Mental Health Association in New York State, Inc.
(Publication Archives)

Friday Fax from Albany

Early Thanksgiving Edition

MHANYS Calls on Leaders to Exempt OMH
from 5% State Agency Budget Cuts

“It would be a truly callous government, indeed, that cut funding for mental health services in the face of what we all know,” says MHANYS President/CEO Joe Glazer

The Mental Health Association in New York State, Inc. (MHANYS) today called on state government leaders to exempt the NYS Office of Mental Health from the 5% across the board agency budget cut called for by Budget Director Carole Stone late last week.

In a letter to Governor Pataki, Senate Majority Leader Bruno and Assembly Speaker Silver, the organization pointed to eight months of continuous revelations regarding the terrible state of New York’s mental health system. The letter stressed the New York Times’ articles that added the inappropriate settings of adult homes and nursing homes here and out of state to the existing list of prisons, jails and homelessness.

“In sum, it is painfully evident that tens of thousands of people with serious mental health needs are facing poor or insufficient care, improper treatment settings and unwarranted incarceration, hazards and dangers,” the letter states.

The organization says that dual problems are at the root of New York’s mental health care morass --- historic under-funding of mental health programs, and 25 years of failure to create the comprehensive system of community-based mental health care promised by Governor Hugh L. Carey.

“MHANYS recognizes that our state faces tough financial times. But the continued failure to fund and coordinate our mental health programs (they really can’t be called a system) cannot be ignored. The reality is that we must, both morally and legally, provide quality services in the community for people with mental illnesses. We urge you to protect and improve what we already have, and not knowingly and willingly add to the quagmire,” Glazer concluded.

MHANYS is a 501(c)(3) not-for-profit corporation, made up of consumers, advocates, providers and family members involved in mental health. The organization provides education, training, outreach, information and advocacy for its 33 affiliates serving 54 counties across the state.

Mental Health in the News: For being such a short week, it was a very active week where several articles of interest to the mental health community found their way to the pages of newspapers across the state.

Most prominently, the state’s interagency adult home initiative announced the actions the state plans to take to address the unacceptable conditions in adult homes as they were reported by the New York Times earlier this year. An Associated Press and New York Times article are attached to this Friday Fax from Albany.

In addition, this week also brought editorial pages in major newspapers calling for the development and implementation of a comprehensive plan for mental health services, similar to that which MHANYS’ has called for in its report, The Unfinished Promise of Willowbrook. Editorials from the Journal News and Syracuse Newspapers are attached to this Friday Fax from Albany.

Lastly, talk about the upcoming budgetary situation the state is likely to face next year, has once again raised fears that psychiatric hospital closures and consolidations will again be options the state will consider. The editorial found in the Syracuse Newspapers makes reference to this as well as the article in the Middletown Times Herald Record, both are attached to this Friday Fax from Albany.

State Pledges to Improve Care in Adult Homes.
Associated Press, November 26, 2002

(Versions found November 27, 2002 in multiple newspapers, including the Albany Times Union, The Ithaca Journal, the Rochester Democrat and Chronicle, the Poughkeepsie Journal)

By Michael Gormley

ALBANY, N.Y. (AP) - The state will assess the medical conditions and needs of the 32,000 residents of adult homes as part of an effort to protect patients from abuse and neglect, the Pataki administration said Tuesday.

Nurses will also be deployed to private adult homes statewide to make sure needed medications are available and properly administered. Independent case managers will help coordinate care and improve treatment for the 12,000 mentally ill residents at the homes, according to Harvey Rosenthal of the state Association of Psychiatric Rehabilitation Services.

"This infusion of outside skilled professionals is critical to properly enhancing and assuring the quality, integrity and effectiveness of the care adult home residents have a right to receive," Rosenthal said.

Rosenthal's group was among the advocates for the mentally disabled who worked with the administration to devise the new initiatives.

