Table of Contents
The New York State Office of Mental Health (OMH) issued the 2004-2008 Statewide Comprehensive Plan for Mental Health Services in January, 2004. This 2004 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.
This Interim Report contains a summary of Executive and Legislative Budget actions, and legislation related to OMH and the New York State Public Mental Health System.
This document also briefly reviews the stakeholder input that was presented at the 2004 briefings and hearings. OMH will use this input to shape the 2005-2009 Comprehensive Plan.
Governor Pataki is committed to the provision of high-quality mental health care that promotes hope and recovery for New York State residents with psychiatric disabilities.
Under the Governor’s leadership, the Office of Mental Health is working toward a recovery-oriented public mental health system that is consumer and family focused, responsive to individual needs and respectful of culture and language, that promotes wellness and reduces the burden of mental illness.
We believe that the primary locus of mental health care should be in the community, enabling individuals to remain at home, at work, in school, with friends and loved ones. But, be assured, we know that this does not dismiss the need for a quality inpatient system of care that also provides sufficient capacity.
I am working to drive OMH to provide a future filled with hope and opportunity for New Yorkers with mental illness, and I look forward to continuing my partnerships with the thousands of consumers, family members, providers and other stakeholders whom I have come to know as we work together toward that goal.
Some of the principles we are keeping in the forefront of our thinking include:
- Consumers and families are best at determining “what helps.” Using consumer-defined recovery- oriented performance outcomes, and listening to and taking direction from consumers to determine the measure of our success is part of the foundation to the quality agenda.
- OMH believes that viewing the wellness of the whole person - connecting physical health, emotional health, self esteem, and symptom management - will contribute to determining the appropriate course of services for individuals in treatment.
- Viewing the whole person and his or her connection to family and community, will build alliances to sustain individuals in treatment and services. When providers are aware of a consumer’s housing, employment, social connections, spirituality and educational desires - and work in partnership with consumers to fulfill those desires - consumers and their families can be better supported in their homes and communities.
We know we need to work on access to services and cultural adaptation of services. We also need to document “what works” at the community level to build the science base demonstrating effective practices. OMH is eager to take research findings about interventions that work, and use them to build effective service systems. We want to make recovery a possibility for everyone.
We all know that stigma plays a large role in preventing individuals from seeking the treatment they need. Stigma is pervasive and, as mentioned in the report of the President’s New Freedom Commission, must be eliminated. Americans must understand that mental health is essential to overall health. To address stigma, we need to carry out a community-based message that is tailored to match for culture - ethnicity, gender, age, language, and spiritual practices. These efforts require continually developing partnerships at the neighborhood level that will need to be sustained over time.
Working with the Governor, I am implementing a person-centered approach that includes:
- A new, exciting public mental health role for New York State that includes culturally relevant public awareness campaigns about topics such as suicide prevention, eating disorders, and building resiliency;
- The use of services that have a scientific base and have been proven effective;
- Business continuity in the face of disaster;
- Data-driven decision making which results in improved service system performance, improved service provider performance and improved individual clinician performance; and
- Population-based planning that promotes focused attention on care coordination across diverse disability groups.
As we look to the future, New York State will continue to be guided by strategies and governing principles to promote wellness, and reduce the burden of mental illness.
New York State has the opportunity to help parents achieve what they want most for their children - to have them home, happy, successful in school, with friends. We have the opportunity to ensure that adults with mental illness can live and work in the community. And we have the opportunity to further break the walls of stigma that surround us.
It is our hope and belief that these aspects of a vision for a public mental health system can, through all of our ongoing collaborations, commitment and hard work, come together to move us ever closer to the day when recovery from mental illness is a real and achievable goal for all.
The 2004-2008 Statewide Comprehensive Plan for Mental Health Services combined future planning directions as required by statute with a description of agency progress during 2001-2003. It also encompassed a range of topics beyond the scope of services to adults with serious mental illness and children with serious emotional disorders. In addition to describing program initiatives and future plans for both of these major target groups, the Plan provided valuable information concerning a broader agenda of public mental health promotion through education and advocacy.
It was the intent of OMH to expand the planning horizon. Building a community-based system of care continues to be a priority in New York State and a major focus for program and policy development during the 2004-2008 planning period. To reinforce the intent to create holistic, person-centered systems of local care, it is necessary to develop a planning platform that is wider ranging than those used in the past. The 2004-2008 Plan broadened the planning platform by supplementing the factual information it presented with important materials and statistical information that are included in a series of appendices. The appendices displayed State and local data in an integrated fashion, at county-specific levels, and by auspice (e.g., private, general, and State-operated hospitals) where helpful. These layers of detail were intended to generate interest toward an analytical, population-based planning approach which is used in other areas of public health, but not widespread in public mental health.
Chapter 1 described OMH’s role as public mental health authority and our commitment to quality care. It contained specifics on the implementation of the OMH strategic planning framework, the ABC's of mental health care, with discussions of accountability structures at the local-level. Chapter 2 provided an overview of the planning process and described population-based planning, which is also included in discussions on service utilization, inpatient care, performance measurement, and adult and children services found elsewhere in the Plan. These examples were intended to generate interest in localities toward developing data-driven, results-oriented specific plans for different target groups and services throughout the State.
Following the overview of the public mental health system in Chapter 3, Chapter 4 presented a starting point for this planning approach by including considerable detail on issues concerning inpatient capacity, utilization, costs and preliminary outcome measurement indicators for both State and local sectors. The Plan's discussion of inpatient services was a way to introduce a new series of local planning forums intended to create a collaborative, transparent approach to determining how resources are currently used and can best be used to maximize outcomes. A focus on positive social outcomes such as recovery and community integration is the motivation for proposing this person-centered, location specific approach to service-system planning.
