Mental Health Association in New York State

CIVIL COMMITMENT OF SEXUAL OFFENDERS ISSUE UPDATE: Over the past 24 hours, the issue of what to do with sexual offenders who continue to pose a threat of re-offending after serving their prison sentence has evolved very quickly.

On Monday morning at 11 a.m., MHANYS joined with NAMI-NYS and the Association of Board of Visitors to hold a press conference at which we outlined our concerns with using the state’s mental health system for the purposes of confining sexual offenders post-incarceration.

Misuse of mental health system: We have consistently maintained that placing any individuals, including sexual offenders, who do not have treatable, serious mental illnesses into psychiatric centers is a misuse of the system. Psychiatric facilities are designed to provide intensive treatment to individuals with serious mental health needs to help them stabilize and return to the community as soon as possible. They are not intended to provide long-term housing or treatment to anyone other than those with a serious mental illness.

Safety Issues: People with psychiatric disabilities living in the community are 12 times more likely than the general population to be victims of violence. To house sexual offenders in psychiatric facilities could place those individuals with serious mental health needs, who are even more vulnerable than those in the community, at significant risk. Furthermore, if many of the sexual offenders who would be considered for civil commitment are as dangerous as many contend, it would be far more appropriate to house these individuals in facilities operated by the Department of Correctional Services, which is primarily responsible for detaining dangerous individuals.

Resource Issue: If sexual offenders were to be housed in psychiatric facilities, we would have serious concerns about siphoning off of resources – both dollars and hospital beds – from the existing, under-funded, mental health system. A large percentage of these already scarce resources would be diverted to pay the $200,000+ per year to house each sexual offender in a psychiatric center, compared to the $40,000 cost of housing someone in prison for a year.

Stigma Issue: Associating sexual offenders with individuals with serious mental illness simply perpetuates the unfounded myths about people with mental illness being violent and dangerous. To the person on the street who knows little about mental illness, such a policy would greatly increase the already overwhelming stigma individuals with mental health needs face that hampers their full recovery

Instead of using psychiatric facilities, we recommended that the state examine alternatives employed by other states to address this societal problem. Specifically, we pointed to the experience of Florida which confines sexual offenders in a facility adjacent to an existing correctional facility, pointing to the availability of state correctional facilities already closed or slated for closure that could be modified for such purposes. In addition, there is the experience of the state of Washington, in which a completely separate state agency is responsible for all initiatives dealing with sexual offense, from prevention services, to civil commitment, to post-release supervision. Also, there is the experience of Texas, which utilizes an out-patient civil commitment procedure that allows for additional incarceration of sexual offenders if they violate any provisions of their release agreement.

One hour later, at noon, the Senate Majority held a press conference to discuss the issue of the extension of Megan’s Law - the legislation that requires registration of sexual offenders living in the community. At that press conference, Senate Majority Leader Joseph Bruno indicated that he would be open to alternative locations for the civil commitment of sexual offenders, rather than using psychiatric centers.

Toward the end of the afternoon, the Assembly Majority released a new bill, A.9282. As is the case with similar legislation put forth by the Governor and Senate, we believe this legislation is flawed in that it continues to place responsibility for sexual offenders on the Office of Mental Health in a facility that “may be located on the grounds of a state correctional facility.”

At the end of the day and into the evening, rumors abounded about a proposal coming from the Governor that would establish a completely separate facility for housing sexual offenders. The main question revolved around whether this would be under the auspices of the Office of Mental Health (perhaps using a closed psychiatric facility or a facility slated to close (i.e. Middletown PC)) or under the Department of Correctional Services.

Today, the Governor indeed did release a new proposal regarding the civil commitment of sexual offenders. On the grounds of a former Department of Correctional Services facility in Chemung County, previously called Camp Pharsalia, the Governor is proposing to create a completely separate 500 bed facility operated by the Office of Mental Health exclusively for the civil commitment of sexual offenders. According to the Governor’s press release, he will include $130M in his executive budget proposal, to be unveiled next week, to construct this facility. In addition, the Governor’s press release cites an $80M annual operational cost at this facility, which would employ more than 1000 staff.

The Governor’s press release also states, “In the Executive Budget, an additional $35 million will be made available for the renovation of current OMH facilities to meet the on-going, short-term needs associated with the demand to house and treat sexual predators. Also, included will be a total of $27 million in new operating support for OMH in connection with housing and treating sexual predators in existing facilities in 2006-07.”

MHANYS is somewhat mollified by the Governor’s new proposal in that it addresses some of our most serious concerns about the safety of individuals currently in the psychiatric centers. However, concerns about the appropriateness of using the mental health system for confining sexual offenders and the impact that such additional responsibility will have on the Office of Mental Health’s budget remain.

