2005-2009 Statewide Comprehensive Plan for Mental Health Service Services
Chapter 1: Mission and Vision

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Introduction

The New York State Office of Mental Health (OMH) is committed to enhancing the quality of our State’s public mental health system. During 2005-2009, the agency’s fundamental goals are to continue maximizing access to quality mental health services for adults with serious mental illness and children with serious emotional disturbance, and to continue promoting the mental health of all New Yorkers through public education and advocacy.

Maximizing access to appropriate and effective mental health services is central to promoting recovery for individuals with mental illness so they can live full and productive lives in their communities. Recent research shows high rates of recovery for people with even the most serious diagnoses, and new studies document the effectiveness of self-help and rehabilitation. Collectively, these studies demonstrate that people with psychiatric disabilities can and do recover and services can be designed to enhance this process. This emphasis on recovery oriented services is central to achieving quality outcomes and to advancing OMH’s mission, vision, and values.

Leaders in health and mental health care including the World Health Organization (WHO), the U.S. Surgeon General, and the President’s New Freedom Commission on Mental Health have identified a need for a public mental health approach to mental illness that expands efforts beyond treatment for the most severely affected individuals. OMH also recognizes this need and will continue to pursue initiatives to educate people about using health promotion and disease prevention interventions designed to improve and enhance quality of life.

This 2005-2009 Statewide Comprehensive Plan for Mental Health Services is intended to be read and utilized in conjunction with the 2004-2008 Plan. In the 2004-2008 Plan, OMH provided an extensive discussion of how we are applying our strategic planning framework to promote the agency’s commitment to quality. This continues to be the basis for addressing trends and challenges during the 2005-2009 planning period, and OMH will continue its commitments in these areas. Although the planning framework is not rearticulated in its entirety in this 2005-2009 Statewide Comprehensive Plan, last year’s presentation of agency initiatives in the context of the strategic planning framework can be found in Chapter 10 of the 2004-2008 Plan on the OMH Web site at http://www.omh.state.ny.us/omhweb/statewideplan/chapter10.htm.

This 2005-2009 Statewide Comprehensive Plan complements last year’s plan by expanding the strategic planning framework into a 2005 agency strategic plan. It presents new and expanded information on emerging topics central to moving the quality agenda forward based on input from our 2004 public forums. It also provides comprehensive overviews of selected segments of the public mental health system which have not been fully addressed in earlier plans.

The Strategic Planning Framework

In the 2004-2008 Statewide Comprehensive Plan, OMH described a strategic planning framework to guide agency operations and to support its commitment to quality. This framework consists of two components. The first includes the agency’s mission and vision statement, its values and the “ABC’s” of mental health care, which are core operating principles governing the conduct of agency business. The second is OMH’s commitment to recovery as a guiding principle for agency operations. These two components comprise the framework for developing specific long and short term goals and for implementing solid action plans to achieve them – a process which is referred to as strategic planning.

OMH has a strong commitment to strategic planning requiring that managers act “strategically,” meaning that they develop and use a targeted approach to achieving measurable goals and that they continually “check and correct” progress toward goal attainment. The OMH Strategic Plan appears in Chapter 9, however, it is not possible to have a strategic plan without first having a strong framework to direct agency initiatives toward “true North” – a compass point intended to guide managers at all levels of the system as they integrate strategic planning into daily management operations. Having a “true North” helps OMH to consistently reflect on the degree to which operations are aligned with our organization’s cultural norms and expectations.

OMH’s Mission, Vision, and Values

An emphasis on recovery-oriented services is central to advancing OMH’s mission, vision, and values, and achieving quality outcomes.

OMH is pursuing its mission and vision by focusing on accountability, best practices, and coordination of care to plan and manage performance in its day-to-day operations. Known as the “ABC’s of mental health care,” they are:

• Accountability for Results, whereby a clearly defined entity or individual is responsible for the effectiveness of services delivered. Services are designed and delivered to achieve specific outcomes, which are measured by performance indicators.
• Best Practices, whereby service design and delivery is based on the best research and evidence available and best practice guidelines are incorporated into treatment practices. Adherence to these guidelines is measured as part of the accountability process.
• Coordination of Care, whereby coordinated, comprehensive networks of providers deliver a balanced array of medical, self-help, social, supportive and rehabilitative services and programs. These services are focused on rehabilitation and recovery, and individualized service plans are designed around the needs and desires of the individual.

