June 30, 2022 (Reprinted from NYAPRS ENews)
NYAPRS Note: Last week, NYS Attorney General Letitia James held a public hearing on New York’s mental health crisis and, in particular, the impact of the decline of both adult and youth inpatient psychiatric beds. The Attorney General’s objectives in this hearing were “to shed light on this crucial issue, explore potential areas of reform, and guide future investigations into allegations of inadequate mental health treatment….”
Over the course of the 4+ hour hearing, the Attorney General also explored and endorsed a broad array of community based approaches that were emphasized within presentations by government leaders and rights and recovery advocates, including NYC Commissioner of Health and Mental Hygiene Dr. Ashwin Vasan, Disability Rights New York’s Sabina Kahn and NYAPRS’ Harvey Rosenthal. See the excerpts below. You can listen to the entire hearing testimony at https://ag.ny.gov/livestream/public-hearing-access-mental-health-care-new-york.
Harvey Rosenthal CEO NY Association of Psychiatric Rehabilitation Services
….All public policies and services should be based on the fundamental belief that recovery should be the expectation for everyone, regardless of the extent of people’s current and past challenges. In doing so, we must ensure that people are afforded a full continuum of supports that runs the gamut of personalized outreach and engagement, crisis services, housing, peer to peer support, clubhouse and Medicaid funded psychiatric rehabilitation and treatment, emergency, inpatient and detox services.
…it is essential that we address the critical role that the social determinants of health play in promoting stability and community success, including the attainment of appropriate housing, financial stability related to employment and/or entitlements, culturally appropriate and responsive social relationships and support and appropriate access to transportation and food.
In doing so, we must address the root factors that typically precede addressing the symptoms and struggle people currently face: homelessness, poverty, hunger, health inequities and racial, gender and other forms of discrimination.
Recommendations:
…Our ultimate focus has to be on improving discharge planning and follow up with a full continuum of community services. It is critical to understand that our success will not lie in building more hospital beds but in ensuring access to a well-functioning community-based system of services and supports.
Every individual with a significant and repeat history of hospitalization should leave inpatient stays with a personalized peer bridger who stays involved with them for a period averaging 9 months, in keeping with the evidence based Critical Time Intervention model.
We must dramatically increase our investments in what is called ‘low threshold housing’, programs that provide immediate access to harm reduction-based Housing First and Safe Haven models.
We must dramatically accelerate our creation of a much more robust continuum of crisis services that features the use of the new 9-8-8 emergency hotline and follow along mobile crisis supports as needed. We must triple the number of newly planned crisis stabilization centers and, recognizing that these are only 24-hour interventions, create a continuum of step-down peer operated crisis supports, including 10-30 day respite and ‘living room’ programs.
We must make major investments in mental health alternative to police first responders. While we will continue to offer appropriate training to police officers, ultimately our success will lie in sending out the right people to defuse a crisis and divert an avoidable altercation, arrest or tragedy. This must include the launching of Correct Crisis Intervention Today which are peer and EMT led models based on the 30-year success of Oregon’s CAHOOTs model.
We must take racism head on and address our significant failure rates in engaging people of color as evidenced by the runaway rates of coercion and incarceration inflicted on these communities. This must include efforts to dramatically increase the number of agency administrator and direct care workforce who look and talk like the people they support.
We must invest in new models of support that voluntarily not coercively engage people ‘hard to serve’ individuals. Our focus should not be on blaming them for our difficulties in engaging and supporting them. Accordingly, we should see a great increase in successful programs like the INSET program in Westchester County, whereby persistent efforts by peer staff (people in recovery who serve their peers) have engaged 80% of a cohort with major histories that would have otherwise subjected them to coercive practices.
We should ensure the widespread use of psychiatric advance directives that can guide crisis care based on the preferences expressed by people when they are doing well that help them when they are not.
Finally, we must continue to make huge investments in a linguistically and culturally competent workforce and the agencies in which they work.