Mental Health Newstm

MENTAL HEALTH NEWS TM YOUR TRUSTED SOURCE OF INFORMATION, EDUCATION, ADVOCACY AND RESOURCES SPRING 2008 FROM THE LOCAL, STATE, AND NATIONAL NEWS SCENE VOL. 10 NO. 2 Housing for People with Mental Illness Governor Eliot Spitzer Proposes Historic Housing Initiative

Vision to Build Supportive Housing Praised by Mental Health Community

Office of The Governor “Good homes are the key to making a New York State community livable. For over 100 years, New York led the nation with a progres- sive, visionary housing policy that helped overnor Eliot Spitzer today to ensure that people had housing they visited the Rheingold Houses could afford,” said Governor Spitzer. “In in Bushwick, Brooklyn, to recent years, that vision has dimmed. In G highlight steps his administra- too many parts of our State, our children tion is taking to increase affordable and cannot afford to come back to the supportive housing throughout New York. neighborhoods that they grew up in, and Housing advocates, developers, commu- their parents cannot afford to stay in the nity and business leaders applauded the homes where they raised their families. I Governor’s historic $400 million Housing will propose the biggest housing initiative Opportunity Fund, which was announced in a generation, a $400 million Housing during the State of the State address last Opportunity Fund. This fund will build week. The proposal is part of a $1.5 bil- homes for the men and women who teach lion infrastructure and economic develop- our kids and police our streets. This fund ment plan to enhance economic growth will also build supportive housing that and opportunity across the state, and part enables persons with disabilities and others of Governor Spitzer’s plan to ensure New with special needs to live independently.” York is the best place to live, work, raise a family and run a business. see Governor Spitzer on page 42 Mental Health Housing Waiting List Legislation Mental Health Housing in New York State: Introduced in the New York State Senate An Interview with OMH Commissioner Mike Hogan

Office of NYS Senator Staff Writer Thomas P. Morahan Mental Health News

ew York State Senator Tho- How important is housing for mas P. Morahan (R-C-I-WF, someone recovering from New City), Chairman of the mental illness? Safe, decent N Senate Committee on Mental Q and affordable housing is a cor- Health and Developmental Disabilities nerstone of recovery from mental illness, today reintroduced legislation (S 568) as well as a mainstay of "the American establishing a waiting list for people with Dream." Stable access to good housing is mental illnesses seeking community a fundamental problem for many people housing and support services. with mental illness because of their pov- “Matching an individual's needs erty, the limited supply of very-low- with suitable housing and services in income housing, the rising cost of rental the most integrated setting is very im- market housing and discrimination. portant and needed. This bill is a powerful first step in identifying current Q. How do you respond to those who and future needs for mental health say that we need more mental health housing in New York State. The legis- housing? New York and the nation face lation would help to bring the state in a crisis in affordable housing. Many fac- line with the Americans with Disabili- tors contribute to this problem, including ties Act,” said Senator Morahan. Thomas P. Morahan the federal government’s abdication of a Michael F. Hogan In 2007 the legislation passed the Sen- low-income housing development role ate and Assembly, but was vetoed by as the needs of those with serious mental and distress in the housing finance mar- area and on Long Island) is the epicenter Governor Spitzer. “I anticipate that the illnesses, he will concur that the time has ketplace. With the highest proportion of of a national mental health housing crisis. merits of this legislation will result in indeed come for this legislation to be- renter-occupied housing among the states, Governor Spitzer’s proposal to establish passage in both houses of the legislature. come law,” said Morahan. very high housing prices, and large num- a $400 million Housing Opportunity Fund And I am also confident, that when the bers of poor people with a disability, New Governor reviews the facts, data, as well see Senator Morahan on page 41 York State (especially in the Metro NYC see Commissioner Hogan on page 25

NON PROFIT Mental Health News Education, Inc. ORGANIZATION 16 Cascade Drive U.S. POSTAGE PAID Effort, PA 18330 WHITE PLAINS, NY PERMIT NO. 153 PAGE 2 MENTAL HEALTH NEWS ~ SPRING 2008 Table of Contents

The Publisher’s Desk Columns

3 From the Publisher: Reflections on Supportive Housing 6 The Mental Health Lawyer: The Padavan Law

7 Point of View: Housing for Older Adults with SMI Mental Health NewsDesk 8 The NYSPA Report: Electronic Medical Records 4 Home of Your Own Mortgages at OMRDD and OMH 9 The Economics of Recovery: Solution for The Homeless 4 Congress Passes Gun Law: Remains Stigmatizing

4 Britney Spears: Let’s Talk About All of Us Other Articles of Interest 5 Governor Spitzer Signs Prisoner Legislation 11 Agency Coalition Receives Grant to Address Health Crisis 5 Abilify Gets FDA Approval for Multiple Uses 21 Using Psychoeducation With Adolescents Housing For People with Mental Illness 27 Achieving Positive Outcomes

1 Governor Spitzer Proposes Historic Housing Initiative 27 The Mental Health Needs of Iraq-era Veterans 1 Senator Morahan Introduces Housing Legislation 28 Headlines that Perpetuate Stigma 1 Housing in NYS: An Interview with Commissioner Hogan 36 Mental Health News: Health and Wellness Forum 11 Guiding Principles for the Redesign of Housing Policies 37 Mental Health News Campaign Raises Vital Funds 12 Making a House a Home, Making Recovery a Value 13 Innovation in Housing: Three Model Programs 13 City Awards New Housing Contracts Upcoming Theme and Deadline Calendar

14 Residences for People Living with Mental Illness Summer 2008 Issue: “Employment for People With Mental Illness” 16 Housing Is Where Recovery Happens Deadline: May 1, 2008

18 Home at Fountain House Fall 2008 Issue: “The Interrelationship Between Physical & Mental Health” 18 Blending Housing and Mental Health Services Deadline: August 1, 2008 30 Transformations: Made Possible by Supportive Housing Winter 2009 Issue: “Understanding & Treating Posttraumatic Stress Disorder” 32 In-Home Mental Health Care: A Holistic Approach Deadline: November 1, 2008 35 A Home of Their Own Spring 2009 Issue: “Follow-up Care After Hospitalization” 35 Community-Based Family Care for Adults Deadline: February 1, 2009

Mental Health News TM Board of Directors

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Note: all articles sent to the publisher must be e-mailed. Members of the Board of Directors Group photo credits always view from left to right. Peter D. Beitchman, DSW, Executive Director Leo Leiderman, PsyD, Director, Latino Treatment Services Phone us at (570) 629-5960 or E-mail us at [email protected] The Bridge Saint Vincent Catholic Medical Center

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In My Room: Reflections on The Lifeline of Supportive Housing

By Ira H. Minot, LMSW For these reasons, studies show that sup- Providing housing must be the corner- Founder and Executive Director portive housing often increases property stone of a comprehensive mental health Mental Health News Education, Inc. values. Because supportive housing is recovery system. New York State cur- designed to meet tenants’ needs, the peo- rently has about 30,000 units of suppor- ple who live there thrive. Dozens of stud- tive and licensed housing. The NYS Cam- was 12 years old when I first heard ies attest to the positive impacts of this paign for Mental Health Housing continues a beautiful song by the Beach Boys form of housing stating that residents stay to call for preserving and reforming existing called “In my Room”. The year was housed, get healthy and reconnect to the units, and developing 35,000 new units of 1963. It was the year President John community. mental health housing statewide over the F.I Kennedy was assassinated in Dallas next ten years. This plan must succeed. and when 200,000 people marched on My Personal Experience My experience in receiving supportive Washington in support of civil rights and housing so quickly was the exception, not heard Dr. Martin Luther King deliver his For me, supportive housing was a life the norm. It was well known by consum- “I Have a Dream” speech. It was also the saving safety net that was there to catch ers in my community (at that time) that year AT&T premiered touch-tone tele- me when I became so disabled by my there was a 3-5 year waiting list to get an phones, the post office introduced zip illness that I was no longer able to care for apartment. There was an equally long and codes, and the sedative Valium was made myself. Before my illness I had been a frustrating application process to simply available to the public. productive member of the community. I get put on the list. Many people waited This issue of Mental Health News is had a professional career and had always and ended up being hospitalized over and devoted to housing for people with mental worked hard to be a good father and pro- over again. We can’t let people fall illness. Let’s talk about supportive hous- vider to my family. Becoming ill with through the cracks within our community ing. Supportive housing provides people depression was the last thing I would have care system. This is not good treatment, it with a safe and stable living environment. Ira H. Minot, LMSW thought could stop me cold in my tracks, is not cost effective, and strains already It’s a key factor in enabling consumers to but it did. After 10 years of failing to beat burdened community resources. better receive the psychiatric treatment it on my own, my illness had left me Perhaps the severity of my last hospi- and rehabilitation programs designed to lives. Supportive housing is the single homeless, destitute, and alone. talization was the reason why I was given, aid in their recovery process. most effective, and most cost-efficient, Unable to go on, I was admitted to a a chance, and it gave me an opportunity to In my late thirties, I became ill with a way to reduce homelessness. It strength- psychiatric hospital. It all seemed so fa- reflect on my years of trying to get well. I serious form of depression. I would spent ens communities and helps integrate peo- miliar. I had three prior visits at different realized that there was still one other im- the next 10 years of my life trying to re- ple with disabilities and other special hospitals during my illness. After review- portant thing missing from our system of cover. I would not have made it without needs into the life of their neighborhoods. ing my case, the doctors gave me the so- care besides treatment and housing. Out- supportive housing. I will tell you the bering facts that since I had been unre- side of the few hours a week I was seeing details shortly. First, imagine my memo- More Cost Effective sponsive to traditional medication treat- my doctor and attending outpatient pro- ries of that time. I am in my room in my ments that I would be sent to a state hos- grams, nobody was reaching out to me supportive housing apartment. As in the The SHNNY reports that supportive pital if this attempt failed. during my many hours at home in my song, it’s a room where I could go and housing is significantly less expensive Perhaps it was chance or fate, but this room. Because of that, I had the vision to feel safe and secure, even though the rav- than the institutional alternatives that hospitalization proved to be the one that create Mental Health News. I knew that ages of my depression were working to homeless and disabled people often cycle would finally help me get back on the people with mental illness would benefit tear my world apart. through (including shelters, institutions road to recovery and reclaim my life from receiving a publication containing I dusted off my record player and and hospitals). It ends recipients’ depend- again. I was offered and accepted a three information, resources and ongoing mes- played that Beach Boys song. The melody ence on emergency services for healthcare week course of ECT (Electro Convulsive sages of hope—so vitally important when and the harmonious lyrics harkened happy and treatment. Therapy) treatments. Perhaps a barbaric you are feeling lost and alone. and innocent thoughts of my teenage A 2004 study by The Lewin Group treatment to some, for me it was the Three years ago, I was able to say years in the 1960’s; trepid thoughts of highlighted these cost savings with the magic bullet that broke the chains of my goodbye to my supportive housing apart- growing into adulthood in the 1970’s; sad following data: unresponsive depression. Realizing the ment. Hardly a day goes by that I don’t thoughts of falling ill to depression in the serious nature of my illness and the need think about how supportive housing saved late 1980’s; and rising out of the ashes of Cost Per-day, Per-person for a prolonged and stable post-hospital my life and enabled me to learn so many a shattered existence to begin life anew in In New York City (2004) recovery, the hospital’s social service priceless lessons during my recovery. the 1990’s. team qualified me for vital Social Security I want to thank everyone who helped As I sit here listening to the song I Supportive Housing: $ 42 Disability (SSD) and arranged for me to me create this wonderful housing issue of again I realize I would not have survived, Homeless Shelters: 55 be visited (while still in the hospital) by a Mental Health News. I believe consumers, had it not been for a lifeline that was Prison: 74 local supportive housing organization in parents, treatment professionals, provider thrown to me during my illness—a life- Jail: 165 the community. agencies, and legislators at all levels will line called supportive housing. I know Psychiatric Hospital: 467 Through the caring efforts of my sup- gain a great deal of information within there are people right now reading this General Hospital: 1185 portive housing coordinator I was able to these pages. There still isn’t enough hous- that are struggling with mental illness. If be discharged from the hospital to a small ing for people with mental illness. We you are fortunate to live in supportive Benefits to Communities apartment of my own. It was a place must continue to advocate for more hous- housing, you may feel as I did. Even where I could have the dignity of being ing in every community. when it was dark and I was alone, my SHNNY adds that supportive housing somewhat independent while maintaining Thank you for your continued support room was a place where I could go where has additional benefits because it blends the safety and supervised support of my and participation. We will continue to do I wouldn’t be so afraid. seamlessly into neighborhoods. Because coordinator as I continued in outpatient our part in giving the topic of housing the providers often build on blighted blocks programs and care in the community. recognition it deserves, and spotlight the What is Supportive Housing? or rehabilitate unsightly buildings, sup- issues and the many people who are work- portive housing often paves the way for The Bottom Line ing to make things better. I encourage you According to The Supportive Housing neighborhood renewal. Because it pro- to be a part of our vital mission. We love Network of New York (SHNNY), suppor- vides services to tenants and often fea- If you don’t have a place to live, it’s hearing from you and hope you will con- tive housing is permanent, affordable tures front-desk security, supportive hous- almost impossible to be in a position to tinue to contact us at our E-mail address: housing that is linked to services. It pro- ing often leads to improved community have a successful recovery. All the best [email protected] □ vides low-income, disabled and formerly safety and lower crime rates. Supportive efforts at direct mental health treatment homeless people with the help and support housing is run by locally based nonprofits may be for naught if consumers do not Good luck in your own recovery they need to stay housed and live more inde- that must be accountable and responsive have a stable and supportive environment and NEVER give up trying. pendent, healthy and fulfilling to their communities to stay in operation. in which to get better. Have a Wonderful Spring Season !! PAGE 4 MENTAL HEALTH NEWS ~ SPRING 2008

MENTAL HEALTH NEWSDESK

Parents Eligible for OMRDD and OMH “Home of Your Own” Mortgages

NYS Office of Mental Retardation “I am pleased to offer this pioneering now their parents—to SONYMA after and Developmental Disabilities opportunity to parents of people with de- they complete a homebuyer counseling velopmental disabilities who want to program. To be eligible, applicants must achieve the American dream—home own- be first-time homebuyers and have in- arents of individuals with develop- ership,” said Diana Jones Ritter, OMRDD comes of no more than 80 percent of the mental disabilities, mental retarda- Commissioner. “This is wonderful oppor- area median income in the region where tion or mental illness can now ap- tunity to advance the Governor’s housing they live. There is also a limit on the pur- ply for mortgages under the Home agenda and work cooperatively with the chase price, which varies by location. Pof Your Own (HOYO) Program, which is State of New York Mortgage Agency and The program offers a very low 4 percent financed by the State of New York Mort- the Office of Mental Health. Expanding fixed interest rate on mortgages of 30 or 40 gage Agency (SONYMA). the Home of Your Own program will help years, 100 percent financing and reduced The Home of Your Own Program— us put people with developmental disabili- closing costs. Closing cost assistance is also run jointly by SONYMA, the NYS Office ties on the path to greater independence.” available from SONYMA. The program is of Mental Retardation and Development “Recovery from mental illness without offered exclusively through M&T Bank, Disabilities (OMRDD) and the NYS Of- stable, decent and affordable housing is which has agreed to forgo or reduce some of fice of Mental Health (OMH)—helps peo- almost impossible," said Mike Hogan, its normal closing costs. ple with developmental disabilities or Ph.D., Commissioner of OMH. "The The program is available for homes, mental illness purchase homes with Home of Your Own program has already condos, co-ops and double-wide mobile SONYMA mortgages issued at very fa- been a great housing and recovery re- homes permanently affixed to real prop- vorable terms. source for people with a mental illness. erty. Accessibility improvements are Enabling parents to apply for SONYMA We know that many individuals with funded by OMRDD or OMH as needed. mortgages will ease the financial burdens on mental illness live with family, and this Since the program was introduced in families and improve their ability to provide Diana Jones Ritter expansion of the Home of Your Own pro- 1996, 189 households have used $13.2 for the needs of their children. gram will assist even more New Yorkers million to finance their homes. “We are delighted to be able to extend President and Chief Executive Officer of when it comes to financing a home.” For more information on how to apply for our SONYMA mortgages to parents cop- SONYMA. “The Home of Your Own The Home of Your Own Program of- the Home of Your Own Program, contact ing with serving the needs of their chil- Program is very important for our special fers very favorable mortgage terms for Lucinda Grant-Griffin, director of the HOYO dren with developmental disabilities or needs population and we’re glad to be eligible applicants. Under the program, program at OMRDD, at (518) 473-1973 or mental illness,” said Priscilla Almodovar, able to make it more widely available.” OMRDD and OMH refer applicants—and contact OMH at (518) 474-5191. □

Congress Passes Gun Law: Britney Spears: Retains Vague, Stigmatizing Language Let's Talk About All of Us

The National Alliance names to the NICS system and that some The National Alliance illness, which many ordinary Americans on Mental Illness (NAMI) of these states do not have adequate sys- on Mental Illness (NAMI) confront every year. NAMI believes it is tems in place to comply with reporting important that such discussions in our requirements. HR 2640 is intended to Statement of Michael J. Fitzpatrick homes, offices, schools, and stores, as ust before adjourning for the holi- strengthen reporting by providing states Executive Director well as in the media, be based on facts. days, the U.S. Senate passed a bill, with resources to develop reporting systems National Alliance on Mental Illness What is needed—for anyone—is un- the NICS Improvement Amend- and by penalizing states that continue to fail derstanding and support. We encourage J ments Act of 2007 (HR 2640), to to report names to the NICS system. everyone to focus not on Britney Spears, provide incentives to states to report the n recent weeks, a media circus and but on all the ordinary people in our own names of certain people with mental ill- What does HR 2640 require? reckless speculation has surrounded communities who deserve our attention. nesses who are prohibited from purchas- events in the life of pop singer Brit- Getting well can be a difficult process. ing guns. The House passed the bill sev- The new law authorizes grants to ney Spears and her family. It takes time. It may involve relapses. eral months ago and President Bush is states to create or improve systems for I Professional ethics require that mental Involuntary treatment may be necessary expected to sign it into law. reporting the names of individuals who health professionals who have not exam- in some instances, but only as a last resort, are prohibited from possessing or pur- ined or treated individuals not presume to and over time, a person’s insight often re- Background chasing firearms, including people who diagnose them. A person’s treatment and turns and treatment becomes voluntary. are involuntarily committed to psychiatric recovery from any illness also is entitled There should be no stigma for a person Since 1968, federal law has prohibited hospitals, people found by a court of law to privacy—which in fact may be an im- being hospitalized or treated for mental certain categories of people, including to lack capacity to contract or manage portant factor in recovery. illness, voluntary or otherwise. Treatment persons “adjudicated as mental defec- their own affairs, and people who are In the case of Britney Spears, profes- represents medical intervention for a life- tives” from owning or purchasing found not competent to stand trial or not sional ethics also are involved which the threatening medical condition. Treatment guns. In 1998, the National Instant guilty by reason of insanity. The bill pro- media must confront. Roy Peter Clark, also works. Criminal Background Check System vides financial incentives to states to create vice-president of the Poynter Institute, a Doctors and families often respond to (NICS) was established as a way to in- reporting systems, and penalizes them (by leading center of journalism training and other kinds of medical emergencies, such stantly provide gun shop owners with the withholding federal money) if they fail to ethics, recently wrote. “There is clearly a as brain seizures or diabetic shock. Being names of those prohibited from purchas- comply. danger zone, when life and health are at admitted to a hospital under any circum- ing firearms. The NICS system is main- HR 2640 addresses some but not all of stake, when the best thing the press can stance should never be a cause for stigma. tained by the FBI. NAMI’s concerns. The version of HR do is back off. That time for Spears is To guide public discussion, NAMI In the aftermath of the Virginia Tech 2640 passed this week by the Senate contains probably now." offers four resources, as well as a general shootings earlier this year, it was revealed At the same time, the case is an oppor- invitation to browse our Web site: that many states have not been reporting see Gun Law on page 16 tunity for public discussion about mental www.nami.org. □ MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 5

MENTAL HEALTH NEWSDESK

Governor Spitzer Signs Legislation To Enhance The Care And Treatment Of Prisoners With Serious Mental Illness

Office of the Governor from harm. It strikes an appropriate bal- Committee, said: “This legislation im- New York State ance between safety and security concerns proves the way the state of New York and the needs of inmates with serious treats inmates who are afflicted with seri- mental illness.” ous mental illnesses. It advances treatment overnor Eliot Spitzer today Lieutenant Governor David A. Pater- over punishment and better prepares correc- announced the signing of son said: “This groundbreaking legislation tion officers who interact with such inmates, legislation that will enhance demonstrates New York’s leadership in thereby enhancing safety of not only in- G the care and treatment of ensuring that the mental health needs of mates and staff but of the public as well.” prisoners with serious mental illness by prisoners are addressed. It will ensure that Inmates with serious mental illness limiting the instances in which these all inmates, including those with serious who are diverted or removed from segre- inmates can be placed in segregated mental illness, receive appropriate treat- gated confinement will be housed in resi- confinement. ment while in prison - enhancing their dential mental health treatment units that The legislation formalizes the admini- ability to make a successful transition into are jointly operated by the Department of stration’s commitment to removing pris- communities once they’re released.” Correctional Services and the Office of oners with serious mental illness from Senator Michael F. Nozzolio, Chair- Mental Health. In these units, inmates will what are commonly known as “special man of the Senate Crime Victims, Crime receive out-of-cell therapeutic program- housing units” – where inmates who have and Corrections Committee, said: “This ming and mental health treatment. A for- committed disciplinary infractions are historic agreement is the result of years of mal review process involving the input of segregated from the rest of the prison hard work. I commend Governor Spitzer mental health clinicians will decrease the population. The legislation would also im- for his efforts in ensuring this legislation likelihood that inmates will cycle back into plement a more sensitive approach to the would be signed into New York State law. segregated confinement. A number of these treatment of prisoners with psychiatric dis- The New York State Senate has led the new mental health treatment beds already orders while meeting prison safety and secu- fight to enhance support for our correction exist and many more are in development. rity standards. Governor Eliot Spitzer officers and staff and I am extremely The new legislation authorizes the Those inmates with serious mental pleased that our prisons will now be more Commission on Quality of Care and Ad- illness who are not removed from segre- “This is historic legislation that dem- humane and safer for both inmates and the vocacy for Persons with Disabilities to gated confinement will be offered a onstrates New York’s commitment to brave men and women who work there. monitor the quality of mental health care heightened level of care, including addi- providing mental health treatment for The Senate remains committed to ensuring provided to inmates and make recommen- tional out-of-cell treatment and program- inmates with serious psychiatric disor- that New York State continues to promote dations about necessary improvements. ming. Mental health clinicians will also ders,” said Governor Spitzer. “The legis- and advance initiatives that make our State The legislation Governor Spitzer an- conduct periodic mental health assess- lation also recognizes the need to provide prison system the best in the country.” nounced today builds on the State's ongo- ments of all inmates who remain in segre- a safe and secure prison environment Assembly member Jeffrion L. Aubry, ing efforts to enhance treatment and pro- gated confinement. where inmates and staff will be protected Chairman of the Assembly Corrections gramming for mentally ill inmates. □