In this regard, we contend that funding for such a facility must be completely separate from the funding used to operate the existing mental health system, and must be specifically delineated in the budget each year. In addition, any enacting legislation must include language that requires the Office of Mental Health to regularly report on any financial and program impacts that these additional housing and oversight responsibilities for sexual offenders have on the provision of mental health services.

Lastly, while the Governor has identified $130M in additional resources for the purposes of addressing the issue of civil commitment of sexual offenders, we hope that he will also be able to find additional resources for the vastly under-funded community mental health services that help those with mental health needs achieve recovery.

Lawmakers fail to reach agreement on sex offenders. By Candice Choi
The Ithaca Journal, January 9, 2006

ALBANY, N.Y. (AP) -- The Legislature opened its 2006 session on Monday racing against the clock to keep thousands of convicted sex offenders living in communities from vanishing from the public registry beginning Jan. 21.

So far, the Senate and Assembly versions remain far apart. The Republican-controlled Senate wants lifetime registration of all sex offenders, while the Democrat-controlled Assembly seeks a temporary fix until Congress sets a standard for a national data base.

Under current law, more than 3,500 sex offenders in New York are expected to fall off the list by the end of the year.

The Senate's bill would require lifetime registration for the most serious cases, while the lowest level offenders would be able to petition to be removed from the list after 20 years.

The Assembly's moratorium meanwhile would keep offenders on the list until March 31, 2007, giving Congress time to set a national standard for a nationwide data base of offenders.

"The Assembly wants to wait to until March 2007 to see what the federal government does," Senate Majority Leader Joe Bruno said Monday. "This has got to take place. It has to happen now."

Assembly Speaker Sheldon Silver called on the Senate to "stop hiding behind a bill that would violate the provisions of federal legislation, create confusion in keeping track of sex offenders and potentially cause New York State to lose tens of millions of federal dollars."

Sex offenders are likely to remain a key issue in the 2006 legislative session, with the Senate expected to make additional proposals next week regarding civil confinement. The emotional issue is also expected to be part of campaigns in November, when every seat in the Legislature is up for election.

Absent new legislation, Pataki in September ordered state authorities to use existing mental health law to begin evaluating every sexually violent predator in prison before their release to determine whether they should face civil confinement in an institution.

Advocacy groups for the mentally ill opposed the move, saying that the vast majority of sex offenders have not been diagnosed with a mental illness.

"'Mental abnormality' has no basis in science - it's a political diagnosis," said Michael Seereiter, director of public policy for the Mental Health Association of New York state.

David Seay, executive director of the National Alliance for the Mentally Ill in New York State, said there is already a waiting list of people for the 3,900 mental institution beds in the state.

"We oppose the use of mental health institutions as dumping grounds for sex offenders," he said.

NAMI estimated that placing sex offenders in mental institutions would also cost the state $1.7 billion in the next five years.

The Mental Health Association of New York State instead proposed housing sex offenders in separate quarters on the grounds of correctional facilities. This is already done in Florida, said Glenn Liebman, chief executive officer of the association.

The state Senate was looking at alternatives to civil confinement, Bruno said, including housing sex offenders in available prison space.

Fight over Megan's Law continues. By Jay Gallagher
Elmira Star-Gazette, January 10, 2006

ALBANY - Only 12 days before the expiration of a requirement that convicted sex criminals notify the state about their whereabouts, the state Assembly and Senate remained deadlocked Monday over how to extend it.

The Democrats who run the Assembly and the Republican Senate majority passed different bills that would extend the requirement, with each blaming the other for the lack of unified action.

The Senate passed a measure that would mandate lifetime registration of sex offenders, rather then the current 10 years.

The Assembly adopted a bill that would extend the current measure, known as Megan's law, until March 2007, in anticipation of a new federal law that would require either a 20-year or lifetime registration.

The law, named after a 7-year-old New Jersey girl, Megan Kanka, who was raped and murdered in 1994 by a convicted sex offender who had recently moved into her neighborhood, requires that sex offenders notify police of their whereabouts for at least 10 years after being released from prison.

A total of 168 offenders are slated to be dropped from the rolls on Jan. 21 unless the law is changed. By the end of the year, 3,500 offenders could be dropped.

"Without immediate legislative intervention, sexual predators will be allowed to go about completely unnoticed in our communities," said Laura Ahearn of Nassau County, executive director of Parents for Megan's Law, a citizen group, who appeared at a news conference with Senate Republicans and blamed the Assembly for lack of action. "They could be coaching your child, selling them ice cream or working in a toy store and parents and employees would never know," she said.

"It's long past time for the Senate to stop playing politics with public safety," said Assembly Speaker Sheldon Silver, D-Manhattan, urging the Senate to pass the Assembly extension bill..

"It's avoiding and ducking," Senate Majority Leader Joseph Bruno, R-Brunswick, Rensselaer County, said of the Assembly's action. He and other senators said Congress may not even adopt changes in reporting requirements, and that there is no need to wait for federal action before the state acts.

