Yesterday, Office of Mental Health Commissioner Sullivan presented on the
OMH Comprehensive Plan. She very much articulated a vision that is
consistent with the principles of the MHA movement—highlighting policy
issues such as Prevention, Suicide Prevention, ACE Study, Reinvestment,
Recovery Services, Early Intervention, Mental Health and Criminal Justice,
Housing, Workforce and HARP Integration into Health Plans as well as
references to several of MHANYS specific agenda items around Mental Health
First Aid and the Mental Health Education Bill.

We had an opportunity to provide our own testimony. We highlighted several
issues, but it is clear that workforce has become a dominant mental health
issue. We are in a perfect storm of the minimum wage impact, impact of
retraining and retooling our workforce for Managed Care Implementation and
the continued lack of funding for the community workforce.

Statewide Comprehensive Plan Testimony

New York State Office of Mental Health
November 16, 2016
Testimony Submitted
by Glenn Liebman, CEO
MHANYS

Thank you to the New York State Office of Mental Health for holding this
5.07 Planning Meeting. Special thanks to Commissioner Sullivan and her
leadership team for taking the time to listen to our concerns and help to
respond to those needs that many of us in the Mental Health community deal
with on a regular basis.

The Mental Health Association in New York State, Inc. (MHANYS) is comprised
of 26 members in 50 counties throughout the State. Many of our members
provide community-based services. Whether the MHAs provide services or not,
all the MHAs are focused on community engagement through trainings,
advocacy, and education. We are a mission-driven organization and, whether
you are talking about a large downstate provider or a small MHA with a
part-time employee, all are dedicated to a life of recovery for individuals
with mental illness and the reduction of stigma in communities across the
State.

Mental Health Literacy

There is the three-legged stool of mental health literacy.

First Leg: Fighting Stigma

To that end, we are very proud that over the last two years, two pieces of
legislation that we have championed at the MHAs have become law. Last year
at this time, Governor Cuomo signed the landmark Mental Health Tax Check
Off bill. This is the first legislation in the country that specifically
allocates funding in the income tax forms charitable check off to mental
health public awareness. Aside from the continuous funding stream, this
check off shows all New Yorkers that mental health public awareness is just
as significant as other charitable causes including breast cancer awareness
and Alzheimer’s research.

We applaud Governor Cuomo and OMH for your leadership in the Suicide
Prevention Plan; ‘1700 Too Many.’ The plan highlights strategies around
Zero Suicides, Public Awareness, Community Partnerships, and more education
and support for those impacted by suicide completion. This document and the
resources contained will help to spread awareness and reduce stigma.

Second Leg: Education

This year, the Governor signed the Mental Health Education bill which we
have also championed. This bill will insure that health classes in New York
State must also teach about mental health. No longer will youth go through
their school careers without hearing words like anxiety, depression, and
suicide prevention even though these issues impact over twenty percent of
youth on a daily basis.

While many schools do teach about mental health, many do not and this
legislation will level the playing field by insuring mental health is
taught across the board. This legislation does not mandate curriculums or
lesson plans so we urge OMH to work with the State Education Department to
ensure that schools provide curriculums that are consistent with current
information regarding mental health and suicide prevention.

Third Leg: Training

This third leg is Mental Health First Aid (MHFA). We thank Commissioner
Sullivan for her strong support of this training and recognizing the impact
that MHFA has to communities across the State. We also appreciate the
opportunity to work with the OMH Bureau of Forensics in helping to train
law enforcement officials about MHFA.

Mental Health First Aid is an eight-hour training designed to provide tools
to individuals to help them respond to someone in a mental health crisis
and to encourage people who are experiencing symptoms of mental illness to
get help. More than that though, MHFA serves as a great tool in educating
the public about mental health literacy and the misconceptions of mental
illness. Whether you are a family member, educator, law enforcement
personnel, clinician, or in any other profession, virtually everyone is a
candidate for getting MHFA training.

The MHAs have over ninety people trained to teach this class and we are
excited to continue to expand the reach of MHFA into every corner of New
York State.

Recommendation

We will continue to work with the Office of Mental Health, the Executive,
and the Legislature in attempting to get additional support and funding for
Mental Health First Aid.

Reinvestment of Services into the Community

MHANYS has long been an advocate of ensuring that any hospital or bed
closures in psychiatric facilities are reinvested back into community
services. We have been very supportive of the ability of OMH to get this
funding out expeditiously to counties across New York State. As we did in
last year’s budget, we will continue to advocate that all money from
closures go to community support services. This funding should be
identified for community priority needs including housing, peer support,
family engagement, crisis services, jail diversion programs, and other
innovative projects. We must continue to keep the community services
pipeline alive through continued State funding for local assistance and for
the reinvestment funding stream.

