How To Defend Your Children'S Mental Health Care In New York State

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Testimony of Barbara Rock, Chair

OMH Labor Management Committee and Statewide Nurse's Committee The New York State Public Employees

Federation To The

Assembly Committee on Mental Health and Developmental Disabilities

Public Hearing on

"Children's Mental Health Services in Western New York"

May 29, 2015

Chairwoman Gunther, Assemblywoman Peoples-Stokes, members of the Assembly, good morning. My name is Barbara Rock and I am the Chair of the OMH Labor

Management Committee and the Statewide Nurse's Committee of the Public Employees Federation representing 54,000 professional, scientific and technical services

employees statewide.

Thank you for inviting PEF to participate in today's very important hearing to examine the current state of New York State’s mental health care services for children, in particular those needing these vital mental health services in Buffalo.

I want to thank you, on behalf of my members at the Office of Mental Health, for your continued leadership in trying to ensure that the Executive does not relinquish

responsibility for providing mental health services to the citizens of our great State. Your efforts to safeguard mental health services funding by requiring that any reduction in inpatient services capacity is reinvested in community mental health services is appreciated. We at PEF are in full support of providing mental health services that New Yorkers need in the setting that is most beneficial to them; however, we know that inpatient services are needed and we know that the promise that inpatient services can


professionals we represent have not been embraced as partners in developing new and innovative approaches to inpatient services. I wish I could sit here today and tell you that OMH has been able to put in place outpatient services that effectively replace inpatient services for those that need inpatient services, but it is simply not true. We also know that while the State has again put on hold their plan to close facilities

because of the backlash of opposition, including yours and ours, they are instead slowly moving to justify closing facilities by eliminating inpatient beds. This cannot be ignored! We are here today to talk about the mental health services that are available to children in Buffalo and where those services should be provided. The State has decided that they should be provided in one facility where both adults and children can receive State provided OMH services and that the location for children's OMH inpatient services should be moved from West Seneca to the city of Buffalo. This, in fact, is the issue before us today. PEF has asked many questions about the plan to move inpatient services for children throughout the State. The most important questions have yet to be answered. Will the services be improved? Will the services be reduced or eliminated? We need those answers. We have heard the fear that parents, patients and care givers have about the State's plan.

And for the record, we at PEF have been fierce advocates for the services we provide and for the New York citizens that need these services – that are entitled to these services. Since Governor Cuomo announced the planned closures of facilities in OMH, OPWDD and DOCCS in the summer of 2013, we at PEF have been clear:

• We oppose reductions in vital state services to vulnerable New Yorkers – please

be clear – this means that services are easily and readily available where people need them

• We oppose privatization of state provided services as it removes the

responsibility of the State to ensure the availability and quality of services

• We oppose the reduction of qualified state staff who are professionally trained to

provide services and who are bound by the public officers law to ensure those services are provided

• We oppose loss of state-operated services, shifting the economic responsibility

to already economically distressed communities throughout New York State and further removing the State from their responsibility to their most vulnerable citizens

• And, of course we wanted an assurance that there would be continuity of

employment of PEF members with no geographic hardship – we need a


qualified professionals want to enter State service in the communities where they live

We at PEF, along with our community partners, have rallied to Save Our Services all over New York State: in our communities, publically at the Today Show and also at the New York State Legislative Office Building with our Brothers and Sisters from other unions and our community and faith based partners. We delivered thousands of petitions to the Governor in support of all of our workers and public facilities. We advertised on television and radio and launched "Red-Shirt Friday" at OMH,

OPWDD, OCFS, OASAS, DOCCS and SUNY Downstate Medical Center workplaces. I reiterate our messages here again today:

That housing and residential programs need to be operated by the State and staffed by professional State employees to ensure high quality care and the best outcomes possible.

Regional Centers for Excellence as rolled out in the summer of 2013 would have deprived access to quality mental health services, placed patients and children far away from their families and created even longer waiting lists for necessary mental health services.

For example, we know that of the population of children receiving services at Sagamore Children's Psychiatric OMH facility on Long Island, 58% of the current census hails from Suffolk County - - 96% of those children's families visit them at Sagamore. Given that Sagamore provides family based therapy, asking parents to travel as much as 7 hours round trip for a session is unreasonable and


President Kent, PEF leaders and members have spoken out at public hearings, as you know Assemblywoman Gunther, and around the state at every opportunity telling Legislators the State must not relinquish its responsibility to provide public services to New Yorkers and that we oppose any diminishment of the quality of services our members provide.

