Mental Health Update
MHANYS Ten Point Comprehensive Action Plan to Improve New York’s Mental Hygiene System and Crisis Response
Comprehensive Action Plan to Improve New York’s
Mental Hygiene System and Crisis Response: 10-Point Plan
Recent tragic incidents in New York City have drawn intense scrutiny on the criminal justice and mental hygiene systems and how we can better serve those in crisis. While the incidents are under investigation, there are signs of missed opportunities to engage the individuals in treatment and supportive services, including housing and outpatient community-based services. This is especially important for those who are homeless come into contact with the criminal justice system and are often cycling between both. There are systemic issues at play that contribute to the crisis, which New York is in the midst of addressing through the $1 billion investment in mental health under Governor Hochul and through the 1115 waiver that the Department of Health is implementing to assist those with high-need health-related social needs.
As recommendations are considered, we must be careful and deliberate as scapegoating mental illness for public safety incidents perpetuates stigma and discrimination. This in turn can become barriers that keep many from engaging in treatment in the first place. The data and research clearly point to the fact that those with mental health conditions are 10-12 times more likely to be the victim of an attack, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).1 Changing the involuntary treatment process, such as expanding who can initiate and force individuals into treatment, is not the panacea to addressing the underlying issues and contributing factors. These laws have been carefully crafted over the years and upheld by the courts, balancing individual rights, due process, and public safety. MHANYS has prepared a comprehensive 10-point plan that aims to close the gaps in crisis response, which is critical to the efforts to enhance the mental hygiene system and thereby public safety.
1) Workforce
- Investment – Provide a 7.8% increase for mental health and substance use disorder rates and contracts in the FY 2025-26 New York State budget. The 7.8% represents the total of the current inflationary increase of 2.9% (CPI July 2024) and the difference between the human services COLAs over the past three years (12.2%) and the CPI increases (17.1%) over that same period. Due to decades of underfunding, service providers remain engaged in a state of crisis that is characterized by ever-increasing demands for our services, mounting waitlists, very limited access to care, and an extremely hard-pressed workforce that we are struggling to attract and retain. Mental health and addiction service agencies are experiencing a statewide 20 – 30% vacancy rate, depending on provider type, and a 35% annual turnover rate. Read the letter to the Governor hereand the concerns and data here.
2.) Community Transitions
- Target Transitions: We know that when people with serious mental illnesses are discharged from hospitals, or released from prisons or jails, is when they are the most vulnerable. We need safe hand-offs upon 1 https://www.samhsa.gov/mental-health/myths-and facts#:~:text=Fact:%20Most%20people%20with%20mental,productive%20members%20of%20our%20communities
discharge or release. Evaluations should be conducted and all high-need adults should be provided with a peer bridger, a supportive case manager, a care monitoring team, or an ACT team. This should continue for at least the first 30 days after discharge from a hospital, or released from prison or jail, and at least until they are transitioned to an outpatient provider. This should continue if clinically necessary.
- Safe Hospital Discharge Planning: Finalize the adoption of the New York State Office of Mental Health’s regulations regarding safe discharge planning. These regulations would require standard screenings and assessments to take place on admission and active coordination with community and residential providers. The discharge plan process outlined in the regulations includes hospitals identifying and confirming follow-up appointments in the community within seven days, referral for intensive care management services, screening for suicidality, and other support services. Importantly, the regulations indicate that discharge of individuals with an elevated risk of violence “shall include, to every extent possible, close collaboration with the county DCS if applicable, current and new outpatient treatment providers, residential providers if applicable, and school if applicable, to incorporate strategies to address violence risk factors and access to weapons into the overall discharge plan in accordance with section 33.13 of the Mental Hygiene Law.” MHANYS urges final adoption as soon as possible and stringent oversight and enforcement.2
3) Health-Related Social Needs
- Health-related social needs (HRSN), including lack of affordable and stable housing, lack of transportation, and an inability to pay for medical care or prescriptions impede an individual’s ability to address health and mental health-related conditions. For some, these barriers discourage treatment altogether until it reaches a crisis that requires a visit to an emergency room and an inpatient admission that results in significant expenditures for the overall system. New York must move forward as expeditiously as possible with the New York Health Equity 1115 waiver and the social care networks that have received significant funding to partner with health and community-based providers to screen Medicaid members and expand their access to HRSN services.
4) Strengthen & Enforce MH/SUD Parity & Network Adequacy Laws
- The urgency of this recommendation cannot be overstated. New York Attorney General Letitia James’ investigation in December 2023 found that 86 percent of mental health providers listed on health plans’ networks were “ghosts,” meaning they were unreachable, not- in-network, or not accepting new patients. The report noted, “…health plans bear responsibility due to their low reimbursement rates for mental health services compared with physical health care.”3
- Network Adequacy Regulations/Parity: The New York State Department of Financial Services (DFS) and New York State Department of Health have proposed regulations for the network adequacy and access standards for mental health and substance use disorder services, as required by Chapter 57 of the Laws of 2023. The regulations would require networks to provide timely outpatient appointments upon discharge and the ability for individuals to go out-of-network if there is not a provider within the network who is available within the prescribed wait time standards. The regulations specifically require an adequate network of health care providers for mental health and substance use disorders, including subacute residential care, assertive community treatment, critical time intervention services, and mobile crisis intervention services. DFS revised these regulations on November 20, 2024, and would require DFS to make a “determination” that there is a sufficient number for each of the aforementioned provider types before this portion of the regulation can take effect (90 days after such determination). Alarmingly, DFS noted in its assessment of public comments that there is not a sufficient number of such providers and no timetable
2 https://omh.ny.gov/omhweb/policy_and_regulations/#adoption
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for determining provider sufficiency, stating: “The Department has been consulting, and will continue to consult, with OMH, OASAS, and the New York State Department of Health (“DOH”), and at present there is not provider sufficiency. The Department cannot at this time provide a date by which the determination of provider sufficiency will be made.” Behavioral health network adequacy has been required under state and federal parity laws for many years. It is well past time for the state to take all necessary actions to ensure full compliance with the law.
