Health Association in New York State, Inc.
Friday Fax from Albany
MHANYS TO REPLACE FRIDAY FAX FROM ALBANY WITH MHANYS MENTAL HEALTH UPDATE: At the end of December, MHANYS plans to change the name of this publication from the Friday Fax from Albany to MHANYS Mental Health Update. While the format of the publication will not change significantly, we hope that this will enable MHANYS to better keep readers informed of issues that impact New Yorkers living with mental illness. It is our intention that with this change, MHANYS Mental Health Update will be more issue-driven and timely. In addition, we will be sending out timely action alerts on issues of significance. With this new format, we hope to bring the most up-to-date information to the field.
NEW ISSUES EMERGE AT MHANYS’ PUBLIC POLICY FORUMS: This forum provided folks on Long Island the opportunity to discuss issues of significance in their area and hear about MHANYS’ work on issues over the past year. An excellent discussion ensued on some of the consistent priority issues, including: Timothy’s Law, Civil Confinement of Sexual Predators, 10% Funding Increase for Community Providers, Medicare Part D, Access to Medications, Elimination of Solitary Confinement for Prisoners with Psychiatric Disabilities, Adult Home Reform, Models of Care for Integrated Services for Co-Occurring Disorders, and Juvenile Justice Reform.
In addition, a consistent theme we heard both on Long Island and in Buffalo was that of how the mental health system deals with 18-25 year olds. This issue appears two-fold; 1) concerns about the services geared toward this population and, 2) the difficult transition 18-25 year olds presently much make from the children’s mental health system to the adult system.
Regarding the services geared to this population, participants both in Buffalo and Long Island pointed out that there were ongoing concerns about engaging this population under current models of care. Those 18-25 are caught in the middle – too old for the juvenile system and too young for the adult system.
As there are generational concerns with regard to adult home residents, a similar concern exists with regard to 18-25 year olds. It is very difficult to engage younger people in adult homes in any of the existing programs. When I was the Director of the Adult Home Initiative Program, we had discussions with adult home residents and found a significant interest in education (e.g. GED and trade schools) among the younger population.
Among the suggestions raised for better engaging the 18-25 year old population is to develop a strength-based assessment tool, geared toward the current needs of this population (e.g. educational training) and development of innovative treatment plans based on the assessment tool. Also, discussion at the Long Island forum led to an idea with significant potential which would develop an IPRT model geared specifically to this population.
The other component of the concerns surrounding 18-25 year olds has to do with successfully making the transition from the children’s system to the adult. We had discussions about Transition Planning which is defined as a coordinated set of activities for a student with a disability, designed within an outcome-oriented process that promotes movement from school to post secondary education. Essentially, the transition planning process was put in place to help encourage students and their families to participate with the schools in planning for their future after graduation from high school. Though Transition Planning is a federal program, the feedback we heard on Long Island was that a lot of schools have not fully funded this program and it is clearly not a priority in many schools.
Transition Planning sounds like a sound strategy for early intervention. Unfortunately, it sounds like this planning tool has not been universally embraced in school districts across the state. We look forward to working with advocates for children like Families Together in New York State and other organizations in transition planning implementation.
Thanks are due to Steve Greenfield and Marcia Feuer from the MHA of Nassau County for hosting this event on Thursday, December 8th, and for all who participated.
– December 19th from 11-1
– December 20th from 11-1
Please let either MHANYS’ Michael Seereiter (email@example.com or (518) 434-0439 ext. 21) or the local MHA know that you plan to attend. Lunch will be provided at each venue.
ASSEMBLY INTRODUCES PACKAGE OF BILLS DEALING WITH SEXUAL PREDATORS: Late last week, the Assembly Majority introduced a comprehensive package of legislation to address the concerns about sexual predators that have been highly publicized through media reports lately. A great deal of pressure has been put on the Assembly by the Governor and Senate to pass a bill that would allow for civil commitment of sexual predators in the mental health system. This is clearly a hot button issue in Albany for the coming year.
As participants in the Assembly’s roundtable discussions on this topic, and in testimony at a public hearing, MHANYS has been active on this issue due to our concerns about how such civil commitment legislation could impact people living with mental illness. First, we have made the case that while there are some sexual offenders who have mental illness, most do not have an Axis 1 diagnosis. Therefore, we have argued, that sexual offenders without diagnosable and treatable mental illness do not belong in the mental health system. In addition, we have also articulated several practical points in opposition to housing sexual predators in psychiatric facilities:
• Safety Issue: People with psychiatric disabilities are 12 times more likely than the general population to be victims of violence. To house sexual predators in psychiatric facilities will only create an atmosphere that would foster a significantly less safe environment for those with psychiatric disabilities. Furthermore, while it is the business of the Department of Correctional Services to provide security, the expertise contained within the Office of Mental Health is in the treatment of mental illness, not security.
