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July 16, 2008Updates on MHANYS’
Dr.
Harold Koplewicz to be Keynote speaker at We are very pleased to announce that Dr. Harold Koplewicz will be the keynote speaker at our Children’s Mental Health conference on October 24th at the Albany Marriot. Dr. Koplewicz is the Director of the NYU Child Study Center, Director Division of Children and Adolescent Psychiatry at Bellevue Hospital Center and Director of Nathan Kline Institute as well as a frequent guest on Good Morning America. More then his credentials, Dr. Koplewicz is also one of the most compassionate, humorous and informative speakers you will come across on issues of children and mental health. Conference registration will be up and running over the next few weeks. Look for our save the date cards coming out shortly. We hope that you will be able to attend on October 24th as well as attend our awards dinner on October 23rd, celebrating the great works of our MHA’s across New York and our colleagues in the mental health community.
Building Connections Conference in Greene County Building Connections: The Sexual Assault and Mental Health Project is collaboration between the New York State Coalition Against Sexual Assault (www.nyscasa.org ) and is funded by the NYS Office of Mental Health and the Mental Health Association in New York State, Inc. (www.mhanys.org) We hope that you will be able to attend this conference. We would like to especially like to thank our friends at the MHA in Ulster County for working with MHANYS and NYSCASA in regard to the Building Connections Project
BUILDING CONNECTIONS: The Sexual Assault & Mental Health Project Regional Trauma Training September 10th 2008; 9 am - 3:30 pm Greene County Emergency Services Center 25 Volunteer Drive; Cairo, NY 12413 MHANYS
Call for Senate Support for Public Awareness Listed below is a letter that we recently sent to Senate Majority Leader Dean Skelos to urge the Senate to support the bill when they come back for special session, that would create a tax check off in the New York State Income Tax to include funding for a public awareness campaign for mental health July 14, 2008 The
Honorable Dean Skelos Dear Senator Skelos: We know that in working with you and your staff in the past that you are well aware of many of the mental health issues facing New Yorker. One major issue that continues to shame both New York and the entire nation’s mental health community can be summed up in one word---stigma. Despite the fact that one in five individuals in this country has a diagnosed mental illness, less then one third of those individuals ever seek treatment. The number one reason that most people site for not seeking treatment is the stigma associated with mental illness. People with mental illness are often stereotyped as violent and ‘out of control’. The research indicates that this is a far cry from the truth. Individuals with mental illness are twelve times more likely to be victims of violence then they are to be perpetrators of violence, yet the stereotypes continue. The best way to erase stigma is to provide public awareness that talks about the fact that people can and do recover from mental illness with individualized treatment, better medications and a more timely and appropriate delivery system. The recovery rate is astonishing for individuals with depression, bi-polar disorder, schizophrenia and other major mental illnesses. However, as long as people are too fearful to come forward then they will continue to suffer in silence. The New York State Senate can help begin to end that suffering by passing a bill S.8662, sponsored by Senator Morahan. This bill would create a tax check off in the New York State Income Tax that would be used to create a statewide mental health public awareness campaign. This bill has already passed the Assembly (A.6826-A—Rivera). This way greater public awareness would be created at no cost to taxpayers. It is a win for all New Yorkers. When you come back to Albany for special session, we urge you and your colleagues to pass this important legislation. Sincerely, Glenn
Liebman cc: Senator Thomas Morahan
MHANYS Call for Expansion of Crisis Intervention Teams Listed below is a letter from MHANYS Director of Forensics Services, Bob Corliss to Commissioner Denise O’Donnell of the New York State Division of Criminal Justice Services, urging her to consider a statewide Crisis Intervention Team (CIT) Program initiative in New York. We have also shared this idea with the New York State Office of Mental Health, recognizing that the CIT Model developed out of Memphis has been an evidenced based best practice in responding to crisis involving law enforcement and individuals with psychiatric disabilities. July 9, 2008 Hon. Denise O’DonnellCommissioner NYS Division of Criminal Justice Services Stuyvesant Plaza Albany, New York Dear Commissioner O’Donnell: Since 2003, staff at the Mental Health Association in New York State, Inc. have participated in the mental health training provided to the Rochester Police Department’s EDP Response Team and as part of the DCJS/OMH Crisis Intervention Training Officer (CITO) Program. The latter program has been delivered primarily by a core of training folks involved in the Rochester Police Department program in different parts of the state since 2006 under state auspices. We at MHANYS have been extremely supportive of this training. We have promoted the Rochester program and the Troy program—modeled on the RPD program, as well as the national Crisis Intervention Training (CIT) program as evidence-based practices which serve to protect officers and those in crisis alike, as well as to direct those in need to treatment. Over the last 10 years, over 200 police departments in the country have developed CITs—mostly