Commitment to Recovery Oriented Services

OMH’s commitment to expanding the recovery-oriented approach to service design and delivery is grounded in empirical data demonstrating that people can and do recover from diagnoses of serious mental illnesses.¹ Recovery-oriented services are characterized by a commitment to promoting and preserving wellness, to expanding choice and eliminating coercion, and to providing the least intrusive services in the most integrated environments. This approach promotes maximum flexibility and choice to meet individually defined goals and to permit person-centered rather than program-centered services.

The recovery-oriented approach is influenced and informed by people who have been diagnosed with mental illness, recognizing that they have valuable knowledge and insights about healing, coping, and recovery that can help shape service delivery systems. The agency’s commitment to a quality improvement agenda is only meaningful when viewed against a recovery “lens.” Recovery provides the perspective for hope and meaning in each person’s life, and also for a system of care which sees itself as instrumental to improving the quality of life for individuals and their families. While quality improvement activities exist in all business domains, the role of OMH as the State mental health authority is to promote the recovery “lens” within its own constituencies and elsewhere in State government.

The recovery “lens” and OMH’s mission, vision, and values are yardsticks for leaders to use in developing and prioritizing goals and management strategies to guide the public mental health system toward enhanced quality and improved outcomes. The strategic planning initiatives which emanate from this framework serve two purposes. First, they help managers improve the quality of their work in day-to-day operations, and second, they provide a structure where management and planning activities can merge to effectively respond to changing needs inside and outside of our organization. To fulfill the OMH mission, it is essential that there is organizational capacity to chart a course of strategic direction which is responsive to changing conditions and needs. Blending the management of daily operations with strategic direction is generally referred to as a strategic management approach.

OMH’s intent to move toward a strategic management approach begins by describing who we are as an organization, in terms of the agency’s strengths, and challenges. As one of the nation’s largest mental health authorities, OMH can best be understood within the following discussion of roles and functions.

The Office of Mental Health’s Role as State Mental Health Authority

OMH has two primary functions as State mental health authority: to ensure access to high quality services for adults with severe mental illness and children with serious emotional disturbance and to promote overall public mental health through education and advocacy for all New Yorkers. These dual functions are carried out as OMH conducts integrated, results-oriented oversight of State and Local resources. Management decisions are guided by accurate and timely performance measurement focused on the key areas of access to services, service quality and appropriateness, outcomes, and cost. To effectively meet agency responsibilities, day-to-day operations are organized in four lines of business:

1. Regulation, Certification, and Oversight of New York’s Public Mental Health System

OMH is responsible for the regulation and licensing of all mental health facilities and programs in the State other than private practices and Federal facilities. In this role, the agency provides oversight to the State’s 62 counties and more than 2,500 mental health programs operated by Local governments and private agencies that provide mental health services to the people of New York State. The services provided by locally operated programs include inpatient, outpatient, emergency, residential, and community support. While certain policy, funding, regulatory, and management functions are centrally administered, actual program administration takes place on the Local government level. Each year approximately 588,000 individuals receive services in County operated or not-for-profit mental health programs.

OMH oversight includes administrating a Prior Approval Review (PAR) process for the establishment of new programs, establishing rates of reimbursement for licensed programs, and administering a State aid to Local governments funding program. The agency uses certification standards to improve clinical service and quality. OMH ensures that public mental health services are responsive to local needs by collaborating actively with the New York City and county departments of mental health, and evaluating performance of the public mental health system on an ongoing basis.

2. Direct Provision of State-operated Inpatient and Outpatient Mental Health Services

OMH is a major provider of inpatient and outpatient treatment with a broad array of services. Intermediate and long-term inpatient services are provided in a network of 26 psychiatric centers that include 20 psychiatric centers serving adults with severe mental illness, three of which serve adult with mental illness involved with the criminal justice system, and an additional six serving children with severe emotional disturbances.² Appendix 1 contains maps which describe the locations of all New York State adult, children, and forensic psychiatric centers and research institutes, as well as the locations of children’s inpatient programs throughout the State.

State-operated inpatient services are typically utilized by individuals who require longer lengths of stay than what is offered in locally operated community hospitals. State-operated outpatient services are similar to those provided by locally operated agencies, and are primarily used by individuals who also use State-operated inpatient services. This includes an active caseload of prison inmates who receive mental health services while incarcerated in Department of Correctional Services’ facilities in over 33 sites statewide.