Bruno said the Senate vote "has nothing to do with politics, nothing to do with posturing. It has to do with morality."

Both sides called for a conference committee, made up of lawmakers of both houses, to convene later to try to bridge their differences. The Legislature is due to be in session for only three more days before Jan. 21.

State Sen. George H. Winner Jr., a co-sponsor of the Senate legislation, praised the Senate's action and said it sets the stage for negotiations with state Assembly leaders and Gov. George Pataki.

"We have the opportunity to make Megan's Law stronger, more comprehensive and more secure, and we should do it," Winner said in a news release. "Convicted sex offenders should be required to register for life. Assembly leaders shouldn't hesitate to require it."

State Assemblyman Tom O'Mara, R-Horseheads, called for the Assembly to act quickly to follow the lead of the Senate.

"In just a few days, over 150 offenders will be dropped from the registry," O'Mara said in a news release. "We need to act now, because lifetime registration is the best way to protect New Yorkers from these dangerous predators."

The dispute comes amid a growing chorus for stricter penalties against sex offenders. Both houses plan within the next few weeks to adopt a measure that would mandate that sexual offenders continue to be confined after their prison terms expire.

Gov. George Pataki ordered a dozen confined last year after the Assembly refused to pass a measure to mandate the confinements. A judge later ordered them released, saying the governor had exceeded his authority.

Advocates for the mentally ill Monday urged that the sex criminals not be kept in psychiatric centers.

The centers "should not be used to warehouse sexually violent felons," said J. David Seay, executive director of the National Alliance on Mental Illness. He said putting such people in psychiatric hospitals would be dangerous to patients, increase the stigma of being in such a hospital and also cost $100,000 per year per felon.

Drug plan proves a tough pill. By Matt Pacenza
Albany Times Union, January 7, 2006

ALBANY -- Daniel Juliano drives 10 miles from his home in Troy so he can get his prescriptions from a pharmacist he trusts. His dedication to Lincoln Pharmacy on Delaware Avenue paid off this week.

On Sunday the new Medicare prescription drug plan began coverage for Juliano and millions of other Americans. Known as "Part D," it provides affordable medicines to seniors and the disabled.

Interviews with pharmacists, patients and advocates in the Capital Region show that the program has gotten off to a tough start.

When pharmacist Jala "Deen" Jainulabudeen filled Juliano's prescriptions, he discovered the pharmacy was not officially signed up to accept Juliano's plan. The matter will take days to sort out, so Jainulabudeen went ahead and gave Juliano his medications in hopes the pharmacy will get the money back later -- a step many pharmacists report taking.

By far the biggest group of people joining Part D since enrollment began in the fall are those who were automatically added to the program. About 650,000 New Yorkers are covered by both Medicare and Medicaid, meaning they are over 62 or are permanently disabled, which gets them in Medicare, and have very low incomes, which qualifies them for Medicaid.

Medicaid covered their prescriptions until this week, but now they've been switched en masse to one of 15 private drug plans offering Part D coverage to these "dual-eligibles."

There are more than 6 million such people nationwide. Switching them all at once was a terrible idea, said Craig Burridge, executive director of the Pharmacists Society of the State of New York. Gradually implementing the program would have made more sense, he said.

Both the federal Centers for Medicare & Medicaid Services and the individual health plans have been slow to respond to problems this week, advocates and pharmacists report.

Many organizations that serve seniors have set up their own hot lines to help people. Amy Button, who works with the New York StateWide Senior Action Council, one of the biggest hurdles has been the lack of knowledge among staff at the health plans and in government.

"The people within the system who are in charge of catching people's questions have no idea what the answers are," she said.

The rollout has seen several common problems: Some people have a letter saying they've been enrolled, but the Medicare system doesn't know it yet. Others have misplaced their cards or enrollment letters, which can force a pharmacist or advocate to call up to 15 plans to find which one the person is enrolled in.

So the phones are jammed. Jainulabudeen spent 35 minutes on hold with one plan on Thursday morning, until he had to abandon the call because the batteries on his handset died. He said he is filling about one-third of the prescriptions he normally does because of the added time.

Burridge spoke to one pharmacist in New York City who displayed exceptional dedication. The pharmacist has a mentally ill customer who comes in every Monday morning to get his psychiatric medications, which the pharmacist gives him in a seven-day pill box so he takes his drugs properly.

The man came in this week without any of the Medicare paperwork. Determined to find out what coverage the guy had, the pharmacist called nine plans until he found the right one -- a process that took him 2 hours.

"This pharmacist says, 'I had to. I'm his caretaker,' " Burridge said. "I'm the only one who looks out for him."

The muddle of Part D is illustrating a phenomenon that most people aren't aware of: Pharmacists end up playing the role of social workers, advocates and problem-solvers.