The state, which is facing multibillion-dollar shortfalls, did not say Tuesday how it would pay for the changes, however. That concerned advocates for the 12,000 mentally disabled residents living in 450 adult homes throughout the state.

"I think it depends on how much of it is funded out," Rosenthal said. "In principle, what's being offered here is, I think, a fairly substantial program."

Joseph Glazer, president of the Mental Health Association in New York State, said the state's response without funding commitments amounts to simply more evaluation.

"It's amazing," said Glazer, who provided input but wasn't part of the state's working group of advocates. "The residential component of our mental health system is a car wreck and the plan now is for government to slow down and look as it drives by."

"We need a top-to-bottom revamping that will result in a plan and a system for care, none of which exists in New York state right now," Glazer said.

The Pataki administration proposed reforms beginning in April, when The New York Times reported on dangerous adult home conditions. The newspaper found unhealthy and even deadly conditions in mostly New York City-area facilities from unnecessary surgery to dangerously hot bedrooms.

New policies announced Tuesday include:

• Clinical, psychiatric and functional assessments of all residents by highly qualified and trained personnel.
• Improved case management and coordination to make sure appropriate care is provided.
• Improved management of medications by qualified personnel.
• Better social and recreational services.
• Increased advocacy and legal support for patients.

"These actions further ensure that residents of adult homes will receive appropriate services and, when appropriate, high quality mental health care in a safe, clean environment," said state Mental Health Commissioner James Stone.

The Times reported that patients and advocates were critical of the state Health Department's oversight of the homes. The Times found that workers at the homes falsified patient records to cover up inadequate care and coerced residents into unneeded surgery.

Between 1995 and 2001, 946 residents at 26 major homes died, the Times found. Some died of heat-related illnesses in rooms with no air conditioning; others died of routine illnesses that were not promptly treated, or they committed suicide.

Panel Urges Millions for Homes for the Mentally Ill
New York Times November 27, 2002

By Robert F. Worth

Pataki administration panel released a report yesterday calling for hundreds of millions of dollars of spending on new services and housing to overhaul New York's decades-old system of adult homes for the mentally ill.

State health officials embraced the report at a panel meeting and described their efforts to fulfillits recommendations. But they did not say how they would pay to implement them, and they provided no specifics about how to create new housing for the mentally ill, one of the panel's central recommendations.

The state has begun to implement some of the recommendations, including assessing the medical condition and needs of group home residents, deploying nurses to ensure that medications are administered properly and providing better advocacy and legal support, the health officials said yesterday.

"Our initiatives set forth today represent another in a series of important actions to improve the quality of life and services in the adult homes," the state health commissioner, Antonia C. Novello, said yesterday.

But Ms. Novello did not specifically address the panel's recommendation to create about 6,000 units of new housing for mentally ill people currently living in group homes, an effort that is expected to take many years and cost hundreds of millions of dollars. For now, Gov. George E. Pataki has appointed an interagency working group to look at the housing needs of the mentally ill and other populations, officials said.

"We've indicated our willingness to proceed with these initiatives," said John F. Signor, a spokesman for the State Department of Health. "But until we go further along in this process, it is impossible to come up with a realistic price tag."

The panel was established in May by Ms. Novello after The New York Times published a series of articles describing poor conditions and malfeasance at the largest group homes in New York City.

Some members of the panel said yesterday that state officials had told them to expect more details about financing for housing and other recommendations in the governor's State of the State Message in January and in the executive budget.

Governor Pataki declined to comment on the recommendations yesterday. Robert R. Hinckley, his spokesman, said the panel's recommendations "provide an important road map for ensuring that residents in group homes get good quality care they're entitled to."

Full report on mentally ill warranted - Editorial
The Journal News, November 25, 2002

Who are these people? Where are these people?

Mentally ill New Yorkers appear to be missing in action. Certainly, they have been missing from action, given the Pataki administration's unwillingness to present clear answers to questions about their treatment and housing.

