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Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo
Link to 2005 Interim Report PDF Version

2005
Interim Report
Statewide Comprehensive Plan
for Mental Health Services

2005-2009 Statewide Comprehensive Plan

Public Hearing Testimony

New York State
George E. Pataki
Governor

Office of Mental Health
Sharon E. Carpinello, RN, PhD
Commissioner

Keith E. Simons
Deputy Commissioner
Public Affairs and Planning

November 2005

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Table of Contents

Introduction
Message From The Commissioner
Overview: 2005-2009 Plan
Budget Actions
Summary of Legislation Passed during the 2005 Session
2005 Statewide Comprehensive Plan Stakeholder Input

Introduction

The New York State Office of Mental Health (OMH) issued the 2005-2009 Statewide Comprehensive Plan for Mental Health Services in January 2005. This 2005 Interim Report is intended to present modifications to the previously published plan as well as highlight actions that have been taken to strengthen and enhance our planning process.

This Interim Report contains a summary of Executive and Legislative Budget actions, and legislation related to Office of Mental Health (OMH) and the New York State public mental health system. Additionally, the Report provides a summary of stakeholder input received since the 2005-2009 Statewide Comprehensive Plan for Mental Health Services was issued. As outlined in this Report, OMH is utilizing this stakeholder input in shaping the development of the 2006-2010 Comprehensive Plan.

Message from the Commissioner

This 2005 Interim Report to the 2005-2009 Statewide Comprehensive Plan for Mental Health Services is the most recent in a series of planning documents that form the foundation for and support of improved quality throughout the New York State public mental health system.

The hallmark 2004-2008 Statewide Comprehensive Plan for Mental Health Services created strong momentum toward advancing OMH's quality agenda. It made clear OMH's intent to provide energetic, innovative and transparent approaches to quality and stakeholder collaboration. The 2004 Interim Report that followed detailed broad stakeholder response to the 2004-2008 Plan and incorporated this input into the OMH planning process.

The momentum toward quality grew with the release of our 2005-2009 Statewide Comprehensive Plan, in which OMH took a major step forward by operationalizing the agency's strategic planning framework and creating a set of priorities to guide its operations over this planning horizon and well into the future. This set of goals and measurable objectives is central to the agency's "strategic plan," which serves to focus attention on a concise set of pivotal activities to address our priorities.

By closing the 2005-2009 Statewide Comprehensive Plan with an overview of the strategic plan and next steps for performance improvement, we intended to conclude with a new beginning the initiation of an informed, interactive planning process based on performance measurement. Looking ahead, our challenge is to continue to fuel the positive energy and momentum we have built, allowing us to continue our commitment to quality in basic, clinical and services research, and our growing focus on childhood anxiety and depression, on individuals who are in prison and require mental health services, and in the prevention of suicide.

When OMH released the 2005-2009 Plan, I shared two insights based on my personal efforts to reach out and engage the large community of those interested in the State's public mental health system. First, it is increasingly clear that people are hungry for information and for their voices to be heard. In fact, increased stakeholder input has helped to refine our strategic plan, goals, objectives and performance measures. Second, it is evident that building a new, comprehensive, inclusive planning process is not something that emerges quickly, but instead is an incremental process to which OMH remains strongly committed.

This 2005 Interim Report is intended to present modifications to the previously published Plan and to account for actions taken to include service recipients, their families, and providers of services in the planning process. It has been a productive year, and much has taken place within OMH since the release of the 2005-2009 Plan.

In March, for example, OMH released its Final Report on the Status of Assisted Outpatient Treatment, which documented significant increases in the use of mental health services by individuals with mental illness who participate in the program. The positive outcomes of the first five years under Kendra's Law led to its five-year extension, signed into law by Governor Pataki in June.

In May, OMH released Saving Lives in New York: Suicide Prevention and Public Health, a comprehensive, data-driven report on suicide, its risk factors and prevention. Prepared by researchers at OMH, Columbia University/New York State Psychiatric Institute, the University of Rochester and the New York State Suicide Prevention Council, the report includes 33 recommendations and 88 actions steps that are designed to improve access to mental health care and services, enhance identification of those at risk, restrict access to means of self-harm, and expand the knowledge base through research. The release of the Saving Lives report builds upon OMH's Suicide Prevention Education Awareness Kit (SPEAK) Campaign, launched in May 2004 to help New Yorkers become aware of the risk factors and warning signs of suicide. SPEAK materials are available in both English and Spanish, with a Chinese version currently being developed. The kit can be accessed online.

Approximately 450 mental health clinicians, providers and other stakeholders attended the Children's Research to Practice Symposium, a gathering of nationally renowned experts in children's mental health research and best practices held in June in New York City. The symposium highlighted the latest in research on the etiology, treatment, epidemiology and prevention of children's mental health disorders. Coordinated by OMH, the event was jointly sponsored by OMH, the New York University Graduate Medical School, Columbia University College of Physicians and Surgeons/New York State Psychiatric Institute, the New York State Office of Children and Family Services, the New York State Office of Alcoholism and Substance Abuse Services, and the New York University Child Study Center.

The National Institute on Aging of the National Institutes of Health recently announced the award of a $9.1 million program project grant to Ralph Nixon, PhD, MD, and Director of the Center for Dementia Research at the Nathan Kline Institute for Psychiatric Research in Orangeburg, New York. The grant will allow Dr. Nixon and his team to continue their pioneering work analyzing brain cells of individuals at the earliest stages of Alzheimer's disease even before memory problems surface to identify the biological factors that trigger plaque-like aggregates of a peptide called amyloid-beta and other pathology associated with memory impairment. This new avenue of research promises to increase our understanding of the root causes and risk factors for Alzheimer's disease and to contribute to improved therapies to prevent and forestall the devastating deterioration associated with the disorder.

OMH is also continuing to expand its public education function, and is actively working to increase public awareness and understanding of the nature and impact of mental illness, effective treatments and services, useful preventive and coping strategies, and knowledge of how to get help when needed. A number of new mental health resources are available free of charge at http://www.omh.ny.gov/, including information about anxiety disorders, attention deficit hyperactivity disorder, bipolar disorder, depression, medications, schizophrenia and treatment of children with mental disorders.

Governor Pataki has continued to strengthen the public mental health system, including signing the five-year extension of Kendra's Law. The Governor's 2005-2006 Executive Budget Recommendations also established a number of ongoing investments in the public mental health system, including an increase in funding for supported housing; an increase in funding for freestanding mental health clinics for children and adults; the expansion of the Home and Community-based Waiver program for children and adolescents; resources to continue Reinvestment, Kendra's Law and the Enhanced Community Services Program; resources to continue the development of community housing; and resources to preserve New York State's position as a national leader in the mental health quality agenda and as a leader in psychiatric research.

More recently, four new developments demonstrate OMH's focus on promoting recovery, resiliency and positive outcomes for individuals served by the public mental health system. With the devastating effects of Hurricane Katrina unfolding in late August, I reached out to the Commissioners of Mental Health in Louisiana, Alabama, and Mississippi to provide aid and comfort for the victims of the hurricane. Two representatives from OMH traveled to Louisiana to share disaster mental health knowledge and expertise and to provide technical assistance to the disaster-affected areas. Select providers who participated in the World Trade Center disaster Project Liberty counseling program also agreed to offer assistance and support to counseling programs in the disaster-declared areas. As the need arises, we will continue to offer support and assistance to our colleagues who are responding to the many disaster-related needs in their communities and striving to help victims maintain their resilience and begin to rebuild their lives.

In September, I joined Dr. Antonia Novello, Commissioner of Health, in announcing the availability of Risperdal Consta to OMH-certified outpatient clinics. An injectable version of the antipsychotic medication Risperdone, this drug is indicated for use by adults with a diagnosis of schizophrenia or schizoaffective disorder and a history of not adhering to more conventional treatment. Accessibility to this drug formulation provides individuals and their physicians with another important treatment option aimed at producing healthy outcomes.

In late September, more inroads were made in our efforts to address the growing national problem of suicide, when I learned of four grants awarded within New York State. The New York State Psychiatric Institute, a research institute operated by the Office of Mental Health and located in Manhattan, is one of 14 institutions around the nation to receive a Substance Abuse and Mental Health Services Administration (SAMHSA) grant for the implementation of a State-Sponsored Youth Suicide Prevention and Early Intervention Program. Funding in the amount of $388,803 will permit the Psychiatric Institute to implement the New York State Youth Suicide Prevention and Early Intervention Program, providing systematic training in the identification and management of mental health concerns in youth served by Juvenile Probation Officers across the State and in coordination with Columbia University's highly regarded TeenScreen Program, a community-based adolescent suicide screening initiative with programs throughout the nation. Three State universities also received grant awards from Substance Abuse and Mental Health Services Administration (SAMHSA) for campus suicide prevention efforts. The awardees are Syracuse University, Pace University and Rensselaer Polytechnic Institute. The three were awarded a total of $198,314, which will be used to enhance services for students with mental and behavioral health problems. Along with the other 33 suicide prevention grants awarded nationally by SAMHSA, these four grants were made possible through the Garrett Lee Smith Memorial Act for youth suicide prevention programs signed by President Bush last October and are expected to invigorate the national effort to prevent suicide.

