[NYAPRS Enews] Hogan: Tough Realities Ahead

[Harvey Rosenthal]

Tough Realities Ahead
by Michael F. Hogan, OMH Commissioner  January  2011

There is no doubt that the forecast for New York's mental health system
seems gloomy. Two major developments will disrupt our lives, affecting
almost everyone who receives services or works in our vast system. Both
of these developments (Medicaid Redesign and the most challenging budget
in years) will force change, upset the status quo, and force us to think
hard about priorities. There's nowhere to hide from these realities. My
view is that we have to engage, adjust and adapt.

The Medicaid Redesign effort grows from the reality that New York spends
far more on Medicaid than any other state, but does not get better
results. This affects the OMH-directed mental health system
because--like most states--New York has used Medicaid to pay for almost
all mental health care, even that which used to be a pure state
responsibility. So changes in Medicaid mean changes in mental health
care. And the only crystal clear direction for Redesign is less
spending.

When we look at New York's OMH-coordinated specialty mental health
system, we see that we need a big safety net in large measure because of
the systematic failure to address mental health problems in the general
health system--the place where almost everyone goes first when they
think they might need some help. The data show that although the average
age of first mental health symptoms is 13, the average delay until
getting care is 9 years. About half of all MD's report they are
comfortable with diagnosing and treating depression--the most common and
reliably diagnosed mental illness. And this weakness on mental health
care exists across the general health system from primary care to health
plans.

In the long run, we see a positive direction of change. Assuming health
reform is not rolled back, almost everyone in America will eventually
have health insurance, and essentially all insurance will include parity
for mental health care. This is good. In the short term, however, we
face the difficult challenge of advocating for improved mental health
care in the overall health system--and especially for children--when we
know there is little chance to expand anything. We do see an opportunity
to improve coordination of mental health care, and we know many people
use high amounts of emergency and inpatient care because they do not
have a good overall plan of care. Our position is that better care
coordination is needed now, and that is better done by specialists in
mental health care (so called Managed Behavioral Health
Organizations--MBHO's) than by regular health plans--whose track record
and experience with mental health is not very good.

I urge all mental health stakeholders to submit ideas for improving
Medicaid <http://www.health.ny.gov/health_care/medicaid/redesign/>   
to the Medicaid Redesign web site.

In terms of the state budget, we face a difficult time. In recent years,
OMH has increased access (admissions) to our inpatient programs while
reducing capacity and costs--OMH staffing is down by 1,000 FTE's in the
past 2 1/2 years. And we have held onto our community care capacity.
Even this pace of downsizing will not be enough in the very difficult
two years that are ahead. Forced reduction of OMH inpatient capacity is
inevitable, and we may have to consolidate hospital programs. Whatever
challenges we face, we will draw the line on protecting the quality of
care as measured by accreditation. And we are resolved to emerge from
all of these challenges as the best and most substantial state mental
health program in the country.

http://www.omh.ny.gov/omhweb/resources/newsltr/2011/jan/#comm

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