Despite a several day delay (some of us remember the days when the State
Budget was not passed till July) in the completion of the budget, this was
a very productive budget for MHANYS as several of our priority areas were
addressed starting with workforce. In an earlier update, we highlighted the
significance of the funding for the entire mental hygiene workforce. You
can go to www.mhanys for more specific information. There were also
several of our budget initiatives addressed including Reinvestment, Raise
the Age, Veterans Mental Health, Mental Health First Aid, Housing,
Medication Access, Crisis Intervention Teams, Children’s Mental Health and
Suicide Prevention.

Workforce

Over the next two years, direct care workers in the mental health field
will receive a 6.5 percent pay raise while the clinical workforce over that
time frame will receive a 3.25% increase. The initial workforce funding
will start in January 2018 with a three and a quarter percent increase for
direct care staff. Then in April 2018, the direct care workforce will
receive an additional 3.25% increase. Also in April 2018, clinical staff
will receive a 3.25% increase. This is the most significant spending
increase for workforce in many years. This is long overdue and greatly
appreciated. In addition, the Governor’s Executive Budget included three
million dollars for workforce in mental health before the addition of the
new workforce funding. Workforce issue remain a top priority for MHANYS.

We worked with our colleagues across the board around a unified message
that speaks to a living wage for the workforce. The challenges of to the
workforce are enormous—crisis management, respite work, support, 24/7 on
call and so much more are all part of the challenging job description.
People don’t go into these jobs for the money (otherwise they could get a
much easier job at the same salary) but they still have to pay their
bills. We will continue to work with all stakeholders to insure that
individuals and families are treated with the respect and courtesy they
deserve through a well-trained and well-compensated workforce.

While significant, we also recognize that we also need long term systemic
reform of workforce funding. We have to work with the entire human services
sector to increase program funding. Many of the people in MHA programs
work cross systems with individuals who will not qualify for the workforce
increase. We must lift the entire human services sector up. MHANYS will
continue to work with the Restore Opportunities Now (RON) campaign in the
future in support of the entire sector.

Raise the Age

Many of the 16 and 17 year olds who have been tried as adults often commit
offenses driven by an untreated mental illness. By the Governor and the
Legislature passing Raise the Age legislation, it will help create an
environment much more conducive to getting help and support as opposed to
incarceration. This is a great step forward but we will continue to need
prevention and early intervention efforts so that youth with mental illness
get age appropriate services so that they do not end up in the adult mental
health system. We thank the leadership of the Governor and the
Legislature for their efforts. This was a long campaign driven by families
and individuals who were incarcerated for minor crimes at the ages of 16
and 17.

This is a monumental achievement that took a campaign of passion and hard
work from many in the advocacy community as well as the Governor and the
Legislative champions. In the coming days, we will put together an update
about the specifics of the agreement.

Veterans Mental Health

The New York State Senate continues their ongoing support for Veterans
Mental Health. They added over three million dollars to this year’s budget
for the Joseph Dwyer Veterans Mental Health Peer to Peer program. This
program is embedded in over a dozen counties in New York State. Several of
the MHA’s run these programs. The success of this program is predicated on
a veteran helping a fellow veteran in responding to their mental health
needs. There is no judgement and no stigma involved in this process. This
year we had over twenty five veterans attending the MHANYS ‘Mental Health
Matters’ Legislative Day. All of our courageous heroes spoke as one in
support of Veterans Mental Health and the Dwyer Project.

Reinvestment

MHANYS has long had a priority of support for reinvestment of hospital bed
closures into community funding. Though we can certainly debate if there
are enough beds in the State Operated Mental Health system, one area in
which we all agree is that if hospital beds do close, we must make sure
that this money stays in community mental health and not lost to another
area of the budget.

