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June 12, 2008

Governor Paterson and Mayor Bloomberg Announce Series of Recommendations Based on Review of Critical Incidents in NYC Regarding Individuals with Psychiatric Disabilities.

Listed below is the press release followed by the response from MHANYS. If you would like a copy of the entire report, log onto the OMH website at www.omh.state.ny.us Special thanks to MHA-NYC for their continued leadership on these issues.

FOR IMMEDIATE RELEASE:
June 12, 2008

GOVERNOR PATERSON AND MAYOR BLOOMBERG ANNOUNCE IMPLEMENTATION OF RECOMMENDATIONS TO IMPROVE MENTAL HEALTH CARE AND PUBLIC SAFETY

Recommendations from State/City Panel Will Improve the Quality and Consistency of Care for Those with the Most Serious Mental Illnesses and Reduce the Risk of Violence to Themselves or Others

Governor Announces Legislation to Authorize Intensive Case Reviews,
as Recommended by the Panel

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Governor David A. Paterson and Mayor Michael R. Bloomberg today announced plans to implement a comprehensive set of recommendations from the joint New York State (NYS)/New York City (NYC) Mental Health-Criminal Justice Panel that will improve the quality and consistency of care of individuals with serious mental illnesses. Through examination of cases of violent incidents involving individuals with serious mental illnesses, assessment of the current mental health and justice systems and consultation with national experts in mental health and violence, the Panel indentified many opportunities to improve mental health service delivery and public safety.

The Panel identified four areas where improvements were needed, and recommended specific measures to address these challenges. These challenges include: (1) poor coordination, fragmented oversight and lack of accountability in the mental health system; (2) inconsistencies in quality of care within the mental health treatment system; (3) limited capacity to share information within and between the mental health and criminal and juvenile justice systems; and (4) insufficient training, supports and tools to identify and engage individuals with mental illnesses in the criminal and juvenile justice systems.

“This collaborative effort by officials from State and City mental health and criminal justice agencies has resulted in recommendations for real reforms that will help to improve mental health services and enhance public safety,” said Governor Paterson. “Taking a hard look at what may have gone wrong in particular cases is a necessary first step toward improving the care and treatment of those with serious mental illnesses – both in the mental health care system and when those persons become involved with the criminal justice system – and the State is prepared to move forward in implementing the Panel’s recommendations.”

NYC Mayor Michael Bloomberg said: “We took a hard look at the facts and made common sense recommendations that will both improve the quality of care for people with the most serious mental illnesses and also improve public safety. While you can't predict every violent incident by implementing these recommendations we strengthen our system and offer a coordinated response to those who need it most.”

NYS Office of Mental Health (OMH) Commissioner Michael F. Hogan said: "For many years, violent acts by people with mental illness have been headline news in New York. After careful study, we find that several aspects of the issue are clearer. First, considering the fact that mental illness touches every extended family, these incidents are surprisingly infrequent. Second, in cases we considered, uncoordinated care in a fragmented system was a factor in tragic outcomes. Our mission – and we have accepted it – is to improve care to improve safety. There are no quick fixes or easy solutions, but we will not accept failure."

Linda Gibbs, NYC Deputy Mayor for Health and Human Services said: “Our work on the Panel brought together representatives from city and state agencies which, historically, were not at the same table looking at this complicated issue through the same lens. The recommendations are both ambitious and practical and will increase our ability to anticipate problems before they escalate.”

NYS Division of Criminal Justice Services (DCJS) Commissioner Denise E. O’Donnell said: “The recommendations contained in this report would dramatically improve collaboration between the mental health and criminal justice agencies as they respond to the needs of persons suffering from mental illness. All too often, the criminal justice system is unaware of what transpired in the mental health system, and vice versa. But our goal is the same--to prevent unnecessary acts of violence in our communities by improving the treatment of, and law enforcement response to, persons with serious mental illness.”

Highlights of the recommendations described below will transform the way the State and City’s mental health, criminal justice and juvenile justice systems work with individuals with the most serious mental illnesses.

Improvements to the Adult Mental Health Treatment System

In NYC, special “Care Monitoring Teams” that will oversee both mental health services offered to high-needs individuals and the providers that offer high-intensity programs will improve both treatment and services. A database will allow the “Care Monitoring Teams” to monitor the care provided to high-need adults with the most serious mental illnesses, giving staff the ability to take action if there is an interruption in service or an escalating need for care. The recommendations of the OMH/NYS Office of Alcoholism and Substance Abuse Services will be implemented, improving access to care for individuals with co-occurring mental health and substance abuse disorders. Legislation will be proposed authorizing OMH to conduct intensive case reviews of critical incidents involving individuals with mental illnesses, with relevant state and city officials participating, for the purpose of reducing care errors and improving public safety. Standards of care for mental health clinics serving adults will be issued and enforced, which will improve treatment and require regular risk assessment for violence to self or others.

