PUBLIC HEARING: TO INVESTIGATE THE IMPACT OF THE OFFICE OF MENTAL HEALTH'S REGIONAL CENTERS OF EXCELLENCE ON COMMUNITY BASED SERVICES, ACCESS TO INPATIENT CARE, AND THE EFFECT ON LOCAL COMMUNITIES, CONSUMERS AND FAMILY MEMBERS

Patient 24 25 ---oOo--- 1 SENATOR CARLUCCI: Good morning. 2 I'm Senator David Carlucci, Chairman of the 3 Mental Health and Developmental Disabilities 4 Committee of the New York State Senate. 5 I want to thank everyone for joining us here 6 today on this very important hearing on the 7 Regional Centers of Excellence. 8 And, again, I want to thank everyone for 9 coming, because the idea here, is to have your 10 testimony heard in the public, to make sure that all 11 of the opinions, the ideas, are heard so that these 12 decisions aren't made in a vacuum, but are made with 13 the people that are on the ground. 14 Many of you who have dedicated your careers 15 and your lives to serving those with mental illness, 16 we want to hear from you. 17 I want to thank Tom Santulli, the 18 county executive, for hosting us today, and, all the 19 employees here at Chemung County Office Building. 20 And with that, I'm going to turn it over to 21 our host Senator, Senator Tom O'Mara. 22 SENATOR O'MARA: Thank you, Senator Carlucci. 23 Let me push my button, and now you can hear 24 me, and I don't have to talk so loud. 25 Thank you, Senator Carlucci, for bringing 1 this Committee hearing to Elmira, in Chemung County. 2 Thanks to Chemung County and 3 County Executive Santulli for hosting us here in 4 your legislative chambers. 5 I also want to recognize that we have 6 Joe Sempolinski from Congressman Tom Reed's office 7 here, and, the Congressman has been very outspoken 8 in support of the Elmira facility that we have here, 9 that is targeted for closure on inpatient services 10 by the Governor's Regional Centers of Excellence 11 model. 12 A concern that certainly that I have over -- 13 over that, is the impact to mental-health services 14 to those in my community, in my Senate District, and 15 in the 11-county region that the Elmira Psychiatric 16 Center services for mental-health patients. 17 The Elmira facility has been recognized for 18 many years as being the number-one performing 19 mental-health facility for in-patients of adult 20 treatment in New York State. 21 It has provided these services in an 22 excellent and cost-effective manner for the largest 23 region of any facility in the state to cover 24 these -- this treatment. 25 So, I think when we look to a model in the 1 state for Regional Centers of Excellence, and we 2 should be looking for excellence in all aspects of 3 government, including the mental-health treatment, 4 we should not be looking at just a 5 "Thruway Corridor" model that includes Buffalo, 6 Rochester, Syracuse, and Albany to cover the upstate 7 region. 8 It's not fair to the many people in the 9 Southern Tier region that would have to drive hours 10 for their treatment, or go untreated. 11 When we're looking at having Centers for 12 Excellence, I believe we should start and model our 13 excellent facilities after those that are already 14 excellent, and that includes Elmira who is number 15 one in adult mental-health treatment, and Binghamton 16 that is rated number one for youth and adolescent 17 inpatient treatment for the mental-health services. 18 I'm pleased that we have here with us today 19 Assemblywoman Donna Lupardo from the Binghamton 20 area, who was been very active in the efforts to 21 restructure mental health in New York State, and 22 representing the Binghamton area very well, and 23 working with us for saving the Elmira Psychiatric 24 Center and the Binghamton Psychiatric Center. 25 So, Donna, thanks for being here, and, go 1 ahead. 2 ASSEMBLYWOMAN LUPARDO: Well, thank you, 3 Senators. 4 If you'll allow me, I'd like to provide some 5 testimony, brief testimony, and then we'll get on 6 with the rest of the hearing. 7 I want to thank my Senate colleagues for 8 convening this very important hearing in Elmira. 9 Excuse my voice. I'm feeling a little 10 laryngitis, so you may have to read my remarks if 11 I lose my voice. 12 I'd also like to thank you for allowing me to 13 sit with you, and to deliver some brief remarks. 14 Just to provide some of the overview, and 15 where we stand, and why I'm here from Binghamton, 16 the Office Mental Health is proposing to divide the 17 state up into five Regional Centers for Excellence: 18 Western New York, Central, Hudson River, 19 New York City, and Long Island. 