- Enforcement: New York must also strengthen compliance and enforcement of the mental health and substance use disorder parity laws as continued non-compliance impacts access to care as well. This includes raising the fines the Department of Financial Services can levy for non-compliance.
5) Incident Review Panels
- Conduct specialized reviews of critical incidents. Section 31.37 of the Mental Hygiene Law establishes a process to establish “mental health incident review panels” to review critical incidents that involve persons with serious mental illness, often with the involvement of the criminal justice system. We believe that this authority has never been used. Whether we follow that statutory process or not, it is common sense that systemic problems can be identified and resolved by reviewing current and past serious incidents.
6) Mental Health Courts
- Alternatives to incarceration and mental health courts should be expanded. They provide needed services, guidance, and incentives to those individuals who engage in criminal behaviors before they evolve into more serious behaviors. While behavioral health services are provided in jails and prisons, they are not therapeutic environments and cannot always provide effective services in a manner that will have a lasting effect.
- Previous funding has enabled 40 of New York’s 62 counties to establish mental health courts. Governor Hochul and the Legislature recognized the value of these courts and provided an additional $33 million in funding for the 2024-25 budget.4 Following the enactment of the budget, Governor Hochul visited the Midtown Community Justice Center and recognized the importance of the investment stating, “[I] just took a tour of former cells, holding centers, that are now going to be turned into rooms of healing where we can address people and help them get on a healthy path towards recovery.”
- Expand funding for court-based mental health/integrated care navigators
7) Care Monitoring Teams
- The June 2008 New York State/New York City Mental Health/Criminal Justice Panel Report was led by Mike Hogan, PhD, then Commissioner of New York State Office of Mental Health, and Linda Gibbs, then New York City Deputy Mayor for Health and Human Services. The panel included state, city, and national experts in the mental health and criminal justice fields, who came together and agreed upon a number of common sense actions that should be taken to improve the intersection of mental health and criminal justice services. These recommendations included care monitoring teams and incident reviews.5 The aim of this recommendation is to address poor coordination, fragmented oversight, and lack of accountability. These cross-agency joint teams between New York State and New York City would be “… directly responsible for monitoring the care of high-need individuals and the high-intensity programs (such as Assertive Community Treatment and Intensive Case Management) that serve them, to help improve treatment and services.”
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5 https://omh.ny.gov/omhweb/justice_panel_report/report.pdf
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8) Crisis Response
- Funding of 988 Suicide and Crisis Lifeline, which has answered over half a million calls with a 90% in-state answer rate providing vital support and referrals to those in crisis. New York needs a broad public awareness campaign so individuals are aware of this vital resource.
- Expansion of mobile crisis units and Critical Time Intervention Teams
- Operation of supportive and intensive crisis stabilization centers
- Expansion of the Safe Option Support Program. Since 2022, these teams have helped nearly 700 homeless individuals with mental illness secure permanent housing and access an array of intense wrap-around supports and services. Overall, these teams have had nearly 52,000 encounters.
- Crisis Intervention Team Training for law enforcement. Daniel’s Law Task Force report and recommendations are forthcoming on how to best respond to those in crisis.
- Peer and Family Engagement. Mental Health Community Partners and MHANYS Care Path TM are two innovative programs providing critical support for those managing behavioral health conditions in the community. MHANYS Care PathTM helps individuals build a network of support and implement a five-step action plan to build additional support systems and foster wellness.
9) First Responder Training
- Support the State’s first responders: The “Every Responder Overcome Resilience (HERO-R)” Training Program is focused on creating a standardized framework for peer support training, ensuring that first responders have access to consistent, evidence-based tools for supporting their colleagues’ mental health. By setting this standard, the program aims to create a sustainable and impactful model for mental health support within the first responder community.
- The need: In May 2024, the Division of Homeland Security and Emergency Services released the results of a survey conducted as part of New York’s inaugural first responder mental health needs assessment. The survey found 8that 0 percent had negative impacts on home life from work their work as first responders with 16 percent reporting suicidal thoughts. This is a rate higher than the general population according to the Substance Abuse and Mental Health Services Administration (SAMHSA).6
10) Mental Health Literacy
- Mental Health First Aid (MHFA): This is an evidence-based training that teaches people how to identify, understand, and respond to signs and symptoms of a mental health or substance use challenge. Similar to physical First Aid and CPR, MHFA helps an individual assist someone experiencing a mental health or substance use crisis until professional assistance is obtained or the crisis is resolved. There are MHFA trainings for adults, youth, teens, and specialty populations. Studies have found these trainings increase mental health literacy, confidence in individuals’ ability to help someone in distress and reduce stigma. A more mental health literate public increases communities’ “radar” as citizens become more adept at recognizing, reporting, and responding to signs of possible distress.
In summary, New York is in the midst of the most comprehensive investment in crisis services in decades. The full scale and potential for these investments have not been fully realized. Our hope is that you will consider these recommendations as the State develops its response to the recent tragic events that unfolded in New York City.