Finally, after months of scandal and accusations, Gov. George Pataki is supposed to outline a plan tomorrow to begin addressing New York's mental-health crisis, starting with the plight of those in adult homes, Gannett News Service reported over the weekend. Media reports and subsequent investigations apparently spurred the state's response.

It is about time. But any short-term plan must only be considered a first step toward the desperately needed goal of providing New Yorkers a comprehensive, fact-filled, no-nonsense status report on the care of mentally ill people during Pataki's tenure.

That must be accompanied by realistic estimates of what it will cost to reform, and sufficiently fund, a responsible, and responsive, system — followed by the governor's commitment to do just that.

Pressure from many

The problem is not just the 12,000 adult-home residents here in New York.

New Jersey Gov. James McGreevey announced last week that he had ordered his health commissioner and attorney general to investigate why the Pataki administration has sent hundreds of patients from New York psychiatric wards and hospitals to nursing homes and adult homes in his state that do not have mental-health credentials. McGreevey was reacting to a New York Times story that detailed how Pataki's administration has sent severely ill — and therefore costly to treat — psychiatric patients out of New York state.

New York, apparently, is saving millions of dollars by sending the mentally ill from its psychiatric wards, hospitals and programs outside its borders, where the federal government picks up a portion of the cost of caring for them through Medicaid subsidies.

"The practice, if documented, violates acceptable notions of decency, as well as legal and moral standards for patient health care," McGreevey told the Times. "New Jersey clearly was not briefed as to the significance nor the intent of these transfers."

Despite New Jersey's outrage, its investigation must also examine the thoroughness of its own oversight of nursing homes there. Two of the New Jersey homes alone have been paid $82 million by Medicaid to care for hundreds of New Yorkers since 1995, the Times reported. More than 725 psychiatric patients have been sent to the two sites since 1995, according to Medicaid records. Yet the homes have been criticized in reports by their own state.

New Jersey's examination comes on the heels of several others into New York's treatment of the mentally ill, a constitutionally required state responsibility. Other probes have been triggered by the Times and other published reports. United States attorneys in Brooklyn and Manhattan, for example, are looking into adult homes there used by the state.

And, responding to articles, the U.S. Justice Department is specifically reviewing possible civil rights violations of mentally ill people put in locked units in New York nursing homes — a practice the Pataki administration adopted in 1996 and then suspended this year after published reports.

Questions unanswered

During the recent gubernatorial campaign, Pataki repeatedly insisted that, in fact, his administration has brought back 5,000 mentally ill patients from out of state. But his aides and a Health Department official could not offer evidence of that, the Times reported, and refused to answer other questions or supply details about New York's mentally ill people. For example:

• How has the state's psychiatric hospital system managed to go from more than 9,000 patients in 1995 to about 4,300 right now? Where are these people? Certainly, they have not been welcomed home to their communities or others, where group homes and programs for the mentally ill are anathemas.

• Where is the evidence that state requirements for discharge planning of these patients, which include stable housing and consistent services, have been met? When New York has sent patients out of state, what efforts are made to welcome them back? Many allege that they are not even allowed back in to New York.

• Why hasn't Pataki made his signature on legislation renewing funding for the Community Reinvestment Act a priority? The Legislature passed the 2002 act in June, which was supposed to help fund mental-health services. Originally passed in 1994, the act expired in 2001. Advocates, patients and service providers complain bitterly that it never delivered on its intent of using money saved from downsizing state psychiatric facilities to fund local programs. Certainly, without the governor's signature, it can't this year, either.

More than partisanship

In a scathing report issued at the height of Pataki's recent re-election campaign, the Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities called New York's mental-health system "broken." It forcefully blamed the Republican governor: ". . . The administration has hamstrung (the Legislature's) efforts with bureaucratic delays, under-funding and regulations that have blocked effective use of the programs," it said.