Chapters 5 through 9 described agency progress during 2001-2003 and activities anticipated during the 2004-2008 planning period. The agency’s continuing commitment to ongoing and anticipated child and adult evidence-based practice initiatives was reviewed, as well as care coordination efforts achieved through new advances in technology and decision support. Detailed discussions were presented on advances in management information and research. Emerging ideas in public mental health promotion were introduced, which include plans for a new statewide suicide prevention campaign. Finally, Chapter 10 summarized how the major ideas presented throughout the Plan are integrated within OMH's strategic planning framework and specific, strategic initiatives targeted for accomplishment by 2008.
The initiatives and advances described in 2004-2008 Plan are all informed by OMH’s guiding principles for the statewide mental health planning process, which stress the importance of recovery, full community integration, and the application of the highest possible standards of care. The Plan was presented with the perspective that readers will review certain areas and be inspired to request further inquiry and insight concerning the nature of mental health care in New York State.
The 2004-2008 Plan is also available on the OMH Web site at www.omh.state.ny.us/ omhweb/statewideplan/.
The 2004-2005 Executive Budget for Mental Health reaffirmed Governor Pataki’s commitment to the provision of high quality mental health care in New York State. The Executive Budget proposal continued the advancement of an agenda that is integral to promoting recovery and community integration for individuals with mental illness. It maximized access to quality mental health care, while still achieving necessary efficiencies to ensure the most cost-effective use of all resources.
The Legislature completed its budget for State fiscal year 2004 – 2005 in August. Governor Pataki, after reviewing the Legislature’s budget and its impact on New York State’s taxpayers and finances, issued 195 vetoes because the budget was potentially out of balance in the current year, and measurably worsened the State’s long-term fiscal outlook without the passage of real fiscal reforms. Specific Executive Budget recommendations for mental health are outlined below, followed by subsequent Legislative and Executive Action taken:
Bipartisan Commission for the Closure of State Psychiatric Centers
With an estimated State-operated hospital adult census of approximately 4,000 by 2006, New York State must reconsider the role of State-operated inpatient care within the broader continuum of community-based treatment, rehabilitation, and support services available in each area of the State. The Executive Budget recommendation supported the establishment of a Bipartisan Commission for the Closure of State Psychiatric Centers. Composed of gubernatorial and legislative representatives, the Commission was intended to provide facility closure recommendations based on specific selection criteria. The ultimate goal was a cost effective inpatient system that provides sufficient capacity and access to quality care, maximizes the use of taxpayer dollars, and brings the number of operational beds into alignment with the projected need. The Executive Budget also recommended closure of Middletown Psychiatric Center effective April 1, 2005.
This item was not enacted.
Extending the Community Mental Health Support and Workforce Reinvestment Act for an additional three years until the year 2010, and establishing a new provision in The Reinvestment Program to reinvest 50 percent of the savings achieved through facility closures into State-Operated community-based services in the catchment areas served by those facilities.
The proposed legislation to establish the Commission for the Closure of State Psychiatric Centers also contained language to extend the Community Mental Health Support and Workforce Reinvestment Act for an additional three years, until 2010. A companion bill proposed that 50 percent of the administrative, support and overhead costs achieved through future facility closures be reinvested to expand State-operated community-based services in the catchment areas of those facilities. The bill also coordinates the distribution of the 5.07 plan and the annual budget.
The Commission bill was not enacted. However, the Legislature extended Reinvestment to 2010.
Increasing funding for community residences for children and adults.
The Executive Budget recognized that investments to maintain the existing service system must accompany ongoing initiatives to expand it. The budget redirected savings from maximizing Federal reimbursement for programs previously funded by Reinvestment and other sources to provide more than $9 million in funding increases for the continued operation of licensed community residential beds for adults and children. This new funding would enable community residence programs to more appropriately address the rehabilitative and support needs of priority populations. OMH continues to look for additional ways to support its entire residential service system.
This Executive Budget recommendation was enacted as proposed.
Expanding evidence-based community programs for children and adolescents.
The Executive Budget reaffirmed the Governor’s commitment to provide services to children in appropriate settings, and reinvesting all of the savings associated with children’s inpatient bed closures into an array of evidence-based community services. The budget redirected savings ($2.6 million annually) realized from the closure of 21 underutilized children’s inpatient beds during FY 2004-2005. Overall, redirecting these dollars from State-operated inpatient services to community settings would quadruple the number of children who could be served with these resources, and allow them to remain at home while receiving services.
This Executive Budget recommendation was enacted as proposed.
Expanding mental health treatment capacity and clinical staffing for prisoners with serious mental illness.
The Executive Budget continued to support collaboration between OMH and the Department of Correctional Services (DOCS), and built upon the range of treatment services that they have jointly established for prisoners with serious and persistent mental illness. A total of $7 million in new appropriations was provided to significantly expand mental health treatment capacity and clinical staffing for this population. This expansion would support a range of new and expanded treatment services based upon a statewide review of the forensic program, including two new Behavioral Health Units established in DOCS facilities; almost triple the number of beds for the Special Treatment Program; expanded bed capacity for the Intermediate Care Program; and improved access to clinical staff for mental health services.
This Executive Budget recommendation was enacted as proposed.
Continuing the development of community housing for children and adults which, once completed, will support 31,100 community beds.