based on the Memphis PD model, which is nationally recognized. While the CITO training is solid material, derived from the Memphis program, and well delivered, we believe that the approach now employed tends to scatter the training around and is not the best use of existing resources. It certainly does not represent an effective means to encourage the development of Crisis Intervention Teams, which we believe is worthy of consideration as a policy initiative in this state. To this end, we would appreciate an opportunity to meet with you and your staff to discuss the feasibility of establishing a statewide CIT program initiative in New York State, much like has occurred elsewhere, most notably in the state of Connecticut. While the Connecticut program is operated by a nongovernmental organization with state support, we are in no way wedded to that approach. We are including some materials about the Connecticut program as well as a BJA report on “Improving Responses to People with Mental Illnesses”. We at MHANYS are prepared to work with DCJS and OMH to play whatever role makes sense for us in such an endeavor. We will be reaching out to you in the next few days to set up a meeting at a mutually convenient time. Your interest in this matter is very much appreciated. Sincerely, Glenn
Liebman, Chief Executive Officer
In The News: Many of us have seen the horrific video of the Woman in Kings County, Esmin Elizabeth Green, who died in the psychiatric emegerency room while waiting for a placement. This article from Mental Health Weekly discusses several perspectives on the issue. When we have had opportunity to talk with the media about what transpired, we have put great emphasis on not just the quality of care in emergency rooms but in the overarching need for housing in the city and in the entire state. In recent years, the City and the State have been more aggressive in creating housing for people with psychiatric disabilities yet the crisis still permeates the entire mental health community. Until we come up with a comprehensive plan for housing individuals with psychiatric disabilities who are coming from forensics settings, homeless settings, poorly run adult homes and nursing homes, living with aging parents and at risk youth, then we are going to end up with more crisis like we have seen at Kings County.
Brooklyn
ER Hospital Incident Has Mental Health Field Up In Arms; Death Of
Patient Captured On Video Sparks Call For Reform The recent death of a patient inside a psychiatric emergency room in New York has prompted a national outcry from mental health advocates, consumers and the public at large, underscoring a crisis in mental health service delivery and the critical need for making mental health reform a key component of health reform, said advocates. Esmin Elizabeth Green, 49, had been waiting for treatment on June 18 at Kings County Hospital in Brooklyn. News reports indicate that Green suffered from emotional problems and had been hospitalized previously. Most recently she had been distressed after losing her job and apartment. Twenty-four hours after being involuntary admitted, having yet to be seen by hospital staff, she collapsed onto a waiting room floor, where she lay, ignored, for nearly an hour. During that time two hospital security officers and an attending psychiatrist saw her on the floor, none of whom came to her aid or examined her condition, according to news reports. Later a nurse saw Green and summoned another nurse before a team was called to attempt resuscitation. What’s even more shocking, said advocates is that the entire incident was captured on a video surveillance tape and broadcast nationally. “The images are abhorring and very disturbing,” David Shern, Ph.D., president and chief executive of Mental Health America, told MHW. The casual and lackadaisical behavior in the hospital’s emergency room reveals the devaluation of people with mental health issues who are served in the public health system, he said. “It is important for people with mental health illness to recover, and to have hope and a voice,” said Shern. “The visual images were an antithesis of all those things.” A number of issues come to the forefront following the incident, including the adequacy of the workforce, compensation and skill set, said Shern. “We continue to compensate pretty poorly, the people who work most directly with people with mental illness,” he said. Shern added, “We need to work to build a system so that multiple alternatives [are available] to people to receive care so that they don’t end up in a psychiatric crisis in an emergency room. Community-based services should be designed to keep people out of crisis, jails and other [inappropriate] settings.” Shern pointed to a crisis in mental health delivery and access to services, as well as problems with stigma and discrimination. People with mental illnesses are being seen in emergency rooms because of their inability to access care, said Shern. “It all comes down to access,” he said. “Ignorance and discrimination continue to push people toward using crisis services. That’s also true in general health care.” ‘Traumatizing’ Experiences The experiences of consumers with psychiatric disabilities in emergency rooms and inpatient care “is all too often a severely traumatizing event — and sometimes fatal,” Harvey Rosenthal, executive director of the New York Psychiatric Rehabilitation Association (NYAPRS), told MHW. “This is a problem throughout the country.” Rosenthal added, “Many people have said for many years the experience of care is worse than the illness,” said Rosenthal. “This is a terrible example of when the cure is far worse than the disease.” Rosenthal noted that NYAPRS had been involved in Kings County Hospital’s efforts to retrain staff and redesign its