Mental Health Update

Listed below are MHANYS comments to New York State related to DSRIP 2.0.

This is an unprecedented opportunity to insure greater representation from Community Based Organizations (CBO’s) including the call for 30% of funds being utilized by CBOs as mandated in Massachusetts; greater use of funding for the needs of the community workforce including development of a resource pool designated to providing funding to CBO’s based on high vacancy and turnover rates; universal Mental Health First Aid training; greater school resources for the 47% of young people on Medicaid and for those young people with SED transitioning back into schools; funding for family and whole health engagement and direct funding to HCBS designated providers to increase the number of individuals provided with a plan of care for HCBS services.

The Mental Health Association in New York State, Inc. (MHANYS) is a not for profit organization comprised of 26 affiliates in 52 counties throughout New York. Our goals are to advocate for positive changes in the behavioral health system and work to end the stigma of mental illness. We are appreciative of the opportunity to comment on DSRIP 2.0

New York’s ability to leverage DSRIP funding has resulted in some innovative best practices that have both reduced hospitalization and provided quality care. There are many examples of the 25 PPS’s developing promising practices to align with the Triple Aim of improving patient experience, improving population health and reducing per capita costs.

Over the five years of DSRIP in New York, there are several areas that need to be addressed and we are appreciative of the opportunity to focus on several of those areas. In addition, we will provide greater focus on the key reforms that would be part of DSRIP 2.0

1)  Community Based Organizations Engagement:

This is a prevailing theme that many have talked about in the DSRIP narrative. The reality is that there is verbiage throughout the document about the importance of Community Based Organizations as an integral part of DSRIP. Yet, unfortunately the result over the last five years have reflected a lack of engagement with CBO’s.

Community based organization such as the Mental Health Associations across New York State have provided quality behavioral health care for many years. They are recognized as innovators in their communities and are a ‘go to’ for quality mental health programming. The same is true of many of the peer run organizations who are embedded in their communities and provide for the safety net needs of individuals with mental health related issues.

Unfortunately, throughout the process, larger entities have been the major beneficiaries of DSRIP funding and have resulted in those smaller uniquely behavioral health partners from being able to provide the services that many of our community desperately need. Hospitals and PPS lead organizations (several of whom are one and the same) should be contracting with the Community Based Providers to ensure that the unique characteristics of strong embedded community providers are a major part of achieving the outcomes of recovery and independence.

Recommendation:

To that end, we are joining many of our colleagues in the Not for Profit Community in calling for 30% of funds be utilized for community providers as is currently being implemented in Massachusetts.

2)  Workforce

When DSRIP was first implemented, we had great hopes that a portion of this funding would be utilized for the not for profit workforce. Unfortunately, there are few examples of DSRIP changing practices in terms of being able to recruit and retain quality staffs in behavioral health and in other sectors.

The sad reality is that the human service workforce in New York has been undervalued for many years. Not only is this an issue of significance in insuring continuity of care for individuals but it is one of social justice as well. Over 80% of the human service workforce is comprised of women and over 40% are women of color. Salaries are not commensurate with the skills needed to work with vulnerable populations with complicated needs. While in recent years, there has been a recognition of this population, there is still a greater need for funding to insure that the quality staff is needed to help with our loved ones. A well trained and well‐resourced worker is in many ways the most important ingredient in a person’s move toward independence. As a family member myself, I know that so much of my loved one’s recovery was based on their relationship with the staff person they work most closely with.

Recommendation:

We need to provide even greater flexibility and investment in the non‐traditional, non‐clinical workforce. While we support flexibility from the Value Driven Entities for this workforce, there has be a resource pool developed so that individual CBO’s in the PPS network, can provide funding and tuition reimbursements to their staffs based on need. This workforce resource pool would be based on a series of criteria that could include vacancy rates, agency turnover and access to social determinants. Funding should be quickly available to CBO’s. There is no more critical role for DSRIP 2.0 than insuring we have a well‐resourced and well‐trained workforce to work with those in greatest need.

3)  Mental Health First Aid Training

To date, there have been over 1.5 million people in the United States trained in Mental Health First Aid. This eight‐hour training provide individuals with a basic understanding of mental health and how to help someone respond to a mental health crisis.

This training should be mandatory within DSRIP. It is integral in many areas. Many of the ‘hotspots’ that the 25 PPS’s have identified in their area including communities where there is a great deal of complex needs including poverty, health disparities and high level of substance use and mental health challenges. There are people in the workforce in those areas who do not have a full understanding of mental health. Making Mental Health First Aid training mandatory would provide them with a greater knowledge of how to deal with individuals in a crisis.

Another key reform of DSRIP has been the movement to integrate mental health and physical health through primary care initiatives. We wholeheartedly support his movement and recognize models like the Collaborative Care Model should be an ingrained part of the whole health strategy. A basic knowledge of mental health as provided in Mental Health First Aid would be essential for health care providers as we transition to the more integrated approach of DSRIP.

