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By
Sean Moran
“The
mental health service delivery system is broken.”
That is the conclusion of a recently released report from
the New York State Assembly Committee on Mental Health,
Mental Retardation, and Developmental Disabilities, chaired
by retiring Assemblyman Martin A. Luster (D-Ithaca).
Entitled “Broken Promises, Broken Lives: A Report
on the Status of the Mental Health Delivery System in
New York State,” the 30-page report accuses the
state of failing to meet the needs of mentally ill New
Yorkers by its lack of adherence to the statewide planning
requirements of the New York Mental Hygiene Law; allowing
the Community Mental Health Reinvestment Act to lapse
– siphoning away millions of dollars from the mental
health system — and by poor oversight of both the
discharge policies of state psychiatric hospitals and
the scandal-plagued adult home industry, into which thousands
of former state psychiatric patients have been placed
over the past several years.
Combined, these factors have contributed to what the report
terms a “public health crisis,” by which “thousands
of mentally ill persons have suffered indignities and
abuse, and hundreds of others have succumbed to untimely
deaths due to a dysfunctional mental health system.”
Statewide Planning
The Willowbrook scandal of the 1970s led to a thorough
overhaul of the New York State mental health system, codified
through the Mental Hygiene Laws of 1977, which, among
other requirements, mandated that the then newly-created
Office of Mental Health develop a five-year statewide
blueprint of goals and objectives for serving the state’s
mentally ill. With annual revisions and with significant
input from consumers, advocacy groups, and local (county)
government agencies, the statewide plan was intended to
be a “bottom-up planning process” that would
“reflect a partnership between State and local governmental
units, and emphasize how gaps in services would be filled.”
The Assembly Mental Health Committee’s report contends,
however, that a comprehensive statewide plan that conforms
to the spirit, if not the letter of the 1977 Laws, has
not been submitted to the state Legislature by OMH since
1994. The most recent comprehensive plan was presented
by OMH in May 2001, at which time the committee determined
that it fell short of the Mental Hygiene Law’s reporting
requirements. Notably absent, the report said, were any
indications of the plan being formulated from the individual
plans and needs of local governments.
Community Reinvestment
The Assembly committee’s report faults the Pataki
administration for allowing the New York mental health
system to hemorrhage millions of dollars through a lack
of commitment to the Community Mental Health Reinvestment
Act of 1993, which called for the state to direct funds
saved by the closing of state psychiatric hospital beds
into community-based mental health services. Calling the
governor’s support of reinvestment “lukewarm
at best,” the report said savings from state hospital
bed closures were underreported, thereby “removing
significant resources that could have been used to stabilize
and expand community-based mental health services.”
The report cites an internal OMH memo, dated June 3, 1993,
which estimated that for each state bed closure, $64,000
would be available for reinvestment into community-based
programs. While the 1994 Reinvestment Act established
that a minimum of $57,500 be reinvested for each bed closure,
the report claims the state utilized this amount as a
ceiling rather than a floor, allowing $6,500 per bed closure
to escape into the state’s general fund between
1995-1998, costing the mental health system in excess
of $84 million.
Since the expiration of the Reinvestment Act in September
2001, the report estimates that an additional $71 million
has been drained from the mental health system. The report
faults the Pataki administration for allowing the Act
to lapse after the Assembly rejected the governor’s
proposal to close two more psychiatric centers and consolidate
children’s psychiatric facilities in order to fund
a Cost of Living Adjustment for mental health workers
and a Medicaid rate increase for community mental health
programs. The report said the Assembly Ways and Means
Committee had determined there were already sufficient
funds available through bed closure savings to meet the
costs of the COLA and Medicaid rate increase, making the
psychiatric center closures and consolidations unnecessary.
New reinvestment legislation was passed by both houses
of the NYS Legislature in June 2002, featuring a new per-bed
closure savings floor of $70,000. “The Governor
has failed to request the legislation be delivered for
his review and approval consideration,” the report
said.
Discharge Planning
Section 29.15 of the NYS Mental Hygiene Law provides standards
for the discharge planning of individuals in state psychiatric
hospitals. A written, individualized service plan detailing
the patient’s post-discharge treatment and vocational
needs and the corresponding services available to the
patient in the residential program to which he or she
will be discharged, is required, along with post-discharge
follow-up to ensure that the needs indicated in the plan
are being met.
Citing both a study from the NYS Commission on Quality
Care for the Mentally Disabled, “Falling through
the Safety Net: ‘Community Living’ in Adult
Homes for Patients Discharged from Psychiatric Hospitals,”
and the series of New York Times articles detailing the
adult home scandal, the report charges that OMH has failed
to: 1) assess the adequacy of discharge service plans
and residential placements; 2) conduct sufficient post-discharge
follow-up to ensure that the needs of former patients
are being met.
Testifying at a June 2002 public hearing on Adult Homes,
OMH Commissioner Stone defended the post-discharge tracking
of former state hospital patients.
“By way of background, I would just remind everybody
that people can recover from mental illness and people
do recover from mental illness,” he stated. “So
we never have any intention — ours is not a cradle-to-grave
agency in which we track people with mental illness for
the rest of their lives.”
“While Commissioner Stone’s statement that
some people recover from mental illness is true, it is
also true that some do not,” the report states.
“Section 29.15 of the Mental Hygiene Law does not
state that the responsibility of OMH to develop a written
service plan and monitor its implementation ends after
a certain number of days, months, or years. Section 29.15
is open-ended in recognition that for certain chronically
mentally ill persons, the State has a cradle-to-grave
responsibility, just as it does with the mentally retarded
and developmentally disabled.”
Adult Homes
Tied into the criticism of OMH discharge policies is the
oversight of the adult home industry in New York, into
which thousands of former state psychiatric hospital patients
have been placed during the past several years. Some of
the report’s strongest language is aimed at the
abusive practices of some adult home operators toward
mentally ill residents, and the failure of the state’s
Department of Health to provide sufficient regulation
of the industry.
The report cites numerous abuses in the industry –
home to more than 12,000 New Yorkers with mental illness
– from mismanagement of resident funds to unsanitary
living conditions. The report took the Department of Health
to task for reducing the number of state adult home inspectors
from 25 to 5; for reducing fine amounts levied against
adult home operators for violations; for failing to provide
the Legislature with annual reports on the regulation
of adult homes, as required by Section 460(d) of the Social
Services Law, and for failing to complete thorough inspections
of homes every 12 to 18 months, as required by DOH’s
own regulations.
Acknowledging that it relied heavily on the investigative
reporting of Clifford Levy of the New York Times, the
report also briefly discusses the creation of special
nursing home units – often locked floors - for former
state psychiatric hospital patients, which was done without
the knowledge or consent of the Legislature, a violation,
the report contends, of the state Constitution.
Recommendations
“Broken Promises, Broken Lives” makes several
broad recommendations for improving New York’s mental
health system, including the strengthening of OMH planning
requirements; increasing adherence to discharge planning
statutes of the Mental Hygiene Law, and addressing the
mental health housing crisis in a manner consistent with
the Olmstead Act, the federal law mandating states to
place a citizen with a mental disability in the least-restrictive
residential setting possible.
A copy of the report may be obtained by calling Assemblyman
Luster’s office at 518-455-5444.
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