3. Mental Health Research to Advance Prevention, Treatment, and Recovery

OMH research is an important part of agency efforts to identify scientifically based, effective interventions and incorporate them into mainstream practice throughout the public mental health system. Research in basic science to better understand the biochemical and genetic mechanisms underlying mental illness is conducted primarily at the Nathan S. Kline Institute (NKI) in Orangeburg New York, and the New York State Psychiatric Institute (NYSPI) in New York City. Researchers at the institutes conduct clinical trials to develop and evaluate new treatments and services as well, and have been participants in numerous collaborative, multi-site clinical trials that have led to U.S. Food and Drug Administration (FDA) approval of new medications for schizophrenia, bipolar disorder, depression, and anxiety disorder. OMH researchers also focus on outcome studies to determine better methods of service delivery, and recognize the importance of involving consumers from diverse cultural communities at every stage of the process of recovery. OMH research is described in greater detail in Chapters 4 and 5.

4. Promoting Mental Health through Public Education

As part of our commitment to enhancing quality throughout our public mental health system, OMH promotes mental health through education and advocacy for all New Yorkers. OMH is increasing the general public’s awareness and understanding of mental health by developing and distributing information about the nature and impact of mental illness, effective treatments and services, useful preventive and coping strategies, and how to get help when it is needed. The agency’s information dissemination strategies are designed to reach as many New Yorkers as possible, with a particular focus on high-risk groups. As public awareness of the scale and scope of the impact of mental illness has increased, a corresponding increase in societal desire and expectations for an effective mental health system is emerging. More information on specific public mental health promotion strategies regarding suicide prevention is presented in Chapter 8.

Enhancing Quality in Our Public Mental Health System

Before an organization can develop a set of goals and management strategies it needs to assess its strengths. OMH has made four major structural inroads in the past year which can provide significant support to its management initiatives and attainment of goals. First, OMH has a continuing commitment to quality as well as the nationally recognized “Winds of Change,” a campaign dedicated to providing access to mental health services that are based on the best available evidence.³ Second, OMH has adopted a population-based planning approach to the design and delivery of public mental health services. Third, OMH is increasing stakeholder input to the State and Local mental health planning process. Fourth, OMH has initiated a performance measurement system as a critical component of a quality and strategic planning framework. These efforts are all enhanced by OMH’s extensive, multi-year commitment to the development of a decision support infrastructure that is accessible to both State and county mental health planners.

Continuing Commitment to Quality

OMH is a leader in the national mental health quality improvement agenda and our commitment to quality is the cornerstone of all agency planning initiatives. In last year’s 2004-2008 Statewide Comprehensive Plan, OMH affirmed its focus on quality and articulated the agency’s strategy for advancing the quality agenda. In this 2005-2009 Statewide Comprehensive Plan, OMH reaffirms our commitment to this multi-year quality agenda, which includes the “Winds of Change” campaign to integrate evidence-based practices into routine care.⁴ Much of this 2005-2009 Plan chronicles steps in this quality agenda to improve access to and quality of mental health services in New York State.

OMH’s quality agenda is consistent with a sweeping national agenda for improving quality in health care which envisions a health care system with a renewed focus on innovation and quality, based on scientifically proven ‘evidence-based’ treatments and practices as the foundation of routine health care. This agenda is also integral to the promotion of recovery and community integration for individuals with mental illness, because without quality services and appropriate access to care, it is unlikely that the full potential for recovery can be realized. This national mental health quality agenda has been developed with contributions from nationally respected institutions and individuals including the Institute of Medicine of the National Academies, the President’s New Freedom Commission on Mental Health, the federal Substance Abuse and Mental Health Services Administration (SAMHSA), the U.S. Surgeon General, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the Schizophrenia Patient Outcomes Research Team (PORT).

The national quality improvement agenda recognizes that although medical leaders and research scientists make discoveries every day to improve the quality of health care, routine medical practice does not rapidly assimilate these advances. As a result, gaps often exist between what research has identified as state-of-the-art health care and the care that is actually delivered in day-to-day medical practice. In the mental health care system, there is a need for substantial reform to fully implement a science to practice quality agenda. Through our ‘Winds of Change’ campaign, OMH is collaborating with the research, academic and clinical communities to effectively bring proven evidence-based practices into day-to-day clinical settings. Over time, these interventions, if available and utilized, could improve the opportunity for individuals with serious mental illness and serious emotional disturbance to lead more productive, satisfying lives in their communities. Examples of OMH achievements in this area are presented throughout this Plan.

Population-based Planning

As part of our commitment to quality improvement in mental health care, OMH is utilizing a population-based planning approach in the design and delivery of public mental health services. OMH’s population-based planning goals include determining:

• The current and future mental health care needs of priority populations.
• The types of mental health care services across the continuum that will be required to meet these needs.
• Where mental health care services should be located throughout our communities and mental health care system.
• What types of facilities and providers are needed to accommodate these services.
• What quality of life outcomes are experienced by service recipients within these populations.