Finally, in October, I initiated a public dialogue to better understand how New Yorkers would see a transformed system of care. In drafting a vision statement for a transformed system of care and noting important attributes of such a system, I am hoping to spark thought and discussion on ways our public mental health system can move toward transformation. The draft statement and listing of attributes have been combined into a single document, which is now available online. This is a living document and will be revised as feedback from the public is incorporated. Ultimately, this document will serve as the impetus for fundamental change in our system of care, change that places individuals at the very heart of the service system. I am encouraged by the responses I am receiving for example, thoughtful recommendations to promote services based on individual, family and community involvement and to take into account spiritual and cultural needs. I look forward to sharing what we learn and to using the information to promote client- and recovery-oriented service provision.

This is an exciting time in the mental health field. We are continuing to implement evidence-based assessment and treatment protocols that are changing the path to recovery, and we are beginning to see tangible results of those efforts. I am optimistic that by providing appropriate interventions and supports, we can provide hope for the future and truly make recovery a reality for everyone. I look forward to working with all of you toward this goal.

Overview: 2005-2009 Statewide Comprehensive Plan for Mental Health Services

The 2005-2009 Statewide Comprehensive Plan for Mental Health Services complements and expands the 2004-2008 strategic planning framework through the creation of a set of priorities, goals and objectives to guide future agency operations. This strategic planning framework represents a major step forward in operationalizing the agency's mission, vision and values. OMH sought and will continue to seek public input as an integral and crucial part of the planning process.

The Plan presents new and expanded information on emerging topics central to moving the quality agenda forward, and provides comprehensive overviews of selected segments of the public mental health system that have not been fully addressed in past plans. Information concerning a broader agenda of public mental health promotion and advocacy, including expansion of the agency initiatives regarding suicide prevention, received particular emphasis and attention. Content contained in the 2005-2009 Plan includes the following.

Chapter 1 highlights OMH's emphasis on recovery-oriented services, which is central to the agency's mission, vision and values. Specifically, it describes the agency's mission, vision and values, provides details of the agency role as the mental health authority, and highlights the agency's commitment to enhancing quality in our public mental health system.

Chapter 2 provides data about who is being served by our mental health system, while

Chapter 3 offers a brief overview of planning activities and collaborations carried out since the release of the 2004-2008 Statewide Comprehensive Plan for Mental Health Services.

Chapters 4 and 5 present the essential, ground-breaking work being conducted by OMH in the areas of basic and clinical research as well as mental health services research.

Chapters 6 through 8 offer a full overview of selected segments of the public mental health system that were not fully addressed in previous plans. Specifically addressed are children and depression, forensic services, and suicide prevention.

Chapter 9 provides an overview of the agency's strategic planning framework. The goals and related objectives discussed in this section form the framework for agency quality improvement activities during this Plan's life cycle.

The 2005-2009 Plan is available on the OMH website. This plan is intended to be read and utilized in conjunction with the 2004-2008 Statewide Comprehensive Plan for Mental Health Services, which provides an extensive discussion of how we are applying our strategic planning framework to promote the agency's commitment to quality. This commitment continues to be the basis for addressing trends and challenges during the 2005-2009 planning period.

Although the planning framework is not rearticulated in its entirety in this 2005-2009 Statewide Comprehensive Plan, a 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 website.

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 strategic planning framework for developing specific long- and short-term goals and for implementing solid action plans to achieve them.

Budget Actions

The 2005-2006 Executive Budget for OMH advances the Governor's transformation of New York State'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 Fiscal Year (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.

Provide 100 Percent Reinvestment to Enrich and Expand State-operated Community Services in Orange and Sullivan Counties with the Closure of Middletown Psychiatric Center

The Executive Budget recommends the April 1, 2006, closure of Middletown Psychiatric Center, and provides that 100 percent of the $7 million in annual savings realized through the elimination of administrative, support and overhead costs associated with this closure be reinvested to expand State-operated community services in Middletown's catchment area of Orange and Sullivan Counties. This closure will also avoid a $28 million required capital investment.

There is no reduction in inpatient beds or outpatient services associated with this proposal. Inpatient services currently provided at Middletown will transition to and be provided at Rockland Psychiatric Center, while outpatient services currently provided by Middletown Psychiatric Center will continue to operate in their current communities. New State-operated outpatient programs utilizing Community Reinvestment funds will support services for adults and children.

OMH will develop strategies to facilitate employment opportunities and to help ensure a smooth transition for employees.

• This Executive Budget recommendation was enacted as proposed.

Continuation of Funding for Prior Years' Initiatives to Strengthen the Forensic Mental Health Service System

Continuing the Governor's commitment to strengthen the forensic mental health service system, the 2005-2006 Executive Budget includes $7 million to continue the expansion of mental health treatment capacity for prisoners with serious mental illness. This funding supports a range of new and expanded treatment services based upon a statewide review of the forensic program. OMH continues to work with the Department of Correctional Services to establish a new Behavioral Health Unit program model; establish nearly triple of the number of beds for the Special Treatment Program; expand bed capacity for the Intermediate Care Program; and improve access to clinical staff for mental health services.

• This Executive Budget recommendation was enacted as proposed.

Fingerprinting Legislation

The Executive Budget provides $2 million to comply with the requirements of the recently enacted Fingerprinting Legislation. This law requires fingerprinting of all prospective staff of local providers who would have regular and substantial physical contact with clients. Funding for the $75 fingerprinting fee is included in the Aid to Localities recommendation.

• This Executive Budget recommendation was enacted as proposed.

Other Budget Actions

The Executive Budget achieves savings associated with the elimination of vacant positions in Administration and Finance.

• This Executive Budget recommendation was enacted as proposed.

Increased Funding for Supported Housing

The Executive Budget recognizes that investments to maintain the existing service system must accompany ongoing initiatives to expand it. This action builds upon last year's commitment of $15 million to increase funding for Community Residences and to stabilize the entire residential system. The 2005-2006 Executive Budget includes $6.5 million in savings from various initiatives to provide Supported Housing stipend increases. This new funding will enable Supported Housing programs to address appropriately the rehabilitation and support needs of priority populations.

• This Executive Budget recommendation was enacted as proposed.

Increased Funding for Outpatient Mental Health Article 31 Clinics for Adults and Children

The Executive Recommendation strengthens outpatient clinics and provides an increase of $6 million State share of Medicaid for Article 31 outpatient clinics. The State share of Medicaid expenditures represents 25 percent of the total expenditures when combined with Federal and County shares. This represents a $24 million increase in Medicaid revenues to be used for Article 31 clinics, including a statewide fee increase, increases to children's clinics providing evening and weekend services, and other targeted enhancements. This action builds on OMH's commitment to providing access to quality mental health services for adults and children.

• This Executive Budget recommendation was enacted as proposed.

Expand the Home and Community-based Waiver Program for Children in Collaboration with the Office of Children and Family Services

OMH and the Office of Children and Family Services (OCFS) embrace the philosophy that children and their families should have access to a comprehensive and well-coordinated array of services, provided in the most integrated setting appropriate to individual need. The Home and Community-based Waiver program enables children at risk for institutional placement to remain at home and in school while receiving needed services. The 2005-2006 Executive Budget for OCFS includes $2.3 million in new State funding to provide 245 additional Home and Community-based Waiver slots for children in foster care or at risk of institutional placement. When combined with the full annual support of Reinvestment to expand children's services, this represents a more than 50 percent increase in the number of children served.

• This Executive Budget recommendation was enacted as proposed.

Community Bed Development

The 2005-2006 Executive Budget provides operational and capital funding for local programs to maintain the existing residential system, and continue the development of previously authorized community beds. The Governor's budget also continues the development of 2,000 additional beds with a new $75 million capital appropriation to support the State's contribution toward the second phase of 1,000 beds. Including this commitment, the Budget supports 27,000 beds currently in operation, 1,600 beds from prior years' initiatives that are expected to open by the end of 2005-2006, and another 2,500 in various stages of planning and development, for a total of 31,100 beds.

Included in capital funding is a new $75 million appropriation for development of the remaining 1,000 residential beds authorized by the Governor during 2003-2004.

• This Executive Budget recommendation was enacted as proposed.

Continuation of Funding for Prior Years' Initiatives to Provide Services to Residents of Adult Homes

Continuing the Governor's commitment to transform the mental health system, the 2005-2006 Executive Budget annualizes prior years' initiatives and includes $5.2 million to provide Supportive Case Management and Peer Specialist mental health services for 3,500 residents of adult homes; $7 million in funding for 600 Supported Housing beds; and $2.6 million associated with new children's initiatives.