• Resource Issue: If sexual predators were housed in psychiatric facilities, we would be very concerned that resources in the existing mental health funding system would be in jeopardy. We already know that existing resources for the mental health community are scarce. Without sufficient funding, individuals with diagnosable and treatable mental illnesses would have fewer resources to assist them in recovering because those resources would be diverted to pay the $200,000+ each year to house sexual predators in psychiatric centers. This would cost taxpayers far more than the average cost of housing people in prison at $40,000 per year.
• Stigma Issue: Associating sexual predators with individuals with serious mental illness just perpetuates the myths of people with mental illness being violent and performing maladaptive behaviors. To the person on the street who does not know about mental illness, this policy greatly increases the already overwhelming stigma of mental illness that hampers full recovery.
In some of our more recent research on this subject, we have learned that the recidivism rates for sexual offenders are much lower than proponents of civil commitment have articulated, that prevention and treatment in prison works to help reduce recidivism, and that early interventions that are successful at stemming the future sexual offenses at an early stage. One thing is for sure, there is much more to the puzzle of how to deal with sexual predators than civil commitment alone.
Therefore, we were pleased with several of the components of the Assembly’s proposal. We embraced the provisions that would provide for early intervention for those displaying sexually deviant behavior, which will help prevent sexual offenses from taking place at all. We also support the increased sentences associated with sexual offenses. We also support the mandated treatment of sexual predators while in the correctional system, which will reduce the number of offenders who still pose a threat upon completion of their sentence. These components will reduce the number of offenders still dangerous after serving their sentence, but will also reduce the number of people who offend in the first place.
However, MHANYS and many other mental health advocates stand strongly in opposition to any civil commitment of sexual predators in existing psychiatric facilities, which the Governor, Senate and Assembly now all support.
SOLUTIONS: As advocates it is not only our responsibility to bring issues to the fore but also to talk about solutions. We believe the state should be looking into the development of therapeutic residences for sexual predators located on the grounds of the correctional facilities so that individuals deemed to remain a threat after completing their sentence could be provided treatment to make a successful and safe reintegration into the community. In an environment such as this, these individuals could be provided with a custom tailored package of services designed to address their particular needs, including any necessary mental health services. This would resolve the public safety concerns by keeping dangerous sexual predators off the streets, save taxpayers money, and provide these individuals the services and treatments they need in order to eventually make a safe reentry into the community. All of this could be achieved while keeping these individuals out of the mental health system, where most of them don’t belong.
CONSUMER AND BUSINESS OUTREACH PROGRAM (CBOP): Last week, MHANYS held the quarterly meeting of the Statewide Business Advisory Council. These councils have been developed in four areas around the state to encourage businesses to work with job-seekers with psychiatric disabilities. We are pleased that a variety of businesses have been participating in the program, including Bank of America, Marriott Hotel, Verizon and many others. At the state and local level, we work closely with our network of partners from the Department of Labor, VESID, OMH, vocational services and supported employment programs to assist in the coordination of events and trainings, as well as implementing best practices.
Samantha Phillips, the Director of this program, has been traveling around the state soliciting ideas from various groups about the program. Recently, Samantha visited several MHAs to promote the program and encourage workforce development. Program goals for 2006, include a one day employment conference and job fair in early spring, as well as further collaboration with the business community and other organizations to promote job opportunities and education. Please visit the new CBOP website at www.mhanys.org/cbop for more information, or contact Samantha at firstname.lastname@example.org if you are interested in hosting or participating on a MHA Business Advisory Council.
Also, look out in March for a one-day conference on employment.
MEDICARE PART D UPDATE: We are pleased to see an article in this week’s Mental Health Weekly mentioning our new web page dedicated to finding resources about Part D – www.medicarepartdnys.org. Also, on Friday, OMH provided a review of all the existing benchmark plans for dual eligibles in New York State. In our initial look, we were pleased to see that the array of atypical antipsychotics and anti-depressants appear to be in all the plans formularies. OMH’s drug plan comparison chart can be found at http://www.omh.state.ny.us/omhweb/MedicareD/formulary_guide.htm.
In addition, MHANYS has been conducting trainings for mental health service recipients and mental health service providers in locations throughout the state including NYC, Buffalo, and Essex County.
At this point, we have one additional training scheduled to take place before the holidays:
- December 20th from 2-5
MARK KISSINGER LEAVING THE GOVERNOR’S OFFICE: Mark Kissinger, the Governor’s Deputy Secretary for Health and Human Services, is leaving to take the position as head of New York Home Care Association, right across the hall from MHANYS’ office in Albany.
Over the years, I have had the opportunity to work with Mark on several different issues. Though we didn’t always agree on every issue, I always found Mark to be candid, dedicated and knowledgeable. He was a real asset to New York State and he will be missed. We wish him luck in his new position.