outpatient program to be more recovery-focused. “In fairness, the hospital had been making some efforts to improve, but clearly they weren’t enough, particularly in the areas of emergency room and inpatient care,” he said. “This is a horrific tragedy,” Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness, told MHW. “It’s an indication of a broader systemic issue that affects mental health care in many communities. This is a national problem. The mental health system is in collapse. It’s an indication of a system where people can’t get the services when they need them.” Fitzpatrick pointed to a recent survey, “Emergency Department Crowding: High Impact Solutions,” released by the American College of Emergency Physicians in April which found that more than 60 percent of psychiatric patients needing admission to a hospital have to stay in the emergency room over four hours after a decision has been made to admit them. The survey also found that 62 percent of emergency department medical directors indicated there are no psychiatric services for patient care while patients are ‘boarded’ — waiting in the ER to be admitted because there aren’t enough psychiatric beds — prior to admission or transfer. Patients should be treated with humanity and with great care, noted Linda Rosenberg, president and chief executive of the National Council of Community Behavioral Healthcare. “We need increased services, but we have to be vigilant about how we treat people with serious mental illness and not devalue them,” Rosenberg told MHW. The situation points to a ‘fragmented’ health care system, said Rosenberg, “People get lost in the cracks. Was this woman in treatment? Did anyone know she had gone to the ER? We need a system that monitors and tracks the needs of people with mental illness.” That the tragedy occurred in a hospital is even more upsetting, said Rosenberg. “It breaks your heart,” she said. “An issue like this makes people passionate about reform. We have to make sure we have adequate community-based services.” Rosenberg said that the New York City Health and Hospitals Corporation (HHC), which oversees Kings County Hospital, needs to change the hospital’s culture and provide the kind of leadership that is needed to turn this situation around. ‘Culture Of Complacency’ The culture in many emergency rooms toward people with mental illness has been one of complacency and discrimination, Steve Miccio, executive director of PEOPLe, Inc. (Projects to Empower and Organize the Psychiatrically Labeled), a Poughkeepsie, N.Y.-based peer-run, non-profit organization, told MHW. Emergency rooms are often the front line where people first start to deal with mental health issues, said Miccio, who noted that he was first diagnosed with bipolar disorder by a psychiatrist in a hospital emergency room. “The approach to care has often been dehumanizing and disrespectful to the point where the lack of care has exacerbated trauma for patients and family members and, for the most part, people do not know what to do to change this paradigm,” said Miccio. Miccio said that in order to move forward in a more proactive manner, hospitals, community members, consumers of services, family members and interested parties need to develop a long term strategy to permanently prevent this from ever happening again. One suggestion is to place mental health peer advocates in the emergency room to accompany patients through the screening process and to effectively ensure respectful, compassionate care for all who wish to have an advocate, he said. (See box on page 7). Hospitals, community service providers and interested parties should also develop alternatives to hospitalization in the form of Diversionary Services, he said. Examples of these services are:
Legal Update The Kings County Hospital was named in a civil rights lawsuit last year, filed by the New York Civil Liberties Union, Mental Hygiene Legal Service, and Kirkland and Ellis, LLP. The union released the surveillance tape to the public last week. One camera angle that was not shown publicly, revealed patients in the hallway making efforts to alert staff about Green and being brushed off, said Beth Haroules, staff attorney with the New York Civil Liberties Union and lead counsel on the case. Following Green’s death, New York City has agreed to a series of reforms at the hospital; topics to be discussed will include that every patient be checked every 15 minutes, and that there be no more than 25 patients at any time in the psychiatric emergency ward, Haroules told MHW. The hospital has also indicated plans to bring a peer advocacy program, for 24/7. Officials say the peer program will be up in place within the next month, she added. “This is a really critical issue,” Haroules told MHW. “It’s unfortunate that it took a woman’s death to get some attention and get some changes made. This situation is endemic to many urban psychiatric centers. No attention is being given to bolstering community-based services.” “We suspect this is a national problem,” she said. “It struck a chord. There has been a lot of feedback from people in other locations who have indicated the same experiences — long stays in the ER, inattentive staff and inappropriate placements.” Haroules added, “We’re hoping for stronger changes and for patients to be treated with dignity and given what they need to come back into the community. Peer Advocate Suggests Hospitals Establish Better Standards Of Care Steve Miccio, executive director of PEOPLe, Inc., in Poughkeepsie, N.Y., offered some suggestions in order to prevent tragedies like the one that occurred last month in a Brooklyn psychiatric room where a patient died while awaiting care. Hospitals, he said, need to set standards of care that address:
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