This year the Executive Budget proposed an additional $11 million in the
budget for reinvestment. This brings the total amount of money for
community reinvestment to over $92 million annually. This funding is
embedded is annualized in the budget and a recognition of the continuing
importance of funding local assistance in the budget even with the
continued movement to Medicaid Managed Care.

The reinvestment funding is used for housing, employment supports, crisis
services, peer and family support and much more—all priority areas to
MHANYS and our members. To the credit of OMH, this money has gone out in a
very timely manner.

Crisis Intervention Teams

Another priority issue of MHANYS has been support for Crisis Intervention
Teams (CIT). We were pleased to see both houses speaking out strongly in
support of this intervention. There is $1.4 million dollars in the budget
identified for CIT funding. Several years ago, New York lagged behind many
other States in development of CIT teams. The increase in awareness
regarding the importance of law enforcement being trained to work with
families and individuals to identify how to respond to an individual in
crisis has created a burgeoning number of counties that have CIT teams.

Over the last several years, the Senate has spent money to provide many
upstate localities with CIT teams, we are working with our colleagues in
the Assembly to identify additional counties that can utilize this funding.

Mental Health First Aid

A signature program of MHANYS has been Mental Health First Aid (MHFA).
MHFA is an eight hour training designed to educate the general public and
other stakeholders about mental health as well as to provide tools and
techniques as to how someone can respond to a mental health crisis. This
evidence based model has been taught to almost one million people across
the country. Through the leadership of the State Senate, MHANYS has funding
in this year’s budget to continue our work to expand the number of
trainers in the fifty two county Mental Health Association network.

In addition, MHFA has proven to be an important supplement to CIT. In
several areas around the State, individuals in law enforcement are not able
to be CIT trained because of funding or time constraints. MHFA, while not a
substitute for CIT, has proven to be an important tool for law enforcement.

Housing

This year the Governor’s Budget proposed adding ten million dollars for
housing subsidies for mental health housing programs. This ten million for
rate increase is largely intended to help supplement existing rental rates
in areas downstate where housing prices are at the highest. While we were
advocating for additional funding in this year’s final budget, there was no
additional funding forthcoming. We will keep highlighting this as a
priority area.

Medication Access

To the credit of both the Assembly and Senate, they rejected language that
would have precluded Prescriber Prevail across all disease states in
Medicaid formularies. Though we are very appreciative that the Executive,
in their original budget proposed, supported continuation of Prescriber
Prevails for Mental Health Medications, this language by the Legislature
continues to recognize the increased risk of other health issues that
individuals with mental health related issues have such as diabetes and
heart disease.

Children’s Mental Health

There was $10 million dollars set aside in the budget to preserve,
restructure or provide expansion of Children’s Behavioral Health Services.

Suicide Prevention

The New York State Senate provided $250,000 to Sources of Strength, the
innovative suicide prevention initiative for youth. This program has been a
successful intervention for educating youth about suicide in schools. In
addition, there is $200,000 in the Senate budget for the Comunilfe Project
developed by Dr. Rosa Gil in response to the suicide prevention needs of
youth in the Puerto Rican/Hispanic Community. Between these innovative
programs, the work of the Mental Health Associations (and other colleagues)
in Youth Mental Health First Aid and the passage of the Mental Health
Education Bill, this will go a long way to helping to support youth with
mental health related issues.

Health Care Facility Transformation Program

Yesterday in our update we reference our frustration about not including
HCBS designated providers in the funding for the Health Care Facility
Transformation Program. The good news is that this language has been
modified. $200 million of the $500 million of the Healthcare Facility
Transformation Program funding now includes language that would allow the
Legislature and community stakeholders (including those of us who are HCBS
designated) to put forward new project type and applications for money. In
addition, $75 million of that $200 million is set aside specifically for
not for profit providers

This language provides not for profits in mental health the opportunity to
advocate for our capital needs in regard to healthcare transformation. As
we expand into managed care, HCBS designated agencies could use the capital
funding for needs such as satellite offices, expansion of existing space,
vans and a host of other needs that are no different than those of larger
health care providers. While not addressing all our specific needs, we are
appreciative that the language opens up the opportunity for us to advocate
for community mental health HCBS designated provider capital needs. It will
now be incumbent on the not for profits to make the case that we are a
necessary part of the transformation program.