The Executive Budget provided operational and capital funding for local programs to maintain the existing residential system and continue the development of previously authorized community beds. It supported 26,700 currently operating beds, 1,300 new beds from prior year initiatives that are expected to open by the end of Fiscal Year (FY) 2004-2005, and another 3,100 beds that are in various stages of planning and development. Included within these numbers, under the Community Mental Health Support and Workforce Reinvestment Program, the Executive Budget authorized 600 new supported housing beds for adults by redirecting savings ($7 million annually) from 100 adult non-geriatric State psychiatric center bed closures in 2004-2005. These supported housing beds would bring the total number of community beds to 31,100.
These Executive Budget recommendations were enacted as proposed.
Providing full funding for critical community services, including the Enhanced Community Services Program and the Assisted Outpatient Treatment and psychiatric medication grant programs established under Kendra’s Law.
The Executive Budget preserved funding for critical core programming including the Enhanced Community Services Program, the Assisted Outpatient Treatment and psychiatric medication grant programs established under Kendra’s Law, and housing development. It achieved $7.7 million in local efficiencies by applying a targeted reduction, while preserving residential, case management, and outpatient programs. The Budget also achieved $800,000 in savings by eliminating the Alternative Rate Methodology reimbursement program for those hospitals still receiving it, and achieved $2.3 million in savings by eliminating 30 vacant positions in OMH’s Research Division.
These Executive Budget proposals were enacted as proposed.
Improving the Lives of Adult Home Residents (Department of Health Budget)
The Executive Budget built on the Governor’s reforms to strengthen the oversight of adult homes, and included $10 million to support initiatives to improve the quality of life and safety for New Yorkers who live in the homes.
The Legislature moved $3 million of the $10 million into Office of Temporary and Disability Assistance (OTDA) budget to support a multi-year Supplemental Security Income (SSI) increase, and this was vetoed by the Governor. The language redirecting the $7 million remaining in the DOH budget was also vetoed by the Governor, thereby enacting a $7 million program as proposed in the Executive Budget.
Legislation Passed During the 2004 Session
The following bills, of interest to stakeholders in the public mental health system, passed the Legislature this session and were approved by the Governor.
Comprehensive Care Centers for Eating Disorders
Chapter 114 of the Laws of 2004 Signed by the Governor on June 21, 2004.
Effective Date: June 21, 2004
This Chapter adds a new Article 27-J to the Public Health Law to provide for development of Comprehensive Care Centers for Eating Disorders (CCCED). Article 27-J authorizes the Department of Health (DOH) to facilitate and approve the development of these entities. DOH is authorized to issue a Request for Applications and provide a "written notice" which qualifies applicants, for two years periods, to be a CCCED. DOH must provide adequate access to these services by qualifying a sufficient number of CCCED across the State. This legislation also amends certain sections of the Public Health Law to provide funding for such centers from funds allocated from revenues associated with the Health Care Reform Act (HCRA) tobacco settlement funds. Additionally it establishes a Comprehensive Care Centers for Eating Disorders Development Grant Fund. Finally, the new law amends the Insurance Law to specify that group health plans, HMOs, and major medical coverage may not exclude coverage for the treatment of eating disorders by providers under a CCCED if such coverage is otherwise available.
Comprehensive Psychiatric Emergency Program
Chapter 131 of the Laws of 2004 Signed by the Governor on June 29, 2004.
Effective Date: June 29, 2004
This legislation extends until July 1, 2008, the authority of the Commissioner of Mental Health to designate general hospitals, local governmental units and voluntary agencies to be issued an operating certificate for a Comprehensive Psychiatric Emergency Program (CPEP). CPEPs provide and coordinate emergency psychiatric services for persons who are in psychiatric crisis. They were developed in response to a host of problems including long wait times and poor quality psychiatric emergency care in the mid 1980's. The CPEP model has four primary service components - emergency room assessments, extended observation beds, mobile crisis team and crisis residences. The first CPEP was licensed in 1989 and currently nineteen hospitals across New York State are licensed to provide services in accordance with the CPEP model. In 2003 there were over 87,000 patient visits to these programs. The CPEP model has been successful in addressing the problems that led to the creation of this program. Recent evaluation has shown that, by using the CPEP model, the quality of assessments has been strengthened, the emergency department physical environment has improved, and there is an improved ability to serve patients who present to emergency departments with a wider range of treatment options.
Chapter 58 of the Laws of 2004
Effective Date: August 20, 2004
Sections 36 and 41 - 51 of Part B of Chapter 58 (which is part of the enacted budget language bill) amend the Social Services Law, the Public Health Law, the Corrections Law and other laws regarding certain issues related to adult homes and other residential programs including the following:
Section 36 makes amendments relating to the Quality Incentive Payment Program (QUIP) for adult homes. The amendments require that the Department of Health provide a hearing prior to the denial of QUIP payments to adult home operators. It also adds air conditioning in resident's areas, as an improvement to the physical environment for which such funds may be expended.
Section 41 amends Public Health Law §2803-m to explicitly provide that patients about to be discharged from a hospital to an adult home, enriched housing program or residence for adults may not be directly referred to any facility that is on the "do not refer list" pursuant to Social Services Law §460-d (15).
Section 42 amends subdivisions 11 and 12 of Social Services Law §460-d to include the Department of Correctional Services and the Division of Parole among the agencies that are to be notified regarding actions taken by the Department of Health to penalize adult care facilities, including notices regarding revocation or suspension actions and placement on the "do not refer list." (OMH is already required to be notified of such actions.)