20 Noticeably absent from this plan is the 21 Southern Tier and the Finger Lakes region. 22 The goal is to drive more resources into the 23 community mental-health services. 24 While these goals may be noble, the speed of 25 the transition certainly needs to be questioned. 1 Along with the lack of specific details about 2 what these community hubs might entail and the local 3 resource shift, many of us have seen this before and 4 it has not always worked out that well. 5 There seems to be a greater issue that needs 6 to be discussed, and that concerns the impact the 7 plan will have on the Southern Tier. 8 And Senator O'Mara has already outlined a 9 number of my concerns. 10 The plan calls for the closure of all acute 11 inpatient services at Greater Binghamton Health 12 Center and the Elmira Psychiatric Center next 13 summer, July of 2014. 14 That's very fast. 15 Let me be clear about this: 16 Under this plan there will be no, zero, acute 17 or long-term inpatient adult or children psychiatric 18 beds in the entire Southern Tier and Finger Lakes 19 region of the state of New York. 20 This encompasses 15 counties that are 21 previously served by these facilities: 1.5 million 22 people; 25 percent of the entire land mass of the 23 state of New York. 24 Adults and children previously served in 25 Elmira will need to go to Buffalo. 1 Adults previously served by Binghamton would 2 need to travel to Syracuse, while children would 3 need to travel to Utica. 4 These are not short distances, especially in 5 the winter, and especially for people who have 6 transportation concerns. 7 This "Thruway model of care" that we're 8 calling it will not only create numerous hardships 9 for individuals and their families, it will be very 10 disruptive to our local mental-health system that, 11 by all accounts, is a model for others in the state. 12 It will cripple our hospital systems that can 13 barely keep up now with the need for psychiatric 14 services, and will further tax our local jails that 15 are already full of people with mental-health 16 concerns. 17 If the decision had been based purely on 18 program effectiveness and positive outcomes, 19 facilities in the Southern Tier would have been the 20 last to be eliminated. 21 As Senator O'Mara mentioned, we have some of 22 the best facilities in the state. 23 If you will allow me, Senators, I'd like to 24 enter into the record some of the testimony that we 25 received at the hearing that we conducted in 1 Binghamton last month. 2 The general consensus that has come out of 3 that testimony, and what has occurred through 4 community meetings, forums, and other meetings that 5 we've held, is that OMH should create a sixth 6 Regional Center of Excellence, for the 7 Southern Tier, and covering portions of the 8 Finger Lakes as well. 9 The Broome and Tompkins County Legislatures 10 have already passed resolutions recommending this. 11 The Chemung County Legislature and others in 12 the region are doing the same. 13 Law-enforcement professionals from across the 14 region, county medical associates, and others are 15 passing similar resolutions, calling upon the 16 Legislature and Governor to endorse the plan to 17 drive more community resources into needed services, 18 but to create a sixth Center of Excellence so the 19 great Southern Tier portion of the state of New York 20 will have the services it deserves. 21 This is basic health-care services. 22 This is not a luxury, especially in 23 communities like ours that are economically 24 challenged. 25 We need more, not less, mental-health 1 services. 2 So I sincerely hope you'll work with us to 3 offer a counterproposal to OMH. 4 This plan does a huge disservice to the 5 Southern Tier, and I'm sure the testimony that we're 6 about to hear will further clarify this point. 7 Thank you. 8 SENATOR CARLUCCI: Thank you, 9 Assemblywoman Lupardo. 10 Next we're going to hear from our 11 county executive here in Chemung County, 12 Thomas Santulli. 13 THOMAS SANTULLI: Good morning. 14 First, Senator Carlucci, thank you for coming 15 today; it's greatly appreciated. 16 These are very, very important topics. 