Abilify Approved for Adolescent Patients with Schizophrenia and First Medication for Add-on Treatment of Major Depressive Disorder

Staff Writer placebocontrolled study that demonstrated ABILIFY® (aripiprazole) in pediatric sufficient relief for their symptoms with Mental Health News significant improvement with ABILIFY patients, 13-17 years old, with a pri- antidepressants alone,” said Madhukar compared to placebo on the primary effi- mary diagnosis of schizophrenia. The Trivedi, M.D., Professor and Chief- tsuka Pharmaceutical Co., Ltd. cacy endpoint, Positive and Negative Syn- study, sponsored by Otsuka Pharmaceu- Division of Mood Disorders, University and Bristol-Myers Squibb drome Scale (PANSS) Total Score. tical Co., Ltd. and its U.S. subsidiary, of Texas Southwestern Medical School, Company (NYSE: BMY) an- “We are extremely pleased that Otsuka Pharmaceutical Development & Dallas, Texas. “Now physicians have a O nounced today that the U.S. ABILIFY, the first available dopamine Commercialization, Inc. (Princeton, proven new option they can add to their Food and Drug Administration (FDA) partial agonist, is approved for the treat- N.J.), was conducted at 101 centers in13 patients’ antidepressant treatments to help approved the supplemental New Drug ment of pediatric patients (13 to 17 years countries and enrolled 302 ethnically them feel better and relieve unresolved Application for the atypical antipsychotic of age) suffering from schizophrenia,” diverse pediatric patients. depressive symptoms.” ABILIFY® (aripiprazole) for the treat- said Tatsuo Higuchi, President and Repre- The approval is based on results from ment of schizophrenia in adolescents aged sentative Director, Otsuka Pharmaceutical ABILIFY Used With Another two six-week, double-blind, randomized, 13-17 years. In adolescents, ABILIFY Co., Ltd. “ABILIFY offers an effective Antidepressant Can Help Adults Living placebocontrolled, multicenter studies treats positive and negative symptoms of new option to help treat this serious With Depression Who Have Failed to (n=743). The results from both studies schizophrenia. The FDA first approved mental illness.” Achieve Adequate Symptom Relief demonstrated significant improvement in ABILIFY for the treatment of schizophre- “Schizophrenia is one of the most depressive symptoms in adult patients nia in adults on November 15, 2002. complex of all mental health disorders,” The U.S. Food and Drug Administra- with a primary diagnosis of major depres- “Until now, FDA-approved treatment said Elliott Sigal, M.D., Ph.D., Executive tion (FDA) approved the supplemental sive disorder who had experienced an options for adolescent patients with schizo- Vice President, Chief Scientific Officer and New Drug Application for ABILIFY® inadequate response to monotherapy with phrenia were limited,” said Robert Findling, President, Research and Development, Bris- (aripiprazole) as adjunctive, or add-on, one or more ADTs in the current episode M.D., Director of Child and Adolescent tol-Myers Squibb. “We remain committed treatment to antidepressant therapy (ADT) and then added ABILIFY to their treat- Psychiatry, University Hospitals Case Medi- to providing innovative therapies, such as in adults with major depressive disorder ment regimens. cal Center, Cleveland, Ohio. “The approval ABILIFY, to help patients, including ado- (MDD). ABILIFY is the first medication “We are committed to helping those of this new indication for ABILIFY pro- lescents, living with schizophrenia.” approved by the FDA as add-on treatment who suffer from depression, one of the vides an additional effective treatment op- The findings are from a six-week, for MDD. leading causes of disability in the United tion for these patients.” double-blind, randomized, placebo- “The approval of this new add-on States and worldwide,” said Elliott Sigal, This approval is based on results from controlled, multi-center study that treatment option is critical for adults suf- a six-week, randomized, double-blind, evaluated the efficacy and safety of fering from depression who cannot find see Abilify Approved on page 14 PAGE 6 MENTAL HEALTH NEWS ~ SPRING 2008

THE MENTAL HEALTH LAWYER

The Padavan Law and Group Home Placement

By Eric Broutman, Esq. Concerns with the Padavan Law Housing Amendments Act (“FHAA”) of and Douglas K. Stern, Esq. 1988. The FHAA extended the protec- While on its face the Padavan Law tions of the 1968 Fair Housing Act, which would appear to do nothing but good for eliminated housing on the basis of sex, he term, Not in My Back Yard, the mentally ill and those wishing to erect race or religion, to the physically and familiarized by the acronym housing on their behalf, there is some mentally disabled. This includes barring NIMBY, held true with particu- ambivalence. Clearly, there is some con- land-use regulations and special use per- lar force in the 1970’s with re- cern over the Padavan Law’s allowance mits, which leads to de-facto discrimina- Tgard to group homes for the mentally ill in tion. From a legal perspective, the ques- for a community to conduct a public hear- New York. Towns, villages, and cities, ing in order to discuss the pros and cons tion then becomes, does the Padavan Law often with misplaced and misinformed of the opening of a group home. Which conflict with the FHAA? In reviewing fears about the effect the mentally ill will of us would appreciate our future similar laws in other states some courts have on their neighborhoods successfully neighbors and colleagues gathering at a have concluded that they do and some barred group homes from their communi- public meeting and debating whether or have concluded that they do not. No Court ties. This goal was achieved mainly not they want us to move into their com- has yet to rule on a direct challenge to the through zoning restrictions that limited munity? Padavan Law in New York. the number of non-related people that live Secondly, the process that the Padavan Apart from the legal question is a under the same roof. Law dictates takes a substantial amount of question of practicality. For 30 years the In 1978, recognizing the need for an time. If a community wishes to challenge Padavan Law has guided the opening of integrated placement of the mentally ill in OMH’s determination in court, that proc- group homes for the mentally ill. And community settings, the legislature ess has taken upwards of three years to while there has been difficulty with the law passed, N.Y. Mental Hygiene Law conclude. In that time, those whom the as described above, the procedures and prac- §41.34, colloquially called the Padavan facilities would be a home to are either tices are well known to providers of hous- Law. The law derived its name from State left homeless or in much more restrictive ing for the mentally ill. Moreover, the Senator, Frank Padavan, who shepparded Douglas K. Stern, Esq. facilities, like a psychiatric hospital. Padavan Law has established firm legal the law’s passage through the legislature. Some have argued that the Padavan rights and housing for the mentally ill has In essence, the Padavan Law exempts Law, and similar laws in other parts of the flourished during its tenure. The question qualifying group homes from zoning days to accept this site or reject it. Where country, are in fact unconstitutional be- is despite its problems is doing away with laws, thereby eliminating the main barrier a disagreement persists between the facil- cause they conflict with the federal Fair the law riskier than it is worth? □ communities erected to their opening. The ity and the municipality over the suitabil-

Padavan Law, however, does place re- ity of an alternate site, OMH will inter- quirements upon the proprietors of group vene and render a decision on the appro- homes before they can open their doors to priateness of the municipality’s alternate residents with a mental illness. Munici- site suggestion. palities were still legally empowered to When the municipality chooses the Carolyn Reinach Wolf, Esq. object to the opening of a facility because third option, and objects to the facility Douglas K. Stern, Esq. of an over-concentration of facilities in outright, OMH will conduct a hearing the area. within 15 days to determine if the proof posed facility will in fact create such an The Padavan Law over-concentration of facilities that it ABRAMS, FENSTERMAN, FENSTERMAN, EISMAN, would alter the nature and character of the GREENBERG, FORMATO & EINIGER, LLP The law applies to facilities that pro- area. The law also allows for judicial re- vide a residence to four to fourteen men- view of any decision by OMH. Attorneys at Law tally ill people that provide on-site supervision, and is operated by, or subject to The Padavan Law in Practice are

licensure by the New York State Office of Mental Health (“OMH”). The law defines Since the Padavan Law’s inception, some Devoted to the Practice of Mental Health Law these facilities as community residential communities have continued to challenge facilities. The law further directs any or- the opening of group homes for the mentally The Firm represents more than twenty major medical centers, ganization wishing to open a community ill. Accordingly, these communities have as well as community hospitals, nursing homes and outpatient clinics, residential facility to provide written no- attempted to use the law itself to further in the New York metropolitan area in the field of mental health litigation, tice of the location and activities of the their NIMBY goals as opposed to challeng- consultation, advocacy, and related disciplines. facility to the chief executive officer of ing the validity of the Padavan law. There the municipality where the facility will be has been a great deal of litigation where In addition, our team of attorneys, with more than forty years combined located. Within 40 days of receiving no- communities have opposed the facility in- experience, offers legal representation to families and individuals affected tice, the municipality has one of three voking the Padavan’s Law’s over- options: (1) approve the site; (2) suggest concentration language. However, no com- by mental illness. We provide a broad range of legal services and counsel on at least one alternative site within the mu- munity has ever successfully challenged an such matters as: mental health case management and continuity of care; nicipalities jurisdiction that is suitable to OMH determination that a facility should discharge planning; Assisted Outpatient Treatment (Kendra’s Law); accommodate the proposed facility; or (3) open because it will not fundamentally alter Mental Health Warrants; Hospital Treatment over Objection and object to the establishment of the facility the nature and character of an area. Com- Retentions; Patients’ Rights and Guardianships. on the basis that, when taking into ac- munities have argued that opening facilities count other like facilities in the area, there will effect such disparate concerns as over- Our firm regularly contributes to a number of publications concerned with will be such an over concentration of fa- loading the septic system, increasing traffic, Mental Health and related Health Care issues and participates in seminars cilities that the nature and character of the eroding of the tax base and fears of residents and presentations to professional organizations and community groups. area would become substantially altered. over what they perceived to be the unsavory Prior to issuing its response the munici- nature of the proposed residents. Yet, Courts pality may hold a public hearing to debate have concluded that these concerns are not 220 E. 42nd Street - Suite 505 1111 Marcus Avenue - Suite 107 the pros and cons of the facility in its valid and the only consideration is whether neighborhood. or not an over-concentration of facilities will New York, New York 10017 Lake Success, New York 11042 If the municipality recommends an result from the opening of the proposed (212) 279-9200 (516) 829-3838 alternate site, the facility has up to 15 facility. MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 7 POINTPOINT OFOF VIEVIEWW

Housing for Older Adults with Serious Mental Illness

By Michael B. Friedman, LMSW for residences for older adults. and Kimberly A Steinhagen, LMSW Suicide prevention: Housing providers have the frequent opportunity to observe changes in mood among residents. Being t’s great news that the Governor’s sensitive to those changes and screening for Budget Request contains a major depression could help identify suicidal risk. affordable housing initiative, some Permanent housing with onsite super- of which will be set aside for people vision: In the mental health system, the withI disabilities, and that it contains a most extensively supervised residential proposal for 2000 new units of housing programs are designed to be transitional. specifically for people with serious mental The expectation is that people are making illness. This is such an important ad- their way from hospitalization to inde- vance in housing policy in NYS that we pendent living. This expectation often don’t want to add a “but” to it. But, in does not make sense for older adults with fact we are very concerned about an over-abundance of problems. There whether these housing initiatives will be needs to be supervised congregate care in beneficial to older adults with serious small homelike settings where older mental illnesses. adults can remain for the rest of their Why? Because many aging people lives—remain, that is, in the places that with serious mental illness will develop have become their homes and with people serious physical problems and will need who have become their families. to have housing that addresses their physi- End of life care: Permanence, of cal as well as their psychological needs if course, becomes particularly difficult for they are to be able to remain in the com- Michael B. Friedman, LMSW Kimberly A Steinhagen, LMSW people with terminal health conditions. munity rather than going to adult or nurs- Most housing programs are simply not ing homes. Of course, most community- must be addressed to help older adults providers to establish satellites in congre- prepared to provide the kind of health and based residential programs that serve peo- with serious mental illnesses to remain in gate housing programs. And they can do hospice care that many people need as ple with serious mental illness provide the community. People with long-term it by developing their own health centers, they approach the end of the lives. Many some supports for people with complex mental illnesses are at very high risk of centers that cater to people with mental of us who are not seriously mentally ill ex- problems, but very few are able to provide obesity, hypertension, diabetes, heart dis- disabilities. pect to rely on in-home hospice care at some adequate care for those with co-occurring, ease, pulmonary conditions, and commu- point. Why can’t people with serious men- serious physical and mental disorders. nicable diseases. (4) Housing providers should also intro- tal illness have the same expectation? The most recent study on their life duce medical care management into their Not just OMH funded programs: We What is needed? expectancy indicates that adults with seri- programs. Medical care management want to be clear that the principles of care ous mental illness die 25 or more years means that someone follows up with a we have outlined above are not meant to Accessibility for people with physical earlier than the general population, largely person who has diabetes, for example, to be applied only to housing provided or disabilities: The most obvious need is due to poor health and poor health care. make sure that he or she eats well, takes funded by the Office of Mental Health. housing that is accessible to people with Earlier studies put the difference at about their insulin, etc. Nurses are widely Older adults with serious mental illness physical disabilities. Not walkup apart- 10 years. Whichever, it is terrible to think viewed as the professionals most able to can be, and are, successfully housed in ments or upstairs bedrooms or doorways that people with serious mental illness do this work. But we believe that there “supportive housing” and senior hous- and hallways too narrow for wheelchairs will die substantially younger than the could be peer medical care managers who ing—if there are adequate supports. or walkers. general population because their health is could do much of the follow up—perhaps It goes without saying that the service Safety and accident prevention: Falls neglected. It has got to be the responsibil- more effectively than professionals. and support needs we have identified are are a major cause of avoidable disability ity of the mental health system to increase not easy to address outside the health sys- and mortality for older adults. Housing, life expectancy; and this has got to be a (5) Housing programs should work col- tem. The housing needs of older adults therefore, needs to be designed to prevent major goal of residential programs for this laboratively with home health providers to with both serious physical and mental both falls and injuries from falls. population. provide on-site services. They can even illnesses aren’t part of the basic expecta- Assistance with activities of daily liv- That entails five programmatic thrusts, help foster the development of, and train tions of what the mental health system ing: People with long-term psychiatric which are in fact as important for younger cadres of, home health providers to spe- does, nor are they part of the portfolio of disabilities who do not recover as they age adults with serious mental illness as for cialize in serving people with psychiatric the supportive or senior housing systems. (and some do) generally have reduced older adults. disabilities. That is why so many move to adult and cognitive functioning due to schizophre- nursing homes. But it is possible to help nia, severe depression, and the like. They (1) Housing programs should place an Adapting the concept of recovery to older adults with co-occurring health and are as susceptible to developing dementia emphasis on health promotion, with par- older adults: In principle, the concept of mental health disorders to remain in the as any other population and therefore ticular attention to smoking cessation, recovery in mental health calls for the community. We hope that some of the sometimes have double cognitive impair- exercise, and good nutrition. achievement of totally individualized new housing initiatives will be carried out ments, vastly reducing their self- goals in ways that permit a person with a with this in mind. management abilities. Of course, they (2) Housing providers need to be mental illness to experience his or her life could be sent to a nursing home, where equipped to manage multiple medications, as satisfying and meaningful. But in prac- Michael B. Friedman is the Director of ADL management is routine. But if there especially as people age and present with tice, recovery focuses heavily on work. the Center for Policy and Advocacy of were significant supports available in co-morbid chronic conditions. Some older adults, of course, want to The Mental Health Associations of NYC community-based housing—at home; in work and should be helped to do so. But and Westchester. He is also Chair of the complexes with private apartments; or in (3) Housing programs should take respon- some want to retire, and this should be a Geriatric Mental Health Alliance of New small, homelike community residences— sibility for assuring that their residents get legitimate path for older adults with mental York. Kimberly A. Steinhagen is Director many people with serious mental illnesses good health care. They can do that by illness. This means that some older adults of The Alliance. The opinions expressed in who go to adult or nursing homes could developing formal relationships with will want to spend more time at home than this column are their own and not necessar- live in settings that are more integrated health providers. They can do it by as- at a program. Most supervised residential ily the views of the MHAs. Mr. Friedman into the general community. siduously developing informal working programs cannot allow this because of regu- can be reached at [email protected]. Assistance with health problems: Poor relationships with local health providers. latory expectations and because they don’t Ms. Steinhagen can be reached at steinha- physical health is the core problem that They can do that by persuading health have enough staff. This should be changed [email protected]. □ PAGE 8 MENTAL HEALTH NEWS ~ SPRING 2008 The NYSPA Report

Electronic Medical Records

By Glenn Martin, MD stolen and misused for centuries. What will they understand that certain medica- Vice President the electronic world has done is to make it tions or laboratory results strongly imply New York State Psychiatric Association much easier to lose or steal vast quantities a given diagnosis, for example lithium of information at a single incident. A and bipolar disorder? Do patients think it misplaced laptop or portable thumb drive is a good idea to have their data used for or anyone with one or more that was not using proper data security research without their knowledge, even if chronic illnesses, or who cares software can lead to the loss of an aston- their identifying information were first for someone who does, the need ishing amount of data. A malicious indi- removed, if the research might be used to to coordinate medical informa- vidual with an IPod can use it as a data develop something they are opposed to? tionF from multiple sources is very chal- Consider the use of information that storage device and leave a business, office lenging. Be it the relatively simple task of or hospital with thousands upon thousands might promote the development of a bet- having one physician, hospital or clinic of records. ter form a birth control, or a medical eco- forward the record to another, or having a Exchanging information for a patients nomic research that might be used to jus- comprehensive list of allergies and medi- benefit is desirable but the control and tify limiting access to certain medications cations available to share with all pre- monitoring of that exchange can be very or type of care. scribers, or trying to maintain a compre- problematic. Should information be All of these issues are currently being hensive record to be used when visiting an shared automatically among those treating debated at the federal and state levels. emergency room, the logistics can be a patient, or should the patient have to New York State has already committed to daunting. To address these and other give consent to each individual physician funding exchanges and promoting elec- needs there has been an increasing move- to give or receive information? This may tronic health records and e-Prescribing, ment to promote the adoption of computer be ideal, but practically it may be such a before many of these questions have been technology and the internet to improve burden for individual practice to obtain fully explored or answered. It is vital for healthcare. The advances include elec- Glenn Martin, MD and track consent that the doctor may all of us to remain informed and to insist tronic medical records, e-prescribing, re- decide not to participate. Should the pa- that patients’ privacy, autonomy and dig- gional health information exchanges or Regional health Information Ex- tient be allowed to withhold certain infor- nity be respected as we move forward and community data repositories and personal changes (RHIOs) are planned to link care mation even if it leads to a potentially “electrify” the medical record. health records. While all of these have givers and support services in a commu- misleading and dangerous situation? For the potential of increasing safety, improv- nity. When implemented they should al- example, it may be reasonable to suppress Dr. Martin is Director of Medical In- ing outcomes and lowering costs, they low all the physicians involved in a pa- mental health or HIV/AIDS information, formatics for the Queens Health Network also come with risks. tients care to see all the lab and radiology but if a doctor prescribes a medication of New York City’s Health and Hospitals For those with chronic psychiatric con- results and medications ordered. Unneces- without realizing a patient is on antide- Corporation. He is also Associate Direc- ditions both the benefits and risks of these sary duplicate testing should be signifi- pressant or ant-retroviral there could be a tor of the Program for the Protection of electronic transformations may be even cantly reduced and medication mishaps potentially dangerous outcome. Even if a Human Subjects at the Mount Sinai more evident. Persons with serious men- caused by prescribing without access to a patient says “suppress the diagnoses, but School of Medicine, and has a private tal illness frequently take multiple medi- full list of active medications or medical share the medication and laboratory list” psychiatric practice. □ cations, have complicating medical condi- conditions will be vastly reduced. Refer- tions and over their lifetime have received rals between physicians could be made

care from a multitude of professionals at securely with pertinent information ex-

many different locations. And so, while changed. Emergency room physicians will those with mental illness stand to benefit have the record available for a potentially from these advances, because of discrimi- confused or unconscious patient being nation and stigmatization the risks from seen for the first time. Secure emailing New York State the potential misuse of the data or a loss from patients to their doctors is generally of confidentiality are also increased. supported. Many of these RHIOs will Psychiatric Association Electronic medical records allow doctors eventually include patient portals that will and health care facilities to maintain com- give patients direct access to the informa- prehensive legible organized records. It is tion. Public health reporting will be fa- rather easy to misfile a paper record or to cilitated and community health issues can Area II of the American Psychiatric Association inadvertently file a piece of paper (a referral be more closely monitored and improved. note, lab results, etc.) into the wrong chart. Just as a given medication can be life Representing 4500 Psychiatrists in New York An electronic record minimizes those prob- saving but come with significant risks of lems. Good software also incorporates adverse effects, so do the technologies “decision support” that provides clinical described. Nationally and internationally Advancing the Scientific advice at the point of care. A physician can the loss of personal private data, financial be alerted if a drug being prescribed might and medical, by theft, accident, careless- and Ethical Practice of Psychiatric Medicine interact with another drug already being ness or negligence is a growing problem. taken. Necessary laboratory studies can be In 2007 the Identity Theft Resource Cen- Advocating for Full Parity suggested at the appropriate time to properly ter reported that there were 448 data in the Treatment of Mental Illness monitor a condition. The latest practice breaches exposing over 128 million re- guidelines can be made readily available as cords. Medical and Health care data the physician is developing a treatment plan. breaches occurred 66 times with the expo- Advancing the Principle that all Persons E-Prescribing allows a prescriber to sure of almost 4 million records. In No- with Mental Illness Deserve an Evaluation transmit a prescription directly to a phar- vember the United Kingdom lost CD’s macy to be filled. The system that sup- containing information on 7.5 million with a Psychiatric Physician to Determine Appropriate ports this function will generally also pro- families receiving child health benefits. vides some checks for allergies, medica- The disks contained the name, address, Care and Treatment tion interactions, and improper dosing. date of birth, National Insurance number As the transmission is electronic the risks and, where relevant, bank details of 25 Please Visit Our Website At: of mistakes due to illegible handwriting, million people. spelling errors, etc. are minimized. Nei- There is nothing new about the loss of ther the patient nor the pharmacist gets a misuse of information. Paper based re- www.nyspsych.org paper prescription to misplace. cords have gone missing or have been MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 9 The Economics of Recovery: Cost Effective Solutions for The Homeless