Section 43 amends Social Services Law §460-d to add two new subdivisions 15 and 16. Subdivision 15 requires that the Department of Health shall maintain a "Do Not Refer List" on its website, listing all adult homes, enriched housing programs for adults and assisted living programs that have received notices of enforcement actions which are based upon violations of law or regulation which endanger resident health or safety or pending enforcement actions against the facility's operating certificate. Subdivision 16 prohibits any operator or controlling person of an adult care facility where the operating certificate is currently revoked, suspended or limited, from applying to the Department of Health or any other State agency (including OMH), for an operating certificate for an alternative type of facility.
Sections 44 and 45 amend Social Services Law §461-f, which relates to authority for appointment of a court appointed receiver to protect the health, safety and welfare of residents of an adult care facility. This section of law is amended to provide that, in addition to the existing provisions for court appointed receivers, an adult home operator may enter into an agreement with DOH for the temporary (60 days) appointment of a receiver, or may request the appointment of a receiver under an agreement with the Department of Health.
Section 46 amends Social Services Law §461-q to provide authority to the Commissioner of Health to promulgate regulations with respect to allowable temperatures in adult homes, enriched housing programs and homes for adults.
Section 48 amends the Correction Law to add a new §72-b which provides that inmates may only be discharged to an adult home, enriched housing program or residence for adults that meets their needs, has an appropriate and valid operating certificate, and is not on the "do not refer list."
Section 49 amends Mental Hygiene Law §29.15 to provide that no patient about to be discharged from an inpatient facility licensed by OMRDD or OASAS, shall be directly referred to any facility subject to licensure, certification or approval by any state agency unless it has been determined that such facility has a currently valid license. (Currently this requirement applies only to State operated facilities.) In addition, no patient about to be discharged from a facility licensed by OMRDD or OASAS, may be referred to an adult home, or residence for adults, which has received certain notices regarding revocation, suspension or limitation of its operating certificate, from the Department of Health, or has been placed on the "do not refer list."
Chapter 575 of the Laws of 2004 Signed by the Governor on October 5, 2004
Effective Date: April 1, 2005
This legislation requires certain providers of mental health services and services for the mentally retarded and developmentally disabled persons, and employees and volunteers thereof, who have "substantial and regular unsupervised" or "unrestricted physical contact" with clients, to have their criminal history reviewed by the Office of Mental Health (OMH) and the Office of Mental Retardation and Developmental Disabilities (OMRDD), respectively. This legislation provides that those subject to these background checks shall not be permitted to operate a program or work directly with clients if they have a felony conviction at any time for a sex offence, felony conviction in the past ten years involving violence, or a conviction for endangering the welfare of a disabled person pursuant to Section 260.25 of the Penal Law. For a conviction of any other crime, OMH or OMRDD may, in its discretion, direct denial of approval to operate a program or to become employed, in accordance with prescribed procedures.
Informational Briefings and Public Hearings
This year, OMH took a number of steps to substantially increase opportunities for public comments regarding New York’s public mental health system, and for stakeholder input into the planning process. In addition to increasing both formal and informal interactions and dialogue opportunities throughout the year, OMH conducted a series of informational briefings and public hearings on the 2004-2008 Statewide Comprehensive Plan for Mental Health Services in April through June 2004. The briefings and hearings were both open to the public and were advertised through direct mail notices from OMH Central Office and the Field Offices and on the OMH Web site (www.omh.state.ny.us).
Representing OMH at the briefings and hearings were Keith Simons, OMH Deputy Commissioner, the local Field Office Director, and Field Office staff. Interested stakeholders including recipients, families, providers, advocates, and county mental health directors and their staff were in attendance.
The informational briefings were designed as informal, interactive meetings. Their purpose was to provide an overview of the 2004-2008 Plan and opportunities for questions and discussions; review planning data provided in the Plan; and solicit input on regional planning priorities, initiatives, and information needs.
Informational briefings were held in each of the State’s five OMH regions. A total of eight briefings were held throughout New York State in April and May 2004. Each briefing was approximately three hours long, with more than one hour dedicated to receiving input from participants.
Across the state, the briefings covered a full range of topics. Issues discussed included topics chosen by attendees and addressed both the adult and children’s mental health systems locally and statewide. Topics included the local and statewide planning process, and areas of the public mental health system requiring ongoing attention.
The public hearings were formal meetings that were also open to the public. Interested individuals presented verbal and/or written testimony in response to the 2004-2008 Plan. In each instance, the local public hearing was preceded by an informational briefing in that region.
The Planning Process
Participants applauded the data-rich content of the 2004 comprehensive plan, and pointed to their ongoing need for data and technical assistance to facilitate meaningful local planning. They asked for additional data including diagnostic information related to the presence of trauma histories, and also suggested an increased emphasis on planning efforts related to services for children and adolescents. Participants suggested the planning process include discussion and local input within a timeframe that informs OMH’s budget making, and they asked that the unique needs of upstate and rural counties be better recognized in the planning process. They also suggested that the relationship between inpatient admission rates and co-occurring mental health and substance abuse issues be the focus of analysis and planning.
Participants also applauded the focus on quality of life indicators such as employment and housing as a part of planning and performance measurement. The goal of recipient and family involvement in all levels of planning was a recurring theme, and participants asked that recipient and family input continue to be an essential part of the state and local planning process.