"It's a routine part of the pharmacist's day, that's coming to light because of the Medicare benefit," said Mario Zeolla, a pharmacist and assistant professor at the Albany College of Pharmacy.

Jagat Patel of Crestwood Pharmacy on Whitehall Avenue in Albany also has spent much of his workday on hold, but he said his customers are handling the glitches well. He said he is comforted by the reminder that Part D is offering cheap drugs to some people who had little or no drug coverage before. "There's been a couple of people in here already it has helped tremendously," Patel said.

Federal authorities issued a written statement on Thursday emphasizing that millions of prescriptions under Plan D have been filled this week without incident. They also said they have taken steps to improve their services to "dramatically reduce the wait time to get the information pharmacists need to fill all their beneficiaries' prescriptions."

Many pharmacists report they are giving their customers a few days of free drugs while the problem gets straightened out, a practice that can get very costly. "Sometimes we get burnt," said Patel.

Burridge lays the blame for this week's logjam on President Bush and Congress, who created a massive plan with little thought of the challenge of a rapid implementation. As his phone has rung off the hook this week with calls from baffled and frustrated pharmacists, Burridge came up with an idea: Every member of Congress should have to spend a morning or an afternoon behind the counter of a pharmacy, talking to patients, trying to get answers on the phone.

Medicare drug plans start by causing big headaches. By Joy Davia
Rochester Democrat & Chronicle, January 6, 2006

Mary Sayyeau's new Medicare drug plan hasn't worked very well for her this week.

On Monday her pharmacy had trouble confirming her enrollment, so she went two days without some of her medication for diabetes and congestive heart failure.

She returned to Saratoga Pharmacy on Thursday, only to learn that the drug plan didn't cover two of her six other prescriptions.

"I'll just go without," she said of the drugs for her emphysema and panic attacks.

The rollout of the first-ever Medicare drug plan, known as Part D, hit many glitches in its first week, prompting delays in getting medication to some seniors and the disabled.

The week began with pharmacists struggling to confirm drug plan enrollments, whether it was because of system problems or phone lines that were busy or had wait times of an hour or more. Miscommunication among federal officials, pharmacists and health plans fueled the confusion.

"It's been a nightmare," said George Faris, owner of Faris Pharmacy in Greece. Some pharmacists and federal officials said Thursday that the situation had improved since the beginning of the week.

The Centers for Medicare and Medicaid Services, for example, added support lines and reduced computer response times, said Larry Kocot, a senior policy adviser. His agency works with health plans responsible for the new benefit to make similar adjustments.

"A transition is never without challenges," said Kocot, adding that pharmacists nationally have filled millions of prescriptions through the new drug plan.

"We're not saying there haven't been issues," he added. "But as they've come up, we have addressed them."

A surge in Medicare drug plan enrollment during the last week of December prevented many drug cards and confirmation letters from getting to people by Jan. 1, said agency officials.

Wegmans Food Markets workers are "getting claims through," although the process has been slowed by computer glitches and customers not yet having drug cards, said Julie Lenhard, manager of managed care.

But others said glaring problems still exist, especially for the population officials are most worried about: "dual eligibles" such as Sayyeau, who qualify for both Medicare and the low-income program, Medicaid.

Those people all were assigned to or selected Medicare drug plans, which now require $1 or $3 drug co-payments that can no longer be waived, as they often were before.

Many dual-eligible people can't afford co-payments, especially those who take a dozen or so drugs monthly, said several local pharmacies that serve big Medicaid populations. Or their new plans don't cover every drug.

"We have given out free medication in some cases," said Kristin Goold, a pharmacist at Lima Pharmacy in Livingston County.

Almost all the customers at Rochester's Saratoga Pharmacy on Lyell Avenue are covered by Medicaid. On Tuesday alone, the pharmacy covered $200 in co-payments, said pharmacist Dana Gignac.

"We had to absorb that cost," he said. He didn't know how much longer he could do that, since he has added extra help to deal with the drug plan.

Saratoga's problems started Monday, when not one customer with Part D got needed medications: There were computer glitches, jammed phone lines and customers showing up without any way of confirming eligibility, among other problems.

Several health plans also told Gignac that they wouldn't abide by a "first fill" rule, in which the health plan covers a dual-eligible's 30- to 60-day prescription for a drug not on the plan's covered drug list.

"I've heard that anecdotally," said Selig Corman of the New York State Pharmacists Society. "But I've heard it enough times to believe that it's happening."

That means dual-eligibles such as Sayyeau are going without their drugs — which patient advocates and health officials fear will lead to more costly and serious health problems.

Sayyeau, for example, was in her doctor's office on Tuesday. She wasn't feeling well after going without her medications.

"In some cases, things are going smoothly and pricing has been great and people have saved money," said Goold of Lima Pharmacy.