By Donald M. Fitch, MS ter “gives backs” of about $700/year per glue or requiring a building permit (it’s Executive Director resident drawn from the fifty-thousand considered “temporary”) for about $1500 Center for Career Freedom dollars they receive, provides a sustain- (a portion of the proceeds is donated to able funding source. the Centers’ programs). Interviews with the Departments of n Westchester County, about half of Privacy Wall: Creating New Housing County Planning, Section 8, fire, and all single adult homeless refuse to be building officials found no barriers to mentally and/or physically screened While the obvious solution for home- implementing this solution. Further con- or, to sign over their disability lessness is a home, accessing permanent sultation with attorneys, accountants, di- checks.I The current policy is to then deny supported housing can take years and, the rectors of supported housing programs them access to the Shelters. They must growth in the available housing stock and and Section 8 landlords confirmed the remain in the Drop-Ins, without medical funds never seem to keep up with the feasibility and interest. or psychiatric care. They are offered a numbers of consumers in need; The only remaining question was; chair in a “Warming Center” or “three “Stable access to good housing is a fun- “how would the homeless and current hots and a cot, no questions asked.” damental problem for many people with renters respond to the idea”? Drop-In residents are our highest risk mental illness because of their poverty, the Our survey found one-hundred percent of and least served population. Three- limited supply of very-low-income housing, the homeless persons would “definitely be quarters ask for help staying off drugs or the rising cost of rental market housing and interested” in the concept, (anything to get alcohol, half take psychiatric medications discrimination.” (NYS Office of Mental out of the shelters). However, only one- and over one-third receive Social Security Health 2007). third of the current renters felt the same Disability. The critical question is: What The average rent for a one-bedroom way; “I value my privacy, a roommate would it take to convert the “hard core” apartment in Westchester County today is would take my food, make a mess, party, I homeless to accept shelter services? Donald M. Fitch, MS about $1,270/Mo. At 30%, the consum- would want to meet them first, there would ers’ share of supported housing (Section have to be a trial period, etc.” Even a finan- Research Findings 8/Shelter Plus) is $381/Mo. This is about cial incentive of a rent reduction of $150/ half of the average consumers’ Social Mo. did not change their minds. To answer this question, the Center Surprisingly, our study (Chart below) Security Disability check ($800). interviewed thirty Drop-In residents this found almost nine out of ten Drop-In resi- Food, utilities, clothing, personals, co- Return on Investment past winter to ascertain their interest in dents would accept the Shelters’ rules for as pays, transportation, debt service, etc. The financials are impressive; in addition four hypothetical procedural and mone- little as $100/Mo personal needs allowance. easily exceeds the remaining balance of All of the disabled residents surveyed said $419. for most consumers. to reducing the consumers’ rent by $150/ tary incentives; 1) a waiver of their medi- they would leave the Drop-Ins and enter the The ideal solution to the lack of afford- Mo., Section 8 landlords would receive an cal assessment i.e. drug testing, 2) a Shelters if they were allowed to keep their able housing would be to 1) rapidly increase extra $221/Mo. per unit, a 20% increase in waiver of the mandated substance abuse SSA Disability checks. the housing stock, 2) reduce the consumers’ the buildings’ cash flow and net worth. program (if they tested positive) 3) in- Interestingly, hypothetical waivers of rent and, at the same time, 3) increase the An investment in the “Privacy Wall” of creasing their personal needs allowance the mandated Shelters’ assessment and landlords’ rental income and, 4) reduce $1500. pays for itself in less than seven from $45/Mo to $100/Mo and, 4) allow- program rules were found to be ineffec- HUD’s cost for supported housing. months. The annual increase in rental in- ing disabled residents to keep their Social tual. Our study confirmed that a few extra The simple “win-win” solution the Cen- come for twenty units would be over fifty- Security checks ($700/Mo). dollars is a more powerful motivator than ter developed to meet these criteria is to thousand dollars! Lately, municipalities are using direct bending the rules. divide the living room of a typical one- The United States Housing and Urban De- cash payments to promote positive behav- bedroom apartment using a “Privacy Wall” velopment Department (HUD) would save ior, an incentive that businesses have used Action Implications to create a second bedroom. (Plan below) over $9,000 annually for each converted apart- successfully for centuries. After considerable research, we found ment because HUD would not have to pay for Under Mayor Michael Bloomberg. This study identifies a practical, cost the New York Wall Company two, one bedroom apartments. If HUD in- New York City instituted cash reward effective solution for converting Drop-In (www.thewallpeople.com) will install a vested in 10,000 new apartment units through- programs to motivate students to earn A’s, residents to Shelter residency in order to fire retardant laminated particle board out New York State, they would save over 73 so they graduate high school, reduce new access vital psychiatric and medical ser- sound proof wall with a specially engi- Million dollars a year! In turn, this money teacher attrition and to get parents to at- vices. Next steps are to pilot test and re- neered aluminum frame, door, knob and could be used for over twelve-thousand addi- tend school nights. fine a financial incentive program. Shel- lock in about four hours, without nails, tional new units. □ PAGE 10 MENTAL HEALTH NEWS ~ SPRING 2008 Mental Health News - New York City Section: Spring 2008 Page 11 The Mental Health News New York City Section

Guiding Principles for The Redesign of The Office of Mental Health Housing and Community Support Policies

By Robert W. Myers, PhD Unmet Needs dential care, to move toward local systems Senior Deputy Commissioner of care that can arrange, provide, and sup- NYS Office of Mental Health The unmet need for decent, safe and port people in housing that is appropriate affordable housing--often with supports-- to their needs and preferences at any level is very substantial for people with mental of recovery. afe, decent and affordable hous- illness. As a consequence of poor access ing is a cornerstone of recovery to community housing, inadequate levels Current Services from mental illness, as well as a of mental health housing, and clinical mainstay of “the American programs that do not support people in The New York State Office of Mental S getting/keeping housing successfully, Health funds and oversees a large array of Dream.” Stable access to good housing is a fundamental problem for many people many people with a mental illness are housing resources and residential rehabili- with mental illness because of their pov- poorly housed or institutionalized. Thus, tation programs. These resources include: erty, the limited supply of very-low- many people with a mental illness are income housing, the rising cost of rental “stuck” in: Adult Programs market housing and discrimina- • homelessness and the shelter system Congregate Treatment tion. Given this context any approach to (Group Homes): 5,071 units in 348 sites reforming housing for people with a men- • institutional settings (nursing homes, tal illness must stress: adult homes, state psychiatric centers) Residential Care Centers for Adults (Treatment and Support): 802 units in 7 sites • expansion of low income housing in • family-supported housing that cannot general be sustained (e.g., with aging parents) Licensed Apartments: 4,133 units

Robert W. Myers, PhD • flexible supports that do not condi- • staffed residential programs (instead CR-SROs: 1,720 units in 35 sites tion housing on services Additionally, to reduce stigma, assuage of a home) “community resistance” and provide op- Supported (uncertified) • expansion of specialty “supported portunities for recovery and rehabilitation, Reform must balance improved access SROs: 2,453 units in 65 sites housing” developed for people with a housing in normal/mixed neighborhoods to housing for all of these individuals with mental illness and settings is preferable. the need to improve “old” models of resi- see Guiding Principles on page 25

Six-Agency Coalition Receives Grant to Address Health Crisis

Staff Writer mentations of best practices, is working rarely receive the full range of recom- tion or develop new habits to manage Mental Health News with ICL to coordinate this initiative. The mended interventions. their mental illness, and thanks to the goal of the Initiative is to make sure peo- The dilemma is further compounded Smoking Cessation Program, many have ple with mental illness can look forward by the fact that some pharmacological quit smoking. When issues of lifestyle he not-for-profit Institute for to a better quantity of life, as they work to treatments for serious mental illness in- changes to improve physical health come Community Living (ICL) an- achieve a better quality of life. crease risk factors for and exacerbate up, many clients equate that to eliminating nounced today that New York chronic medical conditions. Rarely are yet another source of enjoyment – food. State Health Foundation The Crisis behavioral and medical medications coor- How does one motivate them to T(NYSHealth) is providing a $572,419 24- dinated on an individual level to achieve change yet another part of their lives for month grant that will enable a coalition of “All my friends are dying out there,” optimal outcomes and avoid iatrogenic the better without their feeling there is NYC behavioral health agencies to impact says Marvin, a client of ICL’s mental effects. Likewise, preventive and early nothing left for them to enjoy? The needs the way the mental health care system health services. Marvin refers to a crisis intervention screening, assessment and of the client, in this sense, have to be kept works with people with serious mental within an overlooked population; people intervention for medical conditions are in delicate balance, and a case manager illness and co-existing (or at risk of ac- with mental illness die 25 years younger rare in the era of community-based care. has to understand the relationship of quiring) Type 2 Diabetes. This project than the general population, and they die Their predominant access to health pro- physical, mental and emotional health does not rely on new medication or new from the same diseases – diabetes, heart fessionals is within the mental health concerns in the client – and keep all of treatment, but rather, a new way of ap- disease and cancer. community where there is a lack of atten- them in mind when determining recom- proaching and making lifestyle changes to By middle age, adults with serious tion and focus on medical issues because mendations for treatment and lifestyle address diabetes. mental illness often suffer a significant the psychosocial issues being confronted changes. For example, one client, who ICL has spearheaded the Integrated physical decline secondary to chronic tended to overshadow other concerns. was having difficulty finding an effective Wellness Initiative: Diabetes and brought medical conditions. With an average re- anti-depressant, remarked to his case together The Bridge, Federated Employ- duction in life expectancy of 25 years, the The Challenges manager, “I’m so depressed. I don’t see ment and Guidance Service (FEGS), The average consumer lifespan hovers be- the point of staying sober.” Jewish Board of Family and Children’s tween 50-60 years, near that found in un- Many people living with mental ill- Services (JBFCS), Services for the Under- developed countries such as Sudan and ness, especially those with histories of The Integrated Wellness Initiative: served (SUS) and The William F. Ryan Haiti. Estimates are that 60% of excess poverty and homelessness, have a high Diabetes Health Center (Ryan Center) to form a mortality has been due to medical condi- tolerance for discomfort. This tolerance ground-breaking coalition. The Urban tions that were largely preventable or can create difficulty in motivating an indi- Integrated Wellness Initiative: Diabe- Institute for Behavioral Health, a consor- treatable and that despite advances in the vidual to make changes to improve health tes is an ambitious plan that proposes tium of 21 behavioral health agencies treatment of these life threatening disor- and well-being. Additionally, many ICL which specializes in multi-agency imple- ders, people who are seriously mentally ill clients have worked hard to kick an addic- see Health Crisis on page 14 Page 12 Mental Health News - New York City Section: Spring 2008

House Proud Making a House a Home, Making Recovery a Value

By Geraldo Ramos, Regional Director, When Candace moved into Tanya Tow- Community Residence & Homeless Services, ers in March 2006, the staff immediately Melanie Germain, Regional Director, saw her strengths and with guidance she has Apartment Programs, Sara Smith, Director, been able to become self-sufficient. Can- 124th St. SRO, and Ellen Stoller, Assistant dace’s motivation and determination never VP Community Services, Training and stopped. She graduated high school and is Consumer Affairs, F.E.G.S. Health and currently applying to college. With her in- Human Services Systems creasing confidence in herself she was able to meet people and now has a much broader social support network. Candace’s mother his year F.E.G.S. Behavioral and sisters have come to appreciate her Health Residential Services strengths and abilities. celebrates 20 years of providing Supported housing with others who residential services to adults were coping with similar complex needs Twho have a mental illness. In 1988 we was the start for opening Candace’s opened our Brooklyn Apartment Program world. Feeling “at home” is as much housing 36 people. Today we have over about support as it is about place. In 700 people living in the full range of sup- F.E.G.S.’ network of housing options for portive housing opportunities in Manhat- people with mental illness, people aged tan, the Bronx, Brooklyn, Queens and 14 - 80+ receive the level of support and Nassau County. In this array, we operate treatment they need to both feel “at specialized services for people who are home” and work on their recovery goals. deaf, deaf/blind, homeless, HIV+ and ado- Diego, 62 years old, was born and lescents with both serious emotional prob- raised in Cuba, where he obtained a col- lems and substance abuse. We continue to lege degree and taught school. As a po- develop new approaches to supportive litical prisoner seeking freedom, he came housing, including one for young adults. to the United States, where he had family. The availability of safe housing seems Unable to verify his prior academic so basic to recovery, yet there is nothing achievements, he sought to obtain a GED simple about it. Our partnership with con- so that he could begin to pursue to the sumers has taught us to listen to what American dream. they want and need, respect where they Diego owned a record store in upper are and not where we “assess” that they Manhattan when he started using cocaine. should be. Our focus is on a person’s in- He soon found himself addicted, eventu- dividual journey towards recovery, their ally losing his business and his apartment. wishes, dreams, strengths and struggles. After losing a rented room, he ended up This consumer-centered approach chal- in the street, living underneath Riverside lenges our staff to always think crea- Park in the Amtrak Tunnels. He was tively. The goal is to break down barriers homeless for four years. During his that hold someone back from living the homelessness, the concern of a writer life they want. Every recovery is a thumb- from the neighborhood lead to his being print, unique to that individual. Here are photographed and interviewed for a book some illuminating stories. on those living under the city of Sometimes living with our family New York. As the blight of those living holds us back. That was the case for Can- underground was brought to public atten- dace (pseudonym). Born deaf, Candace tion, outreach workers from many agencies also developed a major depressive disor- went out to these areas to offer help and der while still a teenager. Candace, who support. Diego, diagnosed with schizophre- is 21, grew up with her mother and three nia, as well as substance abuse, was assisted half-sisters in a small apartment, where with case management and a referral to the she struggled constantly with her family FEGS 124th Street CR/SRO (community because she was the only deaf child. Her residence single room occupancy). father was both physically and emotion- Diego was drug-free one year prior to ally abusive. He sometimes used an iron his arrival at 124th St. SRO. Over the cord, knives, or a gun to threaten her past 11 years, he has maintained his so- mother. When Candace was 5 years old briety. Determination and hard work her father abandoned them. Her family helped him to reach those goals important had to move to a smaller apartment be- to him: taking medication on his own, re- cause the three-bedroom apartment they learning the skills he needs to live inde- were living in was too expensive. Feel- pendently, staying clean and sober and ing misunderstood most of the time fed learning about his mental illness and how her growing depression. At the same to stay well physically. Diego is a regular time, Candace was regularly absent from face at the in-house community meeting, school without permission because her advocating for the rights of all residents. mother was too depressed to escort her. Diego attends a program five days a week Throughout her high school years, Can- where he was recently honored for his dace had trouble organizing her day-to- achievement in teaching computer skills day activities and fell behind in her to students of English as a Second Lan- schoolwork. She was isolated and had guage class. few friends. Although her family thought In a recent article, Diego is quoted, “it is she should drop out of school, Candace the loneliness that is the main problem for had other hopes for herself. With the homeless people.” He credits the family- help of her school guidance counselor she like atmosphere and staff support provided was referred to F.E.G.S. Tanya Towers at his F.E.G.S. residence for his success at Apartment Treatment Program supported by the NYSOMH. see House Proud on page 41 Mental Health News - New York City Section: Spring 2008 Page 13

Innovation in Housing: Three Model Programs Developed by The Bridge to Meet the Needs of Special Populations

By Peter D. Beitchman, DSW, LMSW uses essential service partnerships. School of Medical Science. Students who Executive Director With capital funding from HUD, the are aspiring to medical careers will par- The Bridge Inc. City of New York (HPD) and the Federal ticipate in the program, assisting staff and Home Loan Bank, a 24-studio apartment participating in training and education building was constructed in The Bronx. activities. or more than 25 years The Given the special needs of the residents, Staff training is a major focus of the Bridge Inc., the mental health special attention was given to handicap project. In order to be effective as care rehabilitation agency that pro- accessibility and sufficient office and pro- managers, residential staff need basic edu- vides services to 1500 men and gram space was created to allow for allow cation on the medical conditions and womenF in Manhattan, Queens and The for enhanced services. treatments of the residents. An extensive Bronx, has been providing housing to The program is designated as a Sup- training program is being developed to es- adults with serious mental illness. As the ported SRO by the State Office of Mental tablish staff competencies in these areas. profile of the mentally ill has changed Health, which is providing the lion’s share The residents at Sheridan Hill House over the years – the long-term hospital of services funding. A grant from the range in age up to 78 years old. Serious “chronic patients” of 30 years ago have New York City Council is also being used medical conditions include hypertension, been replaced, often by persons with mul- to enhance services, along with City De- diabetes, cardiovascular disease, hepatitis tiple needs stemming from long-term partment of Homeless Services SRO Sup- C, lung disease, cancer, stroke, glaucoma homelessness, co-occurring chemical port funds. HUD is providing ongoing and anemia. Many residents have multi- abuse, HIV/AIDS, aging or involvement funding for building operations. ple medical conditions. in the criminal justice system - The At the heart of the program are two In the eleven months since it opened, Bridge has developed innovative ap- additional partnerships: The Jewish Sheridan Hill House has been highly suc- proaches to meet their needs. This has Home and Hospital, which is a licensed cessful in offering clients a community often involved using multiple funding home care agency in Manhattan and The living alternative to nursing homes that sources to support services, working in Bronx, provides an on-site Nurse Practi- addresses both their mental health and partnerships with other agencies, and pro- Peter D. Beitchman, DSW, LMSW tioner at Sheridan Hill two days a week. medical needs. Resident hospitalizations viding staff with the specialized training The NP not only works with individual and visits to emergency rooms have de- and support that they need to provide ness, those involved in good treatment clients on their medical conditions, increased significantly and they are receiv- quality services. This article describes and rehabilitation services are surviving cluding monitoring their medical regi- ing expert help in managing their medical two currently operational models and a into old age with its inevitable medical mens, she also runs educational groups for conditions. As the cohort of persons with third in development that are specifically complications – an even greater challenge both clients and staff. An additional serious mental illness becomes “grayer” designed to meet the needs of today’s for mental health agencies. Bridge LPN will be introduced into the Sheridan Hill House offers a tested model of special populations. The Bridge has developed a model program this spring. community-based housing and services. With the community mental health residential program, Sheridan Hill House, A second resource for the program is a The second innovative program that movement now more than fifty years old, to address the needs of aging, medically- new primary care clinic at Bronx Lebanon The Bridge has been operating for a num- and with the vast majority of persons with compromised clients. In doing so, the Hospital specifically tailored to the needs ber of years is Iyana House, a permanent serious mental illness living in the com- agency has addressed two goals: to im- of persons with serious mental illness. housing and services program targeted to munity, The Bridge and other agencies are prove and sustain the quality of life of its This program offers comprehensive pri- women with serious mental illness and co facing the challenges of providing ser- residents in familiar community surround- mary care and integrated specialty care at -occurring substance abuse who have vices to an aging population. Although ings, and to avoid placement in much the hospital. been released from Bedford Hills State recent studies have documented and de- more costly and alienating nursing homes. Another component that will be intro- Correctional Facility. The program was plored the 25-year reduction in life expec- The model created by The Bridge com- duced this spring is an internship program tancy for persons with serious mental ill- bines Federal, State and City funding and with students from The Bronx High see The Bridge on page 30

City Awards New Housing Contracts

By Laura Grund, Acting Director, lion annually for services and operating constructed or renovated congregate) Office of Housing Services, NYC expenses. housing. Already, DOHMH has an- Department of Health and Mental Hygiene NY/NY III aims to reach populations nounced 13 awards for 544 of the congre- not served in the past. The first two NY/ gate units and 20 awards for 996 scattered NY Agreements created supportive hous- -site units. This new housing has already dequate housing services for ing for single adults with a serious and started to become available and more will people with mental illness are persistent mental illness who had a history open later this year. an essential part of recovery -- of homelessness. While NY/NY III will Participation in supportive services A and a top priority of the New also serve this population, housing will is voluntary. Tenants in NY/NY III York City Department of Health and also be available for adults in State psy- housing will have leases and pay rent Mental Hygiene (DOHMH). Safe, reli- chiatric centers who are at risk of home- that is 30% of their income. The ser- able, supportive housing that promotes lessness; chronically homeless families vices vary depending on tenants’ needs

independence and stability is necessary with a head of household who has a men- but often include case management; Corporate Photographics – Bob Zucker, Photographer for people to take control of their lives. tal illness; and young adults age 18-24 mental and physical health assessment 910 DeKalb Avenue Brooklyn With this in mind, New York City has who have a serious mental illness. A total and counseling; drug and alcohol abuse joined with New York State in an un- of 5,500 units will be designated for peo- counseling; educational and vocational precedented supportive housing agree- ple with mental illness. NY/NY III will services; medication management; and ing tenants’ health; and increasing appro- ment. The New York/New York III Sup- also house other populations, including assistance in gaining access to govern- priate substance use and mental health portive Housing Agreement will create homeless adults with a substance abuse ment benefits. services use. The evaluation will help 9,000 new units of supportive housing by disorder; chronically homeless families Supportive housing is an evidence- ensure that the people served by NY/NY the year 2016, transforming the landscape whose head of household has a sub- based, cost-effective way to serve people III housing receive the support they need of supportive housing in New York. The stance abuse disorder; and young adults with mental illness. To monitor NY/NY to live independently and contribute to number of units that New York/New York age 25 or younger who have “aged out” III, the City and State are conducting an their communities. III will create is nearly double the number of foster care. evaluation that will assess the effective- Supportive housing works. Govern- of units created by the two previous NY/ NY/NY III housing will consist of ness of NY/NY III housing in decreasing ment at all levels must increase and tar- NY Agreements combined. The City and scattered-site (apartments rented from the use and cost of publicly funded health- get resources to provide supportive State investments total close to $1 billion private landlords that are spread through- care and social services; reducing chronic housing, including appropriate mental in capital funds and more than $150 mil- out a community) and single-site (newly homelessness and incarceration; improv- hygiene services. □ Page 14 Mental Health News - New York City Section: Spring 2008 A Place Called Home: JBFCS Residences for People Living with Mental Illness

