Summary of Recommendations to Improve Mental Health Services in New York
The 1954 Community Mental Health Services Act proposed a bold agenda to create a comprehensive system of community-based care to replace the disgraced state-run psychiatric hospitals. In the ensuing decades, however, the goals of this landmark legislation failed to be realized and by the mid-1970s, with the full impact of deinstitutionalization on display for all to see, there were widespread calls for reform. (An in-depth history of New York’s mental health system can be found in Mental Health In New York State 1945-1998 | An Historical Overview)
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The list below highlights some of the most prominent efforts to define the core problems with the state’s mental health system and offer recommendations to correct the shortcomings that prevented people from securing services that were both effective and desirable.
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Note that many of these recommendations highlight the need for a coordinated planning process that includes peers and providers, that there needs to be measurable goals, and that the state and local communities should collaborate closely to fund programs that meet community needs.
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Finally, we don’t need another commission or study to analyze the problem and offer solutions. Instead, we need to reform the planning process [Jennifer – link here to The Solution section] by including peers and providers in the local planning process, establishing clear goals and a timeline for meeting these goals, and a sustainable funding mechanism that allows providers to hire and retain high-quality staff.
Past Reports
1976: Mental Health in New York, NYS Assembly Ways and Means and Mental Hygiene Committees
Key Findings: No process to develop and evaluate measurable goals, no statewide system of services, and programs that contradict and conflict with State or local priorities
Key Recommendations: Consumer and citizen involvement must take place at all levels of the system, and in every phase of operation. Clients should actively participate in establishing goals, planning, decision-making and evaluation of the system at the State and local levels
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1978: From the Back Wards to the Back Alley, NYS Assembly, Mental Health Subcommittee on Community Aftercare
Key Findings: Fragmented and unclear responsibility for services and lack of well-coordinated support between State and local agencies
Key Recommendations: Add at least four mental hygiene advocates to the health planning commission and improve OMH’s inter-agency coordination with federal and county service agencies, as well as with other state agencies.
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1980: Single Room Occupancy Hotels: A dead-end in the human services delivery system, NYS Senate Mental Hygiene and Addiction Control Committee
Key Findings: No follow up care, former patients are being victimized, and SROs without supports are a burden on communities.
Key Recommendations: A special agreement should be developed between city and state officials to ensure a continuity of services for discharged patients; establish a 24/7 hotline number for discharged patients, and; establish a continuum of aftercare facilities with specific goals for the number and types of facilities and a timetable for implementation.
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1984: The Governor's Select Commission on The Future of The State-Local Mental Health System, Jerome M. Goldsmith, Ed.D. Chairman
Key Findings: Extensive fragmentation of priorities and goals, planning/management, funding, accountability, and service systems.
Key Recommendations: Create a statewide uniform planning format/framework to be used as a base for the development of long-range plans, provide 100 percent state funding of services for all homeless mentally ill persons, simplify funding, and establish an independent review panel to address barriers and evaluate the implementation of these reforms.
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2002: Broken Promises, Broken Dreams: A Report on the Status of the Mental Health Delivery System in New York State, NYS Assembly Standing Committee on Mental Health, Mental Retardation and Developmental Disabilities
Key Findings: Disjointed, top-down planning process that is inefficient and wasteful, and systemic failures to ensure that individuals are provided stable housing and support services following discharge from the hospital.
Key Recommendations: Strengthening planning to ensure a community directed system based on individual needs, create short and long-term responses to the housing crisis, and simplify funding--including the use of blended rates.
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2005: An Evaluation of the Delivery of Mental Hygiene Services in New York State, Mental Hygiene Task Force of the NYS Assembly Standing Committee on MH, MR and DD
Key Findings: No single entity accountable for services coordination and integration, the system is fragmented, services not person-centered or culturally and linguistically competent, and inflexible funding streams.
Key Recommendations: Planning needs to be data-and outcome driven, planning and service delivery must incorporate consumers, families, and providers, need to provide financial incentives for integrated care for behavioral health and primary care, and expand training to integrate peers into the workforce.
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2008: New York State/New York City Mental Health Criminal Justice Panel, Michael Hogan, NYS OMH and Linda Gibbs NYC Deputy Mayor for Health and Human Services
Key Findings: Poor coordination, fragmented oversight and lack of accountability for service delivery; insufficient training and supports to identify and engage justice-involved individuals with mental illnesses; and limited capacity to share information between the mental health and criminal and juvenile justice systems
Key Recommendations: Create a data sharing program to identify individuals with serious mental illnesses who have become involved in the justice system, establish Mental Health Care Monitoring Teams for of high-need individuals, implement family care coordinators for justice-involved youth, pilot aa alternative-to-detention program, and create a dedicated mental health unit at the NYC Department of Probation.
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2012: Improving Outcomes for People with Mental Illnesses Involved with New York City’s Criminal Court and Correction Systems, Council of State Governments Justice Center
Key Findings: People with mental illnesses dad consistently longer lengths of stay, were less likely to make bail, and experienced delays in case processing
Key Recommendations: Provide pretrial, plea, and sentencing options that allow people with mental health needs to reenter the community while maintaining public safety and establish centralized hubs to coordinate and communicate assessment information and community-based supervision and treatment.
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2020: Our Homeless Crisis - The Case for Change, New York City Council
Key Findings: Racism and poverty are barriers to accessing care,
Key Recommendations: Ensure individuals who are experiencing homelessness and providers are meaningfully engaged in decision making regarding system transformation, conduct data-focused evaluations of program outcomes in order to determine the most effective strategies, and expand a housing navigation program for homeless individuals discharged from city hospitals.
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