The alliances between PEF and state legislators like Assembly members Gunther and Peoples-Stokes resulted in last year's crucial "side letter" and laid the groundwork for the statewide side letter in this year's budget covering six OMH facilities – 4 of them, Elmira Psychiatric Center, Greater Binghamton Health Center, Richard H. Hutchings Psychiatric Center and St. Lawrence Psychiatric Center treat both children and adults; two of them, Sagamore Children's Psychiatric Center and Western New York Children's Psychiatric Center treat only children.


To ensure that we are included in decision making as important stakeholders in this process, we will continue to reach out to the Commissioner of OMH, legislative chairs of the Mental Health Committees and DOB to make clear that the voices of our members must be heard when plans on how to provide mental health services are being


Mental health care in New York State and around the nation is in crisis. As President Kent has testified repeatedly, there are now more than 10 times as many seriously mentally ill individuals in our jails and prisons than in inpatient psychiatric facilities in the United States. How disgraceful.

In fact, nearly 40% of adults with severe mental illness such as schizophrenia or bipolar disorder received no treatment in the previous year, according to the 2012 National Survey on Drug Use and Health. Among adults with any mental illness, 60% were untreated. And when it comes to children, just 20% of children with mental illness receive treatment in any given year.

Earlier this month, a psychologist made national news because of her assignment to serve as executive director of the second largest jail in the country in the City of Chicago. Her position was created because there are so many inmates in jail with mental illness. Sadly, her story is reflected all over the nation, because when states de-institutionalized psychiatric hospitals it resulted in mass incarceration of the mentally ill. And now we need psychologists to working in our jails instead of our hospitals.

Yet, instead of working to address these huge gaps in care and service to those with mental illness, the Governor and his administration are working feverishly to close inpatient psychiatric hospital beds, push people with mental illness out into the community and rush ahead with a policy not ready for prime time.

And in this case, today's hearing, we are talking about children. Children's Mental Health Services

Children's mental health care services, including access to inpatient psychiatric beds, has never been needed more in New York State and across the country. Recent studies show that children are being diagnosed with mental illnesses more and more. While most of these children can and should be treated in the community by skilled mental health care providers, the need for inpatient psychiatric beds for children must be readily available as well. It is unconscionable to think our children, in their most

vulnerable state, would be relegated to a general hospital emergency room with little if any trained mental health care providers for days or weeks at a time only to be released into the community without adequate support services because of the lack of inpatient psychiatric beds.


Unfortunately, according to the CDC, while there is an increase in mental illness

diagnosis, one recent report found that up to half never receive any treatment at all. The need is there, but the services are not.

According to the Centers for Disease Control and Prevention, up to 20 percent of children in the United States suffer from a mental disorder, and the number of kids diagnosed with one has been rising for more than a decade. Childhood mental illnesses cost the nation an estimated $247 billion per year in medical bills, special education and juvenile justice services. Some studies found that many as 75% to 85% of children and youth in need of mental health care services do not receive treatment.

Children with mental disorders often have trouble learning in school, making friends, and building relationships later in life. They are more likely to have other chronic health problems, such as asthma and diabetes, and are at risk for developing mental illnesses as adults.

Poor children are at a higher risk for developing certain conditions, according to the CDC. Latino children are least likely to receive treatment and care for mental illness than children of other ethnic groups.

Boys were found more likely to have most of the listed disorders except for depression and alcohol abuse, which affect more girls.

And today, children are coping with more societal problems that can contribute to

mental illness from bullying to self-harm and increased stress and anxiety. Coupled with a more demanding educational system and constant social media pressures, kids today are suffering from more and more episodes of self-harm and instances of anxiety. The study also noted that suicide, which can be precipitated by an untreated mental illness, was the second leading cause of death (after accidents) among children 12 to 17 years old and the third leading cause of death among children ages 15-24.

The numbers are humbling. The bottom line is our most vulnerable and disadvantaged children in the greatest need are simply falling through the cracks.

As we begin to address childhood mental illness, some factors remain constant. Multiple studies show that families play a key role in a child's mental health treatment. Children need to have access to treatment and the involvement of their families is crucial. Closing facilities, merging hospitals creates unnecessary barriers to access and complicates family involvement in a child's treatment. When the State considered closing Sagamore on Long Island, the plan called for children to be located in an adult facility in Queens, creating a huge hardship on the families and their children receiving top-notch mental health care services at Sagamore. This is an extreme example, but one that will come to be a reality if the State doesn't commit to ensuring OMH services


in the communities where people need them. We fought against this bad idea and won. We intend to win here in Western New York too.

It is critical that we have available to our children all options, including inpatient beds, to provide the necessary mental health care services to our most vulnerable children. When family members are actively involved, according to the National Alliance on Mental Illness, mental health care outcomes can be dramatically improved. Coordinated care, family involvement and trained mental health professionals are essential to successfully treating our children. We cannot stand by and watch

diminished care, growing shortage of qualified mental health care provider in the face of a growing numbers of children with mental illnesses and in the face of significant

shortages of mental health providers.