We want to acknowledge the work of both the Executive and the Legislature
in responding to those of us who have raised concerns in the community.

ISSUES STILL TO BE ADDRESSED

Long Term Community Funding

The mental health community had many hard fought advocacy victories this
year. The Governor and the Legislature were very responsive to our concerns
as highlighted by successful funding in several areas of greatest need.
While we advocate for bigger systemic fixes, we are very appreciative of
the workforce funding in the budget. We will work together with our
colleagues in the community to help develop more strategies for a
well-trained and well compensated workforce in the future for the
behavioral health community. Recognizing the needs of the entire human
services sector, we will continue to work with the Restore Opportunities
Now campaign in the future.

The needs of community based mental health providers’ remains of great
concern. We need a strong and robust community based system of care.
Without these programs in place and a more equal playing field between
state operated and community based programs, there will continue to be loss
of quality services, long waiting lists and program closures.

The community system of care is involved with over 700,000 adult New
Yorkers with mental health related issues. Many of those programs are run
through Mental Health Associations in their communities. We must enhance
funding in these community programs in support of people with mental health
issues and their loved ones.

Mental Health and Criminal Justice

The Legislature denied funding assistance to localities in relation to
restoration to competency treatment in jail based settings. Advocates in
the community have continued to be in opposition to jail based
restoration. MHANYS is advocating for a roundtable discussion about this
issue and broader community mental health concerns. This one specific issue
aside, we must come together to insure that adults with mental health
issues in jails and prisons need to have Medicaid approval before
discharge. Last year, advocates were able to push for a thirty day waiver
for individuals who are incarcerated to receive approval for Medicaid.
Unfortunately that waiver has languished at the federal level.

Now on to Legislation

The Legislature is going on break and will not reconvene till late April.
We will be spending those last few months of this year’s Legislative
Session on priority bills including the inclusion of mental health first
aid as part of training requirements for teacher certification; advocacy
for more mental health services through legislation on college campuses;
reviewing the role of not for profits as part of the state pension system
and the next movement around fighting mental health stigma; license plates
dedicated to raising awareness about mental health.

SUMMARY

Largely driven by the very successful BFair2DirectCare Campaign, from our
colleague in the Developmental Disabilities community, we were able to
include mental health and addictions disorders as part of the direct care
workforce need. We have often talked about the lack of workforce funding
over the years and this year’s funding does not make up for past cuts, but
it certainly is a significant step forward and an important recognition of
the importance of workforce. A six and half percent increase for direct
care and a three and a quarter percent increase for clinical staff over
the next two years is the most important workforce reform in several years.
Through the combined efforts of eleven behavioral health organizations as
well as our lobbyist Kevin Cleary, we were able to raise the importance and
visibility of the workforce to the Legislature and the Executive. To their
credit, they listened and were very responsive to our concerns.

Many other MHANYS issues were also addressed including CIT, Mental Health
First Aid, Reinvestment, Veterans Mental Health, Housing (though we
certainly need a lot more community housing support), Medication Access,
Suicide Prevention and Raise the Age. That said, we all know much more
needs to be done and we will continue to advocate for those systemic
changes.

We are appreciative of the support of Governor Cuomo and the Legislative
leadership as well as our mental hygiene chairs, Assemblymember Gunther and
Senator Ortt for their leadership. We also want to acknowledge the grass
roots advocates who took the time to write, call and e-mail. Your actions
are invaluable and a testament what can be done when we all work together.

Let’s continue this momentum moving forward through the rest of this
Legislative Session.

Glenn Liebman, CEO
Mental Health Association in New York State, Inc.