• This Executive Budget recommendation was enacted as proposed.

Maximize Revenue to Produce Savings

The 2005-2006 Executive Budget achieves $3 million in savings ($4 million annualized) by maximizing Federal Medicaid reimbursement in a number of areas. None of these revenue maximization initiatives will reduce gross funding levels to impacted programs, nor will they result in an increase in local share.

• This Executive Budget recommendation was enacted as proposed.

Preserve Services through Local Efficiencies and Other Actions

New York State's current fiscal environment requires efficiencies in all areas of government. The 2005-2006 Executive Budget includes $3.9 million in savings, which will be achieved through prioritization of services including targeted cuts to less cost-effective programs, and establishment of administrative standards. These savings initiatives include $2.1 million in savings to reflect reductions in funding for underperforming or less cost-effective programs and savings associated with administrative costs in excess of the statewide average overhead in licensed outpatient programs ($1.8 million annualized).

• This Executive Budget recommendation was enacted as proposed.

Mental Health Medicaid Reform (in the Department of Health Budget)

The Executive Budget recommends Medicaid reform actions to eliminate reimbursement inequities and unnecessary overutilization; establish a Medicaid Utilization Threshold System (MUTS) for Continuing Day Treatment (CDT) visits while allowing for additional services, if clinically warranted, through the process currently used by clinics; and eliminate specialty rates for Article 28 dually licensed mental health outpatient programs.

•The CDT MUTS recommendation was enacted as proposed; however, the enacted budget rejects the elimination of specialty rates for Article 28 mental health outpatient programs and restores the funding for programs that receive specialty rates.

Legislative Additions

Restoration of 2004-2005 Local Assistance Funding Reduction

The 2005-2006 Enacted Budget includes a proportional restoration of $4.365 million for consumer-oriented services including, but not limited to, peer support, advocacy, legal services, drop-in centers, and respite impacted by a funding decrease implemented in State fiscal year 2004-2005.

Alternate Rate Methodology System (ARMS)

The 2005-2006 Enacted Budget includes $600,000 for the alternate rate methodology for Article 28 hospitals.

Local Assistance Program Adds

The 2005-2006 Enacted Budget includes additional funding for mental health program initiatives ($350,000), for eating disorders ($50,000) and for Hospital Audiences ($175,000).

Article 31 Day Treatment Services

The 2005-2006 Enacted Budget includes $200,000 for services and expenses related to an increase of the medical assistance reimbursement rate for Article 31 of the Mental Hygiene Law (MHL) freestanding children's day treatment services.

Summary of Legislation Passed During the 2005 Session

This section contains brief descriptions of bills affecting OMH that passed the Legislature in the 2005 Legislative Session. The status of each bill, as of the publication date of this report, is also indicated.

Community Services

Kendra's Law
Chapter Amendment
 Approved
Chapter 158 L. of 2005
A.8954 Effective: June 30, 2005

In 1999, Kendra's Law established the statutory framework that creates the Assisted Outpatient Treatment Program (AOT) to ensure that certain persons with mental illness and a history of hospitalizations or violence participate in community-based services appropriate to their needs. The 1999 legislation included a "sunset date" of June 30, 2005. This bill extends the AOT until June 30, 2010, and amends the program in a number of ways, as outlined below.

1. Timely investigation
Under the 1999 law, OMH Program Coordinators have certain oversight and monitoring roles related to AOT. This bill makes modifications to this authority, in section 7.17 (f) of the MHL, to also require OMH Program Coordinators to monitor the establishment of procedures by the County Directors of Community Services to ensure the timely investigation of reports of persons who may be in need of AOT.

The bill also clarifies the responsibilities of County Directors of Community Services to receive and conduct timely investigations of reports of persons who may be in need of AOT and file petitions for such persons; to establish procedures to provide notice upon the completion of such investigations; and to document such investigations. The required documentation must be included in quarterly reports sent to OMH Program Coordinators.

2. Amendments to the "look-back" periods
Under Kendra's Law, one of several criteria required for an AOT petition to be filed is that a person has a history of lack of compliance with treatment for mental illness over a certain period of time, commonly referred to as the "look-back" periods. This bill amends subdivision 9.60(c) of the MHL to amend the "look-back periods" pertaining to this history. Previously, if the individual was hospitalized or incarcerated when the petition was filed, the duration of that hospitalization or incarceration was excluded from the look-back period. The new amendments exclude from the look-back period the entire duration of any hospitalization or incarceration that ended within the six months immediately preceding the filing of the petition.

3. Ability of psychologists and social workers to file AOT petitions
The bill amends subdivision 9.60(e)(1)(vi) of the MHL to add licensed psychologists and licensed social workers to the list of persons who may petition the court to order AOT, provided that the psychologist or social worker is currently providing mental health treatment to the subject of the petition.

4. AOT petitions in counties with a population of less than 75,000
Amendments are made to subdivision 9.60(e)(4) of the MHL to authorize (but not require) OMH to make available to counties with a population of less than 75,000, a physician for the purposes of making the affirmations and affidavits necessary for filing petitions, as required under Kendra's Law.

5. Development of the written treatment plan
Amendments are made to subdivision 9.60(i)(1) of the MHL, which establishes the roles of physicians and Directors of Community Services in developing the written treatment plan. These amendments clarify that the written treatment plan must be developed by a physician, in consultation with the Director of Community Services. All service providers identified in the written treatment plan must receive notification that they are included in such plan.

6. Renewal of AOT order
Subdivision 9.60(k) of the MHL is amended to clarify that petitions for extensions of AOT orders (i.e., additional periods of treatment) must be filed within 30 days prior to the expiration of the AOT order currently in effect. Renewal petitions may now be brought by original petitioners who are family members or persons who live with the individual who is under an order. If a petition to extend an AOT order is filed in a timely manner, the order will be automatically extended, pending the court's disposition of the extension petition.

7. Removal for observation and examination
Subdivision 9.60(n) of the MHL contains the provisions of Kendra's Law that establish the procedures to be followed when the subject of an AOT order fails to comply with the order. The amendments to this subdivision are intended to address situations where the subject of an AOT order who is not complying with the order meets the standard for removal from the community for examination in a hospital, but he or she is present in a county other than the county in which the AOT order was obtained. The bill now authorizes a Director of Community Services to direct the removal of the subject of an AOT order who is not complying with the order, and who is present in his or her county, to an appropriate hospital based upon the determination of the appropriate Director of Community Services.

8. Judicial training
These amendments direct OMH, in consultation with the Office of Court Administration, to develop a mental health training program for supreme and county court judges and court personnel regarding AOT and general mental health issues.

9. Record disclosure
Amendments are made to MHL Section 33.13(c) (3) and (12) to clarify that the clinical records of a patient of a facility licensed or operated by OMH or the Office of Mental Retardation and Developmental Disabilities (OMRDD) may be released to an attorney that is representing the patient in an AOT proceeding, as well as to the Director of Community Services who is completing the investigation, filing a petition, or providing services pursuant to the AOT program.

10. Annual reports
This legislation newly requires OMH to contract with an external research organization to conduct an evaluation of AOT. A report of this organization's findings must be submitted to the Governor and the Legislature by June 30, 2009. In addition, OMH is required to submit data relating to the AOT program to the Governor and the Legislature by March 1, 2006, and thereafter on an annual basis. Fiscal reports must be submitted to those bodies by OMH by June 30, 2006, and annually thereafter. These reports must detail appropriation, allocation, and expenditure data related to AOT.

Kendra's Law
Chapter Amendment
 Approved
Chapter 158 L. of 2005
S.5909 Effective: June 30, 2005

This legislation amends MHL Section 9.60(c), by making a technical clarification regarding the eligibility criteria for AOT. It amends the newly enacted Kendra's Law (Chapter 158 above), which provides that the individual for whom an AOT order is sought must be "unlikely to be able to participate voluntarily in outpatient treatment interventions," by adding the phrase "that would enable him or her to live safely in the community."

Geriatric Mental
Health Act
 Approved
Chapter 568 L. of 2005
S.4742 Effective: April 1, 2006

This bill creates a new Geriatric Service Demonstration Program in Section 7.41 of the MHL to provide grants, within appropriations made therefor, to providers of mental health services to elderly persons. This program will be administered by OMH in cooperation with the State Office for the Aging (SOFA), as well as other State agencies the Commissioner of OMH determines necessary for the operation of the program. Grants may be awarded to providers of care to older adults with mental disabilities for purposes that may include one or more of the following: community integration; improved quality of treatment; integration of services; workforce development; family support; finance; specialized populations; information clearinghouse; and/or staff training.