Areas requiring ongoing attention
Across the state, participants expressed enthusiasm and support for OMH’s broader focus on prevention, promotion and early intervention. They voiced support for population-based planning, and asked that the planning process better address aging-out issues and needs of young adults 17-26 years old. Participants also suggested that more data specific to mental health needs and services for older adults are needed. The issues faced by parents with psychiatric disabilities, including concerns about maintaining custody of children, were also discussed.
More information about Personalized Recovery Oriented Services (PROS) was requested. The need for affordable housing options was a concern in the lower Hudson Valley and Metropolitan New York City. The difficulties providers face related to workforce recruitment and retention were also discussed.
All briefing attendees were invited to participate at one of the five formal public hearings held throughout the State in May and June 2004.
A total of five hearings were held throughout New York State in May and June 2004.
A broad overview of testimony given during these hearings is provided below, and the complete transcript of the 2004 public hearing testimony by region is available on the OMH Web site (www.omh.state.ny.us) for public review.
Participants in the public hearings supported the goal of the 2004-2008 5.07 Plan to move toward a county-centered approach that maximizes local and stakeholder participation. They were hopeful that OMH would follow through on the Plan’s commitment to a collaborative planning process, and that the State plan will be shaped by local recommendations from consumers, providers, and localities. It was suggested that OMH initiate regular forums throughout the State to promote discussion and input on critical regional and state level issues, and that focus groups be used to support consumer input to planning discussions.
Testimony supported the Plan’s commitment to quality, the move toward population-based planning, and the inclusion of an agenda of public mental health promotion. While participants acknowledged that the 2004-2008 Plan covered more topics and provided more data than before, some felt that additional efforts are needed to identify, collect, and analyze data to address current and future needs. It was suggested that these efforts include a collaborative, comprehensive, and inclusive public planning process that is meaningful to local governments’ abilities to effectively plan, monitor, and evaluate services, and which includes enhanced OMH consultation and technical assistance to localities. Participants also proposed including prevalence, demographic trends, utilization and workforce data in next year’s plan.
Participants asked that local priorities be better addressed in the Plan. For example, it was noted that historically, needs of small, rural counties have not been emphasized. Participants also noted that a mechanism to formally incorporate State facilities into the local planning process would be helpful.
Participants had a number of suggestions with regard to interagency planning. It was suggested that the role of the Interoffice Coordinating Council (IOCC) be expanded to include behavioral healthcare for all three disability groups. This could lead to structural and regulatory changes focused on assuring that individuals with multiple diagnoses do not fall through cracks between systems. They also expressed hope that OMH and OASAS collaboratively plan a full continuum of integrated services and develop viable procedures to identify which system is responsible for each individual. In this regard, funding enhancements, regulatory modifications, and evidence-based training opportunities are considered necessary. Others suggested that OMH convene a task force that includes VESID, the Department of Social Services, and local governments to study vocational services for individuals with Serious Mental Illness (SMI) and adapt best practices in this area.
In addition, participants asked that OMH continue to collaborate with the Conference of Local Mental Hygiene Directors (CLMHD) to receive county input to the State plan; and develop strategies with CLMHD to accommodate regional and local needs in the context of State priorities.
Individual testimony varied widely in content and focus. When considered in full, the testimony provided at the five hearings addressed virtually all aspects of the public mental health system and ranged from offering praise and encouragement, to making detailed suggestions for improvement, to constructive criticism of specific elements of service planning and delivery. The full text of the testimony is available for public review on the OMH web site, but specific topics and program areas addressed in individual testimony include fiscal matters, forensic services, adult homes, housing, population-based planning, specific programmatic issues around service access, effectiveness and support, services for children, young adults and the elderly, and State inpatient services.
Other ongoing opportunities for public dialogue and input
In addition to the above-described briefings and hearings, which were held specific to the release of the 2004-2008 Statewide Comprehensive Plan, OMH systematically worked to increase ongoing input into statewide planning. To that end, OMH has increased its outreach efforts to all stakeholder groups, and is working to create new opportunities for ongoing dialogues that promote the cooperative sharing of information and ultimately promote recovery.
OMH considers input from its advisory committees (Multicultural Advisory Committee, Recipient Advisory Committee, Commissioner’s Committee on Families, Mental Health Planning Advisory Council, and Mental Health Services Council) to be vital to the planning process. Additionally, the first several in a series of roundtables with key stakeholders and mental health experts has occurred, and more are planned in the coming months. The focus of the roundtables is improving treatment and access to care for children and adults.
Commissioner Carpinello has set the stage for ongoing collaboration with all stakeholder groups by continuously working to increase the public presence and visibility of the Office of Mental Health. Since the release of the 2004-2008 Statewide Comprehensive Plan, she and other members of OMH Executive Staff have participated in numerous conferences, meetings, institutes and seminars, and have presented the vision of a recovery-oriented system of care to thousands of individuals and stakeholder groups across the State. At the same time, they have solicited input and opinion about what the audience considers to be critical issues facing New York State’s public mental health system. These stakeholder groups include providers of community-based inpatient and outpatient mental health services, providers of support and housing services, county leaders, recipients of mental health services, family members, and policy makers.
In addition to this continuing awareness-building effort, OMH has put into place a number of formal and informal methods to cultivate ongoing dialogue and obtain public input. Several illustrations of the revitalized planning effort are briefly outlined below.
Partnership with the Conference of Local Mental Hygiene Directors
An ongoing collaboration between OMH and the Conference of Local Mental Hygiene Directors is a critical element of a revitalized planning process, and that collaborative planning agenda was formally renewed in 2004. An initial meeting was held in January, and we continue to work together to develop and implement principles that will guide the planning process. We are also working to refine and strengthen the specific planning roles for the counties and for OMH.