Improvements to the Adult Criminal Justice System

A pilot program for sharing information between the criminal justice and mental health treatment systems will identify people with serious mental illnesses who have become involved with the justice system. A NYC alternative-to-detention pilot program will provide assessment, case management, supervision and community-based treatment to defendants with mental illnesses who might otherwise be detained while their cases are moving through the courts and who do not pose a high risk of recidivism or flight. A dedicated mental health unit at the NYC Department of Probation will establish relationships between probation officers and probationers’ mental health providers and assist probationers in receiving appropriate services. Training for 911 call takers and dispatchers will be improved to better elicit information about whether an incident involves a person with a mental illness.

Improvements to the Juvenile Justice System

Clinical interventions for youth with serious emotional disturbances (SED) in the custody of NYC Department of Juvenile Justice or NYS Office of Children and Family Services will be enhanced to ensure that adolescents in State or City custody have appropriate supports, including improved discharge planning, and that crucial mental health information follows the youth throughout transitions. Family Care Coordinators will help families navigate the juvenile justice, mental health and other service systems; facilitate information sharing among providers and families; and arrange for family case conferences that assist youth and their families in getting care and support, especially during transitions. Coordinators would use their own experiences negotiating the mental health system and other systems to empower families to advocate for their own needs."

New Legislation Proposed

The Governor is proposing legislation to implement one of the Panel’s recommendations. The Governor’s Program Bill allows the Commissioner of OMH to convene quality assurance review panels that include relevant state and local officials to examine incidents occurring in the community in which persons with serious mental illnesses are harmed, cause harm to others, or become involved in violent criminal incidents. This will lead to both improved quality of care and enhanced protection for the public.

The NYS/NYC Mental Health-Criminal Justice Panel was convened by NYS Deputy Secretary for Health and Human Services Dennis Whalen and NYC Deputy Mayor Gibbs. It was co-chaired by OMH Commissioner Hogan, Deputy Mayor Gibbs, DCJS Commissioner O’Donnell, and NYC Criminal Justice Coordinator John Feinblatt. Members of the Panel included top State and City officials in mental health, substance abuse, criminal justice and adolescent services.

The Panel’s full report, including the entire list of recommendations, is available at www.omh.state.ny.us, www.criminaljustice.state.ny.us, and www.nyc.gov.


MHANYS RESPONSE TO REPORT:

This morning the administrations of Governor Paterson and Mayor Bloomberg have issued a report involving the recent incidents in NYC in regarding individuals with psychiatric disabilities.

Though we have not had the opportunity to fully analyze, the document seems to be very fair minded in the attempt to recognize the rights of individuals with psychiatric disabilities and issues of public safety.

There are two overarching themes that are present throughout the document:

A) People with psychiatric disability are no more likely to be violent then the general population.

B) People with psychiatric disabilities can and do recover everyday and live productively in the community.

The great fear that many of us had was that there would be an overreaction in response to several violent incidents that transpired in New York City involving individuals with psychiatric disabilities. We were very concerned that the stigma of the violence of people with psychiatric disabilities would be perpetuated in this report. We were pleased that this was not a major theme in the report.

If the initiatives in this report are implemented, the likelihood is that oversight, coordination and accountability will improve leading to the hope of better outcomes for individuals with psychiatric disabilities.

The report has four major themes---A) Lack of Coordination and Accountability, B) Inconsistency in Quality of Care, C) Limited Capacity for Sharing Information, D) Insufficient Training

We have not had the chance to analyze each one but some of the key recommendations are enclosed:

Care Monitoring Teams for High Need Individuals and Relevant Sharing of Information

Among the major initiatives to come from the report is the idea of each borough having a care monitoring team comprised of city and state mental health workers whose jobs would be to work with provider agencies to help in identifying individuals who may need additional care coordination and more timely services. One of the major components of this is the ability to identify these individuals through existing data.

The great hope of this initiative is that once an individual is identified, there would be a collaborative approach between the borough teams and the provider agencies in insuring the best results for the individual.

It is a good idea but it is also important to recognize that this should be more then just a model of stabilizing someone in the community. It should also be the responsibility of the teams working with providers to insure that an individual can reach the next step of moving forward in their lives through greater access to housing, employment, educational opportunities, wellness, self direction, and a host of other productive living skills. Stabilization should not be a long term goal—the long term goal should be independence.

Coordination with Mental Health and Criminal Justice

The idea of better coordination with mental health and the criminal justice system is important. We strongly support the notion of increased opportunities for mental health courts and jail diversion as well as additional police training.

