Dear Andrew:
Your "Action Plan" rightfully bemoans the "ever proliferating tangle of boards, commissions, councils, departments, divisions, offices, task forces and public authorities" in NYS and then goes on to propose a new commission to study eliminating some, saving money, and improving services.
You don't need a commission. Here's what you do:
Eliminate the New York State Office of Mental Health (OMH). Elimination of OMH will help solve the state's deficit problem, and simultaneously improve care for the seriously mentally ill.
It's not as farfetched as it sounds. On November 2, 1999 residents of NYC voted to eliminate the former New York City Department of Mental Health, Mental Retardation, and Alcoholism Services and merge its mental health component into a combined Department of Health and Mental Hygiene (sic). The result has been cost savings for government, better medical based care for the most seriously mentally ill, and safer streets for everyone.
The major problem at OMH today is identical to that of the NYC department in the 1990s: unbridled mission creep. As a result, the ability to get medical treatment from OMH has become inversely related to need. Instead of providing medical services to those with the most serious mental illnesses--those living on the streets, eating out of garbage pails, and screaming at voices only they can hear--OMH is spending a large share of its $3 billion on helping the worried-well worry less.
OMH currently 'serves' 650,000 residents with a variety of talk, grade-improving, job-finding, 'holisitic' "therapies." But they only serve 5,400 (.08%) in the two programs that serve the most seriously mentally ill: hospitalization and Assisted Outpatient Treatment (AOT, commonly known as "Kendra's Law").
Hospital beds are needed when individuals with the most serious illnesses like schizophrenia decompensate and need to re-establish, often with medications, contact with reality. In those cases hospitals can provide 'asylum' in the best, most positive sense of the word. A refuge. In 1999, OMH had about 6,000 hospital beds available for the seriously mentally. Today, they've cut that to less than half. They're locking the front doors and opening the back, and ignoring what happens. You are now 1.2 times more likely to be incarcerated for mental illness in New York than hospitalized. That is a direct result of OMH's refusal to treat the most seriously ill.
Assisted Outpatient Treatment (AOT) is another program for those with serious mental illness and another medical program OMH wants to see go away. Commonly known as "Kendra's Law" it was enacted over OMH objections and allows courts to order the most severely ill--those who have a past history of violence or recidivism--to take medicines as a condition for living in the community. A key component of the law is that it not only commits the patient to accept treatment, it commits the mental health system to provide it. Serving the seriously ill is not a responsibility they want. Kendra's Law has dramatically cut rates of hospitalization, incarceration, arrest, homeless, violence, and suicide among the seriously mentally ill.
OMH proposed legislation to bring Kendra's Law to an end in 2015. In the interim, they gave money the legislature allocated for AOT to counties that have no AOT program. Of the over 8,000 individuals who courts found were either dangerous or needed AOT to survive safely in the community since 1999, there are only 1900 (22%) in the program today. What happened to the others?
In OMH Commissioner Michael Hogan's budget testimony, he himself stated, "While mental health care in the general medical sector is more convenient and less stigmatizing, it is not always available and does not always work." But neither is care in the mental health sector. So Andrew, why not eliminate that sector?
Recipients of OMH's largesse are not likely to tell you the benefits of eliminating their sugar daddy. They don't want to be forced to focus their efforts on the psychotic. But the truth is eliminating the New York State Office of Mental Health could be the best thing to happen to the seriously mentally ill in New York.
Since it is not likely to happen until after you are elected, if at all, the legislature ought to make Kendra's Law permanent, improve it, and declare a moratorium on closing state psychiatric beds. Doing so will force OMH to concentrate their $3 billion where the public wants it: helping the seriously mentally ill.
Sincerely yours,
DJ Jaffe
Advocate for people with SERIOUS mental illness
Go here to tell your NYS Legislator you want them to make Kendra's Law Permanent http://www.change.org/petitions/view/help_the_mentally_ill_in_new_york_make_kendras_law_permanent#