Changing Needs in the Community 

Community mental health organizations deal with a myriad of difficult
issues including: lack of community housing options, a population of people
who are often imprisoned for minor offenses, the epidemic of heroin and
opioid abuses, needs of adult home residents, uneven implementation of
parity regulations, medication access issues, and much more.

We are also simultaneously dealing with all the changes occurring with the
transformation of the behavioral health system. The changing landscape has
necessitated some dramatic policy shifts in regard to strategies around
Medicaid Managed Care, DSRIP, HARP Eligible Services, and Health Homes.

The fundamental changes for MHAs and other community-based organizations is
daunting. Among the many questions we ask are: how do small MHA’s and other
CBO’s that have never billed for Medicaid start the billing process; does
it make sense to be part of a larger entity that has additional resources
but does not necessarily completely support the great work that we have
done in our community for years; how do we continue to increase our
bandwidth as an agency without losing the core values of our mission; can
we create a product line through a HARP service that is economically
feasible while driven by patient care; what do we do with the people we
serve who are dual eligible and non-Medicaid individuals, etc.

These questions and many others are front-loaded in the minds of many
not-for-profit directors across the State. We recognize the enormity of
this issue and appreciate that OMH and other State agencies have been
meeting with us regularly and have provided us with seed money both for
preparedness and IT cost.

Workforce

So with all these disparate issues, what is the common denominator shared
by everyone? The answer is *workforce.* MHAs and other community providers
have proven time and time again that they are up for the challenges that
have been thrown their way over the years. The nimbleness and flexibility
of not-for-profits reflect many of the innovative practices that have kept
people out of the hospital and in the community despite being dramatically
underfunded.

The problem of workforce retention and recruitment has been a front burner
issue for many years but it continues to worsen. The recent movement to
raise the minimum wage, while laudable, could have a serious negative
impact to not-for-profits in the mental health community.

Without subsidies from the State, not-for-profits will not be able to
sustain the pay increases that will come about as a result of the minimum
wage increase.

The people in our community are often driven to work in the field because
of a belief that they can change lives in a positive way. That is a great
motivation but unfortunately, as they look around at their colleagues in
other arenas like fast food and other service jobs, they realize that they
are making less pay for tougher jobs. The scales have to tip in the favor
of the not-for-profit workforce, not just for the direct care workers, but
for their supervisors and other dedicated employees.

Frankly, over the years, there have been almost no rate increases in
community mental health which is shameful. A few years ago, the Legislature
and the Executive approved a two-percent increase for direct care workers
and for some individuals in supervisory positions. Largely, that has been
the only real increase in almost a decade.

The existing challenges of the complex day to day work, as well as all the
changes to the workforce because of the systems transformation, combined at
the same time with not-for-profits not having any real salary increases,
creates a perfect storm for the workforce.

You can create the greatest evidence-based programs and systems in the
world, but if you don’t have a well-trained and well compensated workforce,
the system design will fail.

So what can we do to better enhance the mental health and human service
workforce?

Our recommendations listed below reflect the priorities we have heard from
our members. In addition, MHANYS is part of the Restore Opportunity Now
(RON) campaign, a group comprised of human service sector agencies across
New York State. This list represents an amalgam of recommendations that we
believe should and could be implemented in New York State in both mental
health and for the entire human services sector.

Recommendations

  • First and foremost, we must have enhanced funding for the
    community workforce. Without across the board salary increases for the
    not-for-profit sector, the workforce continues to be dramatically
    underfunded and overworked.
  • Fund the $15 per hour wage increase by amending all human service contracts
  • Create mechanisms through which nonprofits can access cost effective and high quality health and retirement benefits
  • Provide tuition reimbursements to individuals working in the mental health field much like what has recently been to support tuition reimbursements for Psychiatrists
  • Invest in a system to promote professional development and career advancements.

We realize that these recommendations go beyond the scope of mental health,
but we strongly urge OMH and the other State-run human services agencies to
work together to review workforce issues and take into account the
recommendations that have been included. We need real action.

Summation

In summation, there are many issues that MHAs are involved with, both on
the community and State level. We are appreciative of the work that OMH has
been doing to continue a productive dialogue with MHAs and our colleagues
in the community.

We also recognize all that must continue to take place to engineer the
changes dictated by an evolving health care system. However if systemic
issues are left unaddressed through an underfunded workforce, even the most
innovative and evidenced based services, will be at risk.

Thank you for this opportunity.

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

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