Staff Writer for people with an Axis I diagnosis who JBFCS have been homeless for two consecutive years in New York City homeless shelters or as someone who is known to be ay after day, with patience and homeless.” clarity, Rebecca Wulf, LCSW, The Abraham Residence III is a con- explains services, eligibility gregant housing program, where all the and the application process for units are within one building. Referrals housingD for people living with severe often come from shelters, transition cen- mental illness through JBFCS intensive ters or women’s centers. Staff is on-site and supported housing programs. Rebecca 24 hours a day and provide support with is Director of the Bronx REAL Center and medication management, social services, AMI Apartment Programs for the Jewish coping with symptoms and activities of Board of Family and Children’s Services. daily living. Residents receive psychiatric The calls for housing come from dif- services through their day treatment pro- ferent sources -- outpatient mental health gram. The average length of stay is four- clinics, psychiatric hospitals, community and-a-half years. Residents usually move residences and homeless shelters. from Abraham Residence III to a sup- Throughout the Bronx, Brooklyn and ported housing program or permanent Far Rockaway, JBFCS provides 189 beds Section 8 housing. in apartments at various or “scattered site” JBFCS also provides 30 beds for locations (rather than in one apartment homeless people with chronic mental ill- building) for clients who need intensive Rebecca Wulf, LCSW, and Jeffrey Clarke, LMSW ness at Maple House in Brooklyn, a Level support as well as for clients who are able II residence as designated by the Office of to live more independently. The agency residents’ Social Security payments and percent of their income toward rent, but Mental Health. This housing offers four or also offers 138 beds through its commu- Medicaid, which is billed for restorative manage their own finances for food, five single apartments within one suite nity residences. services. The program pays residents’ clothing, utilities and phone. which share a kitchen and bathroom. Ap- “Our mission for both intensive and rent, utility, and local phone bills and pro- In graduate apartments, residents who plication for Maple house is through the supported or ‘graduate’ programs is to vides residents with allowances for per- range in age from 19 to 70 often keep New York City/New York State Agree- provide levels of support that help resi- sonal needs, food and clothing. In the their apartments for 15 to 20 years. There ment (“New York/New York”). dents develop skills to live as independ- intensive program, a worker visits resi- is no requirement that residents move out ently as possible,” Rebecca explains. dents three times per week in their apart- by a certain time as the Office of Mental Community residence serves ments to assess how residents are doing in Health recognizes that individuals living many former patients of state hospitals Eligibility for intensive terms of maintaining the apartment, tak- with chronic mental illness need ongoing and supported housing ing medication and self care and to pro- support. Another program that helps individuals vide supportive counseling and skills de- Unlike intensive housing where visits with an Axis I persistent mental illness In order to be eligible for housing, an velopment training. take place three times a month, in gradu- often referred by state psychiatric centers individual must have an Axis I diagnosis, Residents in intensive housing typi- ate housing, a worker makes home visits is the JBFCS Brooklyn Community Resi- which is a severe mental illness such as cally stay in their apartments two years, twice a month and residents are expected dence. Homelessness is not an eligibility bipolar disorder or schizophrenia accom- until they develop the skills they need to to participate in a daily activity such as requirement and application to the pro- panied by functional impairments. The live more independently. While in the work, volunteering or attending school or gram is through the New York City Hu- application process begins when a treat- program residents must be involved in a a day treatment program. man Resources Administration. Staff at ment provider submits a Human Re- day activity such as a continuing day Brooklyn Community Residence provide sources Administration (HRA) Applica- treatment program, an intensive psychiat- Housing for formerly homeless a variety of services including counseling tion Form 2010E on behalf of the person ric rehabilitation program, out-patient people with psychiatric disabilities and case-management on a 24-hour basis seeking housing. Homelessness is not an clinic, school or work.. In intensive apart- and preparing meals for the 40 residents. eligibility requirement for intensive and ments, residents have roommates but not Since it is widely acknowledged that “All of the JBFCS housing options graduate housing, although JBFCS does more than three people live in an apartment. people living with persistent mental illness share a common goal: to allow individuals provide Abraham Residence III in Manhattan Graduate, or supported housing, has may also face homelessness, JBFCS pro- to live productively in the community and Maple House in Brooklyn specifically for similar eligibility requirements although vides residences to address this problem. rather than on the street or in a hospital,” people living with persistent mental illness and most residents in graduate housing come “Abraham Residence III is a 68-bed Jeffrey notes. impairments who have been homeless for two to their apartments after living in an inten- residence in Manhattan that is a collabora- or more years. See below for more information sive housing program first. In graduate tion between JBFCS and the Metropolitan If you would like more information about these programs. housing, one bedroom and studio units for New York Coordinating Council on Jew- about JBFCS residential programs for JBFCS intensive (supportive) apart- one person are available as well as apart- ish Poverty,” says Jeffrey Clarke, LMSW, people living with mental illness, please ment programs are regulated by the Office ments designed for sharing with a room- JBFCS Director of AMI Community contact Rebecca Wulf at (718) 931-4045 of Mental Health. They are funded by mate. Residents are required to give thirty Residences. “The Abraham Residence is or Jeffrey Clarke at (212) 828-8500. □

Abilify Approved from page 5 ment and Commercialization, Inc. “This Health Crisis from page 11 opportunities for interacting with con- new add-on treatment option for depres- sumers that will promote integration of M.D., Ph.D., Executive Vice President, sion represents hope for many adults suf- nothing short of rapid systems transfor- care, wellness self-management and hope Chief Scientific Officer and President, fering from this debilitating illness.” mation and evaluation. In light of the – a critical element. □ Research and Development, Bristol- Major depressive disorder affects mil- gravity of the current situation and the Myers Squibb. “This approval is a reflec- lions of U.S. adults at some point in their number of lives that are at risk, nothing tion of our ongoing commitment to pro- lives. A recent study evaluated different short of an all-out effort is justified. vide innovative therapies, such as treatment approaches, including adjunc- The Initiative’s goal is self- ABILIFY, to help adults living with tive medications and switching strategies, management. The clinical intervention Read This Issue depression.” in patients with MDD. The study found “toolkit” is predicated on a biopsychoso- “We are pleased that ABILIFY® that 63% of patients did not achieve ade- cial model so as to address the complex (aripiprazole) has achieved this important quate relief of depressive symptoms fol- and multidimensional reality of providing milestone as the first medication ap- lowing the initial treatment with an anti- care to a seriously mentally ill person Online proved as adjunctive treatment for adults depressant alone. Additionally, the study who has or may be at risk for developing with major depressive disorder,” said demonstrated that the use of adjunctive life-threatening diabetes and may have Taro Iwamoto, Ph.D., Chief Executive medications in treatment may be useful secondary substance abuse disorder. The www.mhnews.org Officer, President and Chief Operating to improve unresolved depressive objective of the toolkit is to provide a risk Officer, Otsuka Pharmaceutical Develop- symptoms.□ -adjusted and disease-specific series of Mental Health News - New York City Section: Spring 2008 Page 15 Page 16 Mental Health News - New York City Section: Spring 2008

Housing Is Where Recovery Happens

By Donna Colonna, CEO are being incorporated into its services increased capacity to address the complex Services for the UnderServed toolkit. With the financial support of interaction of co-morbid conditions asso- foundations like The van Ameringen and ciated with homelessness and serious the New York Community Trust, and mental illness, i.e. substance abuse and ervices for the UnderServed affiliations with a learning collaborative chronic disease. (SUS) embraces a philosophy of sponsored by the Urban Institute for Be- hope and believes that individu- havioral Health and the New York State Reports from the field indicate the S als can recover from mental ill- Office of Mental Health, SUS has been following preliminary outcomes: ness and lead meaningful lives in the able to enhance the competency of its

community. SUS acknowledges that re- workforce to make recovery truly accessi- • Case Managers are trained in chronic covery means different things to different ble within its housing settings. disease management by working people, but at its core, it places the con- New thinking and new practices inevi- alongside medically skilled col- sumer at the center of their life plan. Re- tably lead to new ideas. One such idea leagues and become better able to covery is at its root deeply personal. came as the result of SUS examining ser- advocate on behalf of consumers for Supported housing, or perhaps more vice utilization data which described the better primary care. Wellness is ad- aptly put housing with supports, can be a service use patterns of consumers living dressed more comprehensively with powerful platform for a person’s recov- in its scatter site supportive housing. an approach that integrates motiva- ery. Recovery may be defined as “a proc- Over the last 15 years and eight separate tion and skills for managing mental ess of restoring a meaningful sense of contracts with the NYS Office of Mental health, chronic disease and addiction. belonging to one’s community and a posi- Health, SUS developed a substantial num-

tive sense of identity apart from one’s ber of units of scatter-site housing--studio • Staff are empowered by the informa- condition while rebuilding a life despite and one bedroom rentals occupied by peo- tion and skills they have acquired and or within the limitations imposed by that ple in recovery from mental illness. Two the assistance they can provide, mak- condition” (State of Connecticut, 2007). years ago, SUS provided minimal case ing them more potent partners with SUS believes that it is in the 24/7 reality Donna Colonna management services to 244 people with consumers in managing wellness and of the community where one lives that the serious mental illness living in apart- supporting lifestyle change. substantive work of developing a positive rity in all Actions--were at the core of the ments. Its experience was that one-third of

sense of identity, developing a life plan organization’s Ethics in Action curricu- these consumers were fairly independent • Consumers report feeling more sup- and rebuilding one’s life takes root and lum which was designed to touch every and managed well with the minimum con- ported and are more trusting, engaged takes place. An individual’s housing SUS employee. As best practices were tract expectation of case management and encouraged by a team of indi- community and what it lends to recovery being introduced, SUS wanted to ensure contact of 1-2 times per month. About one viduals who can all assist with a vari- is constant and potentially exists in every that a strong culture of respect for the -third was in a medical, psychiatric or ety of wellness issues. Better en- interaction. It is at home with one’s sup- individual would serve as the foundation substance abuse related crisis requiring gagement leads to earlier detection of port system--mentors, friends and to support these new recovery-based ap- more frequent staff intervention (6-8 con- emerging health risks. neighbors--that addiction is conquered plications. These would be the tools for tacts per month) for 30-90 days per year.

with all the imaginable triggers waiting at recovery, and if they were to be truly ef- The remaining one-third was in nearly • Consumers more readily avail them- the front door. It is there that one moves fective, they would have to be delivered constant crisis and heavy users of emer- selves of health monitoring and infor- from disenfranchisement to affiliation. It within a culture of hope, respect and a gency and inpatient medical, psychiatric mation about treatment options is the sense of dignity one feels by hold- belief that people with mental illness can and detox services. There was also con-

ing the keys to one’s front door, and the make their own decisions and exercise cern that in this last group there was a • Staff are better equipped to challenge respect one receives from one’s friends their right to self-determination. The ini- high incidence of undiagnosed and/or the denial that is characteristic of and neighbors that serve as a source of tial rollout of its Ethics in Action curricu- poorly treated chronic disease, e.g., diabe- individuals who just don’t want affirmation for rebuilding one’s life. lum took eighteen months, and it contin- tes, asthma, hypertension. “another diagnosis in their lives”. Housing (where one lives) is where all ues to drive its personnel policies from With a better understanding of its con-

this takes place, and, if the tools for re- recruitment and hiring to employee orien- sumer needs, and armed with its values

covery are provided, the work of tation, supervision and promotion. Now, and best practices, SUS reorganized its “rebuilding” can genuinely take place. it is these core values that characterize scatter site housing resources and created SUS’ Scatter site Mobile Team nurse, It is from a belief in those words, that the “supported” in supported housing, a new model. The newly created model Kathleen Hartmann put it very well: five years ago, SUS’ organizational trans- and it is upon this foundation that SUS consists of a team with a Program Direc- “We’ve kicked things up a notch and that formation into a culture of recovery was continues to build competence in its tor, a part-time Psychiatrist (1 day per is having an impact on quality of life, born. Today at SUS the “supported” in staff with an array of training in best week), a full-time Registered Nurse, a longevity and more efficient use of supported housing is synonymous with practice applications. Certified Alcohol and Substance Abuse healthcare dollars.” recovery: Housing isn’t a service, it is the To reinforce and maximize the value Counselor (CASAC), a Peer Counselor The concept that housing is the plat- place where people live and where their of housing in recovery, SUS has commit- and 4 Case Managers. This new Scatter form for recovery has generated many recovery happens. ted to providing its housing staff with site Mobile Team has also adopted the good things for SUS. It has served as the When SUS embarked on its journey to competence in applying evidence-based communication and tracking strategies impetus for transformation of its organiza- transform its culture, there was acknowl- practices. In the last three years, SUS has used by ACT teams along with best prac- tional culture, it has fostered the enhance- edgement that to achieve genuine trans- launched a broad recovery-based training tices endorsed by the NYSOMH. No formation, values and attitudes would initiative to provide its staff with the skills longer a model that provides case man- ment of competencies in the workforce, it have to be cultivated to promote recovery. to engage in the work of recovery. Well- agement only, the model now offers has led to meaningful collaborations and These values--Respect for the Individual, ness Self-Management, Motivational In- greater flexibility for varying service in- the addition of resources, and most impor- Maximizing Individual Potential, Main- terviewing, Integrated Dual Disorder tensity, and greater direct access to inte- tantly, it has led to better outcomes for taining a Supportive Environment, Integ- Treatment and Family Psycho-education grated interdisciplinary expertise with consumers. □

Gun Law from page 4 is outdated and stigmatizing (“people • Concerns that people had no way of lem implicated in the Virginia Tech trag- adjudicated as mental defectives”). knowing whether their names were on edy, the lack of a mental health system to some compromises and modifications HR 2640 does nothing to change this the list and that once on the list, there respond to people like Cho who are in to the original bill. In testimony pro- stigmatizing and vague language. were no mechanisms to have one’s crisis and in need of treatment. vided last summer at a hearing on fed- name removed from the list. HR 2640 eral gun reporting laws, NAMI ex- • Concerns that there are inadequate partially addresses this concern by re- NAMI is pleased that some progress pressed a number of concerns about HR protections in current law against quiring that states create mechanisms to has made on HR 2640, but we remain 2640 including: breaches of privacy or sharing of allow individuals who are no longer concerned with certain aspects of the bill, information with other agencies. HR dangerous to have their names ex- particularly that the criteria for inclusion • Concerns that the definition in exist- 2640 attempts to address this concern punged from the list. on the list and for removal from the list is ing law of those who should be in- by directing the U.S. Department of vague and confusing, and therefore cre- cluded on the NICS list is vague and Justice to draft regulations addressing • Concerns that Congress, by focusing on ates potential for misinterpretation and overly broad, using terminology that privacy protections. guns, was failing to address the real prob- misapplication of the law. □ Mental Health News - New York City Section: Spring 2008 Page 17 Page 18 Mental Health News - New York City Section: Spring 2008

Home at Fountain House

By Kenn Dudek, Director houses 19 people in studio apartments. work or school they need less support on Fountain House From that point we worked with the city a regular basis for their housing. While and state mental health people and devel- we applaud the concept of housing first oped a whole array of housing programs we know that without a flexible set of ountain House began its apart- in the eighties. Many of these were the old additional support services people will not ment program in 1958. The ini- fashion transitional models which we be successful in the long run. It is our tial set up was two or three peo- were never comfortable with and which observations that the most successful sup- ple sharing an apartment and rent we have been trying to unravel for the ported housing programs tend to have withF the support of Fountain House. Until past ten years. The difficulty in converting additional service support like ACT teams 1980 we had about 40 apartments. What to permanent housing has to do with a or clubhouses. It is a myth that housing we discovered was housing alone was not combination of the original federal and with minimal support is successful. While enough, people needed other support and state funding formulas and the New York there are long periods of time when peo- at Fountain House that comes in the form State reliance on Medicaid funding. Medi- ple do not need extensive support it is also of a job, an education, financial advice, caid funding for housing as well as club- true that there are times when they do. so and social networking. Most of our mem- houses is a mistake and does not work. the ideal support is flexible, long term and bers lived for years in many of the old In the early nineties OMH introduced without time limits. It is our hope that SRO’s which were all over the city or in supported apartments and we had come new funding models will be developed to apartments or with their parents. In the full circle to our ideal housing model for allow for this type of permanent housing early 80’s many of the SRO’s started to the majority of our members. People liv- with support. close and so Fountain House decided to ing in their own apartments with a subsidy In the last few years Fountain House delve into the housing business in order to and a varying amount of support as people has decided to seek new approaches to assist our members to obtain a decent want or need it. We feel we have an ideal housing. We have developed a partnership place to live. The other reason we started arrangement with our clubhouse as the with a not for profit housing developer to develop more housing was that both the Kenn Dudek center or base of support for our apart- called the Lantern Group and this January Department of Mental Health (DMH) and ment network. Not all the people who live we are opening a 135 bed SRO called the Office of Mental Health (OMH) at the chiatric hospitals. Many of these old de- in our apartments are active members of Hunters Moon on the upper Westside of state and city level decided to fund hous- signs are still in place to this day and need Fountain House but the vast majority are Manhattan. We will provide the supportive ing for people with mental illness. Prior to to be changed. Long ago we became con- and receive much of the needed support in services and the Lantern Group will be the this time DMH and OMH did not see vinced that permanent housing is the best that manner. In addition to our clubhouse landlord. With the addition of these beds we community based housing as their job. In approach for housing for our members but we have an Active Reach Out Team that will house over 500 people throughout the those days the models were more transi- that is not how we began. The first build- works with the people who are not active city but we still do not consider ourselves a tional; based on the concept of a half way ing we built was the first HUD 202 pro- in the clubhouse. It is our experience housing agency. We end where we began; a house with practices borrowed from psy- ject for people with mental illness and it however that if a person is active in the home, a job and a chance. □

Blending Housing and Mental Health Services

By Susan Chiappone, Director of pendence while staying within the STEL, can call and know that he will respond,” Marketing and Public Relations Inc. system. They can begin in a highly the mayor added. “He has been a great STEL, Inc. supervised setting and graduate to apart- partner and one who we hope to work ment living according to their goals, skills with again in the future,” said Frey. Frey and abilities. also praised the re-location of the STEL, he idea of blending housing for The jewel in the crown of the STEL, Inc. main offices to the vacant mansion persons with a mental health Inc. housing options is the former Cardi- next door to the school. diagnosis and affordable hous- nal Mindzenty High School in Dunkirk. Whitney uses what was once a home ing in the community may seem The school was closed by order of the for priests serving the Catholic high Tcomplicated enough; add to the mix an Diocese of Buffalo in the late 1970s and school as the executive offices and con- idea to preserve community landmarks remained vacant for many years. Various ference center for STEL, Inc. He has pre- and the idea becomes visionary. The vi- plans were proposed for the multi-story served the graceful building and main- sion is reality for Southern Tier Environ- structure located in the heart of this small tained the integrity of the structure includ- ments for Living, Inc. – known as STEL. rural city. Eventually Whitney and his ing massive oak woodwork, stained glass Under the leadership of Executive Di- development team decided on a walk- windows and fancy pocket-doors. “I love rector Thomas Whitney, the organization through of the building and saw potential. older buildings,” declared Whitney. based in Dunkirk, NY has expanded its “Buildings like this one were solidly “They have character and culture that the visions throughout the western areas of constructed and offered some distinct ad- community should be proud of,” he New York State and offers a total of 159 vantages,” said Whitney. The building was added. Visitors to the STEL, Inc. offices beds in a variety of housing situations built in 1954. For many years it housed a paro- are in awe as they are greeted in a large under its own name. As a partner – many chial high school. The building features 37 Victorian style foyer and ushered to wait more housing options exist including a units of one, two and three-bedroom apart- in the offices library or dining areas that recently completed 75 bed facility with ments. In addition, there is a play area, com- are complete with fireplaces. DePaul in Buffalo, NY. Thomas Whitney munity room and ample off-street parking. Distinctive buildings have been saved “Our partnership with STEL enabled The construction project took 11 months. in several other communities where DePaul to bring a cutting-edge housing “STEL combined their expertise in City of Dunkirk Mayor Richard Frey is STEL, Inc. has housing. Currently there option to persons with serious and persis- mental health service delivery and knowl- highly complementary. “When my wife are apartments or residential housing in tent mental illness residing in Erie edge of innovative funding streams to and I toured the building we couldn’t be- Jamestown, Olean, South Dayton, Wells- County” said Mark Fuller, President of assist DePaul in developing a program lieve how nice the apartments were; they ville and Gowanda. New sites are always DePaul. that will serve as a model for other future were nice enough that we joked about being reviewed by Steven Ald, Housing “Buffalo is now home to Seneca programs. The dedicated staff at STEL moving in,” said Frey. The construction Development Coordinator for STEL, Inc. Square, a service-enriched 75-bed Single worked hard to understand DePaul’s vi- went fairly quickly with acquisition in Ald and his staff work on the compli- Room Occupancy Program that features a sion, enabling it to become a reality,” 2005 and the first tenants moving into ance and permit issues as well as the residential atmosphere with individual Fuller concluded. their homes in January 2006. “There have initial phases of all projects that involve bedrooms, inviting common areas, out- The variety of housing options allow been relatively few issues and the prop- funding. door courtyards, and a host of supportive persons with a diagnosed mental health erty is very well maintained,” he added. services,” Fuller said. disability to achieve higher levels of inde- “Tom Whitney is the kind of person that I see Housing on page 40 Mental Health News - New York City Section: Spring 2008 Page 19 PAGE 20 MENTAL HEALTH NEWS ~ SPRING 2008 A SPRING 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 21

