Listed below is a letter from MHANYS in regard to Mayor Adam’s proposal around involuntary commitment for people with mental health challenges. The letter is also addressed to the Governor because the State budget is a major vehicle for making this change happen. This letter provides a common sense response through short and long term solutions to New York’s Mental Health Crisis. The Mental Health Community knows the answers, we just need the resources to be able to implement the changes that will provide support and services for our loved ones while ensuring public safety for New Yorkers including those with mental health challenges.
Mental Health Association in New York State
(518) 434-0439 | MHANYS.org
Follow us online: MHANYS.org
December 13, 2022
Honorable Kathy Hochul
New York State Capitol
Albany, NY 12224
Mayor Eric Adams
New York, NY 10007
Dear Governor Hochul and Mayor Adams:
Our organization is responding to the recent policy change in New York City in regard to the Involuntary Removal Policy of individuals with mental health related issues. While we are appreciative of several positive changes that have occurred recently, we have grave concern about the impact of these changes around involuntary commitment.
We are not naïve to safety issues across the State. People need to feel safe in their neighborhood, streets or on the subway but scapegoating people with mental health challenges is not the appropriate way to get there.
The notion of blaming mental health issues as the major factor of homelessness and violence is a false equivalency. It does not take into account that there are people who are violent without a mental health concern or that they have significant mitigating factors involved like history of violence, family history of trauma, domestic violence and many other factors.
Instead of using this as an opportunity to put individuals who are homeless and have mental health challenges in the back wards of hospitals, let’s have a common sense approach that does not criminalize mental health while still ensuring people feel safe in their communities.
As we enter into the next budget cycle in New York State, this is also an opportunity for the two of you and other statewide leaders to create a plan that identifies mental health as a priority.
Here are both short term and long term strategies for responding to the mental health crises that is both responsive to the needs of people with mental health issues and also to ensure that all New Yorkers feel safe and supported in their communities.
1) Provide Community Support Services Resources
Service providers deal with difficult issues every day. They know how to deal with complex needs but they need the resources to be able to help keep people in the community and out of emergency rooms. In 2006, an annual Cost of Living Adjustment (COLA) was included in the budget and the law for community-based human service providers, including behavioral health providers. However, over the following 17 years, this COLA has been ‘notwithstood’ and not funded in 13 out of 17 years. Therefore, we recommend that the State must utilize additional local assistance dollars, Medicaid dollars and additional braided funding to provide the community with $500 Million in the budget as an investment and to help make up for the lack of past funding in community mental health.
We talk about more beds in our state and public hospital system as a panacea. It is not and we should not go back to days of institutional care. What we should do is create a public system of community support that recognizes the need of individuals where they are. Housing, ACT teams, peer services, coordinated care management, supported employment and education services, trauma responsive services and family engagement are the ingredients that will help keep people out of hospitals and in communities. Without adequate investments in these services, people will keep cycling back into homelessness or incarceration.
2) Pay the Workforce a Decent Wage
This is not complicated. Our workforce believes strongly in mission driven work but mission driven doesn’t pay the rent. Vacancy rates and turnover in provider agencies are at an all-time high simply because people are not paid appropriately for their hard work. The lack of adequate pay and investments is an equity workforce issue as many of the members of our workforce are women of color, often working two to three jobs to make ends meet.
The pandemic has made a crisis level in mental health care into a perfect storm. Last year, Governor Hochul provided the largest funding COLA in the last 17 years (see above) at 5.4% based on the CPI. It is greatly appreciated but the need does not end. This year the CPI is at 8.5%. This must be included in the upcoming Executive Budget.
3) Medicaid in Prison and Hospital Transition
New York should be encouraging the Federal Government to approve the new 1115 Medicaid waiver application. This waiver includes provisions to include Medicaid eligibility thirty days before an individual leaves prison. Existing policy has not worked for many years and the waiver can help resolve this issue. A large number of people released from jail wait up to six weeks before they receive services including medication contributing to high recidivism rates. Also, the City and State should more aggressively utilize other options including ensuring that the Medication Grant Program is in place for individuals leaving the criminal justice system and hospitals ensuring that they have immediate access to medications.
