Albany Times Union
Friday, January 28, 2011
Mentally ill deserve better care
By D.J. Jaffe
Gov. Andrew Cuomo is to be commended for creating the Spending and Government Efficiency Commission to right-size state government. Its first recommendation should be to eliminate the Office of Mental Health — something that could save money and, counterintuitively, improve care and keep the public safer.
Eliminating the agency may sound extreme, but it’s not without precedent. Or success.
In the 1990s, the New York City Department of Mental Health, Mental Retardation and Alcoholism Services suffered from a bad case of mission creep, just as the Office of Mental Health does. Rather than providing services for the most seriously ill, the city agency cut those and ramped up social service programs for others. The seriously mentally ill went to the back of the line, and the worried-well to the front.
In 1999, New York City residents voted to revise the city charter to eliminate the mental health department and subsume any important operations under the health department. The result has been a more streamlined operation that uses its limited resources for what was most important: helping with the medical needs of the most seriously mentally ill.
The mission creep at the state mental health agency is expensive, extensive and sometimes deadly. According to 2010 state budget testimony, the agency spends more than $3 billion to serve 650,000 people. Only 3,600 are seriously mentally ill individuals in state hospitals, according to agency statistics. Another 1,871 are in assisted outpatient treatment programs. While other programs also serve the seriously ill, these two programs, serving the long-term medical needs of the most seriously ill, represent less than 1 percent of those the agency serves. A nationwide study by the Treatment Advocacy Center and me estimates that New York needs 4,311 more hospital beds for the seriously ill to meet minimal requirements.
Assisted outpatient treatment, better known as Kendra’s Law, is New York’s most successful program for the seriously mentally ill who are likely to become violent. It allows courts to commit some historically violent patients to stay in violence-preventing treatment as a condition of living in the community.
A 2005 Office of Mental Health study compared what happened to individuals for six months before they entered the program and for six months in the program. It showed that 83 percent fewer were arrested when in the program, 87 percent fewer were incarcerated and 55 percent fewer engaged in suicide attempts or physical harm to others. Expensive hospitalization was reduced 77 percent.
But by failing to adequately fund Kendra’s Law, and opposing reforms proposed by Assembly member Aileen Gunther, D-Sullivan County, the agency has effectively capped enrollment at 1,900 people. Using the best available data, Dr. E. Fuller Torrey estimates that more than 4,000 New Yorkers with schizophrenia who need assisted outpatient treatment are not receiving it.
Because the agency has taken its eye off the prize, a lot of the money spent on the seriously mentally ill is wasted. According to Dr. Lloyd Sederer, agency medical director, New York prematurely discharges mentally ill patients and substance abusers from hospitals and does so without community supports. He estimates the cost in potentially preventable hospital readmissions is $665 million (22 percent of the office’s budget.)
Another result of letting the seriously ill go untreated, is that the New York criminal justice system had to create an expensive shadow mental health system. The National Sheriffs Association reports that in New York, you are three times more likely to go to prison for serious mental illness than to be treated in a hospital.
Closing the Office of Mental Health won’t be easy, only smart. While Commissioner Michael Hogan testified during budget hearings about the importance of integrating mental and physical health, the agency may fight to maintain the status quo. And when you spend $3 billion annually, you tend to have a lot of friends. Expect 2,500 community programs funded by the agency to drive busloads of clients to Albany to protest.
Cuomo has the opportunity to save money, start to balance the budget, improve care for the seriously mentally ill and keep the public safer. It requires euthanasia and reincarnation: Eliminate the Office of Mental Health and place programs that serve the seriously mentally ill within the Health Department.
D.J. Jaffe of New York City is the founder of Mental Illness Policy Org. His e-mail address is firstname.lastname@example.org