Using Psychoeducation as a Treatment Approach With Adolescents

By Jennifer A. Powell-Lunder, Psy.D. books describing how antidepressants Program Director, Child & Adolescent changed their lives!” Partial Hospitalization Programs, I have succeeded; she agrees to try. Four Winds Hospital Psychoeducation works! My work with adolescents has revealed to me that so many of them want to be treated maturely. eese, a 16 year old girl who has They understand that until they are 18, had several psychotic episodes their parents have the right to make deci- over the last few years and is sions for them but as they themselves diagnosed with Schizoaffective begin to prepare for the adult world, their RDisorder, walks into my office and plops interest in the world around them is at a down on my couch with a loud sigh. peak. They begin to think and talk about “I’m feeling pretty hopeless,” she says. politics and religion, philosophy and art. “My parents think because I am in treat- They are thirsty for new knowledge. In ment I can just snap out of this and be becoming an adolescent their cognitive fixed. They just don’t get it. No one gets ability to understand things increases tre- it!” mendously, as does their ability to use “I know,” I reply, “It’s frustrating.” abstract thinking and insight. It only “You know, Reese,” I continue as I decide seems logical that many adolescents to take a chance and say out loud what I would have a positive response to psy- am pretty sure she is already thinking. choeducation. Adolescents often report “You’re not crazy. Those things that you feeling very awkward. For teens in crisis-- hear and see that other people don’t--your suffering from a mood disorder, psycho- brain is really sending you messages that depressed.” I continue on as I notice his you say, I do not need meds. I am not sis, battling addiction, managing a learn- they are there.” face soften slightly. CRAZY!” ing disability-- these feelings are often I then proceed to offer her a simplified “You feel as if everyone and every- I know she is going to be a tough cus- more frequent and intense. Many of these physiological explanation of her symp- thing annoys the hec out of you.” tomer but realize that her intellect is my teens report wanting to “fit in,” to be like toms. When I am done I notice that she is I then continue on and offer psy- only tool to help her help herself. everyone else, but feeling that they are crying. choeducation regarding the impact of “So if you had diabetes or a heart condi- somehow different. It can be frustrating to “Reese, what’s wrong?” I ask, con- smoking marijuana on depression as well tion,” I start. feel so different, and have no explanation cerned that I have simply made her feel as on symptoms associated with the cessa- She cuts me off mid-sentence and blurts as to why. more frustrated. tion of smoking marijuana. I end by ex- out “that’s different.” Most mental health professionals “Thank You!” plaining to him that my role isn’t to make I go on to offer psychoeducation about would agree that offering psychoeduca- “For what?” I ask. judgments about smoking marijuana but the physiological effects of depression. I can tion to clients is important. However, my “You are the first person who has ever to explain why given his ongoing battle tell she is listening, but the look on her face work with teens has convinced me that it explained things to me that way. I just with depression, smoking marijuana is not still says she’s not buying. My assumptions often goes beyond being just essential, but thought I was crazy!” a good choice for him. are confirmed when she argues back that pivotal. It can give a teen feeling hope- Charlie, a 17 year old boy with a long He is looking down at the floor when I she has been depressed forever, and that it less, hope; it allows a teen feeling out of history of depression and substance abuse hear him murmur “Thanks. It kind of will not kill her if she does not take meds. control, to feel in control. Psychoeduca- is brought to my office by one of the pro- makes sense. No one ever explained it “Plus,” she adds, “it’s just not natural.” tion offers explanations and meanings; gram staff members after he has become like that, they just told me I shouldn’t In a last ditch attempt I say “ You like air the result--a teen who may realize for the verbally aggressive toward one of the smoke.” conditioning in the summer?” first time, I am not alone, others have been other kids in the milieu. The look on his Raquel is 14 year old girl who reports She gives me a tentative look but affirms through this. Offering the physiological face says it all. Before I have opened up that she has been depressed her whole that she does. I then proceed, pointing out “why” about what they may be experienc- my mouth, he has decided that I do not life. She is sarcastic and often crass. Her that air conditioning is not natural; finally, I ing is often a great relief. It can also be have anything good to say. intellect can be intimidating to her peers have her. the first step in helping an adolescent to “So what’s up, Charlie?” and as a result she has few friends. She I explain why and how antidepressants work in treatment. By starting with a “That kid gets on my nerves, he’s an- has also made it abundantly clear that she work, and respond to her inquiries about fact-based presentation of information, noying, and I didn’t touch him, I could does not “believe in using medication, the side effects including misconceptions adolescents begin to feel more in con- have.” unless of course someone is really crazy.” surrounding the highly publicized “black trol. At a stage when peer relationships “No Charlie,” I say, “What’s up with She is open to more natural ways of treat- box warnings.” I explain to her that be- are so important, explanations regarding you? Are you okay? We got your latest ing her depression and talks about the cause she is in treatment she would be why they may feel different from their tox screen back.” herbal teas she has heard about. I point closely monitored for all side effects. I friends, can open up doors and represent “Hey, I haven’t done anything! I have- out to her that in reality these are drugs, close by offering “If there is one chance hope. This approach also suggests to n’t smoked a single joint in over a week.” and add that they are not even FDA in a million that I may be right and medi- teens that the “I know,” I say. “I am guessing you tested. cation could help you, isn’t it worth it? are feeling agitated, irritable and more “What ever,” she says, “I don’t care what After all, people have written whole see Psychoeducation on page 24

Four Winds Hospital is the leading provider of Child and Adolescent Mental Health services in the Northeast. In addition to Child and Adolescent Services, Four Winds also provides comprehensive Inpatient and Outpatient mental health services for Adults, including psychiatric and dual diagnosis treatment. PAGE 22 A SPRING 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL A SPRING 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 23 PAGE 24 A SPRING 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL

Psychoeducation from page 21 Research focusing on the use of psy- psychoeducation is offered that can make choeducational interventions, specifically all the difference. A straightforward ap- Kirk, D., Chapman, T. & Sadler, O.W. clinician respects their intelligence. Many with adolescents, has confirmed the effi- proach suggests that the clinician ac- (1990). Documenting the effectiveness of adolescents are used to adults telling them cacy of the approach for use in the treat- knowledges and respects the adolescent’s adolescent substance abuse treatment us- to do things without offering explanations ment of, including, but not limited to level of intelligence. Toward that end, it is ing public school archival records. The regarding “why”. It is the offering of the anxiety disorders (Micco, Choate- important that psychoeducational explana- High School Journal, 74(1), 16-21. “why” that can encourage an adolescent Summers, Ehrenreich, Pincus, & Mattis, tions are offered using simple, under- to accept counseling from the clinician 2007), suicide prevention (Esposito- standable language and terms. The goals is Lincoln, T.M., Wilhelm, K., Nestoruic, Y. about the “how” (how to manage and Smythers, McClung & Fairlie, 2006), treat- to encourage the adolescent by offering (2007). Effectiveness of psychoeducation ameliorate the effects of presenting symp- ment of substance abuse (Kirk, Chapman & them a new understanding, not make them for relapse symptoms, knowledge, adher- toms). Through psychoeducation teens Sadler, 1990) the development of positive feel stupid because they are unable to com- ence and functioning in psychotic disor- learn about the mechanisms underlying coping skills (Hayes & Morgan, 2005), prehend the explanations being offered. ders: A meta-analysis. (2007). Schizo- presenting symptoms as well as the conse- managing sickle cell disease (Martin, 2005), Most adolescents respond well to treat- phrenia Research, 96(1-3), 232-245. quences related to the rejection of treat- epilepsy (Snead, Ackerson, Bailey, Schmitt, ment approaches which are direct and ment (Vieta, 2005). Biologically based Madan-Swain, & Martin, 2004), and in honest. By offering psychoeducation, cli- Martin, G.M. (2005). The effects of a psy- explanations validate for teens that what building self-esteem in adolescents at high- nicians suggest to their adolescent clients choeducational intervention on improving they are experiencing is real. This fact-based risk for dropping out of school (Wells, that when presented with the facts they psychosocial functioning and disease man- approach also suggests to teens that there is Miller, Tobacyk, & Clanton, 2002). are mature enough to make decisions re- agement of adolescents and young adults hope-symptom relief is not only possible, It is important to acknowledge however, lated to their own treatment. When ado- with sickle cell disease. Dissertation Ab- but plausible. Suddenly it seems rational to that the greatest treatment gains are noted lescents are armed with the treatment re- stracts International: Section B: The Sci- adolescents that if information regarding the when psychoeducation is provided as a lated facts, psychoeducation can be used ences and Engineering, 65(9-B), 4839. underlying causes of symptoms is fact- component of a treatment protocol (Rouget as a tool to empower them to take the first based and readily available, then treatment & Aubry, 2007). As indicated in the scenar- step forward in treatment. Micco, J. A., Choate-Summers, M. L., protocols offered by clinicians may be fact- ios offered above, psychoeducation can be Ehrenreich, J. T., Pincus, D.B., Mattis, S.G. based and possibly successful. used as a tool to help adolescent clients References (2007). Effacacious treatment components The use of psychoeducation as a treat- make the choice to accept treatment. of panic control treatment for adolescents: A ment tool may not be successful for all Although guidelines have been of- American Psychiatric Association: Diagnostic preliminary examination. Child & Family teens. Some simple guidelines regarding fered regarding who may benefit best and Statistical Manual of Mental Disorders, Behavior Therapy, 29(4), 1-23. teens most likely to benefit include the from this approach, clinicians should Fourth Edition, Text Revision. Washinton, following: not rule out trying this approach with DC, American Psychiatric Association Rouget, B. W., & Aubry, J. (2007). Efficacy other clients. The key is to offer the of psychoeducational approaches on bipolar • Teens with higher levels of intelligence psychoeducation at a level that the cli- Colom, F. (2002). The mechanism of ac- disorders: A review of literature. Journal of ent can best understand. Explanations tion psychotherapy. Bipolar Disorders, 4 Affective Disorders, 98(1-2), 11-27. • Teens who demonstrate an ability to do not need to be complex. For exam- (suppl1), pp. 102, 2000. use abstract thinking ple, in working with teens who suffer Snead, K., Ackerson, J., Bailey, K., from learning disabilities, I am quick to Esposito-Smthers, C., McClung T.J., & Schmitt, M, Madan-Swain, A., & Martin, • Teens who demonstrate insight point out that although they have told Fairlie, A.M.(2006). Adolescent percep- R.C. (2004). Taking charge of epilepsy: me they feel frustrated because they feel tions of suicide prevention group on an The development of a structured psy- The use of psychoeducation in treat- stupid, by definition, in order to be di- inpatient unit. Archives of Suicide Re- choeducational group intervention for ment protocols is not a new concept. In agnosed with a learning disorder an search,10(3), 265-275. adolescents with epilepsy and their par- fact research consistently confirms the individual must demonstrate a statisti- ents. Epilepsy & Behavior, 5(4), 547-556. success of psychoeducation in reducing cally significant difference between Hayes, C., & Morgan, M. (2005). Evalua- symptoms, preventing relapse and encour- their IQ (defined as a minimum of two tion of a psychoeducational program to Vieta, E. (2005). Improving treatment age medication compliance, especially in standard deviations) and achievement help adolescents cope. Journal of Youth adherence in Bipolar Disorder through patients diagnosed with schizophrenia or (DSM-IV-TR). This clearly indicates in and Adolescence, 34(2), 111-121. psychoeducation. Journal of Clinical psy- Bipolar Disorder. The greatest benefits laymens terms, a person is diagnosed chiatry, 66(suppl1), 24-29. have been noted when the families of with a learning disorder because they Hornung, W. P., Kieserg, A., Feldmann, these individuals are offered psychoedu- are not achieving the academic level R., & Buchkremer, G. (1996). Psychoedu- Wells, D., Miller, M., Tobacyk, J., & cation as well (Colom, 2002; Hornung, that would be expected given their level cational training for schizophrenic pa- Clanton, R. (2002). Using a psychoeduca- Kieserg, Feldmann, & Buchkremer, 1996; of “smartness” (as measured by a stan- tients: Background, procedure and empiri- tional approach to increase the self-esteem Lincoln, Wilhelm & Nestoriuc, 2007; dardized IQ test). cal findings. Patient Education and Coun- of adolescents at high risk for dropping Rouget & Aubry, 2007; Vieta, 2005). In work with adolescents, it is the way seling, 29(3), 257-268. out. Adolescence37(146), 431-434. □ MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 25

Commissioner Hogan from page 1 nor Spitzer announced a historic $400 community residences in January 2008; around services for children and teens? million Housing Opportunity Fund that an additional 8 percent increase is antici- Youth facing the challenges of serious will increase the amount of affordable will support affordable and supportive pated (subject to appropriations) in Janu- emotional disturbance may receive resi- housing in New York. A portion of these housing across the state. OMH has ary 2009, and 7.5 percent is anticipated in dential services from a number of state units will be targeted toward persons with launched a broad and multi-year approach January 2010. These funding increases agencies, so an interagency approach is disabilities. In addition, OMH is cur- to reform its approach to mental health show a commitment by the Spitzer ad- critical to effective planning of these ser- rently working with private developers housing and acting with partners in the ministration to support those individuals vices. New York State child serving that have expressed interest in working Administration (HFA, DHCR, OTDA), who need safe and affordable housing as agencies are beginning to engage in a with OMH on the development of inte- housing production is being increased part of their recovery. comprehensive discussion to effectively grated, affordable housing. faster than by OMH acting alone. OMH is evaluate what role residential interven- also working with residential providers to Q. Can we expect any changes in the tions will have in the next ten to fifteen Q. How much mental health housing is emphasize a supportive housing model: near future? OMH has begun a review years in New York. State child and fam- there in New York State? New York providing safe, decent and affordable of housing and related support services ily serving agency leadership are begin- State has the nation’s most extensive housing that is available long term, linked throughout its vast mental health system ning to assess who will be served, what mental health housing program, with to flexible services that can be increased/ of care. Additional flexibility is needed types of residential interventions will be 39,000 units or housing opportunities in decreased as needed. for the mental health housing system to be needed, what types of services and sup- place or under development by OMH. responsive to individual recipient wishes ports will be most effective to those served, These programs, many developed through Q. Do you think this new partnership and needs system goals, and to work ef- and the expected numbers of those who will the “New York New York” partnerships, approach will have any positive results? fectively as a tool in the creation of local require in these restructured programs. have become national models for suppor- It already has. In a speech at the 34th an- systems of care that reduce institutionali- tive housing and urban redevelopment. nual awards luncheon of the New York zation, homelessness, persons stuck in Q. Is there anything being done to Housing Conference, Governor Spitzer acute care settings, and waste. meet the housing needs of adolescents Q. What do you mean when you say highlighted an affordable housing project transitioning into adult services sys- there is housing under development? being developed on Washington Avenue Q. Is the mental health community tem? The needs of children transitioning OMH has a significant housing develop- in the Bronx. This 118 unit project will involved in this review? OMH has into adult services (18-25 years old) are ment pipeline, in addition to what is rec- include 30 units for persons recovering reached out to all funded or licensed hous- uniquely different from those individuals ommended in the 2008-09 Executive from a serious mental illness. The project ing providers, county mental hygiene di- already being served in the adult pro- Budget. OMH will continue the develop- developer, The Arker Companies, is plan- rectors, and other interested organizations grams. OMH has contracted with the ment of these units and will emphasize ning additional housing development in to submit agency-specific ideas regarding Coalition of Children’s Mental Health integration of new housing into main- the NYC, and has expressed interest in how it would reorganize housing pro- Services to research and develop a resi- stream housing. OMH will explore the working with OMH on these projects. grams to become more recovery oriented, dential program model to specifically conversion of 24-hour staffed housing Other developers have also expressed flexible, and responsive to individual re- address the needs of young adults, incor- into supported housing and blend new interest in working with OMH on the de- cipient wishes and needs. Our guiding porating the input of interested commu- OMH housing resources with existing velopment of affordable housing. principles are posted on the OMH website nity members, service providers, consum- OMH housing/residential programs to at http://www.omh.state.ny.us/omhweb/ ers of service and their families. The re- achieve reform. Finally, it will increase the Q. Is OMH doing anything to help News/housing_policy.html We look for- search findings will be shared with coun- supply/focus on treatment/support programs housing providers keep up with the ward to working with local government, ties, municipalities and elected officials to that help individuals with a mental illness rising costs we all face? Existing OMH consumers, family advocates, and provid- facilitate an interagency approach to ser- choose, get and keep their housing. funded housing received a 2.3 percent ers to incorporate flexibility into housing vices and supports. Additionally, this cost of living adjustment (COLA) effec- funding, regulation, and oversight into project provides funding for two tran- Q. Are there any plans to make more tive April 1, 2007 and will receive another OMH funded housing. sitional housing demonstration pro- housing available for New Yorkers with 2-2.5 percent COLA effective April 1, jects to enhance existing mental health mental illness? During this year’s State 2008. In addition, there was an eight per- Q. We’ve talked a lot about housing services to better meet the needs of of the State and Budget messages, Gover- cent operating base increase for licensed for adults, is there anything happening this population. □

Advertise in Mental Health News ~ See Page 43

Guiding Principles from page 11 taken hold. Recovery is truly possible with housing. Person-centered principles of • Emphasize supported housing models the proper access to these resources. recovery will guide the work. and integrated mixed settings. Supported Housing: 11,135 units • On the community systems level, the Guiding Principles • Explore conversion of staffed hous- local mental health housing resources Family Care: 2,413 units ing programs to: It is time, then, to revisit the structures will be viewed as an asset to expand access to supported housing and to Children’s Programs that govern the mental health housing - neighborhood-based supported housing assets in New York. Additional flexibility facilitate broader reforms (i.e., ac-

Congregate Treatment is needed for this housing to be responsive countability, recovery focus). (Group Homes): 272 units in 38 sites to individual recipient wishes and needs, • As restructuring progresses recipient - more specialized staffed housing

system goals and to work effectively as a satisfaction and recovery outcomes • Blend new OMH housing resources Family Based Treatment: 490 units tool in the creation of local systems of will be monitored. care that reduce institutionalization, with existing OMH housing/residential • The new resource commitments in 27,285 of these units are operated by homelessness, people stuck in acute care programs to achieve reform. the 2007-08 budget will be used to not-for-profit agencies and 1,204 are State settings, and waste. To achieve this it is facilitate restructuring. • operated. In addition, 8,843 units are in appropriate to outline guiding principles Balance these development goals development including 1,825 units of sup- which can be used as a compass to focus • OMH will partner with affordable with meeting needs of identified ported housing, 6,738 SRO units and 280 these restructuring efforts. These princi- housing agencies to develop inte- populations. children’s units. ples include the following: grated, permanent housing. These are valuable and also expensive • Increase the supply/focus on treat- resources that are assets for the local men- • Housing is a basic need and neces- OMH will work with stakeholders ment/support programs that help indi- tal health systems throughout the sary for recovery. Most people want (local government, consumers, family viduals with a mental illness choose, State. Many of these units were devel- permanent, integrated housing that is advocates, providers) to incorporate flexi- get and keep housing. oped using approaches put in place in the not bundled with support services bility into housing funding, regulation and 1980s and early 1990s, which emphasized (housing as housing). oversight to introduce the above stated We welcome comments and feedback on a “residential treatment” strategy with principles into OMH funded housing. services and supports provided in and • Within an accountable system of care these principles and look forward to work- sometimes as a condition of housing. there is also a finite need for staffed Action Implications ing with all stakeholders in this ambitious The New York State community-based specialty housing and time-limited and timely effort. Please send any feedback • Continue development of additional mental health system has expanded dramati- residential treatment programs. or suggestions to: Robert W. Myers, Ph.D., housing units: cally during this time. Treatment, rehabili- Senior Deputy Commissioner, NYS Office of th tation and pharmacological interventions • The primary goal of housing reform - in/via mainstream housing programs Mental Health 8 Floor – Adult Services, 44 have made great strides forward and the will focus on the individual and empha- Holland Avenue, Albany, New York 12229, consumer empowerment movement has size expanding access to supported - via OMH resources [email protected] □ PAGE 26 MENTAL HEALTH NEWS ~ SPRING 2008 Mental Health News - Nassau County Section: Spring 2008 Page 27 The Mental Health News Sponsored By The Nassau County Department of Mental Health, Chemical Dependency and Developmental Disabilities and The Mental Health Association of Nassau County Nassau County Section

Achieving Positive Outcomes

By James R. Dolan, Jr., DSW, LCSW worsened and the pain had gotten to the triage nurse must have realized that some Assistant to the Commissioner point that it was difficult for me to stand order needed to be brought to the situa- Nassau County Department of Mental erect. I had probably waited too long, but tion, so she eventually exited the cubicle Health, Chemical Dependency and I realized that I must get myself to an area and walked around the ER to ask the Developmental Disabilities Services emergency room. So I drove to the hospi- patients for a brief statement describing tal, that being a facility with an excellent their problem. When she got to me, I reputation. When I entered the ER, how- knew, based on my research, how to ex- t began one day when I woke up ever, I was surprised and disconcerted. plain my condition. I told her that I have with an ache in the middle of my The place looked very disorganized. “severe abdominal pain”. In response, stomach. I went to work, however, Many people were sitting and some were she said that I would be the next patient to since the discomfort was only a mild standing, but what was most astounding be evaluated by her. concern.I As best I could, I followed my was that there was nothing to indicate that There was another patient who was usual routine, but by mid afternoon the a system was in place to assure that peo- sitting beside me who could overhear my discomfort seemed to be moving to my ple received care in an ordered manner. I exchange with the nurse, so of course that lower right quadrant. At this point, I still could not determine if there was a line to person also told the nurse that they too had not eaten, so I decided to have an see the triage nurse, and if one existed, have severe abdominal pain. When I now apple. Soon thereafter, this seemed like a there was no indication as to who was tell this story in a joking manner, I will mistake because as I digested it, the dis- first on line. state that the ER records for that night comfort I had turned into pain, and it was Off to the corner of this fairly large probably show that, at a particular point, quite intense for a minute or so, until it room there was a nurse who was sitting in the entire patient population reported that subsided somewhat. a cubicle with a patient. I walked over to they had “severe abdominal pain”. At this stage I still did not think there James R. Dolan, Jr., DSW, LCSW that area and I as entered the cubicle the The lesson learned, from a psychoedu- was any reason to worry. In fact, when I nurse abruptly told me to go find a seat. I cation perspective, is that one must be got home, I fit in a baseball catch with my lower right side of my intestines. There- had no idea of where an arriving patient conversant in the areas that relate to their son. As we played, however, I felt pain fore, based on its location, and the type of should sit, so I positioned myself nearby own health care. Being able to describe when I stretched or reached upwards. sensations I was having, I thought that my the nurse’s cubicle. As I was waiting a one’s condition, that being the precipitat- That evening I was beginning to think that condition would be referred to as intesti- number of new patients were arriving and ing factors, and the type of symptoms I might need to see a doctor, but I decided nal cramping. With this phrase in mind, I everyone had the same disoriented expres- experienced helps to assure that one is to wait and see how I felt when I woke up proceeded to do some research on the sion that I must have had when I first diagnosed correctly and that responsive the next morning. computer. I typed in the words “intestinal came in. and timely care is received. Therefore, When I did arise, the discomfort was cramping” but did not find a match; but The ER was now crowded, there was we need to understand ourselves and, to still with me, so I determined that I had to what I did find is that the symptoms I had milling around and a number of people the degree possible, develop the knowl- figure out how to best describe to myself, were referred to as “severe abdominal were expressing their pain through groans edge that enables one to partner with and to a doctor, what I was experiencing. pain”. It also stated that severe abdominal or complaints. In addition, one of the health care practitioners in the treatment By this point the pain had clearly moved pain could be a medical emergency. medical billing clerks was complaining from my stomach, to what seemed like the As the day progressed my condition that patients were using her chairs. The see Positive Outcomes on page 42

Re-framing the Mental Health Needs of Iraq-era Veterans

By Steven Greenfield, Coordinator of • The incidents of domestic violence Special Projects, Family Residences and marital break-up following de- and Essential Enterprises (FREE) ployment has reached alarming levels

• Post-traumatic stress disorder (PTSD) he large number of military men and depression are the leading diag- and women returning from Iraq noses. Treatment is complicated by and Afghanistan who are experi- the high rates of traumatic brain in- encing mental health needs re- jury which often results in mental Tquires a shift in perception and perhaps illness-types of behavior terminology if we are to re-integrate these veterans effectively. First, the facts: • Numerous studies have shown that the symptoms of depression and • 34% of returning veterans who have PTSD often do not become evident sought Veterans Administration until months and even years later, health care have been diagnosed with often triggered by another event, or a mental health disorder. even a noise or a smell.

