NAMIGrading the States: A Report on America's Health Care System for Serious Mental Illness
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Grading the States 2006: New York - Narrative

New York was one of only two states that declined to respond to the survey used in preparation of this report, thereby compromising transparency and accountability. Because lack of specific information was offered for scoring the state as compared to the 48 other states and the District of Columbia that participated, the state has received a grade of "U" for "unresponsive."

The state Office of Mental Health (OMH) manages one of the largest and most complex mental health systems in the country, with 58 local government units and more than 2,500 certified mental health programs. The state is both highly urban and highly rural in nature. Delivery of quality services to people with serious mental illnesses is challenging in both environments. 

In New York City and other urban centers, the need for services far exceeds the supply, contributing to high rates of homelessness and criminalization of mentalillness. There are more people with serious mental illnesses incarcerated in New York City's Riker's Island jail than any psychiatric hospital in the country.

The challenge in rural areas is different but equally daunting. Obstacles such as lack of transportation and serious shortages in qualified psychiatrists, psychiatric nurses, case managers, and other mental health personnel contribute to major problems with access to services in these regions. 

New York devotes significant resources to addressing these serious problems; its average per capita community mental health expenditure of $103.32 per person ranks among the highest in the country. Whether resources are utilized in the most cost-effective manner is, however, open to question.

There is a consensus among advocates statewide that New York has too many state hospitals. There are 26 hospitals, 17 of which serve primarily adults with serious mental illnesses and three of which serve forensic patients. This does not mean that there are too many hospital beds. On the contrary, decades of downsizing hospitals has created an anomaly. Although there may be too many hospitals, there are too few beds available to address the needs of people who require inpatient treatment. There are currently only 4,000 beds available statewide, and the remaining beds are threatened by misguided efforts by the state to enact legislation granting authority to civilly commit sexual predators who have completed their prison sentences to psychiatric hospitals. Laws of this kind divert already scarce treatment resources and also potentially place vulnerable individuals with serious mental illnesses at risk.  

Problems with adult care homes in New York are a major problem. A Pulitzer Prize-winning series of articles in the New York Times in 2003 exposed horrendousconditions in some facilities, as well as serious fraud, abuse, and victimization of residents. The state mental health system had essentially evaded responsibility for the residents - many of whom previously had been patients in state psychiatric institutions - by placing them in substandard facilities run by a different agency, the Department of Health. The state was slow to respond to this crisis.

New York is one of a minority of states that still does not require mental health insurance parity. A parity bill known as Timothy's Law nearly passed in 2005 but stalled in the State Senate. Besides being central to the elimination of the stigma and discrimination often associated with mental illness, parity is important in stemming the flow into the public system of middle class taxpayers with private insurance, who are often forced either to spend down assets or go without treatment.

Across the board, the legislature needs greater awareness of cost-shifting effects from cuts or restrictions on mental health services. Without timely, adequate services, the result is more expensive emergency visits, hospitalizations, and burdens on police and the criminal justice system.

On the positive side, OMH has developed a joint agreement with New York City to develop supportive housing. The plan will increase stable housing for approximately 5,500 people with serious mental illnesses and others affected by homelessness over the next 10 years. These 5,500 units of housing would be added to 31,000 that are either already available or in the pipeline. The challenge for New York is to implement similarprograms in other parts of the state, as well as continuing to expand these services in New York City, where thousands of people with serious mental illnesses remain un-served or under-served.

Enacted in 1999, Kendra's Law also has been a source of progress, authorizing court-ordered assisted outpatient treatment for individuals with serious mentalillnesses, or co-occurring mental illness and substance abuse, who are consistently non-adherent to treatment and at serious risk. Although the law has engendered divisions among advocates, a 2005 OMH report showed clear benefits in terms of reduced hospitalizations, homelessness, and arrests - as well as in treatment outcomes. 

The OMH is investing significantly on a state-wide basis in evidence-based practices (EBPs), Assertive Community Treatment (ACT) teams, and family psycho-education. The state is also in the beginning stages of planning and piloting integrated mental health and substance abuse treatment, illness self-management programs, screening, and integrated family services.

The criminalization of people with serious mental illnesses is a national problem, and New York is no exception. There are several excellent jail diversion programs in the state, including Project Link in Rochester and the Nathanial Project in New York City. Six Mental Health Courts have been established in the state, including courts in the Bronx and Brooklyn serving felons with serious mental illnesses. 

Suicide numbers in New York State have been very high in recent years.   In response, OMH is investing significant resources in a suicide awareness, education, and prevention program that is being implemented in communities and counties throughout the state. 

Overall, New York has developed some excellent services in collaboration with other agencies in certain parts of the state. However, disparities exist. The state has yet to develop a truly seamless and integrated system of care. Solutions also must be found to resolve the shameful adult care home situation.

Finally, New York deserves praise for its two state-of-the-art and nationally renowned research facilities, the Nathan Kline Institute for Psychiatric Research and the New York State Psychiatric Institute. Although there have been attempts by the state to enact cuts to these programs, funding levels have been maintained in recent years.

Unfortunately, closer analysis of specific factors in the state system is not possible without OMH's cooperation.

To the degree that transparency and responsiveness are not available directly to consumers and families - whom NAMI represents - the state's legislative oversight committees are encouraged to seek answers to the concerns reflected in this report's survey and scoring process.

Accountability is a threshold concern for the performance of any mental healthcare system.

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