NYAPRS SEEKS ADMINISTRATIVE ASSISTANT: NYAPRS is seeking a highly motivated, full-time Administrative Assistant to provide administrative support to the NYAPRS office and to our administrative and agency project directors. These duties would include, but not be limited to shared phone, mail and information management duties (including filing, database entry and reporting), member billing, teleconference & meeting set-up, and support for our annual conference.
This position requires demonstration of:
Candidates should submit resume with salary requirements by December 16 to KellyA@nyaprs.org or fax to (518) 436-0044.
sufferers now getting help. By Amanda Benson
The last time Brian Donovan's name appeared in this paper, it was connected to ugly words like "criminal," "guilty" and "addictions."
"Without a doubt, going to prison saved my life, because that's how I finally got treatment," he said.
Donovan, 25, spent 3-1/2 years in state prison after admitting involvement in a 2001 burglary spree in Glens Falls and Queensbury. At the time of his sentencing, he told the judge that he stole in order to fuel his drug habit. But the prosecutor suggested he seemed more motivated by "thrills."
Both were true, as it turns out.
Donovan was struggling with what are clinically termed "co-occurring disorders" -- substance abuse and mental illness.
"Looking back, it was definitely a manic period for me. The burglaries were a way of getting outside myself and having control," he reflected. "Something about it made me feel well. In a sick way, it made me feel human."
Drugs numbed his racing mind and gave him an emotional high when he felt so low that he "just wanted to die," he said. At the time of the burglaries, he told police he was spending $75 to $100 a day on the drug ecstasy.
His alternating episodes of mania and depression were a symptom of bipolar disorder, but he didn't know it at the time.
"I didn't think I had a mental health issue; I just thought that I was a bad person -- and I ended up being one," he said.
Since the age of 16, Donovan had cycled in and out of various substance abuse treatment programs, but it wasn't until he received counseling and medication for his mental illness that his life got back on track.
"I don't want mental health issues to be an excuse for my actions. What I did was very wrong," said Donovan. "I can't take it back, but I don't hold it against myself, either. I've held a lot against myself for so many years."
A common story
Forty percent to 50 percent of substance abusers suffer from at least one serious mental illness, according to the National Mental Health Association. Until recently, however treatment approaches have been completely separate.
In 1999, the state decided to take a chance on a new approach, by funding "dual recovery" programs. The Warren-Washington Association for Mental Health received one of the first grants to create such a program and now handles a caseload of about 40 people with co-occurring disorders.
Cliff Green, coordinator of the Warren-Washington dual recovery program, said substance abuse and mental health are often linked because people with mental illness are seeking a way to become "normal." Drinking or doing drugs with their peers can seem like a way to fit in.
It can also become a form of self-medication.
"With bipolar, for example, research shows that many people survive for years without medication, by using alcohol and drugs to regulate their mania and depression," said Green.
Brad Morrow, a dual recovery case manager, has personal experience with this subject.
"For years, I had used drug and alcohol to mask things. I was trying to stop feeling something, and the scary thing is -- it works," Morrow said. "I knew on some level that what I was doing wasn't sustainable. I knew I was right on the edge of a cliff."
One day, he said, "the addiction just took over." He lost his job as a cook and ended up in rehabilitation.
Even when Morrow emerged from rehabilitation, he knew something wasn't right. He finally went to see a psychologist and was diagnosed with bipolar disorder.
"It blew me out of the water; it really made me question who I was," he said. "I thought my life was over."
Then Morrow stopped into a dual recovery self-help meeting at the East Side Center in Glens Falls and was blown away again.
"I realized, wow! I'm hearing my story coming from other people's mouths," he said. "I felt like, 'Oh, crap, I have a real problem.' But I also felt a sense of relief: 'So this is what it is.'"
Now, he works as a case manager for the dual recovery program and helps run self-help meetings each weekday evening. Attendance at the meetings is growing, he said, because "the status quo isn't working for people with co-occurring disorders.
"The neatest thing is to watch new people coming in, and they get that look in their eyes, like, 'Now I know,' " Morrow said.
Green nodded. "It doesn't mean it's perfect. But it's different for them from then on."
In many cases, treatment is not the first step towards helping people with co-occurring disorders, said Green.
"They've been cycled through dozens of other programs and had different labels put on them," he said. "If you can't sit down with a person and decipher what their most immediate need is -- if you can't help them with what they think they need, not necessarily what you think they need -- you may never see them again."
Many of these individuals have just come from jail, a rehabilitation program or the streets.
"How can you talk about treatment when they don't even have a place to sleep?" he asked. "There's a tremendous housing crisis in this area, and it's very difficult to place people."
In the future, Green said, he hopes the dual recovery program will be part of a "wraparound" solution.
"There will never be enough dual recovery case managers. ... I would rather see all the community providers having the basic knowledge and skills to do what we do," he said. "Co-occurring disorders are not going to go away."