• Soldiers and families have continued to • During 2006, 99 confirmed suicides report a shortage of qualified mental occurred among U.S. Army soldiers, health personnel within the VA, resulting the highest rate in 26 years. The sui- in delays in care and inadequate treatment. cide rate for veterans is twice the national average see Veterans on page 40

See Page 43 for Details Details for 43 Page See

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□ 12/27/07. Newspapers, Community Anton comes in important areas of their lives. lives. their of areas important in comes

This column was previously published by the the by published previously was column This discrimination that leads to unequal out- unequal to leads that discrimination

labeled persons lose status, and experience experience and status, lose persons labeled

stigma. stigma. order to separate “us” from “them.” Finally, Finally, “them.” from “us” separate to order

ing that reinforces fear, mistrust and and mistrust fear, reinforces that ing distinct categories in in categories distinct in put then are sons

tal illness, through malicious name call- name malicious through illness, tal lead to negative stereotypes. Labeled per- Labeled stereotypes. negative to lead

and discredit people suffering with men- with suffering people discredit and signed undesirable characteristics that that characteristics undesirable signed

than taking the opportunity to exploit exploit to opportunity the taking than human differences are labeled and as- and labeled are differences human

individual is less important to them them to important less is individual insights on how stigma evolves. First, First, evolves. stigma how on insights

ate criminal act by a deeply troubled troubled deeply a by act criminal ate lic Health at Columbia University, offer offer University, Columbia at Health lic

and informing readers about a desper- a about readers informing and Phelan from the Mailman School of Pub- of School Mailman the from Phelan

ness. Clearly, simply telling the truth truth the telling simply Clearly, ness. Stigma experts Bruce Link and Jo C. C. Jo and Link Bruce experts Stigma

force stigma in people with mental ill- mental with people in stigma force schoolyard bully does. does. bully schoolyard

promote negative stereotypes and rein- and stereotypes negative promote sinister and have more sway than the typical typical the than sway more have and sinister

al acts in order to to order in acts al crimin isolated about beyond, and the headline writers are more more are writers headline the and beyond,

metropolitan newspapers choose to write write to choose newspapers metropolitan the entire New York metropolitan area and and area metropolitan York New entire the

It is shameful that the editors of major major of editors the that shameful is It bullies except, in this case, the schoolyard is is schoolyard the case, this in except, bullies

do so. so. do headlines are the equivalent of schoolyard schoolyard of equivalent the are headlines

trolled only if one has the moral fiber to to fiber moral the has one if only trolled tion. The headline writers who write such such write who writers headline The tion.

is “all in one’s head” and can be con- be can and head” one’s in “all is sirable stereotype and reinforce discrimina- reinforce and stereotype sirable

idea that mental illness is something that that something is illness mental that idea behavior. In this case they promote an unde- an promote they case this In behavior.

employ such language also reinforce the the reinforce also language such employ ence people’s perceptions, attitudes and and attitudes perceptions, people’s ence

with a biological basis. Headlines that that Headlines basis. biological a with headlines of popular newspapers do influ- do newspapers popular of headlines

, versus a disease disease a versus , behavior irrational and the crime. Language that appears in the the in appears that Language crime. the

tal Illness is a sure sign of dangerous dangerous of sign sure a is Illness tal The headline writers cannot hide behind behind hide cannot writers headline The

“wacko” reinforce the notion that men- that notion the reinforce “wacko” individuals with mental illness is used. used. is illness mental with individuals

Headlines that use terms like “loony” and and “loony” like terms use that Headlines age when stigmatizing language about about language stigmatizing when age

brain are associated to mental disorders. disorders. mental to associated are brain sell newspapers, there is collateral dam- collateral is there newspapers, sell

ies show that physical changes in the the in changes physical that show ies Nevertheless, although juicy headlines headlines juicy although Nevertheless,

despite the fact that neuro-imaging stud- neuro-imaging that fact the despite man did do something undeniably crazy. crazy. undeniably something do did man

sympathy and support. This is the reality reality the is This support. and sympathy moting political correctness. After all, the the all, After correctness. political moting

ficiaries of widespread understanding, understanding, widespread of ficiaries you are reading another tired diatribe pro- diatribe tired another reading are you

cal illnesses, on the other hand, are bene- are hand, other the on illnesses, cal big deal? Or, you may be thinking that that thinking be may you Or, deal? big or call (718) 470-8563 470-8563 (718) call or [email protected] email:

taunts and jokes. Most people with physi- with people Most jokes. and taunts So, you may be wondering, what is the the is what wondering, be may you So,

For more information: information: more For

at the butt end of cruel and stigmatizing stigmatizing and cruel of end butt the at credit all individuals with mental illness. illness. mental with individuals all credit

adults alike - have long histories of being being of histories long have - alike adults of the language in the headlines is to dis- to is headlines the in language the of Glen Oaks, NY 11004 11004 NY Oaks, Glen

tal illnesses - children, teenagers and and teenagers children, - illnesses tal al act, the effect effect the act, al crimin man’s one about Psychiatry Research Department Department Research Psychiatry

Many individuals suffering with men- with suffering individuals Many illness. Although these headlines are are headlines these Although illness.

The Zucker Hillside Hospital Hospital Hillside Zucker The

types to label an individual with a mental mental a with individual an label to types

Anil Malhotra, MD MD Malhotra, Anil

act versus employing insulting stereo- insulting employing versus act

Andrew Malekoff Malekoff Andrew

lighting the lunacy of a desperate criminal criminal desperate a of lunacy the lighting This study is being conducted by by conducted being is study This

“nut” would have been a way of high- of way a been have would “nut”

derisive terms “loony,” “wacko,” and and “wacko,” “loony,” terms derisive

patient will have a single blood sample drawn. drawn. sample blood single a have will patient

Had there been no such history, then the the then history, such no been there Had

Only one procedure: procedure: one Only known history of serious mental illness. illness. mental serious of history known

were referring to an individual with a a with individual an to referring were

National Institute of MentalHealth (NIMH) (NIMH) MentalHealth of Institute National

By now you know that the headlines headlines the that know you now By

Study is sponsored by the the by sponsored is Study

and “Nut’s Life from Hell.” Hell.” from Life “Nut’s and

read: “Wacko Bombs at Hill’s Office” Office” Hill’s at Bombs “Wacko read:

1-866-621-6898 at us Call

printed headlines that that headlines printed News Daily York

New New the days consecutive two For fice.”

Assisting us in this effort is easy. easy. is effort this in us Assisting

“Loony Seizes Hostages in Hillary’s Of- Hillary’s in Hostages Seizes “Loony

read: read: Post York New the of pages front

• Patient is able to provide informed consent consent informed provide to able is Patient • in New Hampshire. A headline on the the on headline A Hampshire. New in

Senator Hillary Clinton’s campaign office office campaign Clinton’s Hillary Senator E

the occurrence of the agranulocytosis or granulocytopenia granulocytopenia or agranulocytosis the of occurrence the

tal illness who took hostages in in hostages took who illness tal

• Patient was discontinued from clozapine treatment at time of of time at treatment clozapine from discontinued was Patient • man with a long history of men- of history long a with man

several news stories about a a about stories news several

granulocytopenia (ANC<1000mm³) during treatment with clozapine clozapine with treatment during (ANC<1000mm³) granulocytopenia

arly in December there were were there December in arly

• Patient was diagnosed with agranulocytosis (ANC<500mm³) or or (ANC<500mm³) agranulocytosis with diagnosed was Patient •

• Patient is age 18 or over over or 18 age is Patient •

and Family Guidance Center Center Guidance Family and

North Shore Child Child Shore North

while being treated with cloz with treated being while apine (Clozaril, FazaClo) FazaClo) (Clozaril, apine

By Andrew Malekoff, Executive Director Director Executive Malekoff, Andrew By

We are seeking patients who who patients seeking are We developed agranulocytosis agranulocytosis developed

That Perpetuate Stigma Stigma Perpetuate That

Headlines Headlines

Page 28 28 Page Mental Health News - Nassau County Section: Spring 2008 2008 Spring Section: County Nassau - News Health Mental Mental Health News - Nassau County Section: Spring 2008 Page 29

Photography by Jean Miele PAGE 30 MENTAL HEALTH NEWS ~ SPRING 2008 Transformations: Made Possible by Supportive Housing at Saint Vincent’s Westchester

By Maureen Italiano, Division Director A visit to the building, as move-in drew tenants offered these comments about their Saint Vincent Catholic Medical Centers near, elicited tears and shrieks of joy from experience at Immaculata Hall: St. Vincent’s Westchester the prospective tenants. The tenants’ experi- Residential Services ences of having lost everything, however, “Being in supportive housing had taken a toll. Many were fearful, reticent, has been such a relief.” untrusting and guarded in their communica- uch has been written about tions with staff. Engagement was a lengthy “Now I decide when I eat and what I eat. the cost-effectiveness of process. I come and go as I please.” supportive housing. To be More than 70% of our tenants have sure, this model of perma- now been with us for more than two “I’m in charge of my life again, here.” nent,M affordable, safe housing with flexi- years. For many, this means that their ble supports is a cost-saver when com- tenancy in supportive housing, and their pared to the alternatives of shelters, hospi- tenure in the community, has been longer In organizing my thoughts for this arti- tals or jails. than their shelter stay. cle, I considered a metaphor comparing This article, instead, will focus on the The staff members are eyewitnesses to an the rooting and blossoming in supportive priceless benefits – the transformation we astounding blossoming: a tenant who has housing to that in a cutting of a house- have seen in the 75 tenants of Immaculata completed her undergraduate degree and has plant that can root in a glass of water and Hall, a supportive housing building, spon- applied for admission to social work school; then, planted in soil, grows and blossoms sored by St. Vincent’s Westchester Resi- another who has been blessed with a new into a new plant. However, there is some- dential Services, which opened in 2005 in granddaughter and, due to her stable hous- thing disrespectful to the tenants in that Jamaica, Queens. The tenants, all adults ing, can offer her home and skills as a baby- metaphor. After all, the power to change with mental illness, most of whom had sitter. Tenants have taken on the direct re- and grow is within the tenant, all we do is been staying in shelters or drop-in centers, sponsibility for the security of the building provide the medium. In this setting of had this to say about their experiences by providing front desk services; another stability, safety and support, tenants grow before coming to Immaculata Hall: Maureen Italiano tenant, now with stable housing and in re- into their God-given potential. With the covery, has become a resource to a sibling medium of respectful, compassionate “I was used to having my own. Staying in At the screening for apartment tenancy, care, the blossoming is thus set in motion. in failing health. Tenants will stop in at the shelter took that feeling away from me.” and during the in-reach process, St. Vin- office to inquire about a neighbor who is It’s a joy to be a small part of it. cent’s managers assessed the prospective hospitalized; and one tenant always prepares “I couldn’t support my daughter when I tenants and answered repeated, questions was in shelter. She needed me then and more food than she can consume so that St. Vincent’s Hospital Residential Ser- about house rules, leases, rent charges, and she’ll have some to share with her vices provides a full continuum of resi- she needs me now. Back then, I couldn’t access to public transportation. The manag- do anything for her.” neighbors. There are even tenants who com- dential and housing options—from transi- ers were mystified by questions such as plain vociferously if they are dissatisfied tional community residences to permanent “I never dreamed that someone like me “What is the curfew?” and “How much with a policy or a building service—as it housing—so that persons with mental could end up in shelter. Then I lost allowance do I get?” It took some weeks of should be. illness and other special needs can live as everything in that fire.” reassurance and explanations to help the Supportive housing is not a utopia. The independently as possible. Residential prospective tenants get comfortable with the scourges of addiction and crime continue Services provides housing options in four “Freedom has always been a particular idea of their own apartment and the con- their ravages in some of our most beloved boroughs of New York City and in West- thing with me. Being in shelter comitant rights and duties. In a nutshell: tenants. We work daily to make options for chester County. For more information, was not free.” fewer rules, more responsibilities. health and recovery apparent to them. Our please call (718) 818-5055. □

We are Now Accepting Articles and Advertising for our Upcoming Summer 2008 Issue: “Employment for People With Mental Illness” ~ Deadline: May 1, 2008 Contact Us by E-mail at [email protected] or by Phone at (570) 629-5960

The Bridge from page 13 Mental health and vocational ser- 2009, Project InPACT is a partnership clients to form a therapeutic alliance to vices are also available at The Bridge between The Bridge and Bellevue Hospi- ease and promote sucessful transition developed in recognition of the special for Iyana House clients, and a number tal targeted to chronically homeless per- from the inpatient unit to the InPACT needs of the thousands of people with of clients have used the vocational pro- sons with serious mental illness and sub- residence. The residence, being built with serious mental illness in the State and City grams to prepare for and secure jobs in stance abuse who continuously cycle tax-credit financing arranged by State criminal justice systems. the community. through the hospital, shelter, street and OMH and to be licensed by OMH as a CR The model begins with an in-reach The clients also participate in a special criminal justice system. This is a notable -SRO, will have shared three-bedroom component at Bedford Hills in which trauma treatment program, Seeking Safety. experiment in which a community-based apartments. On-site substance abuse and Bridge staff work regularly at the prison. This group-modality program focuses on agency and municipal hospital are joining vocational services will be offered with In-reach activities, offered in collabora- both the traumas related to experiences in together to offer a comprehensive residen- linkages to other service providers in the tion with Bedford Hills mental health the criminal justice system, as well as tial and rehabilitation program to interrupt community. Once at the residence, the staff, include screening potential clients, earlier life traumas. the cycle of homelessness and hospitaliza- program participants will continue to who, in addition to their mental illness The project is fortunate in having a tions with a hope that clients will embark work with the integrated Bridge/Bellevue and substance abuse diagnoses, are near- strong working partnership with the State on a positive path of recovery. Akin to team. Back-up psychiatric services will be ing release. Bridge staff engages potential Division of Parole. A dedicated Parole the sectorization model of mental health provided at Bellevue. clients, preparing them for their release Officer, who has special knowledge and services used in many European coun- The three models described in this and move to the Iyana House residence. understanding of mental illness, works tries, Project InPACT envisions a single, article reflect some of the strategies that The Iyana House building contains 16 with all of the Iyana House clients. Two integrated team working with a cohort of The Bridge has developed to address the newly renovated studio apartment, as well additional partnerships support the pro- clients as they move from inpatient care to needs of the special populations that have as staff office and program space. There gram: The State Office of Mental Health community residential settings. emerged in the mental health system. is 24-hour residential staffing and a link to provides funding for rents and staffing, Borrowing from the Iyana House ex- Doing so requires a good deal of creative the OASAS-licensed Medically Super- and services funding is supplemented perience, a major component of InPACT thinking, exploring and accessing multiple vised Outpatient Treatment Program at with a HUD McKinney grant. will be the in-reach team that will engage funding streams, and forming strategic The Bridge, which is licensed specifically to Still in the development phase and clients during their inpatient stay at Belle- partnerships to provide the services and serve persons with severe co-occurring seri- expected to be launched when residential vue. The team, comprised of Bridge and supports that are needed to assist clients ous mental illness and substance abuse. construction is completed in the Spring of Bellevue staff, will work intensively with on their path to recovery. □ MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 31 PAGE 32 MENTAL HEALTH NEWS ~ SPRING 2008 Visiting Nurse Services in Westchester’s In-Home Mental Health Care Program: A Holistic Approach

Staff Writer housing. They work collaboratively with Mental Health News the Department of Social Services personal care unit to ensure that patients receive needed support with activities of t is becoming increasingly under- daily living. VNSW’s services are equiva- stood and appreciated how much lent to on-site nursing, since they are pro- healing and comfort extend beyond vided as-needed in patients’ homes, and, the physical. There is a decided where patients are not in independent mentalI well-being component as well, housing, the agency works closely with recognized by VNSW with the formation housing staff. 8 years ago years ago of its program of VNSW’s services also include high- psychiatric healthcare – in the patient’s level support for various ancillary condi- home, for maximized comfort and effect. tions. “For example,” explains Lisa, “the Coordinating these activities is Lisa mental health population exhibits a high Sioufas, LCSW-R, ACSW, Manager of rate of smoking. We introduce such pa- the Mental Health Program. “Since I be- tients to VNSW’s smoking cessation pro- came manager last year,” says Lisa, gram, not only because decreased smok- “we’ve been seeing a significant increase ing leads to improved health, but also in referrals in both our elderly population because it increases patients‘ desirability as and chronically mentally ill population. tenants in private housing. For patients with The elderly are being seen with diagnoses diabetes, we have a mental health nurse who of depression and anxiety related to the The VNSW Mental Health Care Team: Left to right: Rear row, Program Manager is also a certified diabetic specialist.” changes they’re going through, either be- Lisa Sioufas, Carol Griffiths, Penny Parham, Margaret Burns, Zef Hot, Miriam Listening to Lisa talk about her calling, cause of a new health diagnosis, a change Cruz-Soto and Juan Antonio; front row, Judy Bogart and Annie Balzer. Not pictured: you clearly hear her concern about the in their state of health and ability to care Patricia LaMorte, Gerri McGuire, Mary Jody McKeever, Hugh McKenzie, Samuel growing elderly population, as well as the for themselves or a spouse in the home. It Thompson, Rosamund Duarte Bovelle, Edward Lewis and Carlos Monserate. chronically mental ill. She stresses the is vital for us to monitor their medical need to keep evolving strategies to assist illnesses and their complex interaction the referrals, assign the nurses, problem- 100 percent compliance. We provide free them in staying at home, and identifying with the individual’s mental health. As solve with the nurses regarding the pa- support groups at assisted living facilities resources in the community to help they age, we’re seeing an increased rate of tients they’re currently seeing, help them and senior centers to help address mental achieve that goal. You also hear a heart- co-morbidities in the mental health popu- develop and manage the care plan, super- health needs of older adults. We employ warming appreciation of her team. lation – cardiac illness, pulmonary illness vise them and go out with them into pa- multicultural and bilingual mental health Says Lisa, “Although it’s largely and diabetes – and we offer various spe- tients’ homes. “Because we’re dealing nurses and social workers. Our experi- true of nurses in general, the nurses on cialty programs to help address these con- with such a senior population,” says Lisa, enced psychiatric social workers work this mental health team are unsung he- cerns together with their mental health “one particular diagnosis that we’re see- with our mental health nurses to assist roes. What they do for the patients to treatment. The need for VNSW’s coordi- ing more and more is dementia. For Alz- with accessing entitlements, community enable them to remain at home is abso- nated, quality home-based healthcare ser- heimer’s and other forms of dementia, it resources and appropriate housing. Our lutely incredible!” vices is ever-more compelling.” is urgent that we keep up with the state of staff is available to assess patients at inpa- These services fall generally into 2 the art in medications, and continuing tient facilities so that services can begin For more information call (914) 682-1480, categories, long-term for chronic patients education of our nurses and staff. Looking immediately after discharge and ensure ext. 648, or e-mail [email protected]. □ and short-term, in the area of 2 to 3 for opportunities to access this training is continuity of care. Our patient,” says Lisa, months, for acutely ill patients. The deci- becoming an increasing part of our routine.” “is always our partner – we work together sion is based on a particular patient’s di- Lisa emphasizes the importance of toward recovery and reaching a maximum agnosis and history. According to Lisa, VNSW’s program as an adjunct to com- level of independent functioning. Our “Long-term patients tend to have a history munity mental health services, as opposed staff supports and encourages patient in- of non-compliance with their medications to a segregated, freestanding operation, dependence and our services strengthen and need hands-on management to make and of the program’s flexibility. “We pro- care coordination.” Industry Statistics sure they take their medications, with an vide daily visits 365 days per year, if Patient independence and the ability often-achieved goal of 100% compliance. needed. We work collaboratively with for the patient to recover at home are • 70% seriously mentally ill We also follow up with their appoint- supportive and intensive case managers. among the primary objectives at Visiting inpatient are discharged ments and go to their programs.” Our flexible visitation schedule is de- Nurse Services in Westchester. VNSW’s “Acute patients,” explains Lisa, “tend signed to accommodate patients’ day services allow individuals with all levels without outpatient care to be older. They may or may not have treatment attendance.” of mental illness the ability to remain in had psychiatric diagnoses inthe past, and their homes and involved in the commu- • 20% re-hospitalized in 30 days generally are new to mental heath treat- nity mental health programs that are an ment in the community. They may be integral part of their treatment. The • under the care of a psychiatrist or are on “The nurses on this mental agency’s ability to monitor psychiatric 41% hospitalized in 180 days new or changed medications. We can see health team are unsung heroes. symptoms and medication compliance – them for a shorter period of time, ensuring What they do for the patients to in addition to teaching the skills needed that their medications are taken, that enable them to remain at home by each individual to help manage their VNSW Statistics they’re effective or changed if needed, specific psychiatric needs – empowers that side effects are identified early, and is absolutely incredible!” patients to obtain their optimal level of that the patients keep their appointments. independent functioning/living. VNSW’s • 10,080 home visits 2007 Our nurses may additionally help these nurses regularly observe individuals in patients find a practitioner or other re- She points with professional pride to their homes, enabling the agency to pro- • 513 patients served 2007 sources in the community.” the program’s effectiveness, citing as an vide feedback to caseworkers on the ap- Lisa’s mental health team is comprised at example that the re-hospitalization rate for propriateness of the patient’s housing, and any given time of about 15 nurses, full and behavioral health needs for the program’s often to assist in obtaining housing with • VNSW works with over 30 part time, covering all of Westchester primary psychiatric diagnosis (depressive increased or decreased supportive ser- insurance plans, 20 psychi- County. Once the team receives referrals disorder, schizophrenic disorder, affective vices. Typically, supportive housing pro- atric facilities, numerous from other professional caregivers – a nurse psychosis, neurotic psychosis) is under 1 vides two supportive contacts a month from the team is assigned to do an evalua- percent. and VNSW can supplement these services private physicians and tion, and a plan of care is developed. And she points to various caring, sen- to ensure the patient’s ability to remain at community mental health VNSW’s mental health team receives sitive features that make this program home. agencies referrals from medical doctors, psychia- special. “We have the ability to set up Additionally, VNSW’s nurses provide trists and community mental health pro- and monitor locked medication boxes,” support to patients during transitional, grams. On a typical day, Lisa will review Lisa explains, “to support our objective of stressful periods related to changes in MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 33 PAGE 34 MENTAL HEALTH NEWS ~ SPRING 2008

