Mental Health Update

Good Morning:

Thank you to the many of you that provided feedback to MHANYS budget summary.  An eagle eyed advocate caught a mistake I made in the document. At the end of the report, I referred to OMH and OASAS receiving a block grant of $1.5 billion dollars (I wish).  The actual number for OMH combining the federal block grant and FMAP is around $100 million. The group of a dozen statewide associations that I refer to in this narrative are engaging with OMH to prioritize the funding.

The other question I’ve gotten from several folks was in regard to the consolidation of OMH and OASAS into one larger agency. The consolidation was not passed during the budget. However, since there is not a fiscal attached to the proposed new agency, it still can come up during the course of the rest of legislative session.

It will certainly be an issue on MHANYS radar as will legislative issues around workforce and mental health education, teacher training about mental health, 988, higher education and mental health, telehealth parity, suicide prevention in schools and much more.  Please go to www.mhanys.org/action/   to find out more about our issues.

Thank you for your continued advocacy.

Glenn

Special thanks to my good friend Harvey Rosenthal of NYAPRS who have worked closely with us throughout the budget in helping to achieve positive outcomes for peers, families and providers. 

Final State Budget Impact to Mental Health: MHANYS Analysis:

 Overview:

 New York has passed its Fiscal Year 2021-22 Budget. It’s safe to say that it has been the most complex and difficult Budget in recent memory.

 Let’s first set the context of this Budget, going back to July 1, 2020. As the economic impact of COVID began to take full effect, the State’s deficit was re-estimated at  approximately $15 billion dollars. Just three months earlier, the enacted FY 2020-21 Budget was supposedly balanced.  In response, the State immediately began a series of cash management strategies to mitigate against the deficit. Mental health services were particularly hit hard — the State withheld twenty percent of all county mental health services contracts, excluding residential.

 As a result, by July 1 many programs run by MHAs and our colleagues were severely reduced, forcing cuts to services, imposing longer waiting lists, and laying off essential staff. These actions were taken while a pandemic was raging that was dramatically impacting the State’s overall mental health, increasing depression, anxiety, suicide completions and substance overdoses. In March, the State finally lifted the 20% withholds, and is in the process of paying back counties and providers. Nevertheless, the Executive Budget imposed a five percent across the board cut to all mental health programs.

 Also in March, the Federal Government passed the American Rescue Plan, resulting in $13 billion dollars coming to New York State Government directly to address our existing deficit. Meanwhile, the new State Budget enacts a new income tax surcharge on individuals and corporations that make over a million dollars a year, which will result in an additional $4 billion. The passage of the new sports betting will increase State revenue by an estimated $500 million.

 Virtually overnight, New York’s $13 billion dollar deficit has evaporated, there is now a budget surplus, and the enacted Budget is up almost 8%, now north of $200 billion.  To our great consternation, despite this budget largess, mental health services continue to get short shrift at a time when everyone agrees that mental health demand is at an all-time high.

 Here is the good, the bad, and the potential opportunities now that the Budget is put to bed.

 The Good:

 There are some good things in this year’s budget and we give credit to our two Mental Health Chairs for their leadership—Senator Samra Brouk and Assemblymember Aileen Gunther.

 One of the reasons for the ‘Good’ that I referenced was the combined efforts of MHANYS and our partners in the behavioral health community. The dozen groups statewide that comprise the behavioral health advocates and providers meet frequently and advocate for agreed upon priorities.  The united voices were an effective response to some of the budget challenges.

 In addition MHANYS has a new resource dedicated to responding to our policy agenda. It is referred to as Legislative Action Community Page and includes our briefings on issues, our Legislative priorities, testimonies, White Papers and Memos of Support and Opposition. To access our site go to www.mhanys.org/action/

 Passage of HALT legislation. Though this bill was not budget specific, the positive reforms for people with mental health issues in prisons and jails will have major impact for years to come through these reforms to the use of solitary confinement, and other practices.

 1% Across the Board Cost of Living Adjustment (COLA) for Mental Health, OASAS and OPWDD  ($15 million in mental health). In the past several years, despite a growing acknowledgement of our workforce through some piecemeal funding, this is the first time in a dozen years there is a full COLA. There is also language built in to the COLA to insure that agencies can utilize the money with some flexibility. This is a significant step forward and we will continue to advocate for an increased COLA in future years.

 Restoration of proposed 5% cuts to mental health. ($17 million) Funding was restored to insure that there would be no cuts to any mental health programs as the Governor had proposed.

$20 million for mental health housing. Last year, the State did not spend the funding that was allocated for specialized housing, but this year’s Executive Budget adds back the funding. This funding will be used to increase rates for providers to help defray the increased costs of housing.

 $5 million for the Joseph Dwyer Veterans Mental Health Peer to Peer Project. The very successful Dwyer project continues solidly supported by the Legislature. These new monies will add additional counties to insure that money is available to pay for counseling services and support for military veterans. We are honored that several of the Dwyer projects are funded through MHA affiliates across the State.

Crisis Stabilization Centers (Urgent Care Centers for Behavioral Health).  This is discussed in greater detail in the Opportunity section but the Executive and the Legislature are committing Capital dollars to these Centers.  Not sure of funding totals at this point.

Minimum Wage Increase:  ($5.1 Million) The original proposed Executive Budget put aside funding for the increase in minimum wage. We were pleased to see it stay in the final budget.

