$126 Million More?Package Linked to Delay in Deinstitutionalization
NEW YORK CITYVOICES: November/December 1999
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By David Kellogg
Governor Pataki announced in November a proposal to add $126 million to community mental health services for children and adults. More than half of the $80 million earmarked for adult services will be used to expand case management and Assertive Community Treatment (ACT) teams, with the balance funding supported housing and transitional residences at state psychiatric centers in New York City.
The proposal comes at a time that the state has been under increasing criticism for a failure to provide adequate community services. Gaps in the mental health service system have been linked to several high-profile incidents of violence involving persons with psychiatric histories. A recent draft report from the State Commission on the Quality of Care for the Mentally Disabled, sited a lack of proper case management and supervised housing as contributing to the failure to provide adequate care to Andrew Goldstein, who is charged in the death of Kendra Webdale.
The Governor's package calls for several specific service enhancements critical to the success of the recently enacted involuntary outpatient commitment law known as "Kendra's Law":
An additional $10 million will be used to expand the capacity of the state Office of Mental Health to oversee the quality and appropriateness of community care. OMH will increase its field monitoring staff and use of information technology for this purpose.
- Case management and Assertive Community Treatment (ACT) teams to monitor and coordinate care to promote access to and compliance with treatment -- increase the number of persons served from 15,600 to 25,000 ($52 million);
- Supported housing -- 2,000 new units ($20 million, with two-thirds state funding); and
- Transitional residences at all five state psychiatric centers located in New York City for individuals who temporarily need extra support and supervision ($8 million).
Funding for children's mental health services will be increased by $36 million, with significant expansion in several programs:
The Governor's initiative also calls for a one-year delay in further closing of psychiatric center beds under the policy of deinstitutionalization, suspending efforts to reduce the number of inpatients from the current level of approximately 6,000 to 3,700. The delay will allow for a re-assessment of the need for long-term inpatient beds.
- Home and Community Based Waiver program to serve children at-home who would otherwise be placed in institutions -- increase the number of slots for 248 to the full federal allotment of 600 ($14 million)
- Case management services -- more than double the number of children served from 1,950 to 4,530 ($13 million)
- Family Based Treatment program serving children and adolescents placed with specially training surrogate families -- expand opportunities from 365 to 490 ($5 million)
- Family Support Services including home care, respite, transportation, education/support groups, and advocacy training to expand the number of families served from 4,000 to 5,200 ($2.6 million)
- Mobile Mental Health Teams serving juvenile offenders in facilities operated by the state Office of Children and Family Services and expand pilot program to serve another five facilities.
The delay in psychiatric center bed closure calls into question the future of the Community Mental Health Reinvestment Act of 1993, which has been an important source of funds for the expansion of community services. Peer services, in particular, have relied on Reinvestment funds.
Under Reinvestment, nearly half of the $62,500 saved with each bed closure is allocated to funding community services. It is uncertain whether any Reinvestment money will now be made available in 2000 (Reinvestment Year 6), despite the approval of $14.7 million in the state budget for fiscal year 1999-2000. Year 6 funding was based on the assumption that 470 beds would be closed in 2000.
While advocates were generally receptive to the Governor's proposal, in light of several years of cuts in mental health funding, several issues of concern remain to be addressed. Absent from the package is more funding for 24-hour supervised housing, which is considered by some to be critical for the recovery of many seriously ill individuals. Administration officials are apparently hoping that the new housing units will open up much of the existing 24-hour supervised housing for new occupants.
Also missing from the Governor's proposal was an answer to the concerns over the previous cut of funding for 146 state shared-staff positions critical to community services in several counties. Neither did the proposal provide encouragement to not-for-profit providers who have been struggling for years to gain a living wage for direct care workers and to have state reimbursement rates that cover the actual cost of programs.
One barrier to the implementation of the Governor's proposal may be the so-called "Medicaid neutrality" rule, under which counties must exchange or turn-in slots in current Medicaid-funded programs in order to receive state funding for slots in new Medicaid-funded programs -- or pay both the state and county share of Medicaid costs.
The administration has yet to clarify its plan for handling Medicaid neutrality under the new proposal.
Advocates also emphasize that the proposal, while a step in the right direction, falls significantly short of the need in certain areas. With 2,000 new community beds proposed, and 2,800 in "the pipeline," the total of 25,800 statewide will still leave a gap of 10,000 to 15,000 beds -- according to previous OMH estimates.
(David Kellogg is Director of Public Policy for the Mental Health Association in New York State and Legislative Analyst for New York City Voices.)
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