Human Development Services of Westchester

When you need help, Westchester Jewish Community Services is here for you Creating Community

• Human Development Services of Westchester serves adults and families who are WJCS offers comprehensive mental health services recovering from episodes of serious mental illness, and are preparing to live independently. Some have had long periods of homelessness and come directly from the shelter system Out-patient Treatment for People of All Ages • In the Residential Program, our staff works with each resident to select the Specialized services for individuals level of supportive housing and the specific rehabilitation services which will with developmental disabilities assist the person to improve his or her self-care and life skills, with the goal of returning to a more satisfying and independent lifestyle. Intensive Community–based Services • The Housing Services Program, available to low and moderate income

for Children and Their Families individuals and families in Port Chester through the Neighborhood Learning Center for children and adults Preservation Company, includes tenant assistance, eviction prevention, home ownership counseling, landlord-tenant mediation and housing court assistance. Geriatric Care • Hope House is a place where persons recovering from mental illness can find Continuing Day Treatment the support and resources they need to pursue their vocational and Mobile clinical services educational goals. Located in Port Chester, the Clubhouse is open 365 days a year and draws members from throughout the region. Case management • In the Case Management Program, HDSW staff provides rehabilitation and

Social Clubs support services to persons recovering from psychiatric illness so that they COMPEER may maintain their stability in the community. All services are offered on a non-sectarian basis HDSW HOPE HOUSE 930 Mamaroneck Avenue 100 Abendroth Avenue Mamaroneck, NY 10543 Port Chester, NY 10573 Call WJCS at (914) 761-0600 (914) 835 - 8906 (914) 939 - 2878

Mental Health Association in Putnam County, Inc.

1620 Route 22 Brewster, NY 10509

Promoting a vision of recovery for individuals and families coping with mental health issues

● Peer-Run Information and Referral Warmline ● Consumer-Drop-In-Center ● Peer Bridging Program ● Self-Help Groups ● Education and Support for Family Members ● Community Outreach and Education

all of our services are available free of charge.. call us at

(845) 278-7600 MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 35 A Home of Their Own

By Andrea Kocsis, LCSW cial, recreational, and spiritual needs. The life skills training for successful reintegra- Executive Director children are particularly disadvantaged tion into the community, and linkages to Human Development Services and are at an environmental and genetic emotional, educational and recreational of Westchester (HDSW) risk of developing a mental illness. Men- resources for the children. tal illness is reported to be afflicting chil- After over 11 years of our Supported dren at an increasing rate. The rate of Housing Program operation, an impres- here are families headed by a schizophrenia in the general population is sive 88% of our families continue to live person with mental illness that 1%. If one has a parent or sibling with successfully in the community, a testi- are currently living in West- schizophrenia, the risk rises to about 10%. mony to how seriously the parents work chester shelters. There are other If both parents have schizophrenia, there on their recovery. For the families and for Tsimilar families who are living in the our staff, this is one of the most exciting is a 40% chance that their child will also homes of family members, often moving have schizophrenia.1 The average age of and gratifying outcomes that we have from couch to couch. Human Develop- onset for persons with bipolar illness has experienced in our agency’s thirty-nine ment Services of Westchester is a mental fallen in a single generation from the early years of service. health agency that can help these families 30s to the late teens. Experts estimate that Most importantly, however, this pro- move into homes of their own with rent a million preteens and children in the U.S. gram succeeds because: subsidies provided by the New York State may suffer from the early stages of bipo- Office of Mental Health Supported Hous- lar disorder. “Experts believe that chil- • There is as little disruption as possible ing Program or by the federal Department dren are being tipped into bipolar disorder for the families – they are able to move of Housing and Urban Development by family and school stress, recreational from the shelter directly into an apart- through its Shelter Plus Care Program. drug use, and a collection of genes that ment of their own without having to All these families have young children express themselves more aggressively in experience transitional housing. who need the comfort and security of a each generation…children with one bipo- home of their own, and the stability that Andrea Kocsis, LCSW lar parent have a 10% to 30% chance of • There is as much empowerment as comes when their parent is supported by developing the condition; a bipolar sibling possible – the families are able to the case management services that HDSW that are unmet. For many of the children, means a 20% risk; if both parents are bi- select the area where they want to provides. We presently serve over 45 the HDSW apartment is the first stable polar the danger rises as high as 75%,” live, and can reject specific apart- families, with over 125 children, in our environment they have experienced. explain Cray and Ressner.2 ments until they see one in which Supported Housing Programs, but there While the parent is HDSW’s primary cli- Bipolar disorder, schizophrenia, de- they will feel comfortable living. are many families still waiting. ent, our staff evaluates the needs of each pression, and certain anxiety conditions And, if they find, with time, that they Each family we serve includes a par- child in the family and provides support are powerfully influenced by surround- are not feeling safe or satisfied with ent, usually a mother, who is recovering services, activities and equipment, and ings. If a child is raised in a steady and this living arrangement, they can work from mental illness and who also may linkages to resources in Westchester’s stable home the odds of his developing a with their housing case manager to have issues with substance abuse. Many system of children’s services. In the past mental illness are reduced.3 Healthy life- choose and move to a more acceptable families face multiple problems and have few years, HDSW has experienced un- style management and family support are apartment. This degree of choice is already experienced several unsuccessful precedented growth in its Supported among the most important interventions to extremely valuable to the families. housing placements. These parents are in Housing Program. However, as our fund- address mental illness in children and need of mental health as well as primary ing barely covers the needs of the parents teens. Through the Supported Housing • The program operates with a “housing health care services; they are low-income, in our program, we are frequently unable Family Program, HDSW strives to main- first” philosophy – families are admit- unemployed and usually have not to provide for the costs of extremely im- tain the stability of the family unit and ted to and are able to remain in their achieved educationally. portant interventions for the health and reduce the risk of mental illness’ occur- housing whether or not they wish to Historically, the children in these fami- well-being of the children and of the fam- ring among its children. In addition to engage in treatment for their psychi- lies have been underserved. As a result of ily as a whole. assisting families to access housing, atric illness (or for substance abuse family crises, lack of resources, and fre- HDSW has found that the children HDSW offers case management services issues, if present). Our staff, of course, quent moves, the children have “fallen living in these households often need as- to the parent. These include parenting through the cracks” and have many needs sistance with health care, schooling, so- training and stress reduction education, see A Home on page 40

Community-Based Family Care for Adults

By Mary E. Barber, MD homes, and are reimbursed for room and gram in Orange and Sullivan Counties. filled home. “Look at yourself, you’re a Director, Community Services board. The family is expected to integrate “We have a great group of families, and a beautiful person!” she tells them. And the Rockland Psychiatric Center residents into their own household rather great group of staff, and that’s really what men and women, who may have never than simply giving them meals and a makes it work,” she says. “Most of our heard themselves described this way before, place to sleep. Each Family Care pro- referrals for new homes come from word slowly begin to take pride in themselves. amily Care is the oldest form of vider is screened and receives training by of mouth, from providers referring other Another Family Care provider in Middle- housing for adults with mental their local program. Case managers visit families they know through work, or town, Orange County, NY, gets a lot of illness in New York State, going the family and residents to provide sup- through church.” Cuzo supervises a staff satisfaction out of watching the people shar- back to 1931. Middletown Psy- port, ongoing training, assistance, and of 3 case managers, 2 1/2 nurses and two ing her home as they grow and work toward chiatricF Center, now part of the Rockland monitoring. Residents are expected to be account clerks to oversee the 155 Family recovery from their mental illnesses. “I love Psychiatric Center (RPC) System, was an at work or in treatment services during the Care residents in her program. Hedy doing this work,” she asserts, sitting in her early participant in Family Care, going day. Individuals in Family Care homes Villanueva, who has been directing RPC’s living room surrounded by photos of her back to the 1930’s, and continues to run a may stay for as long as they need. Family Care Program in Rockland and children and husband. large program today. For many years At the program’s height in the 1980’s Westchester Counties for over 20 years, In sum, Family Care has many advan- after its inception, Family Care homes there were about 2,400 Family Care resi- agrees with Ms. Cuzo. “Many of our tages for individuals and for the system as provided the only option for discharge for dents in New York State. Today there are families have been with us for a long a whole: a home-like setting, stability of patients leaving state hospitals who could about 1,500 residents in 500 homes across time. They are very experienced with the housing, cost effectiveness, and individual not return to their family of origin. It also the state. Rockland Psychiatric Center’s work, and we know them well.” choice in participation in programs to remains the least expensive form of men- Family Care program includes 155 resi- One Family Care provider in Otisville in support recovery. Rockland Psychiatric tal health housing. dents in 31 homes in Orange and Sullivan Orange County, NY, is proud of the home Center is in the process of expanding its The Family Care program was mod- Counties, and 20 residents in 6 homes in and support she’s given to different resi- Family Care program in Rockland and eled after the foster care system for chil- Rockland and Westchester Counties. dents over the years. She regularly puts Westchester Counties. If you know of an dren. Families in the community wel- Mary Cuzo is the director of Family residents in front of a carved, full-length interested family, have them call (845) come adults with mental illness into their Care for Rockland Psych Center’s pro- mirror sitting in the sunroom of her antique- 326-8000 for more information. □ PAGE 36 MENTAL HEALTH NEWS ~ SPRING 2008 Mental Health News ~ Health and Wellness Forum

Preventing Alcohol Poisoning What Else Works with Medications

By Colm James McCarthy By Richard H. McCarthy, MD, CM, PhD Emergency Medical Technician Research Psychiatrist

he irresponsible consumption of hen I started this column alcohol is a serious problem that years ago I picked the title, is not only dangerous, but can Working with Medications lead to death. This most fre- W because it had two mean- Tquently occurs during binge drinking. ings. First of all it described part of what Drinking more than five drinks in a row I do each day as a psychiatrist. Medica- for men and four drinks in a row for tions are tools that I use to help people women is classified as binge drinking. In solve problems. I think of medications in order to avoid irresponsible and binge much the same way that I think of the drinking it is necessary to know how your tools that an orthopedic surgeon might body responds to alcohol, what constitutes a use during an operation. The surgeon will drink, and what personal factors can in- use an osteotome to shape the bone as crease your risk of drinking dangerously. needed in an operation. An osteotome is There is no safe alcoholic drink. Beer, a big name for a stainless steel chisel and wine, and alcohol can all cause intoxica- it is not terribly different from a chisel tion. Their ability to do so is related only that a carpenter might use. It is a fairly to their alcohol content. While each drink unsophisticated, possibly crude instru- is different, they can all be compared to ment, which can do a lot of good in the each other based upon their alcohol con- hands of a skilled practitioner. Medica- tent. Generally speaking, the alcoholic Colm James McCarthy tions are very much the same. As sophis- Richard H. McCarthy, MD, CM, PhD content of a 12 ounce beer is comparable ticated as our medications are they are to a 5 ounce glass of wine or a 1.5 ounce tion, prescribed or over the counter, con- still somewhat crude. They are not magic There are other things that work with shot of hard alcohol. Chemically, each sult your doctor. There are almost no bullets that speed directly to the site of medications. There is growing evidence type of alcohol is equally dangerous. medications used for treating mental the problem where they wipe it out. All that some forms of psychotherapy can be Hard liquor is the most dangerous be- health related illnesses that can be safely medications circulate thorough the body very helpful for people with significant cause of how quickly and easily it is to taken with alcohol. and have multiple effects but, in general, mental illnesses. These treatments, with consume a lethal amount since it is so The signs and symptoms of alcohol do more good than harm. All drugs have the best evidence supporting their use, are concentrated. A shot of Bacardi 151, poisoning are easily identified and usu- been developed to be this way and psy- the so-called “Cognitive Behavioral 75% alcohol by volume, is the equivalent ally appear in a predictable order, unless chiatric medications are no different than Therapies” (CBT). These treatments are all of just under two drinks; half way to the alcohol was consumed very quickly. any other medicine. So when I am work- based on the proposition that our thoughts binge drinking. In stage 1, when intoxication first being with medication, I know that I am cause our feelings and behaviors much While alcoholic drinks are easily com- comes problematic, we find that there is working with a tool and it is part of my more than anything else. Therefore, in order parable, people are not. Every person difficulty with speech and fine motor job to use that tool properly. to change our lives, we do not need to responds differently to alcohol based movement, swaying from side to side The patient is in very much the same change the world we are in, we only need to upon a wide variety of individual charac- and dropping small objects. Drinking position. The patient’s medications are change the way we think. CBT seeks to teristics. How “drunk you are” is based should cease now and the individual tools that can help solve some but not all change the way we think so that we will upon your blood alcohol content, the ratio should begin to sober up. Stage 2 occurs problems. The “some but not all” is the feel and act better. This is a very direct amount of alcohol to the amount of blood if drinking continues and results in im- most important part of the previous sen- approach and is very problem focused; in your body. Rapid consumption of paired judgment, difficulty walking, tence. Medications are necessary for most much more directive than traditional thera- strong drinks on an empty stomach is the stumbling, and the beginnings of nausea. patients with serious illnesses to recover, pies; almost always involves “homework”, fastest way for anyone to get alcohol into If one continues to drink and enters stage but they are not sufficient. That is why where the patient works on the newly the blood stream. Smaller people feel the 3 the body begins attempting to remove the patient also must work with the medi- learned ways of thinking between session. affects of alcohol more so than larger the alcohol by causing vomiting, dry cation and not against it. Recovery is This treatment feels more like school than people. Women, on an ounce to ounce heaving despite an empty stomach. In very hard work, and medications will not traditional psychotherapy. Another treat- basis of any drink, are more affected by addition in severe cases there may be a make your life perfect without effort. No ment that works well with medication is alcohol then men. In addition, women complete loss of consciousness, choking matter how good a medication might be, Cognitive Remediation. This treatment is are at a greater risk than men in contract- risks, and possibly death. it is always possible to un-do or over- relatively new, somewhat “school like” ing an alcohol related illnesses such as Prevention is the best approach. Fortu- whelm the benefits that medications may and tends to also focus on how people cirrhosis of the liver and brain damage. nately alcohol poisoning cannot happen if offer. The easiest way to do this is think. New York State published a good, A woman’s risk of breast cancer also in- you are not drinking alcohol. This is an through the use of drugs or alcohol. publicly available handbook about Cogni- creases linearly with increased alcohol easy problem to prevent, don’t drink. If There is no such thing as a perfectly safe tive Remediation that is available on line consumption. you do decide to drink, do so slowly, or benign drug. This includes “natural at http://www.omh.state.ny.us/omhweb/ Medications never mix well with alco- never on an empty stomach and know remedies”, over the counter medications, cogdys%5Fmanual/cogdyshndbk.htm. hol. Never drink alcohol if you are taking your limits. Surprisingly, drinking alco- prescribed medications from physicians One reason we want to use whatever else medications unless you are absolutely hol leads to significant dehydration. and “street drugs”, including marijuana. we can in order to work with medications certain it is safe. This rule applies to both When you, or those around you, begin to All medications have adverse effects: if and avoid working against them is that we over the counter and prescribed medica- notice symptoms of intoxication switch to something is powerful enough to help, it physicians, probably more than patients, want tions. Tylenol and drugs containing aceta- a non-alcoholic drink such as Gatorade, must also be powerful enough to harm. to use the lowest amount of medication minophen are lethal when taken with al- juice, or water which will help hydrate The use of drugs or alcohol work against necessary to help a person recover,. Work- cohol. When in doubt about the interac- medications, when one should be working ing with medication, rather than against tion or risks of alcohol and any medica- see Alcohol Poisoning on page 37 with them instead. them allows us to achieve this goal. □

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of Health and Mental Hygiene SLS Health Dr. and Mrs. Leo Leiderman Jewish Board of

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Alcohol Poisoning from page 36 not need the drink, you will need the passed out from drinking and cannot that nature don’t do anything but in- ambulance. For individuals falling stay awake they require constant obser- crease risks of other problems like hy- your body and aid in recovery. Don’t asleep or passing out or vomiting do not vation or an ambulance. While they may pothermia. drink coffee; it won’t help you sober up allow them to lie on their back. Vomit- be angry at you the later for calling the Alcohol is only as dangerous as you and will cause increased dehydration. If ing in this situation could cause death ambulance, at least they will be alive. let it become. Plan ahead; know how stage 2 arrives, do not force or induce by choking. Instead, place them on their The only real treatment for alcohol poi- many drinks you can have responsibly vomiting. Begin drinking fluids and side with the top leg’s knee posted on soning is the removal of alcohol; this is and never drink and drive. Alcohol poi- stop drinking alcohol immediately. If the floor, head resting on the bottom why your body vomits. The only real soning is simply the ignoring of the you insist on drinking beyond stage 2 arm angled down, and top arm on the cure for alcohol poisoning is stopping many signs your body provides. Listen- and towards stage 3 have a friend call floor in front of the hips. Don’t leave the consumption and letting the body ing to your responsible friends and your for an ambulance as you ask the bar- them alone longer than it would take to remove the alcohol from the system. body makes avoiding alcohol poisoning tender for another drink. While you do call an ambulance. If someone has Cold showers and other treatment of easily accomplished. □ PAGE 38 MENTAL HEALTH NEWS ~ SPRING 2008

Search for Change has been rebuilding lives and strengthening communities for more than 30 years and continues to be a major force that provides a safe haven for individuals recovering from mental illness.

