[NYAPRS Enews] MHW, NYNP: NY Advocates Seek Community Reinvestment Commitment, Laud Cuomo Plan

[Harvey Rosenthal]

N.Y. Advocates Applaud Landmark MH Plan, Seek Community Reinvestment
Mental Health Weekly  July 22, 2013

Although New York state's mental health community is encouraged by the state's plan to overhaul mental health services and shift care from inpatient facilities to the community, they say the initiative should promote recovery, and savings generated from the plan should be reinvested into nonprofit community services.

The sweeping plan, announced July 10 by the state Office of Mental Health (OMH), aims to reduce the state's 24 psychiatric hospital systems to 15 to create regional centers of excellence (RCEs). According to the plan, an RCE model will be regionally based networks of inpatient and community-based services, each with a specialized inpatient hospital program located at its center, with geographically dispersed community services "hubs" overseeing community-based services.

OMH officials say the goals of the three-year plan are to promote recovery and resiliency and support the state's Olmstead planning for integrated settings for individuals living with psychiatric and other disabilities.

Additionally, there will be no layoffs under an RCE plan, according to officials. Instead, OMH employees will be presented with other options such as residential facilities, other state agencies, inpatient settings within the RCE, or training for work in other areas.

"It's a very aggressive plan," OMH Acting Commissioner, Kristin M. Woodlock, told MHW. "The shift in hospital care to providing care in the community is driven by what the local stakeholders tell us." Woodlock led a months-long "listening tour," where she heard from 2,000 community members about such issues as access to service, gaps in the system and employment, all of which were essential to the formation of the plan.

New York state has 24 state-operated psychiatric hospitals, more than any other state, noted Woodlock. California, Michigan and Texas, for example, each has about five to eight state-operated hospitals, she said The state is legislatively required to provide a one-year advance notice on any kind of service change such as a closure or consolidation, said Woodlock. The plan will be implemented July 1, 2014, and be completed by 2017, she said.

Meanwhile, the state is expected to generate $20 million in savings in the first year and annualize to $40 million, she said. "It depends, in part, on where the planning process takes us," she said. "We're looking at the reinvestment of savings into the community as well."

Regional Teams
The plan calls for the establishment of Regional Care Teams to guide the plan and help set priorities, said Woodlock. Each of the five tri-chair regional implementation teams would include one staff member from OMH, a county mental health director and community stakeholder representatives, such as a peer, family member or provider.

"The 15 slots will capture the geography, culture and perspective of that part of the region," said Woodlock. "We are taking nominations for that."

Team members may indicate, for example, the need for crisis services, intensive services or respite services for children in their respective communities, she said.

Woodlock added, "That would be our priority; we want to have that local connection." New York has both a state- and community-operated  behavioral health system, she said. "With this plan we're bringing the two constituencies together and preparing ourselves for the changing healthcare environment," said Woodlock.

Reform "Long Overdue"
"New York is long overdue for this kind of reform," Lori Cole, executive director of the New York State Council for Community Behavioral Healthcare, told MHW. New York state providers are currently unable to meet the needs of consumers with behavioral health issues because the demand is so great, she said.

Cole added, "Consumers want locally driven services in the community where they live. An oversized state hospital is good for no one. The state cannot afford to manage an oversized state hospital system. It's an unbelievable expense."

During a press conference to promote the new plan on July 16, a coalition of organizations pressed for community reinvestment of the savings, said Cole. Currently, there is no formula for allocating the re- sources into the community, she said. The first step is for advocates to get clear about the savings that will be made available [as a result] of the plan and negotiate with the administration to assure savings are returned to the community to consumers who deserve and need additional services," said Cole.

Some beds will remain as needed based on the current census, said Cole. Some of the people will transition out into the community to outpatient centers. There is a great deal of worry among family members who still want a hospital at their disposal for their loved ones, she said.

The proposal outlines plans to retask existing inpatient hospitals so that they become more places for acute triage services, she said. "For us we would like to see numbers hard and fast on the percentage of savings returning to the community-based system," said Cole.

"The plan was intentionally nonspecific in those areas. The time is right for it and we're going to devote all the resources we have, ensuring that at the end of the day local communities have locally driven, community based services that they need."

Major Reforms
The advocacy community is giving credit to Gov. Andrew Cuomo's administration for taking on major reforms, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS). First it was a plan to reform Medicaid, generate savings and improve health outcomes, and now it's an overhaul of the state hospital, Rosenthal said.

"This is an historic moment," Rosenthal told MHW. "We're overhauling the entire system."

"The state has between a $5 and $6 billion mental health system," said Rosenthal. "About $1.3 billion is spent on state operations inpatient and outpatient services. Those dollars are up for redeployment." The state plan is a real specific hospital focus on short-term stays and specialized treatment, said Rosenthal.

Key questions are what money will be saved and reinvested into the nonprofit community, said Rosenthal. Savings from the plan are expected to come from building closures and staff attrition, he said.

Advocates want to see a more recovery-oriented approach for consumers with mental health needs, reinvestment into the nonprofit community and workforce training, said Rosenthal.

"Reforms need to be driven by what it takes to help people recover," he said. The next steps would be the formation of the committee and shaping the plan, said Rosenthal.