Discharge planning from hospitals to the community should also be a major priority as that is where there are cracks in the system of care. The transition to the community from the hospital must include peer bridgers and follow up until the person has stable housing and linkages to community supports and services.
4) Opening More General Hospital Beds
New York should also encourage CMS that public psychiatric hospital bed reimbursements should be the same as surgical and medical beds. Currently there is less reimbursement for psychiatric beds in community hospitals so there is a movement to convert these beds. CMS should quickly rule in support of fully funding psychiatric beds at the same level as med/surg beds. Recognizing people with mental health challenges are not static in their recovery—there should be an additional reimbursement to reflect that need. There should not be a movement back to psychiatric hospital beds in New York but a short term movement around public hospital beds. Such a movement would help provide needed support and offer parity with physical health care.
5) Utilize the Safe Option Support Teams (SOS) and Crisis Stabilization Teams
Earlier this year, the State and City created SOS teams comprised of clinicians and law enforcement teams to together identify people in need of services. This holds promise but it is still a nascent program. In addition, as noted below, the State will be creating crisis stabilization centers authorized by legislation earlier this year. These initiatives provide more opportunity to determine if programs work before unnecessarily expanding involuntary commitment. Before the city rolls out other alternatives, there needs to be a review of the SOS teams and stabilization centers in ensuring support for individuals that are homeless.
6) Outreach and Engagement with Clinicians, Peers and Families/Additional CIT Training and Mental Health First Aid
Law Enforcement should not be the lead agency in determining an individual’s need for hospitalization. Clinical teams in concert with families and peers should be engaged whenever possible. Law Enforcement and other first responders clearly have a role but there must be mental health training in place to ensure knowledge of mental health. There should be additional funding for Crisis Intervention Teams and Mental Health First Aid.
7) Utilizing 988 Resources
There should be a complete engagement by the City of 988 and Stabilization Centers (Urgent Care Centers for Mental Health). When someone is in crisis, 988 will give them a place to call and if they are in need of immediate support, the Stabilization Centers will be up and running to provide an immediate response without going into an emergency room.
Long Term Strategies
As noted earlier, COLAs are the greatest need for our workforce currently but that only begins to make up for all the years of lost resources to our community. We also need to create a long term solution which includes the idea of a retirement system for our human service workforce similar to what happens for the government workforce, law enforcement and teachers. We have over 800,000 people working in the human service sector. Many of them are women of color. We must lift them up for the lifesaving work they do on a daily basis. Providing a retirement system that creates incentives to retain and recruit quality staff would support significant motivation to stay in our workforce. A blending of employer contribution and State and federal response would go a long way to making that happen.
2) Private/Public Housing Partnerships
New York City is the mecca for real estate and construction. State and City Government has a lot to do with the creation of this expansion. Both the State and City government should aggressively work with the real estate industry to create contractual obligations to create housing for people with mental health needs.
3) Gaming and Sports Betting Dollars
The explosion of money for gaming in New York is unprecedented and now there is the reality of developing three casinos in the five boroughs. The State and City should work with the casino developers to ensure that a percentage of that funding goes to community mental health and housing. The State and City have real leverage in negotiations and should use that to help respond to the mental health crisis. Sports betting in New York has made over $650 million for the State since its inception. This is also an opportunity to utilize a percentage of that for mental health services.
4) Prevention in Schools
Much of the needed change of our mental health system starts in school. Recent changes in State law make it easier to teach about mental health in schools but even more needs to be done. Schools are the petri dish for societal changes. Changing school environments to make them more conducive to better mental health and wellness are integral to success. There also needs to be an influx of clinicians in schools and school based mental health clinics. Across the board educators recognize mental health as their top issue. Much needs to be done to respond to that need through identifying funding for mental health in schools.
We are appreciative of everything you both have done in the past to address the mental health needs of New Yorkers. However, our ongoing mental health crisis calls for your leadership to offer both an immediate and long term response.
We urge your support for these significant recommendations.
William Gettman, Board Chair, MHANYS
Glenn Liebman, CEO, MHANYS