Many individuals with psychiatric disabilities end up in the criminal justice system for minor crimes and misdemeanors. Statistically, we know that they will end up incarcerated for longer periods then the general population. There are more people with psychiatric disabilities in Riker Island then there are in any state psychiatric center.

To the extent that better coordination, will help engage individuals before entering the criminal justice system then that will play a major role in safeguarding individuals from cycling between jail and the community. That is why diversion programs and mental health courts must be highlighted as part of any reform.

We also think it is important to have a dedicated mental health unit at the NYC Department of Probation.

However, included in the report is a demonstration project regarding enhanced data sharing between mental health and criminal justice. We want to insure that any demostration projects would have a distinct time frame and that information would be shared with the community. There is the possibility that with greater data sharing comes more opportunities for abuses in the system as well as the perpetuation of the stigma of mental illness.

Juvenile Justice

We are very supportive of family care coordinators for justice involved youth. Many individuals in the juvenile justice system have a psychiatric disability and end up back in jail in numbers of over 70%. Providing significant resources and care coordination around the discharge arena will be very helpful for at risk individuals. It is significant that this report provides a greater emphasis on this problem.

Standards of Care

One recommendation calls for greater standards of care for risk of violence within a provider agency. My understanding is that there would be greater licensure and programmatic review of agencies for standards of care regarding individual’s risk of violence.

Standards of care are important but it is difficult for provider agency to assess that kind of risk with limited funding. Greater training and resources must be available to help create greater standards of care.

Also, at the same time that there are licensing and programmatic reviews of risks of violence, they should also look at the risks of non recovery. Why not create an enhanced rate for agencies that are working with individuals to help them in seeking employment opportunities, vocational training, education, wellness self management, etc. These are the things that licensure should be looking at, not just emphasizing risks of violence.

Co-Occurring Disorders

We strongly support the call by both administrations to support the findings from the Co-Occurring Disorder Workgroup. MHANYS was part of that workgroup and we are strongly supportive of the idea of an integrated treatment system that includes clinics that can provide services to both mental health and addiction disorders as well as a movement to a universal screening and assessment tool.

Initiatives Not Included in the Recommendations:

Though this is a document that calls for some major changes in the system, there are still several pieces that should have been included. We will advocate that these are part of any future discussions;

  • Greater emphasis on workforce. We know from our work on health care enhancements that ultimately the responsibility will be on the providers. With limited funding to keep a strong workforce in place, it is difficult to undertake the fundamental changes needed to implement many of these recommendations. In an era when we are dealing with shrinking funding, it becomes increasingly difficult to add additional responsibilities.
  • Youth in Transition. An important policy change that should be included in the future is greater emphasis on this issue area. Though touched upon in the foster care and juvenile justice recommendations, there must be a complete system change to address the needs of these individuals. We keep talking about the idea of creating interventions before students with psychiatric disabilities drop out and end up homeless, in emergency rooms ore in the criminal justice system
  • The Report should have taken into account the already innovative programs being run in the community. Many of the MHA’s in New York have innovative programs that address the myriad needs of individuals with psychiatric disabilities. The MHA in NYC has done some very innovative work already in several of the policies addressed in the report.
  • Greater Public Input. There was a limited opportunity for any kind of stakeholder response to the ideas put forth by the workgroup. We would strongly recommend that there be an ongoing advisory council comprised of stakeholders that can work with the agencies in implementation of these programs. As I mentioned earlier, we have great concerns about the changes in regard to sharing of information and a stakeholder work group would be helpful in alleviating concerns
  • There should be Standards of Care developed that look at individual recovery and not just Risk of Violence. The Quality of Life Scale developed by OMH would be a worthwhile tool in helping to create a standard of care that is more responsive to individual needs.
  • While we support many of the criminal justice initiatives, we also have concerns that one of the nations’ recognized models’ for police training—The Crisis Intervention Team Training Model is not included. This is a best practice that should be included.
  • Through evidence based best practices, we know what works in the community. There should be greater opportunity to implement best practices including ACT teams, Peer models, greater access to medications, family psycho education, trauma training and several other initiatives.

Summary:

Given the difficult climate under which these recommendations have been put forward, there is reason to be supportive of many of the initiatives put forward by the Paterson and Bloomberg administrations. This report could have been used as an opportunity to perpetuate the stigma that people with mental illness are violent and to construct public policy based on that philosophy. Instead, to the credit of the administrations, they recognized that the incidents of violence are minimal and that the greater emphasis should be on accountability, greater coordination of care, better service delivery and stronger outcomes.

With several of the caveats that we identified along with some additional recommendations (including the need for a stakeholder advisory group), there is the opportunity for some real positive transformation of the mental health system.

As we read the report in greater detail, we will provide additional analysis.