In the 2004-2005 planning cycle, the Conference has surveyed its membership on issues impacting persons with mental illness and services in their localities. The purpose was to identify consensus priorities regarding planning issues and needs, priority target populations and priority service needs. The Conference has shared the results of that survey - which had a 100 percent return rate - with us. This input is being considered in the formulation of the 2005-2009 statewide comprehensive plan and the 2005-2006 Executive Budget.
In the longer-term, formal collaboration continues on ways to strengthen the planning process: a work group has been formed to consider key areas including the design and production of county planning templates, and the development of county strategic data sets. An agenda and “next steps” have been developed and agreed upon, and OMH has agreed to provide training and technical assistance to counties, in order to facilitate the planning process.
Partnership with Current and Former Recipients of Mental Health Services
The Office of Mental Health works with mental health service recipients, with the goal of incorporating a consumer perspective into the creation and measurement of New York State’s mental health system. The Bureau of Recipient Affairs maintains a number of mechanisms as well as taking advantage of local opportunities to have dialogue and solicit input from the users of mental health services. These range from impromptu dialogues with recipients before / after events to scheduled town hall type forums.
The Bureau has been involved in more than 40 meetings/town hall forums soliciting advice and input recipients from every part of the state representing individuals who utilize every type of service offered by OMH. These events have provided opportunities for more than 3,000 individuals to provide direct input into OMH deliberations and planning.
The White Paper on Infusing Recovery
In partnership with grassroots individuals and recipient run organizations, the Office of Mental Health commissioned “Infusing Recovery-Based Principles into Mental Health Service: a White Paper by New York State Consumers.” The input obtained from this document is the result of a huge undertaking in which over 10,000 recipients of mental health services from across New York State participated. This process was begun with 200 people participating in the initial dialogues which created the framework. More than 6,000 additional individuals helped refine the document’s content through participation in interactive discussions. Finally over 5,500 other individuals were exposed to the contents and validated the principles contained in the white paper. “Infusing Recovery-Based Principles into Mental Health Service: a White Paper by New York State Consumers” was presented to Commissioner Carpinello in August 2004, and has been heralded as one of the most important documents of recent years. It provides valuable insight and information as OMH continues working toward a recovery-based system of care that supports an individual on his or her personal path to recovery.
Recipient Advisory Committee
The Office of Mental Health established the Recipient Advisory Committee to give the Commissioner advice and guidance from a recipient of service perspective. In the past the committee would seldom have more than it’s 15 members at the quarterly meetings. Encouraging broader participation, the Bureau of Recipient Affairs now has community groups sponsoring more than 50 recipients, representative of each region of the state, at each of the meetings over the past year.
Recipient Affairs Staff
Recipient involvement in planning is further added by the outreach and facilitation of recipient affairs specialists (RAS) which work within each OMH Field Office. These individuals maintain regular meetings and dialogues with recipients of mental health services within their region. Each Recipient Affairs Specialist participated in at least one regional forum in addition to the monthly forums they hold with recipients of service within their region. These opportunities brought input into OMH planning activities from more than 2,000 recipients of mental health services.
Adult Home Outreach
The Bureau of Recipient Affairs targeted specific outreach to engage individuals living in adult homes. A pilot project targeting the resident council of one adult home in each region of the state is underway. This project involves providing training and support to recipients in the adult home enabling them to participate in the home’s resident council and provide feedback to the Office of Mental Health along with other state agencies. This effort has targeted more than 1,000 recipients who live in adult homes.
Most Integrated Setting Coordinating Council
The Office of Mental Health working as part of the Most Integrated Setting Coordinating Council, received public input during each of the public hearings and meetings of this committee. Testimony was taken at four public forums aiding OMH in it’s planning efforts specifically related to the Olmstead Supreme Court Decision. More than 100 individuals provided testimony in addition to those offering suggestions and comments at each of the meetings.
Many OMH facilities have Peer Specialists who facilitate numerous activities and meetings with recipients of mental health services in hospital settings. The more than 20 peer specialists provide feedback and input from more than 5,000 individual recipients who are hospitalized. This unique perspective is brought to policy and planning processes within OMH by the Bureau of Recipient Affairs.
Prepaid Mental Health Plan
The Prepaid Mental Health Plan has more than 30 peer educators responsible for providing a number of education and self-help services to the individuals who use the PMHP. The peer educators bring feedback and input representative of the more than 7,000 users of PMHP services to the Bureau of Recipient Affairs to include in OMH policy and planning discussions.
Partnerships to Serve Children Across Service Systems
There have also been a number of cooperative planning efforts made in the area of children’s mental health services. Over the past year, the vision for the children’s system as outlined in the 2004-2008 Statewide Comprehensive Plan for Mental Health Services, has been shared with various service providers and constituency groups in a number of forums. Dialogues have been held with local children’s subcommittees of the Conference of Mental Hygiene Directors, at the OMH Field Offices with representatives of the state-operated facilities and programs, with the Coalition for Children’s Mental Health, and at meetings with a number of advocacy groups such as the Citizen’s Committee for Children.
Roundtable discussions have played a prominent role in meeting the mental health needs of children and adolescents. When developing the structural design of the 14-bed children’s unit currently under construction at the Greater Binghamton Health Center, OMH administrators and the project’s architect sat down with children who have been hospitalized and their families, facility staff and other area mental health providers. Together, they discussed various design elements that would enhance the recovery process, as well as those that may inhibit it. They fine tuned the details, and the end result will be an inpatient unit truly designed to support recovery. It will balance individual privacy and appropriate supervision, it will provide a safe and therapeutic environment, and it will be family friendly - especially in the visiting areas.
