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Mental Health Home as Hospitals Without Walls: New York State's Mental Health System Reform

September 1, 2011
by Jack Carney, DSW
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It appears that “mental health homes” are the hot new items in the public mental health system. Nationwide.

The Affordable Care Act, Obama’s health care initiative, contains incentives for the tates to establish the homes and incorporate them into their treatment systems. The primary objective is to help States get more bang for their Medicaid buck by promoting “one-stop shopping” or an integrated health care approach, whereby individual agencies or teams will provide primary health care, dental care and mental health treatment to their enrolled patients. New York State, after negotiating sharp cutbacks in its Medicaid budget with its principal stakeholders—voluntary hospitals, 1199s, non-profit providers and consumers, has embraced the homes and intends to make them the centerpiece of its downsized mental health system.

The persons intended to be the primary beneficiaries of the new “homes” will be the persons with serious mental illnesses who are the State’s constitutional responsibility, who possibly have the greatest need for integrated health care and, up until now, have always encountered the most intractable barriers to health care access.

To be more specific, the persons targeted for the homes will be those the State has been concerned with since the dawn of deinstitutionalization: the so-called “heavy users” of services, the estimated 10 percent of all patients who account for 90 percent of system expenditures. These are the folks who are considered treatment resistant – they don’t particularly like being in treatment and don’t believe they benefit from it—and the folks who have the highest recidivism or re-hospitalization rates.

They are also the persons at greatest risk for homelessness, persons who usually have forensic histories, histories of physical and sexual abuse, or histories of past or current substance or intoxicant abuse. Finally, they are the persons most likely to have myriad psychiatric diagnoses, to take cocktails that combine multiple psychiatric medications, to suffer from metabolic diseases like diabetes or heart disease associated with those myriad psychiatric medications, and to be dead by age 55—again largely as a consequence of prescribed neuroleptics. Historically—witness Courtenay Harding’s Vermont Longitudinal Study—we know that the best way for people like these to survive the system is to leave it.

In any event, every ten years or so, the employees of the New York State Office of Mental Health develop an innovative program designed to promote the rehabilitation, recovery, and more recently, “wellness—of persons with serious mental illnesses. I was around and active in the system for most of these programs, but not for the newest, the mental health homes. (I retired in 2010 as the Director of FEGS’s NYC Case Management Programs.)

I was present for the first, Intensive Case Management, which, again, was aimed at the “heavy users” and was the first to embrace psychosocial rehab principles: client-centered, client-driven, rooted in client strengths in an a collaborative relationship.Data compiled by the State indicted that ICM helped but, since it didn’t adequately relieve families of their burden of care, ACT Teams were added to the scene in the mid-1990s and beyond. The clients targeted by ACT teams became those who were most treatment resistant. When neither ICM nor ACT could sufficiently protect the public from crazy and dangerous mental patients, AOT (assisted outpatient treatment) became law in 1999.

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Did you really write "protect the public from crazy and dangerous mental patients"? REALLY! I don't know where judgmental, discriminatory, blaming, stigmatizing language fits into this discussion but if this conversation focused on the black population and you used the "N" word the conversation would be over and you would be on the hot seat. Why is it okay to speak like this about an already oppressed population? Haven't you learned anything from the catholic sex scandals? or how about the Buffalo,NY "bike path killer" incident where a man diagnosed with schizophrenia did nearly 20 years in prison while the guilty murderer lived in a million dollar home in the suburbs raising his family. There are no judgmental, discriminatory, blaming, stigmatizing terms for this guilty party - why? because it is the million dollar home livers' that make the rules and according to their game they are the innocent do-good-ers - NOT. Pick up a newspaper expand your mind, improve your spiritual understanding to "age of enlightenment" level and start giving people of all walks of life an equal chance for a healthy life. Once you are able to share power - give others power not only usurp power for your self- including using respectful language that does not stigmatize a whole group of people for the actions of a small percentage never mind judges the reason for an action of an individual. Then, I could engage with you in discussion about your perceptions of New York State's Mental Health System Reforms.

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Jack Carney

Jack Carney

Jack Carney, DSW, is a practicing social worker with 42 years of experience in the field. He is...