Today, population-based planning provides the most productive method of looking at the public mental health system. It begins with geographically-based analysis of population characteristics such as demographics (e.g., age, gender, race, ethnicity), in conjunction with data related to mental health such as estimates of the prevalence of mental disorders, inpatient and outpatient service utilization patterns, and service outcomes data. Stakeholder input to the population-based planning process is critical for providing important information on how individuals access mental health care services, their perception of service gaps and unmet needs within their communities, and comments on improvements that are needed in mental health care delivery.

Continued movement toward a population-based planning system is necessary to fulfill both the State and national commitments to improving the quality of mental health services by focusing on the needs of each individual. OMH is using population-based planning methods that promote focused attention on care coordination across diverse groups as the foundation for customized, culturally competent care. More information about population-based planning is included in Chapter 3.

Increased Public Input into the State and Local Planning Process

A strong collaboration between the State, Local governments and stakeholders is integral to implementing quality mental health initiatives. OMH’s review of feedback received during the 2004-2008 mental health planning process identified a call from multiple stakeholders to revitalize the planning process by emphasizing a commitment to Local planning input and data driven approaches. The 2004-2008 Comprehensive Statewide Plan was developed using these approaches and has received broad stakeholder endorsement. In 2004, OMH conducted an expanded series of events and opportunities for stakeholder input on how to build on the progress made in the 2004-2008 Comprehensive Plan. Chapter 3 describes the stakeholder involvement that occurred during 2004.

Performance Measurement

The 2004-2008 Comprehensive Plan also described OMH’s commitment to creating a performance measurement system, the extensive accomplishments already achieved, and the strategic direction for the future. Efforts made in 2004 to advance the performance measurement approach are consistent with the leadership provided by Governor Pataki which was reiterated in the 2004-2005 Executive Budget. Throughout 2004, OMH has continued to develop its information technology and data infrastructures and core components of performance measurement.

OMH believes that a next important step in advancing the quality agenda is to enhance and integrate the performance management framework. Relying on the continued leadership from Governor Pataki regarding an outcomes-focused management culture, OMH has consolidated our achievements to date with extensive stakeholder input to create the conceptual framework for the next iteration of the agency’s performance management system, which is articulated in Chapter 9 of this document. A major goal of the 2005 planning cycle will be receiving and reviewing stakeholder input in response to the performance measurement framework presented.

Addressing Challenges - Continuing to Advance the Quality Agenda

The fundamental challenge that confronts New York State and the rest of the nation is reshaping the public mental health system from an institutional to a community-based system of care that utilizes evidence-based services and supports, and financing that transition in a challenging financial environment. Advances in psychopharmacology and mental health treatment interventions have made living in integrated community settings a realistic possibility for most individuals with serious mental illness or emotional disturbance. New York State, under Governor Pataki’s leadership, has engaged in a sustained effort to achieve that goal.

In New York State, the transition away from institutionally-based care has been made possible by increased investments to strengthen and expand community-based services. These increased investments were made possible by reinvesting resources associated with unneeded State psychiatric center inpatient capacity, fully utilizing non-State resources, and achieving administrative consolidations and efficiencies. These investments were further advanced by Governor Pataki’s Enhanced Community Services package, which provided more than $125 million in new funding for key community support services.

New York is recognized not only as a national leader in mental health quality improvement, but also as a leader in investing in mental health care. A recent national survey conducted by the National Association of State Mental Health Program Directors showed that New York State leads all other states in its financial investments in major sectors of mental health service delivery, including inpatient care, mental health residential services, and psychiatric research, and ranks second among states in total investments in community-based mental health care.⁵

While OMH's strategic direction is well defined and substantial progress has been made, fundamental challenges must continue to be addressed to move forward and achieve an even more comprehensive system of care. OMH recognizes the realities of New York State's structural budget imbalance and the need to evaluate strategic objectives against fiscal realities. The challenge is how to align these realities and the OMH mission to achieve the very best outcomes. OMH will retain its commitment to the following two fundamental goals as these efforts continue:

1. Maintaining the Structural Integrity of Existing Service System Capacity

2. Providing Targeted Service System Expansion Where Needed and Supported by the Evidence Base

The agency recommends proceeding on a course in which continued redirection of savings and new investment in these planning priorities take place as fiscal realities allow. Generally, initiatives to reestablish or maintain the structural and financial integrity of existing service providers and capacity take precedence over program expansion.

