THE NEW YORK STATE PUBLIC EMPLOYEES FEDERATION TESTIMONY

To the Joint Assembly and Senate Standing Committees on Mental Health and Developmental Disabilities

9/9/2013

The New York State Public Employees Federation Testimony

The New York State Public Employees Federation Testimony INTRODUCTION Thank you for the opportunity to provide testimony today. I am Susan Kent, President of the Public Employees Federation, which represents over 6,994 employees at the Office of Mental Health (OMH). These members have devoted their lives to providing treatment to people suffering from complex mental health disorders. They are invested in their communities and are an important piece of New Yorks safety net for these patients. Our members are highly trained, have years of expertise and provide security, help, and hope for the future for so many vulnerable patients. It is unfortunate that New York State is keeping these hardworking professionals in the dark about their own future and ability to provide care to those they serve. I ask that you keep them in mind by implementing a plan that maintains the highly trained mental health treatment staff that currently provide your communities with vital services including intensive day treatment programs; inpatient hospitalization; day hospitalization; outpatient clinic treatment; outpatient clinical support services; mobile mental health teams; crisis services; information and referral; and community training. In some ways our members are the original community-based service providers. The state has made it clear that one of its priorities is to provide less inpatient services and more community-based services. PEF would like to see a plan that shows those services being delivered by the highly professional, highly trained state employees that are already serving these patients, rather than by not-for-profits or private entities that have to keep in mind their bottom line. With that said, there are a few specifics that I would like to see addressed, on behalf of my members. PROVIDE A REAL BLUEPRINT Right now, we believe OMH is trying to move forward without a real plan. I would like to see a real state workforce plan, which at a minimum should include the number of positions expected to be reassigned, broken down by the OMH facility losing the Full-Time Equivalent (FTE) and the OMH facility that is expected to gain the FTEs, as well as data on expected attrition. In addition, the agency should work with the labor unions to finalize a reassignment policy and include that policy in any plan. Beyond the needs of the staff that provide these invaluable services, the agency should include a real plan for how care will be provided for these patients as the state is closing facilities. In prior Statewide Comprehensive Plans there has been discussion regarding what the shift to managed care means for how services will be provided. It has been described as the mechanism for a decrease in the use of inpatient care at state psychiatric hospitals, which would then allow funding from those resources to be invested in community-based services. But, what is the plan? There are some patients that need inpatient care and those individuals may now have to travel away from home to obtain those services, making it difficult for families to participate in the patients recovery. You have undoubtedly heard the numerous

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The New York State Public Employees Federation Testimony

stories of how patients and their families at certain facilities, such as Sagamore Childrens Psychiatric Center, will suffer a geographic hardship if these facilities are closed. 58% of the Sagamore census hails from Suffolk County. 96.5% of those children's families visit them at Sagamore. 32% of the current census is from Nassau County. 100% of Nassau families visit. The "other" category includes 3 court remands, 2 children who are New York City residents, and 1 child whose guardian resides out of state but was admitted with a temporary Suffolk guardian. Overall, 88% of kids' family members visit. At Sagamore, families are involved, even picking up their children and taking them to outside medical appointments. Some Sagamore families have health, financial or time (e.g. work/childcare/living way out East) constraints that make it difficult to see their kids here, but they are able to make the visits happen. Given that Sagamore provides family based therapy, asking parents to travel as much as 7 hours round trip for a session is unreasonable and unproductive. A statistic being tossed around is that more than 50% of SCPC beds are occupied by court remands. However, that does not take into account the average length of stay (LOS) for remands versus minor voluntaries. The mean LOS for court remands is 14 days; however, minor voluntaries' LOS averages 113 days. Once that is considered, 86% of Sagamore's beds are used for minor voluntaries and only 14% of admissions are court remands. People from central office OMH keep using the term, think outside the box. We challenge them to do the same to keep services on Long Island for the children we serve from 127 public school districts, in addition to private schools, Nassau, Western Suffolk and Eastern Suffolk BOCES. Approximately 57% of children under 18 in New York State live in New York City and Long Island. Yet the number of inpatient psychiatric beds is being cut almost in half. In an environment where private psych hospitals are closing how are we meeting the needs of these children? There are some patients who may not need inpatient care and can be served by community-based services, but again what is the plan? You cannot and should not discharge patients before community services are in place and doing so will result in patients not getting the services they need. SPECIFY SAFEGUARDS The Medicaid Redesign Team (MRT) and subsequent MRT Behavioral Health Reform Workgroup made recommendations to shift mental health services and treatment into managed care programs and to integrate physical and behavioral health services. This path of care brings forth concerns regarding funding being reallocated away from behavioral health treatment and whether providers will face incentives to provide cost-effective care rather than quality care. We assume the state weighed the risks and benefits and moved forward anyway. However, as this shift began, specialized manage care plans, such as the Behavioral Health Organizations, were being developed. As the state entered into contracts with five of these regional Behavioral Health Organizations, PEF asked repeatedly at Labor/Management meetings about the next steps and what the relationship would be between these specialized plans (and even the Health Homes) and the state psychiatric facilities. We were told that

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The New York State Public Employees Federation Testimony

they were unsure of what the relationship would be between these plans and the behavioral health providers. The Statewide Comprehensive Plans should address and detail the relationship that the Health Homes, Health Recovery Plans (HARPs), and Behavioral Health Organizations will have with the providers, including the relationship that they will have with the Regional Centers of Excellence. The plan should evaluate and specify the necessity of each layer and the safe guards developed to protect against some of the known risks of moving behavioral health care into a managed care system. We believe it is imperative that OMH preserve the state operated programs state oversight of the services that are provided in these settings. SHOW US THE SAVINGS With all of this change is the promise of savings - $20 million over three years. The savings must outweigh the potential disruption in quality services; geographic hardship that both patients and caregivers may face; and risk of completely undoing the current mental health safety net that exists in New York State. However the more the changes progress the more Request for Proposals (RFPs) are posted. It appears that the agencies are beginning to lean more and more on not-for profit organizations and consultants to provide a number of services. PEF is fully aware of the states misunderstanding that privatization equals savings. In 2011-12, the OMH contracted out over $9 million dollars for consultant personal services at an hourly rate of $79 per hour, which is 69 percent more than the cost of an OMH state employee. I would like to see the details on the current use and anticipated use of consultants to provide services that were and/or are provided by state employees and a justification for why state employees are not being used to fulfill the agencies needs. In sum, we believe the state is rushing to build a whole new enterprise without having a clear blueprint of the final product and the impact it will have on those that provide the critical services as well as those that receive these services. Thank you for the opportunity to express our concerns.

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