Recommendation:

Mental Health impacts all the work being done in the community through DSRIP. Mental Health First Aid would provide an essential training to all community providers and school personnel. We urge DSRIP 2.0 to include mandatory Mental Health First Aid Training.

4)  Children’s Population Health and Integration with Schools:

We are very supportive of the importance of highlighting Children’s Population Health as an integral part of DSRIP 2.0. One of the area’s highlighted in the report includes reference to Children with SED and utilizing care teams of clinicians to ensure that they are transitioned into community settings. This is something our organization strongly supports.

New York is the first State in the nation to make it mandatory to teach about mental health in schools. We recognize that nearly half of all High School students will have experienced a mental health disorder and that suicide completion is the second leading cause of death among adolescents. The movement within DSRIP to address these issues highlights the greater need of resourcing schools with stronger outcomes for their students.

The 47% of the state’s children covered by Medicaid are in schools every day and they need to be educated about mental health like everyone else in school. The idea of mental health and wellness are integral to responding to the overall need of young people as evidenced by the Prevention Agenda.

Recommendation:

Use DSRIP 2.0 as an innovative resource for youth and schools. Fund innovation in the community to support children’s programs dedicated to population health. These include school based mental health clinic expansion, Promise Zone Models and MHANYS School Mental Health Resource and Training Center, the only statewide program dedicated to mental health instruction in schools.

5)  Family Engagement in DSRIP 2.0

A significant part of the success of DSRIP has been an emphasis on Whole Health. Collaborations around various partnerships throughout Health Care have helped to formulate the positive results to date.

Mental Health should not be in isolation of physical health much like individual health should not be in isolation of the family unit. A planful system of care as the goal of DSRIP 2.0 should encourage the partnership between the individual and their family. Family members are greatly impacted by the individuals in crisis. With the permission of the individual, families should play a major role in both supporting the individual and being provided with their own resources for their whole health.

Throughout the DSRIP narrative, there are examples of positive outcomes through collaboration. An approach that brings together families and individuals should be encouraged as a promising practice in DSRIP 2.0

A training program developed by MHANYS entitled MHANYS CarePath™ provides individuals and families with the tools needed for successful engagement and recovery. The flexibility of the program makes it ideal for all kinds of settings including hospitals, community based program and the prison system. To date, MHANYS has trained 100 CarePath™ Coaches across New York State assisting youth, adults and their families in person centered planning.

Recommendation:

Within the structure of DSRIP 2.0, there should be training available for the CarePath™. In addition, there should be greater recognition of families throughout DSRIP 2.0. Funding should be provided to make sure that families are educated about DSRIP to help their loved ones navigate the innovations of DSRIP 2.0.

6)  HCBS and HARP:

Much has been made in the mental health community around the transition to Medicaid Managed Care. In response to this change, OMH in collaboration with DOH and OASAS, created a Health and Recovery Plan (HARP)product line that would insure that the tradition non‐Medicaid services would have an ability to bill for Medicaid services instead of relying on fee for service funding.

Our organization has been supportive as we recognize that an individual’s plan of care should include the traditional non Medicaid programs like peer support, supported employment, supported education and family engagement. We are also appreciative that the State was very responsive to our organization’s request to include funding and innovation in community partnerships to enhance number of individuals taking advantage of HARP.

Unfortunately, the numbers, to this point, are not as high as anticipated for the population of people with mental health related challenges that would qualify.

Recommendation:

Create a funding pool within the mechanism of DSRIP 2.0 to fund community based HCBS designated providers directly to engage individuals eligible to HCBS that are not currently enrolled. Innovation of MHA members and other community providers directly being able to utilize a pool will dramatically help with HCBS outcomes and most importantly provide people with all the tools that will help sustain individual recovery and community integration.

SUMMARY

While many of the achievements of DSRIP have been laudable, there is still a need for a DSRIP 2.0 that would both lend itself to the past goals but also formulate a future path to help provide the quality health care that is much needed.

We strongly recommend:

1. A)Greater Engagement with Community Based Organizations. Mandatory 30% contracting consistent with the legislation in Massachusetts
2. B)Funding Pool for Workforce that PPS programs can quickly take advantage of based on vacancy rates, turnover and links to social determinants
3. C)Given the importance of behavioral health to all individuals being served by DSRIP, there should be a mandatory training for all staff around Mental Health First Aid
4. D)Recognition of the 47% of young people on Medicaid in New York is a significant part of DSRIP

2.0. Since this population of young people are in schools, mental health education in schools should be an important part of the Prevention Agenda. Resources such as MHANYS School Mental Health Resource and Training Center should be identified and funded through DSRIP 2.0

2. E)Whole Health is an important part of the philosophy of the PPS’s as identified by their promising practices. The role of families should be an important component of DSRIP 2.0 moving forward. The MHANYS CarePath™ program and more identified family resources and strategies should be part of the programmatic funding for DSRIP 0
3. F)Funding Pool for HCBS Designated Providers to insure that they have access to direct funding to increase the number of individuals taking taking advantage of HCBS services