17 Senator O'Mara and I have -- we talk on a 18 daily basis about what's going on. 19 And this has been a rough few weeks, I'll say 20 it, both, from a service standpoint, and just, 21 I think, the morale of keeping these facilities 22 active with employees who just don't know the 23 certainty of where they're coming from, and most 24 importantly, the clients, the people that use these 25 facilities, not knowing what the future holds. 1 And to Assemblywoman Lupardo, I want to thank 2 her very much. 3 I had the pleasure of testifying in 4 Binghamton, and I really do think your 5 "sixth Center of Excellence" concept for the 6 Southern Tier just makes all the sense in the world. 7 I mean, it's just -- it just nails it what 8 needs to be done. 9 And my testimony, which is before you, I'm 10 not going to read it. I just want to give you a 11 couple of thoughts that are in my head, relative to 12 the importance of this. 13 You know, it's hard to explain to people how 14 a facility that serves 11 counties, and then add to 15 that, Binghamton, which gives us 13 counties, and 16 the people that we serve, and the people that use 17 us, I mean, think about this: 18 People come from counties that border Erie, 19 they border Monroe, and they border Onondaga. 20 Where do they choose to come? Elmira and 21 Binghamton. 22 If there's a message there, I don't know what 23 it is. 24 Some of these counties could walk to these 25 facilities that are right there next to them, but 1 they choose us. 2 And the reason for that is two things: 3 (a) is quality. 4 And I don't want to cast any aspersions on 5 any other facility, but I know what people tell me 6 who live in these counties. 7 They come here because of the quality of what 8 we do. 9 They also tell me that if they had to go to 10 Rochester or Buffalo, you wouldn't get in. There's 11 no room. 12 And I'm trying to figure out how you close 13 two inpatient facilities, and, where do those people 14 go, and how do they get in if they're full now? 15 The other part that scares me is, you know, 16 this word that we use all the time now, everything's 17 a "center of excellence." 18 You know, I said in Binghamton, there's a 19 place that is selling tires now here that are 20 calling themselves the "center of excellence," 21 because I guess they're the only place that has 22 taken the time to figure out how to really sell a 23 tire. 24 I think we put labels on these type of 25 concepts. 1 And, again, I think we're all for Centers of 2 Excellence, but are we ready for a Center of 3 Excellence starting next July, when we still really 4 don't even know how this whole process is going 5 down? We don't have any room in a lot of these 6 facilities. 7 I mean, and think of telling a family, if you 8 have a child, that, Where you're gonna go, 9 I understand, is in Utica. That's where you're 10 gonna meet. That's where you're going to have 11 interaction. 12 Or, if you're an adult, you're gonna go up to 13 Buffalo. 14 I mean, how do we work -- the whole concept 15 of bringing families together and bringing people 16 together, and working together, goes out the window. 17 And I'm not sure how commissioners, the last 18 being Commissioner Hogan, says that these facilities 19 are the crown jewel. That they provide -- and 20 I think he said it publicly. 21 You know, it's one thing, anywhere I go, they 22 always tell you, you know, "You're the best county 23 executive," when you go introduce them. 24 I know they tell it to the other 17 county 25 executives when they're in their county, you know, 1 I've heard the story. 2 But this was said publicly in a lot of 3 places, that these places are high-performers. 4 And I got to ask you the question: If I was 5 going to make two centers of excellence, why 6 wouldn't you take the best? 7 If you really said it and you meant it, why 8 would you close them? 9 And this community right now, in this region, 10 is going through, I just find it so interesting: 11 The head of corrections calls Camp Monterey 12 the best in the state, the lowest recidivism rate. 13 "A model." 14 "A model." "It's a model prison." 15 How do you treat a model prison, one that 16 sets the example for the entire state? 17 We close it. 18 How do you treat -- or at least propose to 19 close it? 20 How do you treat the center in Binghamton, 21 that's rated first in children's services? 22 How do you -- all that work, all that 23 accomplishment, what do you tell the employees there 24 and the people that use the facility? 25 We're going to close it. 1 And you come to Elmira, it's the example in 2 adult services. 