• Residential Services • Career Support Services • Private Case Management Since 1975 • 24 Hour Staff Support

95 Church Street, Suite 200 ● White Plains, New York 10601 (914) 428-5600 fax: (914) 428-5642 www.searchforchange.com MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 39 PAGE 40 MENTAL HEALTH NEWS ~ SPRING 2008

A Home from page 35 in their own individual apartments in for all involved. For persons recovering in New York City, on Long Island, and in neighborhoods throughout Westchester from a psychiatric illness, stable housing is a Westchester and Rockland Counties, will consistently encourage and support County. HDSW serves another 66 resi- proven support to recovery, and provides an many agencies’ programs are threatened any parent to access or return to treat- dents in its Transitional Residential Pro- opportunity for individuals to live in the by yearly deficits. HDSW will continue ment. Frequently, the very experience of gram, and many of these persons eventu- community in surroundings that they can to seek resources to provide the crucial attaining stability in their housing, the ally move on into supported housing with make their own, just like other folks. For case management services to the parents comfort of having a home again, enables HDSW or with one of the several other the community, it is a form of housing that and children of these families that will parents to have hope for their future and housing providers in the County. is most economical. It costs about $17,000 support their recovery and preserve their to see treatment as a way to strengthen In order to sustain the highest degree per year to provide the rent subsidy and case homes. themselves and move forward. of quality service, HDSW measures and management services for an individual in Understandably, supported housing for evaluates its outcomes each year: supported housing, and somewhat more for individuals and for families is one of the most • The housing case management ser- a family, half the cost of shelters and transi- highly desired resources for recipients of men- vices are comprehensive and avail- • Residents of our supported housing tional housing, and a fraction of the cost of tal health services in Westchester County. The able as needed – case managers work program (individuals and families) hospital care. Most providers receive, on wait lists for such housing are long and con- to engage residents in rehabilitation have maintained a 88% housing sta- average, about $13,500 per individual per tinue to grow. Supported housing is truly a and healthcare services consistent bility rate over the last 10 years, year, which doesn’t cover the cost of the “best practice,” but an endangered one. It is with their desire, tolerance and need. rent for most individuals and leaves nothing additionally threatened by the growing refusal Families may be seen every day or • 70% of the residents have been infor case management services (fair market of area landlords to rent to persons who re- once a month, children’s needs are volved in volunteer work, vocational rents for the Westchester County area are ceive rent subsidies from programs such as assessed and addressed, employment activities, educational programs and/ $1,095 for an efficiency apartment; $1,306 Section 8 and supported housing. Currently, potential is evaluated, and linkage to or competitive employment, for a one-bedroom; $1,519 for a two- the Westchester County Board of Legislators vocational and/or educational re- bedroom; $1,832 for a three-bedroom; and is considering a draft amendment to the West- sources is provided, etc. • 90% of the parents in the Family Program $2,259 for a four-bedroom apartment). chester County Human Rights Law that will have participated in parenting education Throughout downstate New York, where make it illegal for landlords to refuse to rent an HDSW serves an additional 140 indi- to help them provide a healthy home the cost of housing stock has skyrocketed, apartment to persons who have a lawful source viduals in its supported housing programs, environment for their children, this financial disparity has caused some of income. We hope that we advocates are including 30 persons in WestCAREs, a providers to consider closing their pro- successful in supporting the passage of this mobile housing and clinical treatment • residents rate their satisfaction with grams. The Westchester County Depart- legislation and that Westchester County will program in collaboration with The Shar- program services at 91%, and hospi- ment of Community Mental Health has join the many other states, counties and cities ing Community and St. Vincent’s Hospi- talization rates are negligible. recognized this crisis and has, when able, that already have source of income protection tal. Some supported housing residents granted providers some additional funding laws, including our neighboring states of Con- choose to have housemates, but most live Supported housing is a win/win situation for case management staffing. However, necticut and New Jersey. □

Veterans from page 27 The military culture emphasizes tough- properly equipped with the most sophis- treated for their combat-related mental ness under stress and ‘not making ex- ticated device available. injuries. Even today, a visit to any home- Despite significant efforts to address the cuses.’ Some soldiers seeking mental Psychological prosthetics functions in less program in the country will reveal stigma associated with mental illnesses, health treatment have even been disci- a similar manner without the mechanical veterans whose lives remain in ruin 35 many people still believe that mental ill- plined or discharged from the service for devices. Proper treatment—which might years later. Veterans make up 26% of the nesses are character issues that an individual behaviors related to their illness. Even include individual and group therapy, homeless population. Besides the human can overcome by ‘toughing it out’ or focus- with the encouragement of family and medication and/or family treatment— tragedy that resulted from our failure to ing on the future rather than on past events. friends to seek treatment, many veterans provides the supports necessary to return respond effectively to Vietnam-era vets, Despite the military’s best efforts to educate continue to deny the need until their situa- to full functioning. Why should a disor- society has paid untold billions in mental commanders to treat the issues of mental tion becomes desperate and treatment der of the brain resulting from combat be health, physical health, domestic violence, health professionally, many servicemen and becomes much more difficult. treated with less commitment and sophis- substance abuse and welfare costs. women have reported inappropriate disci- I propose that we re-frame the need tication than a physical injury? We owe it Let us not fail again to provide the pline and/or demotion when attempting to for psychiatric treatment to a term that to the men and women who risked every- psychological prosthetics necessary to deal with mental health or substance abuse is more acceptable to the public and the thing on our behalf to have not only the assure a restoration of functioning to our disorders following combat experiences. veterans themselves. That term is psy- best treatment but also a complete recov- many brave veterans. If we think of the On the outside, returning Guardsmen have chological prosthetics. A Prosthetic ery. Three sessions with a VA social brain as at least as important as an arm or faced inappropriate actions by employers device is a support that permits the user worker and then a discharge is unaccept- leg, we cannot fail to provide the necessary who became impatient with their returning to return to more complete functioning. able. Either we must fund and staff the therapy and supports to restore Iraq-era vet- employees’ changes. Consequently, soldiers After the initial shock of loss, a soldier VA to provide full and appropriate care or erans to full community participation. are reluctant to admit to having a mental who loses an arm or leg is highly recep- the federal government must contract with Steven Greenfield is the retired Exec. health need and from seeking treatment. tive to replacing the limb. More impor- community providers to fill the gap. Director of the MHA of Nassau County Many veterans themselves self- tant, no patriotic American would deny One of the terrible lessons of the Viet- and currently Coordinator of Special Pro- stigmatize, feeling shame at not being the funds necessary to assure that every nam War is the aftermath of broken lives jects for Family Residences and Essential able to return quickly to full functioning. soldier requiring a prosthetic device is of soldiers who were never properly Enterprises (FREE) on Long Island. □

Housing from page 18 Ald and Whitney are considered ex- Program, Community Development Block goal of Robert and his family. Through perts in funding and investments in the Grant funds and the Federal Home Loan STEL, Inc. programs Robert not only “Until recently the NYS Housing Finance non-profit world. Both have spoken be- Bank. Project closings for STEL, Inc. have found an apartment that he could afford Agency (HFA) was at best a minor player fore several government agencies about exceeded units for 265 persons with dis- and feel safe living in but he also used the in the development of low income hous- the process and advantages of financing abilities in the past five years. vocational program at STEL, Inc. to help ing outside of New York City. HFA was housing through the non-profit develop- The combination of landlord and pro- him find a part-time job to supplement his almost completely uninterested in suppor- ment channels. The results have been nu- vider of services is an area that STEL, Inc. social security income. tive housing anywhere in the state,” said merous successful funding applications handles well but one that many service pro- “The umbrella of services we provide Ald. “Since Governor Spitzer appointed and the development of many new providers do not want to venture into. to our tenants and consumers is all part of Priscilla Almadovar to head HFA there jects. Currently under construction is a “We hire qualified people like Alex Park- our approach to providing an improved has been a dramatic change. Now only new Single Room Occupancy (SRO) man to run the affordable housing side quality of living for people with mental DHCR rivals HFA in dedication to devel- Home to replace the Johnson Adult Home and the issues in rental are handled fairly health disabilities,” said Whitney. opment of supportive housing for low in Fredonia, NY and the Lakeview Mental and with the best interests of tenants and The STEL, Inc. comprehensive services income persons state wide and particu- Health Special Needs SRO in Ithaca, NY. landlord in mind at all times,” said Whit- includes case management services, voca- larly in the upstate region,” he added. “I STEL, Inc. has worked as a developer of ney. Parkman is highly regarded by ten- tional counseling and assessment and Com- believe it is the leadership of Priscilla other properties including several sites in ants. One in particular, Robert S., recently peer, a program that matches trained volun- Almadovar that has lead directly to this the Buffalo and Rochester areas. The team said he felt that Alex would be the person teers with persons who have been diagnosed result. She is responsible for the uses low income housing tax credits to he would want contacted if he had an with mental illness and are looking for so- many innovative steps taken by HFA to finance construction of licensed New emergency. “Alex is a great guy and cial interaction and friendship. sweep away the former barriers to the York State Office of Mental Health someone who I feel would help me out if I For more information about STEL, Inc. development of both regular low-income (OMH) housing. Financing packages have was in need of an ambulance or some visit the website at www.stel.org., or contact housing upstate and supportive housing in included funds from the New York State other assistance,” said Robert. Thomas Whitney at [email protected] or particular,” Ald continued. Housing Trust Fund, the Federal HOME Independent apartment living was a 716-366-7792. □ MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 41

Senator Morahan from 1 meet the eligibility criteria for funded House Proud from page 12 knew how to listen to her peers and ex- and/or licensed housing programs. The plain to staff what was needed. The same Community housing waiting list legis- bill also would require OMH to publish overcoming many obstacles and helping instincts, attributes and skills that helped lation is supported by leading mental such waiting lists on a monthly basis. him stay hopeful about the future. Joanna to be a good mother, despite her health providers, consumers, family Joanna is one of the thousands of many problems, made her a great peer members, advocates, housing developers, BILL NUMBER: S568 women who were considered by the shel- advocate. For Joanna, success led to more social policy experts and legal rights or- SPONSOR: MORAHAN ter system as a “Long Time Stayer”. She success. As her self esteem and confidence ganizations, many of whom rallied in has been in and out of the shelter system in her abilities grew she progressed. Albany late last year to urge New York TITLE OF BILL: An act to amend the since the early 1990’s. At the age of 54, Joanna lives in her State officials to address the housing cri- mental hygiene law, in relation to the Joanna’s upbringing was traumatic. own apartment in the Washington sis for people with serious mental ill- establishment of community housing Early in her childhood her biological fa- Heights area of New York City and at- nesses. The New York State Campaign waiting lists for adults within the office of ther physically and sexually abused her. tends the ICD Business Training Program for Mental Health Housing, a bipartisan mental health service system Joanna first became depressed at the age sponsored by VESID. coalition of over 50 organizations sup- of 18, when her mother died. Her father Housing is not a simple thing, as any- ports the establishment of community PURPOSE: This legislation would enable died a year later. In 1993 alcohol and one who has lost their home due to fire, waiting lists within the NYS Office of the state to track the wait time for persons drug abuse prompted her first psychotic flood, illness, lose of employment, drug Mental Health service system. with psychiatric disabilities seeking sup- break and a period of repeated hospitali- addition or mental illness knows. Hous- The NYS Campaign for Mental Health portive, supervised or congregate housing zations and homelessness. Joanna began ing seems simple but it is not to be taken Housing has worked over the years to edu- in the office of mental health system. to move from shelter to shelter and lived for granted. Without safe, secure housing cate the public and government policy mak- on the streets of New York City for years. one cannot work on other recovery goals. ers about the need for New York State to SUMMARY OF PROVISIONS: Joanna’s string of traumas made it diffi- The staff of successful housing programs undertake a comprehensive plan to: cult to develop coping skills to deal with for people with mental illness develops an • Amends section 7.15 of the mental life. When Joanne married, things did not understanding of mental illness, drug ad- • Preserve approximately 30,000 exist- hygiene law, providing for establish- turn around. Her husband abused her diction, homelessness and trauma. To ing units of supportive and licensed ing waiting lists. physically and psychologically. Despite help residents move forward, staff also housing her depressive condition, Joanna success- needs to be able to think outside the box, • Defines terms “provider of housing fully raised three children. or in this case, “outside the house.” Our • Reform existing models and pro- services” and “agency or institution”. Joanna always expressed interest in staff offers a combination of protection grams to meet the complex needs of education. She graduated from High and support along with an eye and an ear the clients being served; and • The agency shall forward for collec- School, where she majored in cosmetol- to what will make each person’s journey tion names of the applicants to the ogy. She was employed by the V.A hos- to achievement possible. • Develop at least 35,000 new units of office of mental health. pital as a home health aide. mental health housing statewide When Joanna moved into F.E.G.S. For more information on F.E.G.S. over the next ten years • The Commissioner shall prepare a Willow (a shelter based program) and Behavioral Health Residential Services you written report on the community later the Burnside CR/SRO, the staff no- may contact our Central Intake Department Senator Morahan's legislation would housing waiting list. The report shall ticed her potential to become a great ad- at 212-831-7007 ext 203, 204. Actual con- require the establishment of community be submitted to the governor and the vocate. She cared about other people and sumer names are not used in this article. □ housing waiting lists with the New York legislature. State Office of Mental Health (OMH) service system. It would also direct each JUSTIFICATION: provider of housing services within the OMH system to provide: There is a great need for the establishment of a waiting list that would truly INFO LINE • on a monthly basis a list of each per- reflect the need for housing and related PSYCH son referred to housing services for people in New York with A SERVICE OF THE PSYCHIATRIC SOCIETY OF WESTCHESTER mental disabilities, and also match those • a list of each person admitted to housing people up with appropriate housing, in the most integrated setting. This bill 914-967-6810 • a list of each person applying for housing would help to bring the state in line with the already-existing obligations under the This is an information and referral service sponsored by the Westchester • a list of each person withdrawing an federal Americans with Disabilities Act, District Branch of the American Psychiatric Association. application for housing the Supreme Court’s decision in Olmstead v. L.C., and New York State Psychiatrists of this organization are dedicated to providing treatment for • a list of each person denied admis- Executive Law sections 701-703. mental disorders and advocating for equal health care for mental sion to housing provided by an OMH and physical conditions. provider Mental Health News wishes to thank Ron Levine, Director of Communications If you need information about psychiatry or assistance in finding The legislation requires community- NEW YORK STATE SENATE, 38th Dis- a psychiatric physician - please call us. based agencies performing assessments of trict, for the Office of NYS Senator Tho- person with a documented mental illness mas P. Morahan, Senate Majority Liaison THE PSYCHIATRIC SOCIETY OF WESTCHESTER 333 WESTCHESTER AVENUE - SUITE LN-01 • WHITE PLAINS, NEW YORK 10604 to provide OMH with the names of indi- to the Executive Branch, for his help in viduals who have been assessed, and who providing this article. □ PAGE 42 MENTAL HEALTH NEWS ~ SPRING 2008

Governor Spitzer from page 1 tremely fortunate to finally have a gover- quality of life for them. We applaud Gover- stream economic development, smart nor who understands the connection be- nor Spitzer's leadership and vision on this growth and infrastructure programs.” Assemblyman Vito Lopez, Chair of the tween ample affordable housing and the groundbreaking initiative.” Shelly Nortz, Deputy Executive Direc- Assembly Housing Committee, said: “I health of our economy—and who is will- Richard Higgins, President of Norstar tor for policy at the Coalition for the would like to commend Governor Spitzer ing to take bold steps to address New USA, an affordable housing developer said: Homeless, said: “The Spitzer Administra- for proposing this Housing Opportunity York’s housing needs.” "This extraordinary investment will help to tion clearly understands the scale and dy- Fund. This program is the first of its kind in Priscilla Almodovar, President and Chief create hundreds of jobs and revitalize entire namics of the affordable housing crisis in New York State and will go a long way Executive Officer of the State Housing Fi- communities. The impact of this announce- New York State. The Housing Opportu- towards helping us get out of the affordable nance Agency (HFA) said: “This fund will ment will reach far and wide.” nity Fund will embody smart investments housing crisis we’re currently in. I look for- enable us to build on our success during the Ted Houghton Executive Director of of limited public resources to provide ward to helping make the fund a reality.” past year and work collaboratively with our the Supportive Housing Network of New integrated housing opportunities for indi- Senator Liz Krueger said: “Few prob- partners in the private and nonprofit sector York (SHNNY) said: “Everyone who viduals and families - including those lems facing our state are more critical and in the Legislature to create much needed cares about making housing affordable with various disabilities - and strengthen than New York's severe shortage of safe, affordable housing. I am particularly proud should be excited by this historic an- communities across New York State. This decent, and affordable homes. In recent that the Governor is creating a vehicle to nouncement. We finally have a Governor is what government is for.” decades, homeowners and renters in cit- promote and create supportive housing who understands just how serious the Blair Sebastian, Executive Director of ies, towns, suburbs, and rural areas across across New York State.” housing crisis has become in all regions of the NYS Rural Housing Coalition, said: New York have seen the state's affordable Joseph A. Agostine, Jr., Executive the state. Building affordable housing is “Governor Spitzer has already made great housing problems become a full-blown Director of the Neighborhood Preserva- one of the most effective economic devel- strides in bringing new life to Upstate crisis. There are more homeless families tion Coalition of NYS, Inc., said: opment strategies available to govern- New York’s cities and rural communities. today in New York City than anytime “Governor Spitzer's commitment to ex- ment. And the inclusion of substantial This extraordinary proposal is a clear sig- since the Great Depression. Ensuring safe pand affordable housing opportunities in resources for supportive housing – perma- nal that the Governor will continue to and affordable housing is not only a key New York State is terrific and exciting nent housing linked to social services for focus his attention on providing afford- responsibility of state government—it is news. His proposed Housing Opportunity homeless people with special needs – able housing, creating jobs and revitaliz- also good economic and fiscal policy. I Fund will go a long way to make those demonstrates that the Spitzer administra- ing Upstate New York.” could not be more delighted that the Gov- housing opportunities a reality. We ap- tion recognizes that the countless millions Abby Jo Sigal, Vice President and Di- ernor shares this commitment and placed plaud the Governor for his efforts and look spent each year on emergency shelter and rector of Enterprise New York, a leading it front and center on his agenda.” forward to working with him as we continue services for homeless individuals and nonprofit provider of affordable housing Assemblyman Joseph Lentol said: to address this state's housing crisis.” families are better spent on permanent for low-income people, said: “Governor “The Governor understands that many Bernie Carr, Executive Director of the housing and recovery-oriented services.” Spitzer recognizes the crucial link be- working families and individuals are New York State Association for Afford- Michael D. Lappin, President of the tween affordable housing and economic struggling with health or physical disabili- able Housing (NYSAFAH) said: “The Community Preservation Corporation empowerment and revitalization, and we ties are extremely vulnerable to losing Governor knows that economic vitality is (CPC) said: “Governor Spitzer's announce- applaud him for taking such a significant their homes. Others can not find ones they impossible without sufficient affordable ment will bring hope to families whose lives step to address this issue through the $400 can afford. His State of the State message housing opportunities. This historic in- are being made more and more difficult by million Housing Opportunity Fund. Enter- on housing is welcomed and hopeful vestment in affordable housing is good for spiraling housing costs. And moreover, the prise is proud to be a key partner in work- news. I have always said that my constitu- Upstate cities in need of revitalization and economic stimulus produced from this ac- ing with the State to ensure that every ents keep New York going and growing, good for Downstate communities that tivity will serve to help many communities New Yorker has a place to call home.” but they need safe, affordable housing and have been adversely affected by skyrock- emerge from hard fiscal times.” Carl Young, President of the New that need has become a desperate one. I eting housing costs.” David Muchnick, Coordinator for York Association of Homes & Services look forward to working with the Gover- Martin Dunn, President of Dunn Devel- Housing First!, a statewide housing advo- for the Aging, representing New York’s nor on his housing proposals.” opment Corporation, said: “For the afford- cacy organization, said: “This historic not-for-profit and public providers, said: Deborah VanAmerongen, Commis- able and supportive housing development investment is a quantum leap forward in “New York’s low-income seniors and sioner of the New York State Division of community, this is extremely welcomed modernizing the state’s affordable and seniors with disabilities face many chal- Housing and Community Renewal news. These funds will enable New York- supportive housing policies. Investment lenges when it comes to affordable and (DHCR) said: “Governor Spitzer’s com- ers with special needs, currently living in on this scale demonstrates the administra- supportive housing. We are pleased that mitment to affordable housing is unprece- restrictive or substandard conditions, to live tion’s recognition of affordable housing as Gov. Spitzer is making the needs of this dented in New York State. We are ex- more independently and ensure a better a core component of the State’s main- important population a priority.” □

Positive Outcomes from page 27 formance if they know that they are being state 9 of 10, or 90% of the time. His was evolved to the point where many mental monitored by someone who is actively con- clearly using an odd statistical reference, but health providers are becoming adept at pre- process. Being able to perform that func- cerned about the welfare of the patient. it did not concern me, because I was more dicting the type of outcome a client can ex- tion will surely promote the likelihood of a That brings me to a public policy con- impressed by the fact that he could express, pect as a recipient of their services. positive outcome. cern, that on the average, one categorized as with confidence, how my course of treat- This has happened because agencies are As this episode in my life continued, it seriously mentally ill, has a life expectancy ment was likely to proceed. required, as part of their contract with the did not take long for the doctors to diagnose that is 25 years less than that of the general This struck me because, in the mental county, to specify in numerical terms, the that I had an inflamed appendix and that it population. This sad condition, I would health profession, we often resist making type of client centered outcomes that are was on the verge of bursting. Therefore, trust, is due in part to the fact that often assertions about the type of outcome a client expected to occur. In other words, an agency surgery was scheduled for later that evening. times the seriously mentally ill client is es- can expect from our intervention. I find this cannot satisfy the terms of their contract About four hours elapsed from the point that tranged from their family, therefore the in- unacceptable, because we should be able to with the county by simply stating that they I arrived in the ER until I was brought to the volvement of a loved one in their physical tell our clients what they can expect as a will deliver their service to a certain amount operating room. That fact brings me to an- health care is frequently lacking. result of the service we offer. Our clients of individuals. Instead the provider must other point; that being that the quality of The social policy implication is that we are entitled to ask, and have answered, ques- project that a particular number or percent care received is also related to whether or should do more to support families in their role tions such as, is it likely that my symptoms of the program participants will achieve a not a significant other is present and in- as partners in the service delivery process. In will be lessened if I accept your help, or, is desired life change. Later in the contract volved in the health care delivery process. this regard, I trust that innovative programs the quality of my life likely to improve; or, year, we in the county will then assess the My wife came with me to the hospital that address the emotional, financial and time if I participate in your job training program agency’s performance against their antici- and she stayed throughout the emergency demands that are placed on families when a is it reasonable to assume that I will attain pated outcomes. treatment process, and it was apparent that loved one is ill would have a positive impact employment? The result of this initiative is that we are without her involvement, the medications I on the physical health of our clientele. If we are unable to answer those type of finding that agencies are in fact helping was prescribed and the tests that were or- In my situation, I was eventually brought questions, it raises the concern that perhaps great numbers of clients to achieve measur- dered would not have been received in a to the operating room and before being we do not know what kind of effect our able improvements in their lives. This type timely manner. rolled into that area the surgeon introduced intervention will have; and if we do not of development not only validates that we Clearly, the vast majority of health care himself to me. He also did a quick exami- know how we are effecting people, is it pos- have always been helping clients to make practitioners are well meaning and compe- nation and then proceeded to inform me sible that we are doing more harm than progress in their lives, but it serves to dem- tent; however, these individuals are also that, in 18 out of 20 cases, the appendec- good? I am sure that is not the case, but we onstrate to society at large that the work we susceptible to becoming stressed and over- tomy can be performed using a laparoscopic must be able to prove that point, and in or- do is making a tangible and measurable worked. Therefore, matters can and do go method. That was interesting information, der to do so we must get better at measuring difference. The final and most important awry; but this is less likely to occur if a sig- and it elicited two reactions from me. One what it is that we do. effect is that our consumers can know be- nificant other is involved. This is because it of which emanated from the statistician in In Nassau County, initially many of our forehand, the type of benefits they may is an unfortunate fact that many practitioners me, thus I was prompted me to wonder why mental health agencies may have seen this achieve when they buy into the services are more likely to be mindful of their per- the doctor would say 18 out of 20? Why not as a daunting task; however, we have offered by a particular program. □ MENTAL HEALTH NEWS ~ SPRING 2008 PAGE 43 Subscribe to MHNews Advertise in MHNews

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