Wednesday, October 7, 2009

Looking at the state's latest mental health master plan--Toward The New Jerusalem

The state just issued a draft in September of its latest five year projections for mental health services, called the 5.07 plan. This year's master plan is full of words like recovery, resilience and transformation, all pet expressions of the state commissioner of mental health, Michael Hogan.

These odd terms are at the core of the latest planning approaches and reveal a lot about what the agency thinks it is doing. Things start off with:“How do we create hope-filled, humanized environments and relationships in which people can grow?”

The commissioner replies forthrightly: “At the Office of Mental Health, we each find our own meaning in recovery and resiliency. At the OMH our embrace of recovery and resilience recognizes two truths. First, they each reflect a journey rather than a destination. Recovery is not remission. It is not a miracle cure. Rather, it is the process of living a good life despite illness and loss.”

He goes on to say, “The second truth is that recovery and resilience each depend on change made by the individuals involved. Treatment can help. Indeed, for most people, finding the right treatment is a foundation of recovery. But treatment alone is almost never enough. The recovery journey requires personal engagement and action.”

So it goes. We are on a journey toward transformation into better selves. We can pull ourselves up and out of our malaise if we see the light. Others have done it—read their stories. We can kick the habit of street drugs and alcohol, wake out of our stupor, start a brand new life, if we choose.

Maybe. The agency isn't really talking about people with schizophrenia, is it? The word is almost never mentioned, nor is bipolar depression nor any of the illnesses associated with emotional pain and suffering that can last a lifetime. These are the illnesses that may take another half century or longer to figure out and now offer few clues as to their origins, how to cure them or ease the suffering of victims.

The illnesses not mentioned are the ones most difficult and costly to treat, the ones that engender fear and distrust because people with severe brain illnesses can't always control their behavior. The seriously ill may not be on the OMH's radar anymore, along with people who are homeless, in jail and prison, on probation or parole, those with long or repeated hospital stays, who tie up emergency rooms and create problems for nursing home operators. There's a slew of severely mentally ill people who don't receive services and who never will from an agency that thinks the diseases are volitional—that is,where someone only needs to find the motivation to change their ways, find a job, or stay “clean”.

It's a mistake, I believe, when the planning is all about health and wellness and not illness. The book gets stuck on words like resilience and recovery, much like a sermon on Sunday morning. It wants us to believe there's a New Jerusalem out there, a shining light on a hill, a transforming vision of who we are and what we can become. If only we follow the precepts and guidelines of our benefactor, the state.

I'm being sarcastic because I think their stand has too much art in it, it's a smokescreen, part of a political strategy. In truth, they're cutting back millions of dollars in spending for community based mental health—where labor costs are high and some in the public and the legislature don't believe the money is well spent now.

As we suffer from stigma and disgrace, and the population of seriously mentally ill continues to grow, in the matter of spending on needed community services, the state capitulates, closes continuing day treatment programs, eliminates a valuable program called COPs, exerts pressure on the housing providers in order to recoup its so called “excess” Medicaid funds already spent by the group homes. Meanwhile, the state hospitals at OMH direction, refuse patients coming from psychiatric units of general hospitals who should be confined longer, in an unabashed policy reversal to save money

Much is said in the document about restructuring mental health clinics to see that their role is clarified and pay is better. Hospitals with psychiatric units are to receive rewards also. However, the state will continue to shift the locus of care from hospitals, nursing homes and adult homes to the community, without the money alongside. For children and adolescents, at least, there are more in-home services.

With all the emphasis in this document about mental health being an intricate part of general health and how problems are prevalent and troubling, we don't get a picture that they're going to make any frontal assaults on the barricades. “Gaining access to good care is like running the steeplechase--a long process with too many barriers” someone observes.

As to the state's vision, we are asked “What does good mental health care look like?” The reply: “Good care is accessible, personalized, continuous, and integrated, and it emphasizes the ability of each person to live, learn, work and participate fully in his or her community. The best of treatments, including medications, evidence-based behavioral intervention and psychotherapy, do not cure mental illness. Rather, they help people manage their symptoms.” And the new thrust helps people find the motivation.

That's as good as it gets in terms of a modest self appraisal. But we know how much more needs to be done to assure access and affordability of services and facilities. Too few with a serious mental illness hold jobs, live in decent housing, have companions and earn any real income.
Some topics are missing. For example, in the criminal justice arena: Why aren't steps taken to follow through under the law to take mentally ill prisoners out of punitive special housing in prisons? Why don't more city and town police officers receive inservice training from state and county mental health personnel? Why has OMH let the legislature put convicted sexual offenders in parts of some state psychiatric hospitals?

The plan does state that these are harsh economic times and budget cuts have stopped some progress. But it seems mentally disturbed people who are homeless or in jail or prison, who have significant physical problems as well as mental, who are elderly or frail, or stuck in nursing homes and adult homes, aren't attractive to the new creed. They're not included among the groups destined for recovery and we don't hear much about them in this document. .

The 5.07 plan doesn't really deal with them at all, yet they represent a good proportion of the state's troubled mentally ill. Some are wrongly confined in nursing homes in NY City, as a federal judge has recently ruled. It will take more than appeals to the soul to provide more spaces for these adults, to keep up with population growth, to serve veterans, the elderly and others—and this is the responsibility of the state Office of Mental Health. And it will take more than resilience to get it done. (Roy Neville)


  1. "The agency isn't really talking about people with schizophrenia, is it? The word is almost never mentioned, nor is bipolar depression nor any of the illnesses associated with emotional pain and suffering that can last a lifetime."

    What is interesting is I am diagnosed with Bipolar I one of the more severe levels of Bipolar.

    The commissioner is bringing me hope. I don't see him as putting everyone into one catagory and making everyone fit that one.

    It would be foolish and he would look foolish to try such a stunt.

  2. I read that Post and got it fine and informative. Mentalism niche