The bill also creates the Interagency Geriatric Mental Health Planning Council. The Council will consist of 15 members, as follows: the Commissioner of OMH and the Director of SOFA, who shall serve as the co-chairs of the Council; one member each appointed by the Commissioner of Alcoholism and Substance Abuse Services (OASAS), the Commissioner of OMRDD, the Chairman of the State Commission on Quality of Care and Advocacy for Persons with Disabilities (CQCAPD), the Commissioner of the Department of Health (DOH), the Commissioner of the State Education Department (SED), the Commissioner of OCFS, and the Commissioner of Temporary and Disability Assistance (TADA); and two members each appointed by the Governor, the Senate, and the Assembly. The Council is to meet at least four times per calendar year to develop annual recommendations regarding geriatric mental health needs. The recommendations may address community integration, quality improvement, workforce development, family support, finance, and integration of mental health services with services to address alcoholism, drug abuse and health care needs.

The bill also requires the Commissioner of OMH and the Director of SOFA to report to the Governor, the Temporary President of the Senate and the Speaker of the Assembly, with a long-term plan regarding the geriatric mental health needs of the residents of the State, which may include the recommendations of the Interagency Council.

Commission on Quality
of Care and Advocacy
for Persons with Disabilities
 Approved
Chapter 435 L. of 2005
A.1248 Effective: August 9, 2005

This bill amends MHL Sections 16.13 and 31.11 to clarify the jurisdiction of CQCAPD as including certain programs that are funded by OMH and OMRDD, but not licensed or operated by those agencies.

Surrogate Decision
Making Authority I
 Approved
Chapter 715 L. of 2005
S.2751-A Effective: October 11, 2005

This legislation amends Article 80 of the MHL to allow Surrogate Decision Making Committees, which operate under the oversight of CQCAPD, to continue to make medical decisions for individuals for whom it has jurisdiction, regardless of any changes in an individual's place of residence. This bill is intended to address situations where persons with mental disabilities, particularly the elderly, lose the benefit of Surrogate Decision Making Committees as a result of changes in residential status (e.g., movement from a mental health program into a nursing home).

Surrogate Decision
Making Authority II
 Approved
Chapter 126 L. of 2005
S.5339 Effective: June 30, 2005

This legislation amends Article 80 of the MHL to make permanent the authority for CQCAPD to contract with community dispute resolution centers for the provision of administrative support and assistance regarding the operation of the Surrogate Decision Making program.

Case Managers - Emergency Transfers  Approved
Chapter 192 L. of 2005
A.2972 Effective: July 12, 2005

This bill amends Section 9.45 of the MHL to add supportive case managers and intensive case managers to the list of parties authorized to report to County Directors of Community Services, or their designees, on the need to transport a non-consenting individual to a hospital for psychiatric evaluation. Currently, 12 categories of parties are authorized to make such reports. In such cases, the individual must be known to have a mental illness for which both immediate care and treatment in a hospital is appropriate and which is "likely to result in serious harm to self or others."

Out-of-State Placement 
for Children in Residential Care "Billy's Law,"
 Approved
Chapter 392 L. of 2005
S.5810-A Effective: October 31, 2005

This legislation is intended to strengthen the oversight, control, and accountability concerning the placement of children with disabilities in out-of-state residential facilities. It creates an Out-of-State Placement Committee, comprised of the State Commissioners of OCFS, OMH, OMRDD, SED, OASAS, DOH, and the Director of the Division of Probation and Correctional Alternatives (DPCA). This Committee is required to develop core requirements for a "registry" of Approved residential programs for future out-of-state placements. The Committee is responsible for assuring that all out-of-state residential facilities placed on the registry meet minimum requirements, including current licensure with an appropriate state agency in its home state; existence of regulations in the home state to ensure prompt investigations of any abuse or neglect report; prompt notification to the New York State placing agency when enforcement actions are taken against the facility, and compliance with applicable laws and regulations.

One agency member of the Committee is required to conduct a site visit within a time frame to be established by the Committee. The Committee must also establish recommended contract parameters for future contracts with out-of-state schools, designed to assure a high quality of service by registered agencies.

The Committee also must establish "model processes for placement" of a child in an out-of-state program or school, including review of alternative service options to avoid an out-of-home placement and review of all viable and least restrictive options for placing the child within the State.

The Committee is further required to analyze aggregate data on children placed out of state and to make recommendations concerning the development of integrated funding for the purchase of services for children with complex and/or multiply-diagnosed needs. The objectives of these efforts are to reduce or eliminate barriers to providing flexibility in funding programs for children; increase the number of alternatives to placing children out of state by allowing funds for services to follow the child into the most appropriate and least restrictive placement; and allow funds for services to be applied to the purchase of services within the child's community.

The legislation also requires the Committee to submit an annual report to the Governor and Legislature, within 30 days of the submission of the State budget, which includes recommendations designed to attempt to reduce future out-of-state placements.

Clarification of Confidentiality of Records Requirements  Approved
Chapter 571 L. of 2005
S.4775-A Effective: August 23, 2005

This legislation amends two sections of the MHL that relate to the confidentiality of clinical records and access to such records by patients or other qualified persons (Sections 33.13 and 33.16, respectively). The bill clarifies that non-licensed programs that receive funding from, or are otherwise Approved to render services by OMH, OMRDD or a county Director of Community Services, are subject to the confidentiality provisions of these two sections of law.

State Facilities

Security Hospital
Treatment Assistants
Vetoed
July 12, 2005
A.1685 Veto Message #9

This vetoed bill would have designated all security hospital treatment assistants as "peace officers" and would have eliminated the discretion of the Commissioner of OMH regarding such designation.

Prohibiting Temporary
Appointments in the Security
Services Bargaining Unit
 Vetoed
October 4, 2005
S.3004 Veto Message #99

This vetoed legislation would have placed an immediate prohibition on any temporary appointments in the Security Services bargaining unit. OMH employees represented by this unit include safety officers and security hospital treatment assistants. (Note: OMH currently uses temporary staff routinely to fill positions when permanent employees are absent due to sickness, vacation, or workers compensation leave. Using temporary appointments in this fashion eliminates the need to require other permanent employees to fill in for their colleagues on leave, thus reducing the need to use overtime.)

Miscellaneous

Freedom of Information
Law Amendment
 Approved
Chapter 22 L. of 2005
A.6714 Effective: May 5, 2005

This measure amends the Freedom of Information Law (FOIL), Public Officers Law (POL) Article 6, specifically with respect to the date when a request for information under FOIL must be granted or denied. Previously, FOIL required an agency to respond to a FOIL request with a written acknowledgment within five business days and either provide the requested documents, deny the request, or estimate a time when a response will be made. This legislation amends this requirement by adding that when disclosure of the documents is to be made, but cannot be made within a 20-day period from the date of acknowledgment, the agency shall provide a specific date, "within a reasonable period, depending upon the circumstances," upon which the documents shall be provided.

Reporting Requirement
Reform Act
 Approved
Chapter 524 L. of 2005
S.5108-A Effective: November 14, 2005

The bill eliminates outdated reporting requirements for various state agencies, including OMH. Specifically, the bill eliminates the provisions in Section 5.05(b) of the MHL that require the Inter-Office Coordinating Council, which consists of the Commissioners of OMH, OMRDD and OASAS, to annually report with respect to proper treatment models and suggested methods for treatment programs for persons with multiple disabilities.

The bill also repeals Section 33.16(e) of the MHL which requires the members of the Inter-Office Coordinating Council to each submit an annual report with respect to access to clinical records by patients and other qualified persons.

Procurement
Lobbying Reform
Approved
Chapter 1 L. of 2005
S.5873 Effective: January 1, 2006
until December 31, 2007

The intent of this legislation is to enact comprehensive reforms to more effectively regulate lobbying before governmental entities. Among many provisions, a new Section 139-j is added to the State Finance Law (SFL) related to lobbying on contract procurements of State agencies. The bill defines the term "procurement contract" as meaning any contract or other agreement for an article of procurement, involving an estimated annualized expenditure of $15,000. Grants and contracts with not-for-profit corporations are excluded from that definition.

This new SFL section provides that every contracting agency that undertakes a procurement shall (a) designate a person to be responsible for communications relative to the procurement who may be contacted by bidders or potential bidders, and (b) undertake the procurement in a manner that is consistent with procurement principles in the SFL, the POL and other applicable laws. Offerors who contact governmental entities about procurements must be prohibited from contacting anyone except designated personnel about the procurement, and must not attempt to influence a governmental procurement in a manner that violates or attempts to violate the POL ethics provisions.

Model guidelines issued by the Advisory Council on Procurement Lobbying may be consulted by State agencies engaging in procurement contracting, and summaries of the policies and prohibitions against unauthorized contacts must be incorporated into solicitations, bid documents or specifications for all procurement contracts.

The bill provides that every contracting agency must establish a process for reviewing all violations of new SFL Section 139-j. Furthermore, upon notification of alleged violations, the agency ethics officer, the Inspector General or other officials charged with investigating and reviewing such matters are required to investigate and give the contractor notice of the investigation and an opportunity to be heard. If contractors knowingly and willfully violate SFL Section 139-j, the contracting agency must determine that the contractor is a non-responsible bidder and cannot award the contract to that contractor. Any contractor found to have violated SFL Section 139-j twice in four years will be debarred from governmental procurements for a period of four years. Contractors must disclose prior findings of non-responsibility or they will be disqualified from procurement contract awards.