A new life
Like Morrow, Donovan now uses his own experience as a foundation to support other people affected by mental illness and substance abuse. He is taking classes toward a degree in human services and works full time as a peer advocate for Voices of the Heart, a state-funded mental health agency in Hudson Falls. He also volunteers at the dual recovery program.
"Being able to give back helps me stay balanced," Donovan explained. "The odds were against me, and I'm sure they still are. But I refuse to give up. I still have hard times, but they're not like they used to be."
He insists on talking about mental health, rather than mental illness.
"I hate that word, 'illness.' It's debilitating and self-perpetuating," he said. "Ex-con, drug addict, mentally ill -- these are all labels of behaviors. They're not me."
the Envelope. Editorial
Gov. George Pataki wants New York to get tougher on sex offenders. Frustrated for years by the State Assembly's refusal to pass a bill to lock up violent sex offenders in mental hospitals when their prison terms end, he recently told aides to "push the envelope" and try to accomplish the same end through an existing law that was intended for the dangerously mentally ill. A judge predictably rejected that effort as an abuse of the mental-health system, and Mr. Pataki has appealed.
The governor's efforts strike a strong emotional chord. No one can dispute society's duty to protect its members - children most of all - from violent sexual predators, and many will argue that no effort is too extreme, no price too high, for safety. But other states have already tried Mr. Pataki's approach, and run into more problems than expected.
Legislators who are tempted to grant Governor Pataki's wish may want to look at Kansas, which helped set the national civil-confinement trend in motion with a case that went to the United States Supreme Court. By a vote of 5 to 4 in 1997, the court ruled that states could employ civil laws when criminal ones were exhausted and involuntarily confine "mentally abnormal" people deemed likely to commit a violent sex crime.
The consequences of that decision can be seen near Larned, Kan., roughly 100 miles from Wichita. The Sexual Predator Treatment Program at Larned State Hospital is, in effect, an extremely expensive prison. Of the 156 offenders sent there since the program began 11 years ago, only one has been released after completing treatment.
The state says the population could nearly double in the next decade, with costs soaring accordingly. The program cost about $7 million this year, or about $150 a day per resident, triple what the state spends each day on a prison inmate. And those costs do not include the elaborate apparatus of hearings, jury deliberations, medical evaluations and appeals to ensure that no one is improperly kept locked up. A state audit this spring looked at ways to curb the program's growth and concluded that little could be done because so many offenders were going in and were taking so long to come out.
But the problem goes beyond dollars. It is a civil liberties issue, too. Preventive detention - open-ended confinement to prevent the crimes a person might commit - is a Soviet-style approach to justice. And much of the clamor for civil confinement seems to stem from faulty assumptions about recidivism. Crime statistics are frustratingly inconclusive on this issue, but it is clear that not all sex criminals are hard-wired repeat offenders, and that it is impossible to make reliable predictions on which ones will commit new sex crimes.
It would be far better to get more offenders into psychiatric treatment while they were in prison, and to continue treatment, with strict monitoring, when their prison time was up. If vicious predators are leaving prison too soon, sentences need to be lengthened.
The Manhattan district attorney, Robert Morgenthau, proposes that minimum sentences for the most serious sex offenses be raised to 10 years. State senators in Kansas, motivated in part by the runaway cost of civil confinement, are seeking to set a minimum sentence of 25 years for such crimes as raping a child under 14. They are also seeking lifetime parole and supervision for all violent sex offenders, and life terms without parole for three-time violent offenders. Texas has tried to avoid the civil-confinement trap by releasing inmates into outpatient therapy, and ordering them to abide by a court-specified treatment plan and to wear tracking devices. Any violation of treatment requirements is considered a felony.
It would be unfair to accuse Governor Pataki of playing politics with this important and sensitive issue. But it is possible to be sincere and irresponsible at the same time. The goal should be an effective approach to the problem, not a contest to see who can exhibit the highest degree of outrage. Urgent calls for precipitate action, like Governor Pataki's, are tinged with a sense of helplessness that is deadly for creating sensible public policy.
charged debate over sexual offenders. By Alexandra Marks
New York considers whether some should be confined in mental hospitals after their jail terms end
NEW YORK - The national debate over how best to deal with dangerous sexual predators is playing out in a highly charged political way in New York.
It centers on the issue of civil commitment, laws that allow the government to institutionalize unsafe sexual offenders in mental hospitals after they served their time in prison.
Advocates contend this is the best way to keep dangerous, repeat sexual offenders from striking again. But opponents argue that civil confinement of sexual offenders has proved to be extremely expensive and not as effective as longer sentences, intensive treatment, and post-incarceration supervision.
It is a highly emotional issue: Just what does a government do with people who clearly pose a danger? States across the country, which have been grappling with it for two decades, are still working to come up with the best solution. In the 1990s, 16 states passed civil-confinement laws for sexual offenders. Since then, most have focused instead on increasing sentences for sexual offenders and improving post-incarceration treatment and supervision.
