12/16/2010 12:15 pm ET | Updated May 25, 2011

Andrew Cuomo Should Not Keep Eliot Spitzer's Mental Health Commissioner

Eliot Spitzer did more for the seriously mentally ill of New York State than any previous Governor in recent memory. But he did it as Attorney General: he conceived of and got Kendra's Law passed. Kendra's Law is one of the few programs in NYS that helps people with the most serious mental illness. It commits certain people with serious mental illness and a history of violence to take medications as a condition of living in the community. It also 'commits' the mental health system to accepting them. It has reduced violence, incarceration, and improved care.

But when Eliot Spitzer was elected Governor, he hired a Office of Mental Health (OMH) commissioner who didn't believe in the program and wrote "Treatments that are theoretically the best but not accepted by an individual are unlikely to be effective."

Governor David Patterson kept him on. As a result, Kendra's Law which proves involuntary treatment does work--is underused. Recent stabbing events of parents by mentally ill children shows the consequences

Today's New York Post included an op-ed I wrote that points out the qualifications a new NYS mental health commissioner should have if we want to give people with serious mental illness better care than they've been getting. It was written in light of three recent instances of violence by people abandoned by programs certified by the Office of Mental Health:

On Monday, Ryan Devaney stabbed both his parents. The mentally ill Brooklynite killed only one, his mom. In October, mentally ill Staten Islander Eric Bellucci stabbed his parents, killing both. In November, Suffolk County police had to shoot and kill mentally ill Thomas Scimone after he threatened to shoot firefighters and ran through West Babylon brandishing a gun.

The problem it identified is "unmitigated mission creep" at the New York State Office of Mental Health:

Today, OMH has largely abandoned treating serious mental illness in favor of implementing social programs for the "worried-well" - less symptomatic people with bad grades, unhappy marriages or other loosely defined "behavioral" or "trauma" issues. ....
Only 4,000 individuals with serious mental illness have access to state hospitals, and only 1900 access to Kendra's Law. Some are in quality day programs like Fountain House.

OMH continues to provide taxpayer-funded services to 640,000 other New Yorkers. Instead of serious mental illnesses they are:

[O]nes that focus on the "developmental, physical, emotional, social, spiritual, educational and concrete daily living needs (e.g., housing) of children" and "provide hope filled, humanized environments and relationships in which people can grow.

As a result of OMH's abandonment of its medical duties for a social-services agenda:

According to Dr. E. Fuller Torrey of the Stanley Medical Research Institute, the most seriously mentally ill in New York are now 1.2 times more likely to be arrested than treated.

The suggestion laid out in the article is for incoming Governor-elect Andrew Cuomo to replace the current commissioner with one who believes in prioritizing services for the most seriously ill. Sending the seriously ill to the front of the line, rather than the back. In addition, I proposed a return to the days when it was required that the NYS OMH have an MD as a commissioner. This too would help return OMH to its medical roots.

There is something else Cuomo can do that was not discussed in the article. Eliminate the Office of Mental Health altogether and move whatever important functions it has to the Department of Health. NYC did this in 1999 as part of charter revision and it makes sense for the state to follow suit. NYS OMH has a $3 billion budget. Eliminating unimportant programs and moving the important ones to the Department of Health would go even further towards making serious mental illness a priority, improving care, saving money... and, not unimportantly, keeping the public safer.

Happy Holidays.