Finally, governmental entities must now record in the procurement record specified information about the persons that appear before them on governmental procurements.

Closing Ethics Loophole  Approved
Chapter 165 L. of 2005
A.4975-A Effective: July 11, 2005

The bill amends the State Ethics Law to ensure that the State Ethics Commission continues to have authority and jurisdiction over former State officers and employees, former candidates for statewide elected office and former political party chairs with respect to actions taken by those individuals while in State service, party office, or as candidates. This jurisdiction had been compromised as a result of a 1995 Court of Appeals decision, which held that the investigative and adjudicative authority of the Commission under Executive Law § 94(12) ended when the subject of a Commission ethics probe left State service (Matter of Lawrence P. Flynn v State Ethics Commission [87 N.Y.2d 199]).

Residential Facilities
Labor Law Amendments
 Vetoed
October 4, 2005
S.3008 Effective if Approved:
Immediately

This vetoed bill would have amended the Labor Law to permit employers and employees of residential facilities licensed by OMH or OMRDD to enter into labor agreements that confer the jurisdiction of the New York State Employment Relations Board and include "card check" and "no strike and lockout" provisions.

Rent Increase
Exemptions for
Individuals with Disabilities
 Approved
Chapter 188 L. of 2005
A.1092-A Effective: October 9, 2005

This bill amends the Real Property Tax Law to provide that individuals with disabilities, including those currently receiving Social Security Disability Insurance or Supplemental Security Income benefits, are to be considered eligible heads of household for certain exemptions from rent increases currently available to senior citizens. The current exemptions for senior citizens are available in New York City and certain municipalities in Westchester and Nassau counties. These jurisdictions would be permitted to extend such exemptions to individuals with disabilities by enacting a local law.

Contracts with
Not-for-Profit Organizations
 Vetoed
July 26, 2005
A.3454-A  Veto Message #25

This vetoed legislation would have amended the SFL to prohibit a State agency from requiring a waiver of penalty interest as a contract condition when such agency entered into contract with a not-for-profit organization. The Governor's veto message stated that the timing of contracts may be determined by factors outside the State agencies' control and that approval of the bill could have resulted in significant, unplanned and unbudgeted costs to the operating budgets of State agencies. The Governor directed the Division of Budget, in cooperation with relevant State agencies, to identify any impediments to compliance with the Prompt Contracting Law and to recommend appropriate changes to protect not-for-profit organizations contracting with the State.

Budget Language
Legislation
Chapter 58 L. 2005
S.3668 Effective: April 1, 2005

The following is a description of programmatic statutory changes made in the context of the 2005-2006 State Budget:

A. Medicaid Cap-State Takeover of Local Medicaid Costs (Part C,  §§1-9)

The budget authorized State takeover of local Medicaid costs beginning with the State takeover of costs that exceed an annual growth rate, set as follows: 3.5 percent in 2006, 3.25 percent in 2007, and 3 percent in subsequent years. Together, with the takeover of the Family Health Plus program, the cap will save local taxpayers more than $3.3 billion annually when fully effective. In exchange for the State takeover, counties will be required to remit a set level of local revenues to the State, and will be subject to new accountability standards aimed at checking excessive local spending growth.

Beginning in 2008, counties will have two contribution options. Under the first option, local governments can choose to remit to the State an amount equal to the capped spending plus 3 percent annual growth. Under the second option, local governments can choose to remit to the State a fixed percentage of their sales tax revenue equal to the fiscal year 2006-2007 capped contribution.

B. Family Health Plus (Part C, §§1-9)

The budget authorized an accelerated State takeover of the Family Health Plus program for counties outside of New York City. Under the plan, the State would assume all local costs for the Family Health Plus program, effective October 1, 2005. The accelerated takeover of the program will provide $25 million in fiscal relief to local property taxpayers in fiscal year 2005-2006.

C. Preferred Drug Program (Part C, §§10-15)

The budget authorized the Commissioner of DOH to immediately begin establishing a Preferred Drug Program (PDP) that will lead to the creation of a Preferred Drug List. Patients receiving Medicaid will continue to have unrestricted access to drugs on this list and will have restricted access to drugs not on the list.

The legislation creates a Pharmacy and Therapeutics Committee (P&T Committee), which will make recommendations to the DOH Commissioner regarding which drugs to include on the Preferred Drug List. The P&T Committee consists of 17 members, including six physicians, one nurse or midwife, six pharmacists, one pharmacologist, and three consumers/advocates. The P&T Committee, in developing the recommended list for the DOH Commissioner, must consider the potential impact of the PDP on the health of special populations, such as those with mental health conditions.

Certain drugs are not subject to the prior-approval process and will continue to be automatically covered by Medicaid, including atypical anti-psychotics, all anti-depressants, and any other therapeutic class for the treatment of mental illness recommended by the P&T Committee and Approved by the DOH Commissioner. Medicaid will automatically cover drugs on the Preferred Drug List. Drugs not on the list may be covered if the physician receives prior approval when certain conditions are met. The physician can override the prior-approval process when, in his or her reasonable professional judgment, he or she has determined that use of the particular drug is warranted.

In cases of emergency, patients can receive a 72-hour supply of the drug until the prior-authorization determination has been completed. If a prior-authorization determination is not completed within 24 hours and is solely as a result of a failure of DOH, prior authorization will be immediately and automatically granted. If a prior- authorization determination is not completed within 24 hours for any other reason, the patient can receive a 72-hour supply of the drug until the prior-authorization determination has been completed.

The legislation also establishes a second system by which the Medicaid program can restrict access to drugs under the Clinical Drug Review program (CDR). Under the CDR program, the DOH Commissioner will be able to ask the P&T Committee to consider whether Medicaid should automatically cover, or require prior approval for, those drugs that have the potential for overuse, abuse or illegal uses; are being used "off-label" (i.e., to treat different conditions other than those for which they are indicated); or are no more effective than over-the-counter versions of similar drugs. Just as in the PDP, the physician's professional judgment can override CDR access restrictions. Also, the CDR does not apply to atypical anti-psychotics, anti-depressants and any other therapeutic class for the treatment of mental illness recommended by the P&T Committee and Approved by the DOH Commissioner, as these drugs are not subject to prior authorization.

D. Hospital Realignment Commission (Part K, §§1-11)

The budget establishes the Commission on Health Care Facilities in the 21st Century, and charges it with the task of examining the system of general hospitals and nursing homes in New York State and recommending changes to that system. Some of the general hospitals that will be examined include OMH-licensed psychiatric wards located in Article 28 hospitals. This Commission's charge allows for it to recommend, among other things, the closure of facilities.

The Commission consists of 18 members, appointed as follows: two by the Temporary President of the Senate; two by the Speaker of the Assembly; one by the Minority Leader of the Senate; one by the Minority Leader of the Assembly; and 12 by the Governor. The Governor is to designate the Chair.

There are also to be six regional members of the Commission for each region established by this section (i.e., Long Island, New York City, Hudson Valley, Northern, Central, and Western). Regional members are considered to be members of the Commission under the following conditions:

  1. Regional members shall vote and be counted for quorum purposes only when the Commission is acting on recommendations relating solely to the regional members' respective region
  2. Regional members shall not be considered to be members of the Commission for purposes of participation in Commission meetings, except where items relating specifically to their region are on the agenda of a Commission meeting

E. Closure of the Middletown Psychiatric Center with Savings to be Reinvested to Expand State-operated Community Services (Part J, §§ 1-3)
The budget authorizes the closure of Middletown Psychiatric Center (MPC) on April 1, 2006, and requires all savings from the facility closure to be reinvested to expand State-operated community programs located within the service area of MPC.

F. Merger of the Office of Advocate for Persons with Disabilities and the Commission on Quality of Care for the Mentally Disabled (Part H, §§1-19)
The budget authorizes the merger of the State Commission on Quality of Care (CQC) for the Mentally Disabled and the Office of Advocate for Persons with Disabilities (APD) into a single agency, known as the "Commission on Quality of Care and Advocacy for Persons with Disabilities (CQCAPD)." Importantly, this merger will enable the State to claim Federal reimbursement for certain activities performed by APD that are currently paid for with State funds, thereby generating additional revenue to support programs that serve persons with disabilities.

G. Transfer of Compulsive Gambling Programs from OMH to OASAS (Part I, §§1-14)
The budget transfers responsibility for the compulsive gambling treatment and education program from OMH to OASAS.

2005 Statewide Comprehensive Plan Stakeholder Input

The 2005-2009 Statewide Comprehensive Plan for Mental Health Services continues the OMH commitment to quality, an emphasis on collaborative State-Local strategic planning, and greater opportunities for stakeholder input into the strategic planning process. The Plan also introduces the next major milestone in the evolution of the New York State public mental health system strategic planning effort ― the creation and implementation of a performance measurement framework (see Figure 1).

