Table of Contents Commissioner’s Letter ................................................................................................................... 1 The Current New York State-Operated Mental Health System: Making the Case for Change .......................................................................................................... 7 Regional Centers of Excellence Listening Tour Presentation ..................................................... 15 Regional Centers of Excellence Tour Dates ................................................................................ 35 Regional Plans ............................................................................................................................. 39 Additional Background Forces of Change – Challenges and Opportunities for New York State ............................ 49 Be the Change Spotlight – Oneida County ......................................................................... 55 Summary of Inpatient Changes ........................................................................................... 57 . Western New York Region Regional Center of Location Inpatient Services State Operated Excellence Community Service Hubs Great Lakes RCE Buffalo, NY Adult, Child, Adolescent Elmira Rochester Buffalo Western New York Rochester, NY Forensic Adult Forensic Center of Excellence Central New York Region Regional Center of Location Inpatient Services State Operated Excellence Community Service Hubs Empire Upstate RCE Syracuse, NY Adult Ogdensburg Utica, NY Child and Adolescent Binghamton Utica Syracuse Central New York Marcy, NY Forensic Adult, SOMTA Statewide Outpatient in Forensic Center of Prisons Excellence Ogdensburg, NY SOMTA Hudson River Region Regional Center of Location Inpatient Services State Operated Excellence Community Service Hubs Capital District RCE Albany, NY Adult Albany Lower Hudson RCE Orangeburg, NY Adult, Child, Adolescent Orangeburg Middletown Poughkeepsie Westchester County Nathan Kline Research Orangeburg, NY Adult Center of Excellence New York City Region Regional Center of Location Inpatient Services State Operated Excellence Community Service Hubs Greater New York Bronx, NY Child, Adolescent Bronx Children’s RCE Queens, NY Child, Adolescent Queens Brooklyn Manhattan Dix Hills (Serving Nassau and Suffolk) Bronx RCE Bronx, NY Adult Bronx Upper Manhattan Brooklyn RCE Brooklyn, NY Adult Brooklyn South Beach RCE Staten Island, NY Adult, Adolescent Staten Island Brooklyn Lower Manhattan Queens RCE Queens, NY Adult Queens New York Psychiatric Manhattan, NY Adult Washington Heights Institute Research Center of Excellence Manhattan Forensic Ward’s Island, NY Forensic Adult Center of Excellence Long Island Region Regional Center of Location Inpatient Services State Operated Excellence Community Service Hubs Island RCE Brentwood, NY Adult Brentwood (Serving Nassau and Suffolk) The Current New York State-Operated Mental Health System: Making the Case for Change The mission of OMH is to promote the mental health of all New Yorkers, with a particular focus on providing hope and recovery for adults with serious mental illness and children with serious emotional disturbance. To achieve this, OMH has a dual role to: 1) set policy and provide funding for community services; and, 2) operate inpatient and outpatient services. The OMH vision has evolved over time to become much more community-oriented and recovery-focused; however, OMH’s “safety net” role as a hospital provider remains premised on a chronic disease and caretaker mentality from centuries past. In any given year, 1 in 4 New York adults have a diagnosable mental disorder; while 1 in 17 have a serious mental illness. In many cases, those with serious mental illness also suffer from a chronic medical condition, such as diabetes, asthma, obesity, or heart disease. Today, the majority of individuals with mental illness choose to access treatment in primary care settings. Approximately 715,000 individuals access care in specialty mental health settings each year. 10,000 of those individuals were served in OMH inpatient hospitals in 2012, which now has a census below 4,000 and once stood at 93,000 in the 1950’s. That leaves more than 700,000 New Yorkers being served in the community. Despite significant reforms to become more recovery-oriented, OMH remains overly reliant on extended inpatient hospitalization for those with serious mental illness. This reliance comes at a great cost. Over $1.3 billion per year is spent on OMH hospital treatment and care for 10,000 individuals, while $5.3 billion is spent on mental health care in the community for a population of more than 700,000 people. New York’s historical choice to maintain 24 State operated hospitals is no longer sustainable. People Served Gross Spending OMH OMH hospitals hospitals 1% 20% All other All other settings settings 99% 80% 7 The undeniable forces of Number of State State Population healthcare reform; the Psychiatric Hospitals Affordable Care Act, Medicaid New York 18 million 24 Redesign, mental health parity, California 37 million 5 and budget demands have laid Texas 25 million 8 the groundwork for a more Michigan 10 million 3 efficient and effective New Jersey 9 million 4 consumer-oriented model. The momentum of change cannot be halted and the moral force of recovery cannot be denied. With its transformation completed, our whole New York State mental health system can be equipped to enter the new world of healthcare delivery. The only other option is to avoid change, and fail to be a player on the new healthcare field. In short, OMH resources must be aligned with what is known to promote access, resiliency, and recovery for the majority of people served. Shifting those resources to better support the needs of the majority of people in the community- where they do, will, or should reside. How OMH Inpatient Services Look Today New York State spends one fifth of its overall mental health budget to maintain and operate the State’s outsized psychiatric hospital system, which has 3 times the number of state-run hospitals compared to the next largest state operated inpatient system OMH’s inpatient capacity includes fifteen adult hospitals, four for children, three for forensic populations, and several additional child and forensic units attached to the adult facilities. OMH also operates two sex offender treatment programs, two research institutions, and dozens of community outpatient, residential and care management programs. The size and scale of the OMH physical plant is tremendous, with a capital portfolio of over 830 buildings over 2,300 acres of land (and this only for buildings and land associated with currently operating facilities). In keeping with New York’s long history of institutional operations, many buildings were built over a century ago, and over 300 OMH facility buildings are over 50 years old. Maintenance and extensive capital repairs are continual challenges and require constant maintenance and major financial commitments. The OMH interest obligations alone for facility capital bonds are over $1 billion and the annual debt repayment averages $230 million, exceeding some State agencies’ full annual budgets. There are many indications that the “safety net” identity no longer works. Presently, in OMH operated hospitals, overall census numbers are declining and the hospitals are challenged with treating two very different populations: those persons with short-term stabilization needs and those persons who require longer-term rehabilitation services so they can return to the community. In most adult facilities, census declines are masking actual increases in admissions /discharges for individuals who need acute care and are stabilized within three months. OMH’s inpatient services for children and youth also treat significantly different populations, with one sector providing primarily acute care that should be provided in the community, while the other group serves intermediate care needs for children transferred from community hospitals. Both of these populations call for transformation of the mental health system as a whole and to right-size and reform state hospitals in order to prevent disruptive 8 admissions, and to create a smooth transition and stability in the community. The remaining inpatient need, which OMH is well positioned to fill, will focus on specialty assessment, treatment, and stabilization - with an emphasis on recovery and return to the community, and making every day matter. CASE STUDIES FOR CHANGE Adult Long Stays: Many individuals have serious chronic medical conditions in addition to serious mental illness, and may be more appropriately served in supported residential settings with integrated specialty medical and behavioral healthcare. A Gap in Children’s Acute Interventions: In Syracuse, NY the Hutchings Psychiatric Center is the only local hospital with children’s acute mental health capacity despite several community hospitals in the area. Many commercial insurance companies will not pay for Hutchings children’s inpatient services in part due to costs exceeding the norm. As a result, many children in need of acute care must travel great distances to private hospitals with specialized care for serious emotional disturbance. 9 THE WIDENING GAP BETWEEN CENSUS AND COSTS Census Trend - All Facilities, 2004-2013 6,000 5,275 5,000 3,869 4,000 Total 3,000 Adult 2,000 Forensic Census at End SFY Children 1,000 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Total facility census has