Earlier this week, Dr. Lloyd Sederer, the Medical Director of the New York State Office of Mental Health (OMH) made a startling revelation on Huffington Post about spending on the mentally ill in New York: "...$665 million ...was spent (in NYS), perhaps unnecessarily, on people with mental disorders."
That's an amount equal to 22% of the OMH budget. Advocates have known for years that most OMH resources are not being spent on the most severely ill, and that the ability to get care is frequently inversely related to need.
But even critics of the status quo did not know that much of the money spent by New York State on the seriously ill was wasted. OMH is either responsible or DOH is responsible. And the fact that both will inevitably blame the other points to the need to merge the departments.
In an op-ed in today's Albany Times-Union, I suggested that Governor Cuomo's government reorganization committee eliminate the New York State Office of Mental Health and subsume any important functions under the Department of Health. OMH is the elephant in the room, spending over $3 billion annually, and doing a poor job at it.
Unmitigated mission creep has largely caused OMH to abandon treating people with serious mental illness in favor of providing services for the worried-well. OMH serves 640,000 individuals but only has 1,800 in Assisted Outpatient Treatment and 3,600 in state hospitals, the two programs most likely to serve the most seriously ill. As a result of mission creep, more mentally ill New Yorkers are in jail than state hospitals.
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.
So in 1999, as part of charter revision, New Yorkers voted to eliminate the NYC Mental Health Department and have the Department of Health take on it's functions. It worked. Money was saved. Care for the seriously ill improved.
Consumers and the OMH commissioner frequently point out that 'health' is an important component of 'mental health'. The best way to see that both are taken care of is to put both under DOH. This would also help return mental health spending to it's original purpose: providing care for the most seriously mentally ill (as opposed to implementing social services and jobs programs for others).
There may be some opposition to this plan. Trade associations like the New York Association of Psychosocial Rehabilitation Services (NYAPRS) and those who provide mental health services to the worried-well argue for the integration of health and mental health, but may have gotten use to the flow of funds from Albany. I am not sure they will take to having the spigot more carefully guarded by merging the departments. Those that serve the seriously ill, like local hospitals, will cheer this new arrangement as more focused spending has proven to reduce recidivism.
As I wrote in the Albany Times Union,
Cuomo has the opportunity to save money, start to balance the budget, improve care for the seriously mentally ill and keep the public and patients 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.
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