Not all New Yorkers are pleased with the state's new reform efforts. "The state's plan started with an assumption that people can achieve recovery," Steven Horn, president of Koven Care, a New York City-based private agency that provides inhome care for people with psychiatric illnesses, told MHW.

Horn added, "That's not necessarily true [especially] for people who are persistently ill and need 24/7 support." He cited the plan's section on access to housing, education and employment, which indicated that OMH will continue putting housing in its development pipeline and expand by more than 1,900 units. The plan notes it has housing capacity for 36,000 people, he said.

"People who are severely chronically ill will require supportive living services for the rest of their lives," he said. "There's virtually no longer term supportive care for people with serious mental illness whether they receive public-sector funding or if they could pay privately."

"This is a nationwide issue," said Horn. *
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OMH Releases Regional Centers of Excellence Plan for System Reform
New York NonProfit Press   July 11, 2013

NYS Office of Mental Health released its plan yesterday to convert the existing network of State Psychiatric Centers into a new system of Regional Centers of Excellence.   The plan calls for a reduction from the current 24 adult, children's and forensic inpatient facilities to 15 Regional Centers of Excellence over a three year period.  Community behavioral healthcare providers and advocates applauded the plan's basic outline, which assumes that existing State resources in terms of existing OMH personnel and funding will be used to bolster existing community-based behavioral services and fill identified service gaps.  At the same time, however, they expressed concern that specific commitments for reinvestments of savings coming from hospital closures and downsizing were not explicitly spelled out in the plan.

"Today begins a new era in New York's behavioral health system," said Kristin M. Woodlock, Acting OMH Commissioner, in a cover letter outlining the plan.  "Nearly 175 years after the opening of the first Asylum, the time has come to fundamentally change the way we think about mental health in New York State."

Woodlock laid out a number of key assumptions built into the plan.

"First and foremost, the redesign of the public mental health system must be good for the children, adults and families we serve," she wrote.  "Over the course of the next three years, OMH will establish 15 Regional Centers of Excellence (RCEs) across the state.  RCEs will be regionally-based networks of inpatient and community-based services, each with a specialized inpatient hospital program located at its center and geographically dispersed community service 'hubs' overseeing state-operated community-based services throughout the region."

The report noted that every year, 715,000 individuals access care in specialty mental health settings in New York State.  Of these, 10,000 are served in OMH inpatient hospitals, which now have a census below 4,000.   However, while serving just 1% of the overall population of New Yorkers requiring mental health services, these OMH hospitals account for more than 20% -- $1.3 billion annually - of the state's total spending on services.   "New York's historical choice to maintain 24 State-operated hospitals is no longer sustainable," says the report.

Under the new plan, OMH reportedly will operate 15 Regional Centers of Excellence (RCEs) in Buffalo, Rochester (forensic only), Syracuse, Albany, Rockland, Bronx Adult, Bronx Kids, Utica Kids, Staten Island, Manhattan (forensic only), Brentwood, Ogdensburg (forensic only), Central NY/Marcy (forensic), the Psychiatric Institute and the Nathan Kline Institute.

Implementation of the plan for closures and downsizing, along with re-allocation of savings to create new community-based services, will be led by new Regional Centers of Excellence Teams being established in each of OMH's five regions.

Advocates and providers were quick to praise the plan in a joint statement issued by the New York Association of Psychiatric Rehabilitation Services, NYS Council for Community Behavioral Healthcare, Mental Health Association of NYS, Coalition of Behavioral Health Agencies, Supportive Housing Network of New York, Association for Community Living, and the Mental Health Empowerment Project.

"Our organizations welcome these proposals to reconfigure state dollars and staff in a way that maximizes state resources to meet our communities' most pressing needs, while at the same time creating state of the art regional psychiatric facilities that are among the nation's best," they wrote. "This is an historic moment for New York. Thanks to Governor Cuomo's strong and creative leadership, New York will be able to make smart investments that bolster local community mental health systems, increase employment and housing, reduce local and state spending on acute care services and provide an enhanced quality of life for New Yorkers with psychiatric disabilities."

"This is a real breakthrough," said Harvey Rosenthal, Executive Director of NYAPRS.  "The State system should be a treatment program, not a jobs program."

"The Governor and the administration should be commended for taking on this heavy lift," said Lauri Cole, of the NYS Council for Community Behavioral Healthcare.  "With an oversized State hospital system, nobody wins.  All services across the continuum of care suffer.  This plan appears to be a very innovative and very pragmatic approach to a very difficult issue."

"This is an incredibly responsible plan," said Coalition of Behavioral Health Agencies Executive Director Phillip Saperia.  "It addresses many of the concerns of all potential dissenters."  Saperia went on to praise the Regional Center of Excellence Team planning process and the stated intentions to reallocate resources to fill identified gaps in services that currently exist.

Despite this general praise for the plan, advocates and providers expressed considerable concern that specific targets for reinvestment of savings into creation of new community-based resources had not been spelled out.

"We will be scrutinizing the details of these proposals and sharing more detailed reactions and recommendations in the days to come, and during the three year process the state is providing to finalize these landmark reforms," the advocacy groups said in their joint statement.  "We want to ensure that a significant portion of state savings from staff attrition and facility closures is reinvested into local communities to boost effective and cost effective nonprofit services."

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