survey. But first, an opinion: The biggest failing of this study is NAMI's missing the boat on the way New York's mental health system is skewed like no other state to put major resources into some 26 state hospitals (17 for adults, three adult forensic, and six for children). These and the main office take over 50 percent of the budget to serve some 4,000 people, while the other half of the pie is meant to cover over 500,000 children and adults served by the agency who live in our communities with all kinds of problems, from schizophrenia to gambling, suicide risks and sex offenses.
“The OMH has emphasized support for evidence-based practices,” the report begins. “Seventy-seven Assertive Community Treatment (ACT) teams exist throughout the state (one in Schenectady). OMH also funds supported employment, peer counseling, peer education and consumer-run programs.
“Placement of large numbers of consumers in substandard adult care homes has been the subject of ongoing litigation. OMH is working to assist adult home residents to move into community-based housing linked with supportive services.” (see later article on Disability Advocates and adult homes)
“New York is also investing in housing,” it asserts. “A recently signed agreement between New York City and the state, 'New York/New York III,' commits combined state and city resources to develop 9,000 housing units over 10 years. The Pathways to Housing “Housing First” model has become internationally recognized. Despite these initiatives, lack of housing is still a very serious problem.”
Most of us would agree. The shortages seem to be getting worse each year as the numbers of people waiting for apartments and group homes outpace the publicly subsidized units added to the housing stock. People live in substandard housing in the wrong neighborhoods and many of the state's homeless population are mentally ill. While the state office pledges to open thousands more beds each year, it is still clearing a backlog of previous years out of the pipeline.'
“In 2007, the report continues, “New York finally enacted Timothy's Law, after a battle to achieve mental health insurance parity” (yes, it took 20 years from conception to passage) and the law still is not permanent, is up for grabs this year.
“In 2008, another important development was enactment of a law to limit segregation of prisoners with serious mental illnesses and instead provide them with treatment.” That's the SHU law (prison special housing, called “the box,” for mentally ill people and others) that won't be put into effect till 2011. Only last month a proposal to delay this three more years was defeated but it shows you how opposition remains to something as humane as this prison reform
“Kendra's Law, which authorizes involuntary assisted outpatient treatment, has resulted in fewer hospitalizations and arrests, as well as new investments in mental health services and supports,” the survey finds. True, New York's law has become a model for many other states
“Deficiencies exist, including severe shortages of acute care psychiatric beds and crisis stabilization programs. Confronted with dual problems of inadequate reimbursement rates and staff shortages, a number of community hospitals have recently downsized or closed psychiatric treatment units. Predictably, emergency rooms are overwhelmed with individuals in crisis with no available treatment beds.” This is worse than the situation we find at Ellis Hospital in Schenectady but psych beds have closed at Albany Med and elsewhere in the region.
'”New York is surprisingly far behind many other states in developing partnerships between law enforcement and the mental health system. Only two police Crisis Intervention Team (CIT) programs currently exist.” But these take money and you need a fair sized city to support them
“In 2009, New York's economic challenges cloud the horizon. Financial collapse on Wall Street and the recession have resulted in a $15.4 billion deficit, the largest in the state's history. Many consumers and families fear the economic squeeze could negate progress made in recent years.
“New York has potential to become one of the national leaders in public mental health care.” However, the report concludes, “budget cuts, retreats, or delays in improving services will signal a faltering commitment to evidence-based, cost-effective transformation, and recovery. The next few years will be vital in setting the state's course for the future.”
The survey writers might tell this to Commissioner Hogan, who's dead-set to reform the delivery and funding of services. Time will tell if the B grade turns itself into an A or a D next time around. Here are some family and consumer comments that came with the report:
--”Emergency rooms at hospitals...It's like a nightmare and ignorance prevails with staff”
--”No help from law enforcement agency or mental health system unless something bad happens”
--”Most of the providers are dedicated and very caring”
--”We need more housing that is safe and where they dispense the medication.”
(Roy Neville)

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