"There's certainly been a trend in states to pay attention to how long they go to prison and, if they're going to get out, how do we supervise them effectively in the community," says Donna Lyons, criminal-justice program director for the National Conference of State Legislatures in Denver. "They're really looking at the whole picture. There's really not just one solution being pursued."
The story of how civil commitments suddenly became a major issue in New York begins last June, when Concetta Russo-Carriero was walking to her car in the parking garage of a mall in White Plains, N.Y. She was stabbed to death by a homeless man who'd spent 23 years in prison on rape charges. There was outrage in the community, and Gov. George Pataki (R) made it a top priority to pass a civil-commitment law. While the state Senate passed the bill during the summer, the state Assembly so far hasn't, and instead it has focused on passing laws that increase sentences for sexual offenders.
Furious that the Democrat-controlled Assembly didn't act on the civil-commitment legislation, this fall Governor Pataki simply ordered that more than two dozen sexual offenders, who were about to be released from prison, be committed using current state laws. At the time, his staff acknowledged he was pushing "the envelope" but said it was necessary to protect society from violent sexual offenders who are likely to strike again.
The fallout has produced challenges in state court, the first round of which the governor lost. It's also produced some highly charged rhetoric.
"You can either stand with the children of New York [and pass the civil-confinement law], or you're going to coddle up to pedophiles and criminals. It's that simple," says Assemblyman Vincent Ignizzio (R) of Staten Island, chiding Democrats for preventing a vote on the bill.
Democrats were fast to strike back, calling such statements "venom" and "personal attacks."
"As a father, a grandfather, and a law-abiding citizen, I despise all who prey upon women and children, the aged and the physically challenged, the mentally ill and the poor," said Assembly Speaker Sheldon Silver in a recent speech to The Center for New York Law. "I also know the boundaries of our legal system, and I know that you can't strengthen those boundaries with knee-jerk reactions and political game-playing."
States that have passed civil-commitment laws have found some of those boundaries. Thirteen of the states that have such laws have also passed amendments further clarifying how and when they are to be used. Most of these states have been sued.
In 1997, however, the US Supreme Court upheld the constitutionality of the Kansas civil- confinement law, as long as treatment is provided.
Opponents say that's where the problem arises. Civil confinements are very expensive. And they point to Washington State's experience as an example. It was the first to pass a civil-confinement law in 1990, and it has been repeatedly sued. In 1994, a state court chastised officials for not providing the sexual offenders in mental institutions with proper treatment and ordered it to do so. In 1999, it held the state in contempt for failing to follow through. Last year, after the state substantially increased the amount spent on treatment, the court order was finally lifted.
Only 1 to 2 percent of sexual offenders are committed after they serve their time in Washington. Studies show that state taxpayers are spending more than $100,000 per year on each one, a total of $23 million a year. Opponents contend that money would be better spent by providing better treatment to the vast majority of sexual offenders, who may not be dangerous enough to be committed once they serve their term, but still present a threat when released into society.
"The problem is that a large amount of resources are spent on a few offenders when the money could be spent providing more and better treatment to all released sex offenders," says Robert Perry, legal director of the New York Civil Liberties Union.
Experts who treat sexual offenders say there is no silver bullet for society to protect itself against dangerous sexual offenders. What's needed, they say, is a multilayered approach that takes into account the different degrees of danger that each sexual offender presents and at the same time offers the best and most cost-effective treatment and supervision.
advocates favor some parts of sex offender proposal.
Concerns remain over safety
New York mental health advocates concerned about protecting persons with mental illness from being housed in the same psychiatric facilities with sexual offenders say they are somewhat encouraged by a proposal state lawmakers introduced last week to provide increased penalties and tougher procedures for offenders.
The New York Assembly proposed the Child Safety and Sexual Predator Punishment and Confinement Strategy as one of its legislative priorities in the 2006 session. Officials say the comprehensive legislation to protect New York state residents from sexual predators calls for tougher penalties, civil commitment, increased monitoring of sex offenders, and improved services for victims.
The proposed measure would allay some of the fears and concerns mental health advocates have raised about officials placing sex offenders who have served their sentence in state mental health hospitals.
The New York Times reported that Gov. George E. Pataki directed the state Office of Mental Health and the state Department of Correctional Services to use New York’s existing involuntary civil commitment law to keep violent sex offenders off the street.
The state Supreme Court ruled last month that Pataki did not have the authority under existing law to transfer sex offenders from state prison to a state psychiatric hospital.
The proposed legislation would encourage public discussion of whether New York should join other states in enacting an involuntary civil commitment law for sex predators. According to the Washington State Institute for Public Policy, 17 states currently have involuntary civil commitment of sexually violent predator (SVP) laws. The laws permit the state to retain custody of individuals found by a judge or jury to pose risks for reoffending.