Truly, we have only started to address this crisis. Reducing the number of inpatient psychiatric bed will make matters much worse for our children.

Shortage of Mental Health Providers

While more and more children are being diagnosed with mental illnesses, there exists a significant shortage of trained, professional mental health providers, including providers with specific expertise in adolescent mental health. In fact, according to OMH, nearly one-third of counties designated as mental health shortages areas are located in the Western and Central regions of New York State. In Western New York, 15 of 19 counties are designated as having a shortage of mental health care providers. With 15% of the State's population, Western New York State region is home to just 11% of the mental health care workforce.

Recruiting and training psychiatrists, especially upstate, has been extraordinarily difficult. The State has worked to address this issue for example, by increasing the salary grade from a grade 35 to a grade 38.

These professionals in our public institutions are experienced, experts in their field and employee retention is strong thanks to a professional and stable work environment and the benefits that we at PEF fight to provide our members. However, burnout and job turnover in private sector mental health providers is much higher.

Community Mental Health Care

The problem confronting our mental health care system is not the so-called "high costs" of psychiatric beds. We cannot expect good outcomes if we simply shift our inpatient care to the community without absolute assurances that our patients will receive quality care from trained and experienced providers.

Our concern all along is that too many times in the past, promises to shift savings from closing facilities to the community have been broken. When that happens, the outcomes are devastating. The problem with community services is the money never really


follows. While we recognize the commitment by New York State to require $110,000 per bed to follow into the community we also believe the real costs of providing community services is far higher.

Additionally, the ongoing scandal and bankruptcy of Federation Employment &

Guidance Service (FEGS) a nonprofit health and human services organization that held millions of dollars in state and city contracts coupled with last week's release of an audit by Comptroller DiNapoli of a mental health nonprofit provider from long island, calls into question the effectiveness and accountability of community providers. To be fair, these are just two bad examples of many, many providers; however, FEGS was a major provider of services to nonprofits and with the expansion of community providers it is incumbent on the state to ensure that these businesses are not undermining care because CEO’s are profiting from the contracts at the expense of mental health care workers. We are very concerned that the move to “less costly” community care will lead to more costly outcomes like FEGS.

Furthermore, shifting to community-based providers is not going smoothly in many places around the state as neighborhood groups resist the siting of community based providers, group homes and supportive housing for the mentally ill. Lack of public support will continue to delay expansion of community-based mental health care providers and programs.

Managed Care

Managed care premise is to prevent and manage chronic health care conditions. This includes working hard to prevent unnecessary hospitalizations and emergency room visits. While the goal of DSRIP of reducing "unnecessary" hospital admissions by 25% is laudable, reducing beds and closing public hospitals is not the way to go about it. People with mental illness who are denied needed inpatient care do not just go away. Nevertheless, there is still a need for hospitals and inpatient health care. When it comes to mental illness, few hospitals have the resources or expertise in this area and public hospitals have been vital in being there for people in crisis. It is not only the fact that beds be available – it is also necessary that the best trained workforce be available. That is not common in a high-turnover non-profit organization that offers a demanding job, few benefits, little if any job security and no guarantee of fair wages. Managed care organizations prefer low-cost reimbursement obviously than – of course it costs less. As we shift to managed care, we suggest New York State consider what Iowa did recently in response to the Governor of Iowa's “transformation” of its Medicaid program. Iowa capped profits for managed care contractors, created a commission to oversee the transition to managed care, banned finding savings by cutting provider fees, and



Children in Buffalo need mental health services that are professional quality services and easily accessible. They need their families involved and that means services provided where their families live! They need a setting that allows them the best possible opportunity to overcome the traumas that impede their child development and growth into adulthood. Please work with PEF as we seek to ensure that New York State does not relinquish responsibility for these most vulnerable children. Work with us to ensure that inpatient psychiatric facilities, where the most skilled, educated and

trained mental health care professionals work, continue to be available and accessible to those that need them most! Please remember that inpatient beds will be needed while we improve and expand community based services.

Our members are the best prepared to care for our most vulnerable children in New York State. These are the professionals we need to look to in our efforts to "transition" mental health care in New York State. We will continue to press management to answer our questions about configurations and transition moving forward.

PEF employees are invested in their communities and possess the clinical expertise that provides an important piece of the safety net for New York’s most vulnerable citizens. Please help us to protect them, support what they do and provide them the necessary resources so that they can continue working hard every day to protect the public and provide mental health care for those in need.




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