Because of a planned transition that will soon be announced, this will likely be my last OMH News message as Commissioner. Working in the biggest, best (and most complicated!) state mental health agency in the country has been the pinnacle of a long career. Over the past five years, we have seen continuous challenges and made spectacular advances. I would like to reflect on several of these issues and the road that lies ahead.
OMH operated services: maintaining quality amidst many challenges. The quality of care provided through OMH Psychiatric Centers (adult, children, and forensic services) should be a source of pride for all New Yorkers. Despite continuing resource challenges and rapidly changing times, OMH inpatient services continue to meet requirements of The Joint Commission, and our accreditation scores continue to exceed private sector norms. In 2012, Central New York Psychiatric Center was also recognized as a “top performer” among accredited hospitals, with scores on performance measures exceeding 95%, an “A” by any measure. The substantial network of OMH provided community services—including clinics, case management, Assertive Community Treatment and housing programs—has continued to improve on efficiency, focus and productivity. Maintaining quality during tight budgets and continuous downsizing has been a remarkable achievement, and will remain a core commitment.
Continuous change lies ahead. We are currently entering a period that will see the most dramatic changes in health and mental health care since the state’s mental health system was formed. When the Utica State Asylum opened in 1843, there was no health care system. Health care for elderly and indigent people would not exist until Medicare and Medicaid were created in 1965. Until federal “parity” legislation was established and made real by the Affordable Care Act (“Obamacare”) this country had no national health program that clearly included mental health care. As the health system has grudgingly accepted responsibility for mental health care (and as alternatives to institutional care became established with the Supreme Court’s Olmstead decision) it was inevitable that OMH hospital care would be reduced. The merger of adult services at Mohawk Valley Psychiatric Center (the same hospital that began 170 years ago in Utica) with Hutchings Psychiatric Center this year shows the scope and reach of these changes, as does the merger of Hudson River Psychiatric Center (that provided inpatient care for 140 years) into Rockland Psychiatric Center. The challenge before OMH and New York State is whether the future integration of consumers into communities—and mental health responsibilities into health care—will go better than the prior attempt called deinstitutionalization. The quality and adaptability of care that OMH services provide and the strength of a united mental health advocacy community will do much to affect this.
Continuous change in community care. The scope and pace of change in community care has been just as dramatic. Community mental health in New York is changing from a separate and protected “cottage industry” emphasizing long term treatment, to diverse and dynamic environments emphasizing recovery and resilience, aligned with every conceivable kind of health care and community organization. From the 10-fold growth of PROS , to the new clinical and financing models provided under clinic restructuring, to the operation of more OMH supported housing and residential services for people with mental illness than the federal Department has developed through HUD's 202 and 811 programs nationally, the change has been remarkable. It is not slowing down, it is accelerating. With the challenge and opportunity to coordinate care through Behavioral Health Organizations and Special Needs Plans, New York can finally achieve the kind of coordination of care envisioned when the Empire State became the first in the country to pass community mental health legislation in 1954. There are remaining challenges that must be mastered. The mantra of “integration of care” is long overdue. It recognizes that care for mind and body must be delivered in synchrony. It will only be done well if the special passion and leadership of mental health experts and advocates remains aligned.
Three “R’s”: Recovery, Resilience and Research. My career in mental health began just after the publication of Judi Chamberlin’s landmark, “On Our Own”, in 1978. All of us who participated in the mental health system’s struggle—still incomplete—to place people at the center of their recovery and care, are lucky to have come of age and served during this time. New York has a strong foundation for recovery, with hundreds of peer specialists, dozens of consumer directed services, and the nation’s first statewide Employment Network for all people with disabilities, led by OMH. We have a strong family movement on behalf of young people, and youth advocates working in all OMH regions. Although powerful in spirit and mission, the youth, family and peer movements are still at the margins when it comes to funding and clout. Unless they play an increased role as the system evolves, much that is needed will not be achieved.
Although research advances do not yet provide immediate relief for many struggling with mental illness, research remains the best hope for fundamental relief in the future—for treatments that are more effective and less onerous, or even for cures. OMH is fortunate to have two exemplary Research Institutes, The NYS Psychiatric Institute and The Nathan Kline Institute, as OMH facilities. With their academic partners, Columbia University and New York University, and with the Research Foundation for Mental Hygiene, NYS has two of the nation’s “Top 10” mental health research programs. At a time when bioscience clearly has economic as well as health benefits, we must sustain these programs.
Thank you for your efforts in New York’s mental health system. It has been a pleasure and privilege to work with you. OMH will continue to have exemplary leadership in the times ahead, with the strongest team of any state mental health agency. Good luck and godspeed.