A key element of the Assembly’s proposal provides for lifetime civil commitment of dangerous sexual predators after they complete their prison sentence. The proposal would require the state Department of Correctional Services (DOCS) to establish treatment programs by the state Office of Mental Health (OMH) for all sex offenders.
“We’re going to have tougher penalties,” Guillermo Martinez, legislative director for Assemblyman Peter M. Rivera (D-N.Y.), told MHW. Rivera is the chair of the New York State Assembly Standing Committee on Mental Health, Mental Retardation and Developmental Disabilities. “The legislation would spare the mental health system from the financial costs of housing and treating sexual predators. We’re going to have the money come out of the correctional system, not the OMH.”
Gov. Pataki a few months ago used the state’s mental health hygiene law on involuntary hospitalization to place sex offenders in mental health facilities, said Martinez. “The court said Pataki didn’t follow full process when he transferred sex offenders from prison to a mental health facility,” said Martinez. “Assemblyman Rivera was concerned. We have a mental health system that doesn’t have the capacity to provide services for people who need mental health services.”
The legislation serves a greater purpose, said Martinez. “It’s keeping the community safe and saves mental health patients and staff by segregating sexual predators into secure wards in corrections facilities. It addresses the problem with mandated tougher penalties to keep these criminals off the street.”
Martinez added, “The civil confinement system is too expensive. This issue should be handled through the criminal justice system and not the mental health system, especially when you consider the cost.”
Almost 4,000 sex offenders have been placed in state psychiatric hospitals around the country, Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS), told MHW. “Mental health advocates are troubled by this trend. We fear many offenders subject to confinement don’t truly have a mental illness and as a result it would be an inappropriate placement. It would put people with mental illness at risk and be a drain on mental health funding.
“The whole issue of civil confinement — laws that allow states to take sexual offenders who have served their time and are seen as a public threat continue to turn these offenders deemed ‘mentally abnormal’ and confine them involuntarily to state mental health hospitals — has been a bone of contention between the state Senate and the Assembly for some time,” said Rosenthal. “As advocates, we want to stay out of politics [but] we’re very concerned about the potential misuse of the mental health system.”
Rosenthal said advocates want policies that recognize that sex offenders therapies are available and are increasingly effective. The increasing use of self-help groups, medication and cognitive therapy all are helping sex offenders, particularly sex offenders who are in the early stagers or are lower-level offenders, he said. “We’re just concerned,” noted Rosenthal. “We want the public protected, we want policies made in an atmosphere of facts.”
Advocates are also concerned about stigma associated with mental illness. Placing sexual offenders in the same facility alongside individuals with mental illness, even if they are kept separate, increases the stigma of mental illness, J. David Seay, executive director of the National Alliance on Mental Illness (NAMI)-NYS, told MHW. “Associating sexual violent behavior with mental illness exacerbates the public misunderstanding and nature of mental illness,” he said. “Linking mental illness with sexually predatory behavior only adds to the stigma of mental illness and the misplaced perception that persons who suffer from a mental illness present a greater danger to the public than anyone else,” said Seay.
“NAMI-NYS is concerned for the safety of those persons with a mental illness who are hospitalized,” noted Seay. “When society’s goal is incapacitation of sex offenders and public safety, it is unconscionable to look at state psychiatric hospitals as the appropriate system of care. I’m pleased the Assembly bill is attempting to guarantee that the OMH budget is not siphoned off.”
While mental health advocates say they are pleased with some of the components of the Assembly proposal, which address prevention and treatment, their major concern is the civil confinement of sexual offenders with individuals with mental illness.
“It would be important to include treatment for anyone who needs treatment but not in the same environment as potential victims,” Paige Pierce, executive director of Families Together in New York State, told MHW. “We have children who are especially fragile and direct exposure to potential violators and sexual predators is the worst thing you could do. Having separate facilities or separate treatment for sexual offenders may ensure safety for everybody.”
“We’re very supportive of the emphasis on early treatment and prevention,” Glenn Liebman, chief executive of the Mental Health Association in New York State (MHANYS), told MHW. “We don’t like the idea of individuals being civilly committed to psychiatric facilities. We have concerns about safety issues. People with mental illness are 12 times more likely to be victims of violence than the general population.”
“Civil commitment is only one answer,” Michael Seereiter, MHANYS director of public policy, told MHW. “What are we doing to prevent the behavior in the first place? What are we doing to provide treatment to sexual offenders while they are still in jail?”
Seereiter added, “Why wouldn’t they create some therapeutic environment on the grounds of prisons and jails that would provide a wide array of special services to help sexual offenders live in the community?”
“As mental health advocates, we like the explicit restriction that makes sure the sexual offender is housed entirely in different settings from people with psychiatric disorders,” added NYAPRS’ Rosenthal.
Advocates are also pleased that the proposal calls for sexual offenders to be confined to the Department of Correctional facilities in a way that would not jeopardize people with psychiatric disabilities or mental health funding, he said.