In November 2004, OMH hosted a roundtable discussion among prominent providers of inpatient care for children and adolescents in the metropolitan New York City area. The purpose of the meeting was to examine the clinical profiles of the youngsters currently receiving inpatient care, to explore what treatments are currently being used to treat these children, and to discuss clinical, administrative, or structural opportunities that might improve the quality of care provided. A number of issues were discussed including the challenges associated with treating youngsters with both psychiatric and developmental disabilities, use of crisis services, family involvement, assessment and outcome measurement systems, and clinical competencies. Discussions and follow-up will continue.
OMH is also an active participant in the interagency planning process that occurs within the children’s service system at-large, and will continue to participate during the upcoming year on Coordinated Children’s Services Initiative Tier 3. OMH also continues to participate on the Out-of-State Placement Committee, where it works with other agencies and programs throughout the state to plan for the return of youngsters to their local communities for ongoing treatment services.
Partnerships with Families and Loved Ones
OMH has long considered open communication with families of New Yorkers with mental illness to be a critical element of the planning process, and the agency’s organizational structure supports that relationship. The Office of Mental Health’s Family Liaison Bureau works closely with families, recipients and state and local mental health providers to improve the quality of public mental health services. The Bureau, in collaboration with OMH Field Offices, State Psychiatric Facilities and local mental health providers, works to effectively resolve issues and concerns family members and recipients have regarding mental health services.
The Office of Mental Health’s Commissioner’s Committee for Families is comprised of family members and advocates from across the state. This statewide Committee continues to promote participation of families and recipients in mental health planning and development and assures individualized mental health services in accordance with Mental Hygiene Law Article 29. The Commissioner’s Committee for Families meets directly with the Commissioner three times a year to provide recommendations and information on mental health issues. The Committee also has direct contact throughout the year with the Family Liaison Bureau and OMH Executive Staff to provide feedback on issues related to best practices, policies and mental health initiatives designed to improve services for individuals with psychiatric disabilities in New York State.
OMH and the University of Rochester have partnered to establish the Family Institute for Education, Practice and Research, which is available to teach mental health providers throughout New York State how to effectively offer family services to people with mental illness and their families. Through an RFP process, 20 individual sites and a consortium of 17 additional sites are now developing evidence-based family psycho education groups. To date, 16 groups are up and running, another six will begin by early 2005, and the remainder are in various stages of development.
OMH is also working with the National Alliance for the Mentally Ill and the University of Rochester, in an effort to further expand family focused services into the larger mental health system. They are organizing a workgroup that will develop an outline for the design of a spectrum of family-focused services that can be adapted to various mental health treatment settings. This outline will be the foundation for the development of a strategic plan that will be used to embed family-focused services throughout New York State’s public mental health system.
Partnerships for Cultural Competence to Better Serve All New Yorkers
OMH is committed to provide quality mental health services to all New Yorkers in need. Many different communities and constituents are continually engaged to assist the agency in development and evaluation of services that are culturally and linguistically suited for the diverse populations throughout New York State.
The Multicultural Advisory Committee (MAC), comprised of consumers, family members and providers, met directly with OMH cabinet to address population based planning efforts as well as disparities that may be present in mental health services. There was an opportunity to exchange information regarding language assistance needs and service adaptations based upon culture, ethnicity, age and gender. In addition to review of agency initiatives such as PROS, the Trauma Symposium, forensic services and assertive community treatment programs, members also made recommendations for development of a standardized cultural competence curriculum for use in training community based licensed programs. In a follow-up meeting the first draft of the training content was outlined and development continues.
In addition to the statewide MAC, several counties have local multicultural advisories that have assisted in bridging OMH direction with community priorities in efforts to improve service quality. The cultural competence coordinator has been involved in these local activities. For example, Nassau County MAC has developed a series of culture specific training opportunities, Suffolk county held an annual cultural competence symposium, Orange county has expanded its training activities to include technical assistance for development of cultural competence plans for all county human service agencies, Broome county has continued its language interpreter program and Monroe county continues an extensive cultural competence evaluation, training and plan development process for county agencies.
Throughout the state, community networks have partnered with OMH to enhance mental health services. Consumer and family groups such as NAMI Harlem and Harlem Hospital have hosted events to provide a public education forum about mental illness and mental health. The training, “Cultural Competence: Maintaining an Asking Stance” has been presented to provider agencies, trade associations, social work education programs, and community groups throughout the state. Agencies, have adapted the material to directly address specific communities and to enhance service planning.
Recognizing that many New Yorkers seek assistance outside of formal mental health settings, OMH has partnered with other systems and programs such as: Peri-natal Network and the Caribbean Cultural Center. Other alliances have helped to increase outreach efforts; the Association of Hispanic Mental Health Professionals, Black Psychiatrists of Greater New York and the Coalition for Asian American Mental Health.
As OMH continues to focus on delivery of evidence-based practices, every effort is made to assure culture and language are taken into account. For example, every Assertive Community Treatment Program is required to draft and implement a cultural competence plan detailing populations served and efforts to provide culturally relevant services. Additionally, a three year SAMSHA grant OMH received to adapt a family education treatment model to effectively treat African American, Asian and Latino communities continues to be underway. Each of these initiatives provides opportunity for real and meaningful information exchange increasing the quality and effectiveness of mental health services.
