Published in the Westchester Guardian, March 2014
I do not know how this will affect the mentally ill community and their daily suffering but we have a lot of opinions.
Governor Andrew Cuomo has implemented a plan to redesign our mental health system. Ideally, this should decrease overall cost, improve the safety net and its treatment of the inflicted and their families. The closing of 9 of Our State’s 24 mental health impatient facilities and the conversion to ‘hubs’ should save $43 million upon full implementation. There will be 5 Office of Mental Health (OMH) regions with each region containing 2 or more Regions of Centers Excellence (RCEs) for a total of 15 RCEs. “RCE’s will be regionally-based networks of inpatient and community-based services, each with a specialized inpatient hospital program located at its center with geographically dispersed community service “hubs” overseeing state-operated community-based services throughout the region.” (Per NYS OMH Report, July 11, 2013.) Westchester will be a ‘hub’ under the Hudson River Region, headquartered in Orangeburg and providing adult, child and adolescent inpatient services. NYS mental health spending is twice the national per-capital average.
Local politics, via the state legislature has prevented earlier facility closings. (And mental health is not the only area facing closings. Some prisons and juvenile detention facilities were closed despite opposition.) The issues: How much of a trade-off between quality and cost is acceptable? Can the safety net be strengthened or even maintained in the face of financial challenges? Can new ways and structures of implementing services be successfully developed? Will the 15 regions be separate and equal in quality?
Quotes form New Windsor Police Commissioner Michael Biasotti, in an opinion-editorial letter (October 14, 2013, Timesunion.com) states “When psychiatric beds go down, incarceration goes up.” “Because OMH closes state hospitals and refuses to make full use of existing capacity, local psychiatric hospitals become overcrowded. The psychiatrists are put under intense pressure not to admit patients and to discharge those admitted sicker and quicker to free beds for new arrivals. Anyone well enough to walk in and ask for help, is generally not sick enough to be admitted.” “We wait hours for psychiatrists to evaluate them, only to find the doctor overrules us and refuses to admit the patient. If the individual is admitted, they will generally be discharged prior to being fully stabilized or having effective community services put in place.”
In December 2013, the NYS Psychiatric Association states the following developments: RCEs will not take place until local communities are ready, three of the nine hospitals will now remain open until further notice and two new children’s centers are to open. Their Position paper concludes: “Here in New York, if we again embark on another plan to “restructure” the state psychiatric centers to achieve cost savings, we must first plan, implement and adequately fund an alternative state-operated “safety net” to continue to provide crucial services for those children and adults who currently rely on the public hospital system before we dismantle it.” Is there time and ability to do such?
- J. Jaffe of the City Journal “Unlike community-based programs, psychiatric hospitals cater to those who need inpatient services, cannot survive safely in the community, or who refuse treatment. New York currently has about 4,000 state psychiatric hospital beds—roughly 27 per 100,000 New Yorkers, down from 600 per 100,000 in 1955. To meet the generally accepted minimum standard of 50 beds for every 100,000 people in a state, New York needs at least 3,000 more psychiatric beds. As a result of the shortage, at least 9,000 mentally ill New Yorkers are currently incarcerated and thousands are homeless. Closing hospitals and losing even more beds will only make the problem worse.” “Cuomo hasn’t said what, if anything, will replace New York State’s psychiatric hospitals once they close, or what will happen to the patients. The New York State Office of Mental Health (OMH) is circulating a Regional Centers of Excellence Plan containing lots of platitudes but few details. What’s clear is that many previously hospitalized patients will be declared “recovered” and left to fend for themselves. Others will be transferred to distant facilities, making it hard for their families to visit them. Anyone who gets sick after the hospitals close will simply be locked out.”
Positive reviews came from the following reports.
“While it is still very early in the process of analyzing the Governor’s budget proposal, the NYS Council is pleased with the level of support we received for most of our sectors critical needs. I say ‘most’ because we are deeply concerned that our workforce is once again being asked to defer a COLA that is badly needed,” said Lauri Cole, Executive Director of the NYS Council for Community Behavioral Healthcare. “The Governor’s budget proposal does a good job putting together a package of investments that we hope will support the rollout of managed care in our service system. We are counting on the fact that it is enough money to continue New York’s commitment to guarantee access to care through adequate networks composed of behavioral health provider organizations who know best how to meet the complex needs of individuals challenged by an addiction or mental health issue.”
“NYS Governor Andrew Cuomo’s budget proposal for the coming fiscal year addresses numerous long sought budget priorities for NYAPRS members,” said Harvey Rosenthal, Executive Director of the New York State Association of Psychiatric Rehabilitation Services. “Since our origins in 1981, we have long pushed for the state to move resources from institutional settings like state and Medicaid hospitals and adult and nursing homes into the expansion of community recovery services and supports. And we have worked hard over the past 2 decades to help championed the rise and growth of a broad array of rehabilitation, employment, housing and peer run initiatives. This year’s Executive Budget proposal represents the largest single investment and/or reinvestment in community recovery initiatives in decades. The OMH budget increases by 1.6% or $52 million.”
With such diverse opinions, some political, I am at a loss at what to believe or expect. As one with the constant daily pain of mental illness, I pray and hope all this leads to a better system of growth and healing.
#1029
Glenn Slaby Blog