Addressing the fundamentals
By Peter Beitchman

As discussed in recent columns, the past year has seen some of the most important initiatives in the public mental health system since the dawn of deinstitutionalization more than 40 years ago. At the state level, the Office of Mental Health (OMH) launched a major effort to prod and shape the system based on the empirical findings of the best practices literature. With a new emphasis on hope and recovery, OMH has clearly refined its mission to promote quality services for persons with serious mental illness that will provide opportunities to achieve maximal independence and productivity in the community. An emphasis on quality and best practices such as supportive family psychoeducation (a crucial NAMI priority) and supported employment will result in a system that, above all else, places the highest value on consumers who are pursuing independent living goals, with the necessary support of families and a revitalized network of treatment and rehabilitation services.

At the city level, change is also very much in the air. On July 1st, the newly combined Department of Health and Mental Hygiene (DOHMH) was officially launched. With the appointment of Dr. Lloyd Sederer (a nationally recognized, highly experienced mental health professional) as Executive Deputy Commissioner for Mental Hygiene, the Bloomberg administration is clearly signaling its intention to give mental health services the highest priority.

Equally important, the newly revamped department led by Dr. Thomas Frieden offers a broadened public health perspective, which can prove highly advantageous to the mental health community. Whether we’re thinking about the mental health consequences of September 11th, the continuing quest for mental health parity in health insurance, or how the overall public health system can support and serve persons with serious mental illness, a revitalized public health perspective offers the possibility for NAMI-NYC Metro to spearhead some exciting new initiatives.

The city has also moved to implement performance standards in its funded programs. This initiative, which will focus funding and program development decisions on the outcomes that programs achieve, is an important complement to the state initiative on best practices.

In the midst of these very positive state and city developments, however, the funding problems within the publicly funded community mental health system have reached a critical condition. The basic funding that supports clinical, residential and vocational rehabilitation services at the community level remained frozen again this year. With the last significant increases occurring more than a decade ago, it is not surprising that the network of services is actually shrinking as community agencies are forced to tighten their belts by closing or reducing programs. In addition, staff turnover in community mental health programs has reached an all-time high, as increases in fixed costs like rent and insurance eat up a lion’s share of the funding dollars, forcing agencies to reduce staff and depress salaries.

Given this grim picture in community mental health programs, it was a great relief when Governor George Pataki and the State Legislature—under the leadership of Assembly Speaker Sheldon Silver and Majority Leader Joseph L. Bruno—agreed to the significant funding increases that community agencies, NAMI and the entire advocacy community have been advocating for over the past several years. Since the increases in both contract funding and Medicaid reimbursement rates are scheduled to take effect in December, and with the state and city's fiscal problems worsening on a weekly basis, the board remains concerned about whether the increases will be fully implemented. We will, of course, monitor this situation carefully.

At the end of the legislative session, the state Mental Health Reinvestment program, through which so many innovative and vitally important programs have been developed over the past few years, lapsed when its legislative authority ended. And, while reinvestment-funded programs created in previous years would continue, no new programs would be developed. A last-minute legislative initiative, still awaiting Governor Pataki's signature, would continue the reinvestment program under a new form, providing enhanced funding for the recruitment and retention of staff in community mental health programs.

Clearly, both the funding increases approved by the legislature and Governor but not yet implemented, as well as the pending reestablishment of reinvestment funding, are crucial to the continuation and revitalization of community mental health programs. As such, they are essential complements to the state and city initiatives to promote and assure quality services. The NAMI board will continue to monitor events and to advocate for adequate support of the core community mental health service system.

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