Mental
Health Association in New York State, Inc. |
Community Connections, Winter 2002/2003
The Quest for a Comprehensive System of Community-Based Care Postpartum Every year in spring or late summer for the past decade, mental healthcare managers have been given the opportunity to celebrate their profession, network with their confreres, and get an overview of the work they are engaged in at a one-day conference in Poughkeepsie NY, sponsored by the New York Chapter of the Association of Behavioral Healthcare Managers (ABHM). This year on September 20, at the 7th Annual Behavioral Health Care Management Institute, MHANYS president/CEO Joseph A. Glazer Esq. gave the keynote address. His presentation was a “state of the state” of mental healthcare in New York. That the outlook is challenging was not news to the 56 behavioral healthcare managers who attended the conference. Managing the delivery of care to mentally handicapped citizens has always been a challenge. In Mr. Glazer's words, “working to improve the lives of and a system for people living with mental illness is one of the toughest missions we can undertake.” The talk was entitled The Unfulfilled Promise of Willowbrook, and in it he highlighted not only the defects in the behavioral healthcare delivery system, but an agenda for repairing them. In the aftermath of the exposé of squalid conditions at the Willowbrook State School on Staten Island by TV reporter Geraldo Rivera in 1971, state health authorities proposed a program of reforms. In essence, the reform strategy was to provide care in more humane settings outside of the large institutions. Deinstitutionalization closed beds and has moved nearly 100,000 patients out of state hospitals since 1953. But Mr. Glazer pointed out that the 1970's plan to simply close hospital beds is far from satisfactory. For one thing, they addressed the needs of patients with mental retardation and developmental disability, but neglected the needs of mentally ill patients. Up until 1993, when a New York State statute required that monies saved from the closing of institutional beds be allocated for mental health services in local communities, those savings went into the general fund and were used to build roads, bridges, and schools. Millions of dollars were lost to mental health services, leaving the system in a fractured condition. A result of this defect in the deinstitutionalization plan was what Mr. Glazer called transinstitutionalization. “We have moved an entire population of people, by way of police cars and court rooms, from psychiatric hospitals into prisons and jails.” Presently,
there are less than 5,000 patients in partially boarded up state psychiatric
hospitals, while about 200,000 mental health patients are in need of community-based
care. Working toward a comprehensive system of community-based care requires
first that there be a more proportionate distribution of mental health
funding in the state budget. Care in the communities should not exclude
hospitalization entirely, but should provide programs of short-term inpatient
care, taking advantage of drug therapies for mental illness that have
been developed in recent years. Continuity of care must include a support
system that is a direct link from inpatient care to available outpatient
services during the duration of the patient’s recovery. At the ABHM
Institute, Mr. Glazer was speaking to the people who in fact are providing
these services. And while his words and his passion were an encouragement
to them, he also called upon them to include with their day-to-day management
of direct care vigilance in the battle for their patients at the legislative
level. At the present moment, there is a bill on the Governor’s
desk requiring that funds saved from bed-closings continue to be reinvested
in services. “So I remind you,” he concluded: "anyone
who wants to drop Governor Pataki a note and urge him to sign the reinvestment
bill, your patients will greatly appreciate it.” posted 1/28/03 |