The Oct. 31 report accuses the governor and the state Health and Mental Health departments of ignoring legal and oversight requirements regarding the mentally ill. It calls the system "a top-down planning process that is inefficient, facilitating wasteful use of public resources. As a result, thousands of mentally ill persons have suffered indignities and abuse. Hundreds of other have suffered untimely deaths . . ."

It concluded by saying, "The Committee regrets that, with regard to the care and treatment of mentally ill residents of adult homes, it has had to rely, to some extent, on investigative reports of the media . . . "

As late as Thursday, the committee's chair, Assemblyman Martin Luster, D-Ithaca, told the Editorial Board, the administration had not supplied all the information requested by the panel since the adult-home scandal broke earlier this year — nor had it met a deadline for a report due the Assembly committee the previous week related to an important section of the Mental Hygiene Law.

The dispute could be attributed to partisan squabbling between the Republican governor and Democratic-controlled Assembly. It could be, except for the media reports. Except for the investigation called for by New Jersey. Except for the investigations called for by the federal government.

The Pataki administration apparently realizes that it now must answer sooner, rather than later, where New York's mentally ill people are, how they are faring and why.

Shame, Shame - Editorial
Syracuse Newspapers November 25, 2002

No one chooses to be mentally ill. Just as no one would choose to get cancer or contract diabetes, no one wants their brain to betray them. People with mental illness are victims just as those with any other chronic illness. They need medical attention.

Mentally ill people who are too sick to care for themselves or those who are so affected that they could be dangerous are rightly the state's responsibility. For generations, people with mental illnesses were confined to locked hospitals. Some languished in wards for decades, having little contact with the outside world. As science learned more about the problems of the mentally ill, and as different forms of therapy developed, experts recommended that many individuals could lead better and happier lives in community-based programs.

New York, like many other states in the 1960s, began shutting down the hospitals. Some of them well deserved to close. They were horrible places - dark and dank. Unspeakable things happened in those old wards. Patients were abused every way possible. Their closure ended a grim era in this state's history.

But the state never fulfilled the other half of the promise. Patients were chucked out of the hospitals, but there simply were not enough places for them to safely land. Instead of community-based homes with lots of supervision and the proper kind of care, thousands of mentally ill people were left to fend for themselves or they were sent to locked nursing home wards - trading one nightmare for a new set of terrors.

Earlier this year, The New York Times uncovered records that proved hundreds of mentally ill people were prisoners in nursing homes, never allowed outside, living in wards and rooms with little or nothing to help them be well.

This month, the Times exposed another outrage. Hundreds more of these patients were sent to nursing homes in New Jersey and Massachusetts - homes that were already in trouble with their own state governments for being substandard. They are places without the expertise or staff to care for people who are mentally ill. Yet, according to state records, just two nursing homes in New Jersey have collected more than $82 million in New York Medicaid payments since 1995.

In Massachusetts, the Sun Bridge nursing homes, known to be substandard in every important way, were paid $260 million to care for mentally ill New Yorkers, according to the Times, which cited Medicaid records. This is how bad some Massachusetts homes are: One patient gouged out the eye of another with his bare hands.

"Massachusetts regulators say the Sun Bridge facilities have deteriorated markedly in recent years, repeatedly criticizing them for mismanagement, shoddy care, sexual assaults and other violence among residents, including the resident's eye gouging last year," said a Times report.

Mental illness, like physical illness, often requires carefully calibrated care. Medications have to be prescribed and delivered with precision. Talk therapy has to be consistent. Neither of those things that can be provided by people qualified only to look after aged people. Are any of the people sent out of state ever seen by doctors? How does that work?

Through all of this, Gov. George Pataki has insisted the decisions to move patients to nursing homes were made on a medical basis. He told the Times during his campaign that more than 5,000 patients were brought back to New York, but no records could be found to substantiate that. John Signor, a spokesman for the state Health Department, told the Times the administration had sent fewer than 50 people annually to facilities outside New York. In fact, Medicaid records show that since 1995, more than 725 New Yorkers have gone to the Lincoln Park and Andover nursing homes (in New Jersey) alone, an average of more than 90 a year.