“These are some of the provisions we had sought,” said Rosenthal. “These provisions are encouraging. We’re glad they’re on the table and we hope they remain there at the end of the day.”
launches Medicare website for New York residents.
Individuals living with psychiatric disabilities who receive both Medicaid and Medicare will be affected by the new prescription coverage plan (Medicare Part D) in ways distinct from the elderly who get only Medicare. In response, the Mental Health Association in NYS, Inc. has created a new website specifically for residents of New York State. The site reads, “This new benefit can seem complex, and people will receive different coverage depending on such factors as income and which plan that they select.” The site will direct individuals to appropriate online resources. Visit www.medicarepartdnys.org.
Tragedies in the Transition from Medicaid to Medicare Coverage of Prescription
Drugs. By Michael B. Friedman, LMSW
The Medicare Modernization Act, which establishes Medicare coverage of prescription drugs, becomes fully effective on January 1, 2006. Predictable problems with its introduction have begun to make headlines. What these stories rarely make clear is that it is only poor people—people who are eligible for Medicaid as well as Medicare—who are at risk of losing the drug coverage they already have.
For people on Medicare only, glitches could delay getting a new benefit. For people on Medicare and Medicaid—who currently have drug coverage through Medicaid—the glitches in the transition to Medicare coverage could result in tragedy.
This population has come to be called the “dual-eligibles”. In New York State alone there are over 600,000 dual-eligibles. Roughly 200,000 of them have cognitive impairments, including long-term psychiatric disabilities. Nearly 100,000 of them are served by New York State’s mental health system.
Here’s a possible scenario. John Smith has been diagnosed with schizophrenia for 20 years. After a long period of psychological instability resulting in volatile living circumstances, he found a medication that works for him. For the past 10 years he has avoided acute psychotic episodes and has settled into a life that he finds satisfying. Currently Medicaid pays for his medication. This fall he gets a letter informing him that Medicare will cover his prescription drugs beginning January 1, 2006 and that he can choose a plan from a list he can find by calling Medicare. The letter also tells him that he can do nothing and that he will be auto-enrolled in a plan, which is named in the letter. Information about the plan’s network of pharmacies, about the drugs the plan covers (its “formulary”), and about co-payments is provided. The letter tells him that, if he is dissatisfied with the plan to which he has been auto-assigned, he can compare that plan with ten or more other plans with below average costs and choose a different plan. To get information about these plans, the letter says, he can visit a website, call Medicare, call the State Health Insurance Assistance Program, or attend educational events in his community.
Mr. Smith is confused and does nothing. On January 2 he goes to the pharmacy he has been using for years only to be told that the pharmacy is not covered by his plan or that some of the drugs he takes are not covered or that there is a co-pay for each of the drugs he uses ranging from $1 to $3. He is already struggling to manage rent and other basic necessities on the income he gets from Social Security Disability. Co-pays are not in his budget. Obviously Mr. Smith may end up not getting his medication. His mental and/or physical condition might deteriorate. Indeed, he might have a recurrence of acute psychosis, undermining not only his mental state but also his living situation.
There are tens of thousands of John Smiths in New York State, and they are all at serious risk. Some may end up in hospitals and nursing homes; some may end up homeless on the streets; some may end up in jails or prisons; and some may die.
To avert tragedy there are two kinds of action that need to be taken—(1) federal and state policy changes and (2) massive consumer education.
Policy Changes Needed
Perhaps the simplest way to avoid the dreadful consequences glitches can have is to run a dual system for a transitional period. That would mean that for 6 months or a year, dual-eligibles who cannot get the Medicare coverage for which they are eligible would automatically continue to have Medicaid coverage.
Other policy decisions that would help include: Medicaid coverage of drugs not covered by Medicare, a 90-day supply of medications at the end of 2005, Medicaid coverage of co-payments, extension of New York State’s EPIC program to people with disabilities, and so forth.
The good news is that both the federal and New York State governments are aware of the risks and have taken some steps to address them. For example, the federal government has ruled that all plans must include in their formularies “all or substantially all” anti-depressant, anti-psychotic, and anti-convulsant medications. It is not clear that all of the medications will actually be in the formularies, but the ruling is certainly a step in the right direction.
In addition, New York State has said that state Medicaid will cover all medically necessary prescription drugs available in New York State’s Medicaid program if they are not covered by Medicare. We are not yet clear how complex the process will be or how long it will take for someone needing a medication not covered by Medicare to get it. But this too is certainly a step in the right direction.
Whatever policy decisions are made, the transitional process is likely to be exceedingly difficult for people becoming eligible for Medicare coverage. Education regarding their choices and about how to actually get coverage is essential.
The Federal government has developed a variety of educational mechanisms including advertising and an interactive website. New York State has also been alert to the issues and has begun training aimed at ultimately helping people who are dually eligible make the choices they have to make and learn how to get coverage. For example, the NYS Office of Mental Health has already provided trainings in its five regions.