Partnerships to Serve Special Populations
During the public input process following release of the 2004-2008 Statewide Comprehensive Plan for Mental Health services, stakeholders in the New York City area identified the mental health needs of older adults as a priority area to be addressed. OMH received the report “Issues in Geriatric Mental Health Policy,” completed by the newly-formed Geriatric Mental Health Alliance of New York (GMHANY).
In response to concerns in this area, OMH has been meeting with stakeholders, including representatives of GMHANY. These collaborations have resulted in the identification of two specific population groups for consideration: individuals with mental illness who are getting older and developing co-morbid conditions related to aging; and older New Yorkers who are at risk for developing a mental illness. OMH is planning to host a series of Roundtable discussions in late winter, at which experts, stakeholders and providers will further discuss the mental health needs of aging New Yorkers.
Partnerships in the Development and Implementation of New Service Models
The Office of Mental Health seeks and welcomes input from all stakeholder groups as it implements the evidence-based practices that are part of its “Winds of Change” quality agenda. The development and implementation of Personalized Recovery-Oriented Services (PROS) is an example of that cooperative partnership.
Throughout the PROS development process, OMH actively sought input from a broad array of stakeholders, and frequently modified the program design in response to questions and concerns raised by affected parties. OMH has conducted more than 150 briefings and meetings on PROS with other State agencies, county government officials, mental health service providers, and recipients of service who are attending programs that might convert to the new PROS license.
The OMH web site contains a PROS section that includes a program description, announcements on the status of implementation efforts, responses to frequently asked questions, and sections of a draft handbook for PROS providers. Draft PROS regulations (Part 512) have been posted on the web site, and stakeholders have been invited to submit comments in advance of the mandatory comment period that is initiated once the regulations are formally filed as proposed.
OMH has made particular efforts to involve county governments as partners in the planning, implementation and oversight of PROS programs. An extensive county planning process was initiated, to ensure that county mental hygiene directors had an opportunity to manage the impact of PROS on their local service systems. Since PROS programs are funded by Medicaid, OMH has worked with county representatives to fashion regulatory requirements for a county/provider agreement that will replace local contracting for State Aid funding as the vehicle for supporting the county role in program monitoring and quality improvement.
This collaborative relationship is continuing as the implementation process begins. As announced in October 2004, a modest initial implementation phase will begin involving seven counties representing a mix of urban, suburban and rural settings.
The scope of this initial implementation phase has taken into consideration OMH’s ability to provide the intensive technical assistance necessary to support successful program transitions to the new PROS license.
Partnerships for Community Outreach and Public Education
In May 2004, OMH launched SPEAK, a statewide suicide prevention, education and awareness campaign for all New Yorkers. Creation of a web site and a toll-free telephone number has facilitated the exchange of information between OMH and the public on this issue.
In developing the SPEAK campaign, OMH gathered the most current scientific knowledge available about suicide risks and prevention, and assembled SPEAK kits for distribution across the state. The largest single source of stakeholder input on the issue of suicide prevention is the New York State Suicide Prevention Council. OMH holds monthly meetings and/or conference calls with this organization, whose members include nationally recognized experts, clinicians and individuals whose lives have been touched by suicide.
Partnerships with Local Inpatient Service Providers
OMH is also taking steps to strengthen collaboration with general hospitals that operate psychiatric units, often referred to as Article 28 units. We have identified a liaison to the Greater New York Hospital Association, and a series of meetings with metropolitan hospitals has begun. Areas of mutual concern have been identified, and general hospitals in the metropolitan area have been given rosters of contact people at the New York City facilities and Field Office.
OMH is collaborating with the New York City Health and Hospitals Corporation (HHC) to identify high users of inpatient services who also appear not to be connected to community-based mental health services. Our plan is to jointly review the clinical case histories of a sample of these individuals to identify factors preventing or undermining engagement in the community, including co-occurring physical health or substance use disorders, and then to develop person-specific action plans to improve community service engagement and reduce reliance on repeated inpatient care.
Using Geographic Information Systems (GIS) Technology to Strengthen the Local Planning Process
Beginning in April 2004, OMH launched an initiative to strengthen its capacity to use modern geographic information systems (GIS) technology as a support for data-informed state and local mental health planning. Local planning is by definition geographically based, and an increasing number of the data sources needed for data-informed planning include geographic information such as county, zip code, and street address. In recent years, the capabilities of GIS technology have expanded rapidly, making it now feasible to look with fine-grained geographic precision at important public mental health system issues such as prevalence of severe mental illness and access to evidence-based services. The OMH GIS initiative has two tracks: improving staff skills so that increasingly sophisticated and hence useful geo-maps of mental health phenomena can be produced, and incorporating geographic data into the OMH enterprise data warehouse so that geo-maps and spatial analyses can be carried out more efficiently and with greater frequency. A major target audience for OMH GIS efforts is local mental health directors and their staff. In May 2004, at a regional planning meeting with county mental health directors and state psychiatric center directors, OMH staff presented and discussed an initial set of geo-maps that displayed local variation in SPMI prevalence and access to Assertive Community Treatment and Intensive Case Management services at the zip code level. At this and subsequent presentations, counties have expressed strong interest in the GIS initiative and have requested additional geo-maps, including maps of SED prevalence and access to specialized children’s services that OMH is currently working on. Joint state and local planning discussions stimulated by the geo-maps have begun to produce a common understanding of mental illness prevalence estimates and the relationships between prevalence, service access and service use.
Comments or questions about the information on this page can be directed to the Office of Planning.