Figure 1
Model Performance Measurement Framework

Process for Accessible, individualized recovery-oriented services

In addition to documenting OMH's commitment to agency goals and objectives, Chapter 9 of the 2005-2009 Plan reflects a model based on extensive stakeholder input from 2004. Figure 2 presents the Major Goals and Objectives for the 2005-2009 strategic planning cycle.

Figure 2 (pdf format)
Major Goals and Objectives, 2005-2009 Strategic Plan

Goal 1
Improve the mental wellness and resiliency of all New Yorkers through an effective public education function.

1.1. Increase public awareness of the prevalence of suicide and of risk and preventive factors.
1.2. Maintain agency capacity to rapidly and effectively provide mental health support in response to natural and man-made disasters.
1.3. Improve public understanding of the causes and treatment for mental illness in adults and serious emotional disturbance in children.
1.4. Promote rapid response to the detection and treatment of the psychological aspects of eating disorders.
1.5. Promote early intervention and prevention strategies, particularly with primary care physicians and other health care providers.

Goal 2
Improve the quality of mental health services currently available to all adults with serious mental illness and all children with serious emotional disturbance.

2.1. Increase the availability of evidence-based practices in routine care.
2.2. Decrease the risk of experiencing adverse consequences resulting from harm, neglect or sub-optimal care or treatment.
2.3. Increase the State's capacity to measure and monitor the quality of care.
2.4. Increase the State's and counties' capacity to improve performance based on outcomes measurement.
2.5. Maintain adequate resources to ensure that high quality services are able to be provided.

Goal 3
Increase State and Local accountability for improvements in access to services, quality and appropriateness of services, and cost of services.

3.1. Improve the State/Local mental health planning process to promote accountability.
3.2. Improve care coordination for people with multiple inpatient admissions and little connection to appropriate outpatient services.
3.3. Improve oversight of medication practices for both adults and children.
3.4. Improve the service provider certification and licensing process.

Goal 4
Reduce the burden of illness through strengthened ties with the scientific community engaged in both basic and applied research.

4.1. Improve knowledge about the causes of mental illness.
4.2. Promote the development of new treatments.
4.3. Improve culturally competent models of service delivery using consumer input.
4.4. Improve the length of time it takes to disseminate research findings to relevant audiences.
4.5. Improve the degree to which research scientists provide technical assistance (both continuing education and consultation) to service practitioners.
4.6. Improve the degree to which the agency can assess the magnitude of social cost and burden in order to prioritize resource utilization.

Goal 5
Improve outcomes for adults with serious mental illness and children with serious emotional disturbance through use of proven, effective treatments.

5.1. Increase planning efforts concerning inpatient admissions and readmissions.
5.2. Decrease use of treatments shown to be ineffective.
5.3. Increase consumer and family input and participation in the treatment planning process.
5.4. Increase use of underutilized services known to be effective.
5.5. Improve access to services with the potential to help individuals achieve success and satisfaction in living, learning, work, and social environments.

Goal 6
Increase access to appropriate and effective services for special populations.

6.1. Improve services for children with depression.
6.2. Improve services for people with mental illness who use forensic systems of care.
6.3. Improve services for young adults.
6.4. Improve services for older adults.
6.5. Improve services for people with mental illness who reside in adult homes.
6.6. Improve services for people who require intensive levels of care coordination, including people served by the SPOA system, ACT teams, and people served through the Assisted Outpatient Treatment program.

Goal 7
Improve the capacity of State and Local governments to achieve agency goals.

7.1. Maintain sufficient resources for State and Local service delivery at levels necessary to ensure appropriate access to services.
7.2. Improve retention and recruitment to ensure a qualified workforce.
7.3. Improve system capacity for delivery of culturally competent services.
7.4. Improve system capacity for delivery of consumer-requested services.
7.5. Improve system capacity for employee skills development and competency.
7.6. Maintain system capacity to articulate cost-effectiveness.

Central to the development of a performance management system and its components, including measurement strategies and indicators, are the concerns and ideas of key stakeholders. Stakeholders play a critical role in managing and measuring progress by helping the agency to align its operations with its mission, vision and values, to create a climate of innovation and learning, to bridge linguistic and cultural gaps, and to examine expectations in relation to performance. Thus, OMH systematically and continuously conducts forums and meetings and offers other opportunities for stakeholder input. Over the past year, for example, Commissioner Carpinello traveled widely across New York State to meet with as many stakeholders as possible, hear their perspectives, and have these perspectives reflected in the strategic planning process. As part of its commitment to systematically seek stakeholder input into the planning process for the Statewide Comprehensive Plan for Mental Health Services, OMH held its second annual series of informational briefings and public hearings during the late spring and early summer of 2005. Stakeholders were invited to hear discussion and offer comments on the 2005-2009 Plan. In particular, this year's informational briefings and hearings focused on the extent to which the goals and objectives in the 2005 Plan captured the priorities and expectations expressed by stakeholders in the previous year regarding continuous quality improvement in the public mental health system. Specific questions addressed included:

Extensive stakeholder input was elicited during these forums, along with input from the many other forums and opportunities, and was carefully documented and considered by OMH. Two important recommendations were made for the Strategic Plan Framework Vision Statement and the ABC's of Mental Health Care.

Stakeholders suggested a review of the vision statement and refinement to make it more expansive, effectively communicating the fundamental importance of striving to attain person-centered recovery goals in the agency's vision for the future. After a careful review of the literature, OMH determined that the President's New Freedom Commission on Mental Health clearly articulated what OMH envisioned for the New York State public mental health system. The new vision statement is found in Figure 3.

Figure 3
OMH Vision

The New York State Office of Mental Health envisions a future when everyone with a mental illness will recover, when all mental illnesses can be prevented or cured, when everyone with a mental illness at any stage of life has access to effective treatment and supports-essential for living, working, learning, and participating fully in the community.

Stakeholders also acknowledged the importance of the principles upon which the OMH strategic planning approach is built and recommended the addition of a "D" to represent, "disparities elimination and cultural competence," to make known OMH's commitment to diversity planning and inclusiveness in assessing, planning, implementing and evaluating mental health treatment and supports. As a result of this recommendation, OMH has expanded the ABC's of Mental Health Care to the "ABCD's" of Mental Health Care to include "Disparities Elimination and Cultural Competence" to represent the "D." A new statement addressing this principle has been added to read:

Disparities Elimination and Cultural Competence, whereby all service components are held accountable to address disparities in access to and participation in services, differences are managed skillfully, cultural knowledge is absorbed organizationally, language assistance services are provided routinely, and service modifications are made to take into account the diversity of individuals, families and communities.

In addition to taking into account stakeholder input on the Goals and Objectives, OMH conducted a review of the literature to survey and ensure that the latest science and knowledge are reflected in the Goals and Objectives. Together this feedback has been incorporated into a refined version of the Major Goals and Objectives for use in ongoing strategic planning activities (see Figure 4). The information that follows Figure 4 provides a summary of the input received during this year's strategic planning forums with stakeholders.

Figure 4 (pdf format)

Major Goals and Objectives, 2006–2010 Strategic Plan

AIMS

  • To promote the achievement of person-centered recovery goals for children, families and adults
  • To promote wellness and resiliency for individuals and communities
  • To promote cultural and linguistic competence as an integral part of all mental health services
  • To promote community integration and acceptance through the reduction of stigma

Outcomes Domain

Mental Health Services Domain

System Management Domain

Public Mental Health Promotion

Positive Outcomes for Children, Families and Adults

Research to Practice

Continuous Quality Improvement

Access to Services

Service System Capacity

Accountability for Results

Care Coordination

Goal 1

Improve the public health outcomes, wellness, and resiliency of all New Yorkers through an effective public and provider education function.

Goal 2

Improve outcomes for children with serious emotional disturbance and adults with serious mental illness through the use of proven, effective treatments.

Goal 3

Reduce the burden of illness through strengthened ties with the scientific and consumer communities engaged in basic, clinical and services research.

Goal 4

Improve the quality of mental health services currently available to all children with serious emotional disturbance and all adults with serious mental illness.

Goal 5

Increase access to appropriate and effective services, with an emphasis on access for vulnerable and/or underserved populations.

Goal  6

Improve the capacity of State and Local governments to achieve agency goals.

Goal 7

Increase State and Local accountability for improvements in access to services, quality and appropriateness of services, and cost of services.

Goal  8

Increase the delivery of a coordinated array of medical, self-help, social, supportive, and rehabilitative services designed around the needs and desires of the individual.

Objectives

1.1
Increase public awareness of the prevalence of suicide and of risk and preventive factors.

1.2
Maintain the capacity to rapidly and effectively provide mental health support in response to natural and human-caused disasters.

1.3
Improve public understanding of the causes, effects and treatment of emotional disturbance in children and mental illness in adults.