Why the lies? Perhaps it's because the mentally ill don't have big campaign contributors writing checks on their behalf. Perhaps it's because Pataki knows it's wrong to victimize mentally ill New Yorkers this way.

Here in Syracuse, Hutchings Psychiatric Hospital was targeted by Pataki for closure. It still could be, and God knows where the patients would end up. This administration must be more forthcoming about its plans for caring for the mentally ill.

Middletown Psych Center may be shut by state budget crunch
Middletown Times Herald Record, November 25, 2002

By Matt Smitt
Ottaway News Service

Albany – Is Middletown Psychiatric Center on the state's chopping block?

With New York facing a budget gap that could run as high as $10 billion next year, the state's largest labor union fears the Pataki administration – in an effort to control costs – is once again eyeing the shut down of the Monhagen Avenue hospital and others like it across the state.

"We're very, very concerned and this is a large reason why we've been banging the drum," said Steve Madarasz, spokesman for the 77,000-member Civil Service Employees Association, which has long been critical of the Pataki administration's mental-health policies.

State Office of Mental Health spokesman Roger Klingman would not say whether hospital closures were being considered to help the state close its looming deficit, saying it would be premature to comment on cost-cutting measures prior to the release of Gov. George Pataki's proposed executive budget.

Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitative Services, said he expects the administration to call for the shutdown of some of its state-run psychiatric centers.

"I can't imagine that in a difficult budget year, when they're looking to cut costs and close the budget gap, that state mental hospital closures aren't on the table," Rosenthal said. "And I'd think Middletown and Hutchings would be the ones you'd have to look at first since they were targeted last time around."

Two years ago, Pataki proposed the closure of the Middletown center as part of a plan to save the state $64 million.

Under that plan, which also included the shutdown of Hutchings Psychiatric Center in Syracuse, part of the savings would have been diverted to community-based mental health programs and pay for raises of direct-care workers.

At the time, most mental-health advocates supported the shutdowns, claiming local programs were too cash-strapped to adequately provide services. But lawmakers and the CSEA ultimately killed Pataki's proposal, arguing the closures would leave gaping holes in the state's mental-health system and cost too many good-paying jobs.

"There are some so-called advocacy groups that have these delusions that if the state closes these hospitals there will be more money for their operations," Madarasz said. "But, they have been played. The fact of the matter is, the state has walked away from that concept."

Nonetheless, the closure of state-run mental hospitals is nothing new.

With advances in psychiatric medicine and the proliferation of outpatient-treatment programs, more than 80,000 state-run psychiatric beds have been lost over the last 50 years.

Middletown has not been immune to those cutbacks. In 1981, for instance, the hospital had 1,800 beds. Today, there are just 118, Klingman said.

In arguing for Middletown's closure two years ago, state Mental Health Commissioner James Stone said one of the main reasons the hospital was targeted was because $34 million in upgrades are needed to bring the center up to accreditation standards.

"Since then, there really has been no spending per se," Klingman said of the upgrades.

Steward DeGroat, president of the hospital's CSEA Local 415, said the state's claim the center needs multimillion-dollar upgrades is little more than an excuse to shut the facility down.

"This place is in great shape," he said.

Kate Abdoo, spokeswoman for Forestburgh Democratic Assemblyman Jake Gunther, said the assemblyman "wouldn't be surprised" if the hospital is targeted for closure again. But if that's the case, she said, Gunther will fight as aggressively as he did two years ago to ensure that the center remains open.

In recent months, the governor has been under intense fire from activists and the CSEA for discharging mentally ill patients from state psychiatric hospitals and placing then in ill-suited nursing homes and adult homes. Other patients, meanwhile, have literally been shipped out of state.

Until next time, we remain, Working to ensure available and accessible mental health services for all New Yorkers