New York State Adult Psychiatric Center Trends and Opportunities

Today, the New York State psychiatric center system, by far the largest in the nation, continues to support unneeded infrastructure. Table 1.1 describes how New York State's adult psychiatric centers have decreased in size as the locus of care shifted to the community. During the 1950s, New York State operated 18 psychiatric centers with a total inpatient census of approximately 93,000.

Table 1.1
The Shrinking Size of New York’s State Adult Psychiatric Centers

The public mental health system has changed dramatically since that time. Since advances in psychopharmacology and mental health treatment interventions have made living in integrated community settings a realistic possibility for most individuals with serious mental illness or emotional disturbance, New York State and the rest of the nation have engaged in a sustained effort to transition the public mental health service delivery system from institutional to community-based settings.

In New York State this transition has included a substantial expansion of community-based services, including housing, case management and other supports, which have made the decrease in inpatient census possible. The existing community-based residential system currently supports almost 27,000 operating beds and another 4,100 beds are in various stages of planning and development. Including the beds authorized in this year's Executive Budget, the total number of community beds will be 31,100.

New York State continues to operate more psychiatric centers than any other state in the nation, and inpatient bed utilization also continues to exceed that of other mid-Atlantic states. Today, New York operates 20 State adult psychiatric centers, three of which serve forensic inmate-patients. The 17 non-forensic adult psychiatric centers currently have a total inpatient census of less than 4,200. With the number of people requiring inpatient psychiatric treatment only a fraction of the size it once was, there is no longer a need to continue operating this many facilities.

With an estimated adult inpatient census of less than 4,100 by the end of the 2006 State fiscal year, New York must continue to examine the role of State-operated inpatient care within the broader context of community-based treatment, rehabilitation and support services available in each area of the State. The benefits of maintaining the State adult psychiatric center infrastructure at the present level for the number of individuals being served does not justify current associated costs or anticipated future costs.

To continue the transition to evidence-based adult and children's services that are delivered in the community, maintain community access to inpatient services, and avoid investing in unneeded adult psychiatric center administrative and infrastructure costs, OMH has identified the following criteria for the consolidation of adult inpatient capacity:

• Substantial administrative savings could be realized and reinvested in community-based services;
• Large capital expenditures could be avoided that would support unneeded inpatient infrastructure; and
• Inpatient beds could be transferred to a nearby psychiatric center where adequate unused physical space exists.

OMH has concluded that Middletown Psychiatric Center meets these criteria and has recommended its closure; transferring Middletown's inpatient beds to the Rockland Psychiatric Center; maintaining existing State outpatient services in their current communities; and reinvesting 100% of the associated savings to expand State-operated community services in Orange and Sullivan Counties. These actions will be taken without eliminating any inpatient capacity.

Several key factors were considered in reaching these recommendations. Middletown Psychiatric Center is serving a small number of individuals and this number continues to decline: although Middletown once had over 3,000 inpatient beds, it now has only 115. It is difficult to justify the $28 million capital investment that would be required to maintain certification compliance for a psychiatric center of this size. There is sufficient unused physical space at nearby Rockland Psychiatric Center to relocate Middletown's inpatient services. Finally, adults and children in the current Middletown catchment area will be better served by the expanded new State-operated community-based services.

2005-2006 Executive Budget Actions

The 2005-2006 Executive Budget for the Office of Mental Health advances the Governor’s transformation of New York’s public mental health system by continuing to redirect resources to community settings, provide funding for targeted service expansion in science-based treatments, and provide funding to preserve and reinforce the existing service system. The FY 2005-2006 budget continues the advancement of an agenda that is integral to the promotion of recovery and community integration for individuals with mental illness. The Executive Budget strengthens key community programs and maximizes access to quality mental health care, while still achieving the necessary efficiencies to ensure the most cost-effective use of all resources.

Additional information regarding the 2005-2006 Executive Budget is included in Appendix 11.

Notes

¹ Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A. (1987).The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. Am J Psychiatry, 144(6):718-26.

²OMH’s New York State Psychiatric Institute also provides a small number of inpatient services in its Washington Heights Community Service division.

³The Winds of Change campaign is now in its fourth year and is described in more detail on the OMH Web site at http://www.omh.state.ny.us/omhweb/ebp/winds_of_change.htm.

⁴Carpinello SE, Rosenberg L, Stone J, Schwager M, Felton CJ. (2002). Best Practices: New York state’s campaign to implement evidence-based practices for people with serious mental disorders. Psychiatr Serv., 53(2):153-5.

⁵Additional information regarding this national comparative information is contained on the NASMHPD web site.

Comments or questions about the information on this page can be directed to the Office of Planning.