Gov. Andrew Cuomo announced immediately after his inauguration plans to reduce New York’s $14 billion annual Medicaid expenditure. Many stakeholders in the State’s huge and disjointed mental health system – from government and non-profit agencies, consumers and peer advocates – are seeing this as an opportunity to change a system that, for all the money invested in it, produces too few benefits for too few people.
Over my long social work career, I came to believe that the only persons who recover from the effects of serious mental illnesses are those who leave the mental health system. I first joined that system and the community mental health movement over forty years ago as a community organizer for Maimonides Community Mental Health Center, based in a storefront in Sunset Park in west Brooklyn. Our work was rooted in a simple notion: if you helped the community and its residents empower themselves, their individual and collective mental health would improve. That experiment was under-funded and too short; and when our Federal funding ended after seven years, we retreated back into the hospital and became accountable to Medicaid and State and City regulations rather than the communities it had been our mission to serve.
Twenty years later, Richard Surles came up from Philadelphia to be State Commissioner of Mental Health and introduced the recovery model into the State. Its center piece was intensive case management, which was to be client-driven and rooted in the relationship between case manager and client; was to ensure that the State complied with its constitutional mandate to provide needed care to persons with serious metal illnesses; and, in the process, was to reduce State expenditures on emergency room visits and inpatient hospitalizations. In sum, the new recovery paradigm was to be an instrument of change, allowing the dismantling of the State’s psychiatric institutions and their replacement with community-based treatment.
Unfortunately, the savings realized when the State’s hospitals were closed went to balance the State’s budget rather than into community resources for the seriously mentally ill. It was only after a determined campaign by non-profit agencies and consumer advocates that the State legislature was persuaded to approve dedicated monies in several consecutive State budgets for increased community-based services. The late 1990’s saw a proliferation of consumer clubhouses, ACT teams and mental health housing. When the budgeted funds were spent, the State Office of Mental Health obtained Federal waivers to “Medicaid”, i.e., had designated as “medically necessary”, all these new services.