Restoration of Self Directed Care ($400,000)

Prescriber Prevails. The Legislature rejected the Governor’s proposal to eliminate Prescriber Prevails. The rejection of the budget will insure that individuals will have ability to rely on their prescribers’ recommendations for their medication regime as opposed to their health plan’s formulary.

 $1 million added for Crisis Intervention Teams (CIT).  Funding continues for CIT to be spread around additional counties in New York State. CIT engages law enforcement, providers, peers and families through trainings and partnerships to better respond to a mental health crisis.

Suicide Prevention Programs ($1,000,000)

 Adult Home Advocacy Funding:

 Mental Health First Aid. We thank Senator Brouk and the Senate leadership for their continued support of MHANYS receiving funding for Mental Health First Aid for our members across the State. The pandemic has raised the level of discourse around mental health issues. The increase in both awareness and service needs demands a community increase of mental health literacy and knowledge, which Mental Health First Aid provides.

 MHANYS School Mental Health Resource and Training Center. We are very appreciative that the Executive put $500,000 in the Budget to continue the great work of our resource center in helping schools, teachers, parents and other interested parties learn about mental health, and raising awareness about mental wellness and Social, Emotional Learning.

The Bad:

 Reinvestment of closed State hospitals into community-based mental health funding. Both the Executive and the Legislature let us down on reinvestment funding.  The Governor’s Budget proposed breaking an almost 30 year commitment in Reinvestment by proposing keeping  (for the State’s General Fund) the $22 million saved by closing State hospital beds.  The Legislature rejected this budget language, but failed to tie it to bed closures. As a result, there will be no additional funding in this year’s budget for Reinvestment at a time where the need for this funding has never been more apparent. This funding has been utilized for crisis response, respite care, housing, peer services, school programs, prison programs, employment, supported education, family support and more. In short, the life blood of a responsive plan of care for individuals in greatest need.  This cut is shameful, especially in light of the State’s newfound Budget largess. The State has said that they will honor the commitment to reinvestment for next year which means that if beds close this year, that funding will be added to next year’s reinvestment total.

Workforce.  While a COLA is greatly appreciated and supported, it in no way adequately provides the resources to recruit and retain a quality mental health workforce. Our staff are largely comprised of women and people of color. These are the heroes of COVID and yet, they are still working at minimum wage level positions. In addition, competition from the private sector has resulted in a staff turnover over 40%. We are losing talented people every day, and there must be a comprehensive plan developed to help create more funding and career ladders for those in our workforce.  This year’s Budget provides no such plan.

Scope of Funding. While many of the MHANYS priorities were funded, mental health funding  was extremely small compared to the need.   The perfect storm could have impacted in a positive wave this year but it didn’t.  The mental health impact of COVID is our new multigenerational story. All ages have been impacted by the pain, grief, loss, isolation, depression and anxiety brought on by COVID. Almost half the population has voiced mental health issues as their number one concern during the pandemic.  Instead, this Budget is a lost opportunity to fund mental health housing, crisis services, workforce, children’s mental health, school based mental health programs, trauma informed care programs, veterans mental health, aging mental health services and so much more. Shameful.

 The Opportunities:

 Crisis Stabilization Centers. The creation of Crisis Stabilization Centers is a creative response to meeting the needs of people in psychiatric crisis. There are a few already in New York State. If implemented well, this could be the next generations response to a mental health crisis. Think of the Stabilization Centers the way you would think of Urgent Care for physical health.  Most of us have probably been to urgent care for various injuries or illnesses over the years.

 Imagine urgent care center for behavioral health. People with a behavioral issue in any community setting can come in to get services from a psychiatrist, social worker, substance use  and mental health counselor, nurse practitioner, peer, and family member.  Referrals can come from families, schools, law enforcement, hospitals, providers, counties or anyone of many sources.  Due to advocacy from NYAPRS and other colleagues, all these program are completely voluntary.  As a family member myself, I have spent so much time in hospital waiting rooms when my loved one was in crisis. The ability to go to a ‘one stop’ where we are not spending hours waiting to talk to a clinician is groundbreaking.

 The addition of private insurance coverage of these new services is welcome as well.  Coverage requires no prior authorization, and no individual can be billed retroactively.

 988 Emergency. The other opportunity is that 988 will become law in July of next year.  988 is the new nationwide number for individuals in crisis to connect with suicide and mental health prevention. There will be an opportunity to link crisis stabilization centers, 988 and mobile crisis teams into a more integrated package of services.

 But how will we fund these new services? The answer is our other opportunity. There will be over $1.5 billion dollars in block grant funding going to both OMH and OASAS. Much of this money is specifically geared for crisis response so there might be a great opportunity to reshape crisis services for many years to come. This must include responses to the needs of kids in crisis. For too long, the needs of young people in mental health crisis have been under prioritized.

 We have a lot of unanswered questions about where our crisis response system needs to go, but over the next year we have the opportunity to plan and make it work. Instead of focusing on all that could go wrong, lets focus on the opportunities to help restructure and reform crisis services in New York for the sake of our loved ones.

 The combined efforts of our entire mental health community is reflected in the priority funding even if we are still fighting for our fair share. Without your efforts, the budget would have been far worse. We will need your advocacy more than ever for the challenges that lie ahead.  Please continue to speak out in support of mental health as always reach out to us at MHANYS.

Glenn Liebman
CEO, MHANYS
194 Washington Avenue, Suite 415
Albany, N.Y. 12210