In addition, New York State’s mental health providers and advocates have stepped up to take responsibility for helping people who use their services. The Coalition of Voluntary Mental Health Agencies in NYC has established a provider help line and published a guide. The Mental Health Association in NYS has organized education and training as has the Council of Community Behavioral Healthcare, the New York State Rehabilitation Association, and others. NAMI-NYS has also published a brief guide.
At the federal level, The National Mental Health Association in collaboration with several other national groups has developed a website for both providers and consumers.
All of these organizations understand that each person who is dually eligible will need to have individualized help to manage their transition from Medicaid to Medicare. And all of these trade associations are preparing their providers to sit down with each of their clients to figure out what is best.
It will not be easy. I have sat through several trainings now and always get confused and have unanswered questions. Mostly, I’ve come to understand that there will not be one plan that works for everyone because individual circumstances are so different.
For this reason, despite all the efforts by government, providers, and other groups, I remain nervous that a significant number of people will be left without drug coverage for a period of time. It brings back disturbing memories of the early 1970s when there was a transition from locally managed welfare benefits for people with disabilities to the federally managed SSI system. People lost their housing. People came to the program I worked in because they had no other source of food. People came too because they desperately needed advocates on their behalf.
There is a remarkable advocacy effort underway to avert the problems we can anticipate. I hope it will be enough. But I wouldn’t bet on it.
(Michael B. Friedman is the Director of the Center for Policy and Advocacy of The Mental Health Associations of New York City and Westchester. He can be reached at email@example.com. The opinions in this article are his own and do not necessarily reflect the positions of The Mental Health Associations.)
proposes sex crime bills.
By Simon Yirka-Folsom
Assembly Speaker Sheldon Silver proposed a plan to deal with sex offenders last Wednesday, which Assembly Republicans are calling “welcome but long overdue.”
Silver, D-Manhattan, and newly elected Assembly Minority Leader James N. Tedisco, R,I-Schenectady, agree that legislation regarding sex offenders will be a priority in the next legislative session.
While Assembly Republicans have berated their counterparts across the aisle for “stalling,” Democrats say that the hearings on the subject caused necessary delays.
“There are those who have sought to turn these critical public safety issues into a media circus,” Silver said. “The Assembly has been working with experts in the criminal justice, mental health and victims’ rights fields to craft tough, smart, effective legislation aimed at truly protecting our communities.”
Included in Silver’s bill package is a proposal for more severe initial sentences for the most egregious sex crimes. Assembly bill A.8939, would set prison terms for firstdegree offenses involving rape, a criminal sex act, aggravated sexual abuse and sexual conduct against a child at 10 to 25 years to life when the offense involves serious injury to the victim; threat of the use of a “dangerous instrument”; multiple victims; or a previous conviction. A defendant 18 years or older would face the same charge if the victim was under 13.
“Given the delay tactics of the past, we can only hope this is not another smokescreen,” Tedisco said. “It will not be acceptable for the speaker and his conference to simply talk about their support for civil confinement.”
Silver’s proposals also deal with the thoroughly debated issue of civil confinement.
The plan would confine sex offenders deemed to be “sexual predators by jury beyond a reasonable doubt.” The plan introduced by the Assembly majority allows for treatment programs for all sex offenders. Offenders would also be candidates for confinement if they had been originally convicted of a felony sex offense or any murder, manslaughter or kidnapping crime committed in conjunction with a “sexually motivated” offense.
Gov. George E. Pataki attempted to use existing mental health law to confine 12 sex offenders after they were released from prison in September, but a judge, ruling that the offenders’ right to due process had been violated, ordered that they be conditionally released.
“Unlike legislation touted by the executive, the Assembly provides a series of effective tools,” said Jeffrion Aubry, DQueens, chair of the corrections committee. “We implement not only civil commitment, but enhanced parole supervision and victims’ services. At the same time, we ensure legal protections for individuals subject to provisions of the law.”
Michael Seereiter, director of public policy at the Mental Health Association of New York, has expressed fears that once confined in mental institutions, sexual offenders could be a danger to those already being treated for mental illness. The proposed bills seem to take this exact fear into account, requiring “strict separation of sexual predators from persons with mental disabilities.”
“I suppose that makes me feel a little bit better,” Seereiter said. “But we have real concerns about using the mental health system to house people that don’t have a mental illness.”
Seereiter cited a lack of resources within the mental health community to house sex offenders, suggesting that lawmakers confine sex offenders in therapeutic environments within the criminal justice system until they have undergone treatment.
According to the Assembly majority, the plan also includes provisions to expand the use of DNA evidence, assist victims and eliminate the statute of limitations in some sex offense cases.
Civil confinement legislation has passed several times in the Senate but has yet to be voted on in the Assembly.