1.4
Promote the detection, early intervention, and treatment of the psychological aspects of eating disorders.

1.5
Promote screening, early intervention and prevention strategies, particularly with primary care physicians, other health care providers, and community providers important to consumers.

2.1
Increase the use of mental health services that have the strongest demonstrated evidence base.

2.2
Increase consumer and family input and participation in the treatment planning process.

2.3
Promote services with the potential to help individuals achieve success and satisfaction in living, learning, work, and social environments.

3.1
Improve the base of knowledge about the causes and treatments of mental illness.

3.2
Promote the development of new treatments based on the best available scientific knowledge.

3.3
Develop and improve culturally and linguistically competent models of evidence-based services and their delivery.

3.4
Reduce the length of time it takes to disseminate research findings to key stakeholder audiences.

3.5
Improve the degree to which researchers provide technical assistance (both continuing education and consultation) to service providers and policy makers.

3.6
Improve the degree to which the agency and stakeholders can assess the magnitude of social cost and burden in order to prioritize resource allocation.

4.1
Improve service quality through fidelity to the principles of informed choice, recovery-focused and person-centered care.

4.2
Increase the quality of services through the incorporation of evidence-based practices in routine care.

4.3
Minimize the risk and occurrence of adverse consequences resulting from harm, neglect or suboptimal care or treatment.

4.4
Ensure that the State and counties have the tools and resources necessary to measure and monitor the quality of care.

4.5
Increase the State’s and counties’ capability to improve performance based outcomes measurement.

4.6
Maintain adequate resources to ensure that high-quality services are able to be provided.

5.1
Improve access to appropriate and effective services for children with serious emotional disturbance and their families.

5.2
Improve access to appropriate and effective services for children with serious emotional disturbance and developmental challenges.

5.3
Improve access to appropriate and effective services for children with depression.

5.4
Improve access to appropriate and effective services for individuals involved in the criminal justice system.

5.5
Improve access to appropriate and effective services for young adults.

5.6
Improve access to appropriate and effective services for older adults.

5.7
Improve access to appropriate and effective services for people with mental illness who reside in adult homes.

5.8
Improve access to appropriate and effective services for individuals with co-occurring mental health and substance abuse service needs.

5.9
Improve access to safe and affordable housing for individuals with serious emotional disturbance and serious mental illness.

6.1
Promote the capability of State and Local service systems to provide appropriate and effective services.

6.2
Improve retention and recruitment to ensure a qualified workforce.

6.3
Improve system capacity for delivery of culturally and linguistically competent services.

6.4
Improve system capacity for the delivery of services identified by individuals with mental illness and their families as effective in meeting their recovery goals.

6.5
Improve system capacity for employee skills development and competency.

6.6
Develop and refine system capacity to assess and monitor cost-effectiveness.

7.1
Improve the State and Local mental health planning and oversight process to promote accountability.

7.2
Improve oversight of medication practices for both children and adults.

7.3
Improve the service provider certification and licensing process.

7.4
Improve the State and Local mental health planning capacity to identify and address disparities in access to and quality of mental health services based on culture, age and gender.

8.1
Develop collaborative approaches with other State-level child-serving agencies to assure integrated, accessible, effective treatment services that assist children with serious emotional disturbance to remain at home, in school and in their communities.

8.2
Improve the coordination of services for individuals who require intensive levels of care coordination, including children served by CCSI and adults served by the SPOA system, ACT teams, and the AOT program.

8.3
Improve mental and physical care coordination for people with multiple inpatient admissions and little connection to appropriate outpatient services.

Summary of Stakeholder Input on Goals and Objectives

Overall Organization and Emphasis

Input: While stakeholders generally supported the goals presented, they emphasized that overriding all the goals is the aim of recovery. The goals presented in the 2005-2009 Plan, they stressed, support this ultimate aim. They urged a clear emphasis on person-centered, recovery-based goals.

Action taken:
A top level of "Aims" was added to the table to reflect their predominant importance in directing efforts toward the goals. The first of the aims to be added to this level includes:

Input: Stakeholders commended OMH for its new emphasis on wellness, resiliency and public health. They indicated that promoting public mental health, wellness and resiliency for communities and individuals is a top priority and should be treated as another aim of the public mental health system.

Action taken: A second aim has been added to the top level of the plan structure to read:

Input: Stakeholders indicated that cultural and linguistic competence are essential to developing mental health services and supports that are effective in achieving person-centered recovery goals and community wellness and resiliency. Stakeholders advocated another aim to reflect this urgency.

Action taken: A third aim has been added:

Input: Stakeholders expressed a desire to promote recovery through efforts to reduce the stigma associated with mental illness, thereby encouraging individuals to seek and remain engaged in treatment and supports based on their individual needs and desires.
Action taken: A fourth and final aim has been added to address this important consideration to mental health promotion and well-being:

Input: Stakeholders noted substantial opportunities to improve coordination at all levels of the public mental health system: between State agencies, County agencies, human service agencies and social services agencies, between providers, and between providers and government agencies.

Action taken: An eighth goal, Care Coordination, has been added to the planning framework and two care coordination objectives appearing elsewhere in the 2005-2009 Statewide Plan Strategic Plan Framework — 3.2 and 6.6 — have been moved under this new goal. These two objectives now appear as objectives 8.2 and 8.3 in the revised Strategic Plan. A new care coordination objective has also been added, 8.1, which focuses on the specific care coordination needs of children and their families.

Input: The goals and objectives table addresses complicated, interrelated concepts. The organizational scheme could be made clearer by grouping related goals.

Action taken: The table now contains three groupings of conceptually related goals, which appear just above the goal statements and are labeled as domains:

Goals and Objectives

Goal 1 - Public Mental Health Promotion
Improve the public health outcomes, wellness and resiliency, of all New Yorkers through an effective public and provider education function.

Table reorganization: This goal, which is part of the Outcomes group, has been modified to acknowledge the importance of improving the public health outcomes by adding the words "public health outcomes."

Input: As noted previously, stakeholders value the new emphasis by OMH on wellness, resiliency and public health. They strongly endorsed the agency emphasis on suicide prevention and affirmed the benefit of early identification and treatment of eating disorders. Additionally, it was noted that such efforts should also extend to the provider community.

Action taken: The goal has been modified to take into account the importance of broad education efforts, aimed at the public and providers of mental health services.

Input: The last objective should be expanded to incorporate other providers from whom consumers seek support, such as faith-based providers.

Action taken: Objective 1.5 has been revised to read, "Promote screening, early intervention and prevention strategies, particularly with primary care physicians, other health care providers, and community providers important to consumers."

Priority areas identified: Stakeholders identified a number of initiatives related to these objectives and recommended their consideration as future priority activities. They include carrying out targeted education and promotion campaigns related to recovery, stigma reduction, and the benefits of employing individuals with disabilities; increasing understanding of the interrelationship between mental health and physical health; and producing educational materials that are directed at older adults, aim to improve understanding of the value of peer services, and deal with issues faced by women with mental illness who have children or who are expecting.

Goal 2 - Positive Outcomes for Children, Families and Adults
Improve outcomes for children with serious emotional disturbance and adults with serious mental illness through the use of proven, effective treatments.

Table reorganization: This goal was Goal 5. It is now part of the Outcomes group and appears as Goal 2.

Input: As indicated above, stakeholders identified the need to capitalize on opportunities to improve coordination at all levels of the public mental health system.

Action taken: As noted above, a new goal addressing care coordination has been added to the table (see Goal 8). The objective, "Increase planning efforts concerning inpatient admissions and readmissions" has been refined and incorporated into the new care coordination goal and revised to read, "Improve mental and physical care coordination for people with multiple inpatient admissions and little connection to appropriate outpatient services."

Input: As indicated above, stakeholders endorsed the importance of emphasizing person-centered, recovery-based outcome measures.

Action taken: As noted previously, an aim was added to stress the importance of person-centered, recovery-based outcomes.

Input: Stakeholders recommended greater clarity for the first objective, "Increase the availability of evidence-based practices in routine care."

Action taken: The objective now reads, "Increase the use of mental health services that have the strongest demonstrated evidence base."

Priority areas identified:
Stakeholders indicated that outcomes should be holistic and address all important quality-of-life areas. Additionally, they advocated for consumer and family roles in identifying outcome measures. Employment-related outcome measures were emphasized.

Goal 3 - Research to Practice
Reduce the burden of illness through strengthened ties with the scientific and consumer communities engaged in basic, clinical and services research.

Table organization: This goal was Goal 4. It is now part of the Mental Health Services group and appears as Goal 3. It has been revised slightly to acknowledge the contribution of clinical and services research. Importantly, the goal reflects the collaborative nature of research by including the consumer community's contribution to research findings that help to improve the overall quality of services.

Input: Stakeholders were pleased that the 2005 Plan recognized the outstanding work of the Nathan Kline Institute and the New York State Psychiatric Institute and urged continuing State investments in the important work of these institutions. Stakeholders also voiced approval for the Children's Research Symposium coordinated by OMH and affirmed the need to strengthen ties between the scientific community and the general public.

Action taken: Minor revisions to the objectives have been made for clarity. Objective 3.1 has been expanded to specify the inclusion of treatment, and Objectives 3.3 and 3.4 have been revised to acknowledge the importance of basing new treatments and service delivery models on the best scientific evidence available. Objective 3.4 is clearer in specifying that the intent is to reduce the time to get scientific findings to "key stakeholder" rather than "relevant" audiences. Objective 3.5 stresses the need to provide technical assistance to providers and policy makers and Objective 3.6 makes explicit the involvement of stakeholders in assessing the social cost and burden of mental illness.

Priority areas identified:
Stakeholders identified research into geriatric mental health issues as a growing priority as the New York State population ages.

Goal 4 - Continuous Quality Improvement
Improve the quality of mental health services currently available to all children with serious emotional disturbance and all adults with serious mental illness.

Table organization: This goal was Goal 2. It is now part of the Mental Health Services group and appears as Goal 4.

Input: As indicated above, stakeholders stated that the overarching goal or aim of the public mental health system is recovery. In addition, they indicated that person-centered, recovery-based goals and strategies are fundamental indicators of quality services.

Action taken: A new objective has been added (Objective 4.1) to underscore the importance of these views, which reads "Improve service quality through fidelity to the principles of informed choice, recovery-focused, and person-centered care." The other objectives have been renumbered sequentially.

Input: Stakeholders advised revisions to the remaining objectives to make explicit the link to evidence-based practices and to clarify the meaning of "capacity."

Action taken: Service quality has been emphasized in Objective 4.2. For greater clarity and precision, the word "capacity" in Objective 4.4 has been changed to "tools and resources" and in Objective 4.5 to "capability."

Priority areas identified: Stakeholders supported the emphasis on evidence-based models of care and services, saying:

Goal 5 - Access to Services
Increase access to appropriate and effective services, with an emphasis on access for vulnerable and/or underserved populations.

Table organization:
This goal was Goal 6. It is now part of Goal 5 under the Mental Health Services group.

Input: While acknowledging that individuals who are members of special populations should be given priority in access to appropriate and effective services, stakeholders emphasized the importance of having the goal reflect access to all children experiencing serious emotional disturbance and all adults who have serious mental illness. Stakeholders also asserted that a "special" population is one that is likely to include individuals who are vulnerable and/or underserved.

Action taken:
The goal statement was modified to read: Increase access to appropriate and effective services, with an emphasis on access for vulnerable and/or underserved populations.

Input: As indicated previously, stakeholders indicated substantial opportunities to improve coordination at all levels of the public mental health system.

Action taken: As discussed previously, a new goal addressing care coordination has been added to the table (see Goal 8). The second objective listed, "Improve the coordination of services for individuals who require intensive levels of care coordination, including children served by the Coordinated Children's Service Initiative (CCSI) and adults served by the Single Point of Access (SPOA) system, Assertive Community Treatment (ACT) teams, and the Assisted Outpatient Treatment (AOT) program" has been moved to be part of this new care coordination goal.

Input: Noting that the objectives under this goal include the wording "Improving services," stakeholders advised the use of more specific wording such as "access to appropriate and effective services."

Action taken:
Under the objectives, the wording "Improving services" has been changed to "Improve access to appropriate and effective services."

Input: Stakeholders identified several groups of individuals who are vulnerable and/or underserved and advised creating distinct objectives to ensure that the needs of each group are addressed.

Action taken:
The groups added include children with serious emotional disturbance and their families (now Objective 5.1), children with serious emotional disturbance who have developmental challenges (Objective 5.2), and individuals with co-occurring mental health and substance abuse service needs (Objective 5.8).

Input: Stakeholders indicated that access to safe and affordable housing for individuals with serious mental illness and serious emotional disturbance is of high priority.

Action taken:
A new objective, Objective 5.9, has been added to read, "Improve access to safe and affordable housing for individuals with serious emotional disturbance and serious mental illness."

Priority areas identified:
Priority areas identified by stakeholders include measurement of access to child and adult inpatient services, children's clinics, peer programs and supports, case management, and housing. Stakeholders also indicated that another important priority would be to measure access to all appropriate and effective services for individuals who are not eligible for Medicaid.

Goal 6 - Service System Capacity
Improve the capacity of State and local governments to achieve agency goals.

Table organization: This goal was Goal 7. It is now part of the System Management group and appears as Goal 6.

Input: Stakeholders endorsed this goal as one of high priority.

Action taken:
No substantive changes to the goal were recommended.

Input: Stakeholders advised clarifying Objective 6.1 to focus on the capability of these systems to provide appropriate and effective services, expanding the description of "culturally competent" services to "culturally and linguistically competent" services, specifying the meaning of "consumer-requested services" and better defining the phrase "articulate cost-effectiveness."

Action taken: Objective 6.1 has been revised to read, "Promote the capability of State and Local service systems to provide appropriate and effective services." Objective 6.3 has been refined to specify "culturally and linguistically competent services," while Objective 6.4 has been revised to indicate that improvements in system capacity will focus on services that help individuals and their families meet their recovery goals. For precision, Objective 6.6 now reads, "Develop and refine system capacity to assess and monitor cost-effectiveness."

Priority areas identified: Stakeholders expressed concern about the growing reliance on Medicaid reimbursement, the increasing number of individuals who lack health insurance, the decreasing availability of third-party insurance, and the adverse impact of Medicaid managed care. Stakeholders identified inpatient capacity, employment opportunities, housing, clinic capacity, children's services and transportation as priority areas for performance measurement.

Goal 7 - Accountability for Results
Increase State and Local accountability for improvements in access to services, quality and appropriateness of services, and cost of services.

Table organization: This goal was Goal 3. It is now part of the System Management group and appears as Goal 7.

Input: Stakeholders generally agreed that the planning process has improved and has become more open and transparent. Stakeholders supported greater accountability at the State and Local levels and the establishment of clear and measurable standards. They also recommended making quantitative data more accessible to promote accountability. Stakeholders endorsed efforts to infuse the planning process with performance data-driven processes, using data to monitor progress and be accountable for outcomes. Stakeholders saw planning as one area rife with opportunities for improving coordination at all levels of the public mental health system.

Action taken: As previously, a new goal addressing care coordination has been added to the table (see Goal 8). The objective, "Improve care coordination for people with multiple inpatient admissions and with little connection to appropriate outpatient services" has been moved to be part of this new care coordination goal and as noted previously, the objective (Objective 8.3) now reflects the importance of coordinating mental and physical care.

Input: An area of priority for stakeholders is in identifying and addressing disparities in service access and quality.

Action taken: A new objective, Objective 7.4, has been added to indicate intent to improve the State and Local capacity for identifying and addressing disparities in access to and quality of mental health services based on culture, age and gender.

Priority areas identified: Stakeholders indicated that the statewide mental health planning process, including the identification of priorities, should continue to strive for greater community, county and regional input.

Goal 8 - Care Coordination
Increase the delivery of a coordinated array of medical, self-help, social supportive and rehabilitative services designed around the needs and desires of the individual.

Input: As indicated above, stakeholders noted substantial opportunities to improve coordination at all levels of the public mental health system: between State agencies, County agencies, human service agencies and social services agencies, between providers, and between providers and government agencies.

Action taken: As previously described, an eighth goal has been added to the planning framework and two care coordination objectives appearing elsewhere in the 2005-2009 Statewide Plan Strategic Plan Framework — 3.2 and 6.6 — have been moved under this goal. These two objectives now appear as objectives 8.2 and 8.3 in the revised Strategic Plan.

Input: Stakeholders also advocated for a distinct objective specifically related to care coordination for children and their families. They also advised attention to care coordination at the point an individual transitions from an institutional to a community setting.

Action taken: As noted previously, a new objective, Objective 8.1, has been added, which reads, "Develop collaborative approaches with the other State-level child-serving agencies to assure integrated, accessible, effective treatment services that assist children with serious emotional disturbance to remain at home, in school and in their communities."

Priority areas identified: Stakeholders identified care coordination for individuals with co-occurring disorders as a priority. This included individuals with co-occurring mental and physical health needs, co-occurring mental health and substance abuse needs, co-occurring mental health and developmental disability needs, and children with multiple systems needs.

The process of formally hearing from stakeholders during the spring and early summer of 2005 and receiving feedback during other opportunities for input was fruitful and provided substantive contributions to strengthening OMH's planning foundation. OMH is grateful for the seriousness with which individuals approached the public input process, is hopeful the new Strategic Plan accurately and completely reflects the complexity of thoughts and recommendations expressed, and looks forward to ongoing stakeholder engagement in future planning efforts. By continuing to capture a broad representation of perspectives and ideas, OMH is striving to ensure that the agency priorities reflect the importance of recovery and client-centered care for individuals and their families.

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