3 And what's the answer? 4 For all your hard work and all your -- the 5 great things that you've done, we're going to close 6 you. 7 Doesn't make any sense. 8 It just absolutely does not make any sense. 9 And to leave an entire -- I mean, first of 10 all, as county executive, I'm really trying to 11 figure out why the Southern Tier gets, and I'm going 12 to use the word, "targeted" for three facilities. 13 I'm about to put my budget out there, and 14 believe me, I didn't balance it on the back of some 15 village or town. 16 You know, we did the pain of reducing our 17 workforce by a couple million dollars, almost 18 4 million over 2 years, by distributing it. 19 So I just think this is bad. 20 It's bad for the community, economically. 21 But most importantly, I just don't know how 22 you tell the public, and the people that use the 23 facility from 11 counties -- 13 counties for two, 24 that the Southern Tier is going to have no inpatient 25 presence. 1 It makes no sense. 2 If we were flawed with our services, if we 3 didn't perform quality services, I understand it. 4 And the last thing I want to say is this: 5 This is the third time we've been slated for 6 closure. 7 And the prior two occasions, the excellent 8 staff at the Elmira Psychiatric Center, and the 9 people that were their administrators at the time, 10 found ways to save dollars. "Significant dollars." 11 That's what we should be talking about: How 12 can we still save money and still provide these 13 services? 14 One of the criteria is, this great amount of 15 Medicaid dollars that we -- and I understand that. 16 We're up over $1 billion a week in the state. 17 And I could -- as you know, we opened up a 18 model Medicaid home here, and we can show you how to 19 save dollars in Medicaid if that program -- and I'm 20 going to say it -- was run properly and efficiently. 21 And the way not to save it is just by saying 22 "let's close things." 23 If you look at the -- what the -- the money 24 we spend, you know, we're among the lowest of actual 25 users of Medicaid moneys, both facilities. 1 So, in closing, and I said this yesterday: 2 If I was the president of General Motors, and 3 I came in to my board of directors and stockholders 4 and said, "Here's my plan. Here's my plan for what 5 we need to do to rectify our problem: I'm going to 6 close our three best facilities that make the most 7 money," I'd be in the unemployment line. 8 And I think the same is to be said here. 9 Why would you take the two best centers in 10 the state? 11 And I finally heard that there was a 12 downstate facility that finally got its 13 accreditation last week after, I believe, three to 14 five years of the worst publicity in record I have 15 ever seen or imagined. I just can't even 16 understand. 17 They tell me if the place was closed, it 18 would save more money than our two together. 19 Why would you send the message that hard 20 work, good product, you make a difference, you treat 21 the people that use it well, you do a great job, 22 here's your reward, we're going to close it? 23 It's wrong, it's wrong, it's wrong. 24 Thank you. 25 SENATOR CARLUCCI: Do you have any questions? 1 Thank you, County Executive. 2 SENATOR O'MARA: Thank you. 3 SENATOR CARLUCCI: Next we're going to hear 4 from Andrea Smyth, the executive director of the 5 New York State Coalition for Children's Mental 6 Health Services. 7 ANDREA SMYTH: Thank you for the opportunity 8 to testify on the Office of Mental Health's Regional 9 Center of Excellence plan. 10 I'm Andrea Smyth. I'm the executive director 11 of the New York State Coalition for Children's 12 Mental Health Services, and a member of the 13 Regional Center of Excellence Steering Meeting at 14 the state level. 15 The New York State Coalition for Children's 16 Mental Health Services has developed a position 17 statement on the Regional Centers of Excellence, and 18 I'll read that for the record: 19 The New York State Coalition for Children's 20 Mental Health Services believe that children and 21 families will have access to a stronger, more 22 responsive child and adolescent behavioral-health 23 service array as a result of the five 24 Regional Center of Excellence planning teams. 25 The coalition supports the planning process 1 as an effective vehicle for families and community 2 representatives to play a significant role in 3 identifying strategic investment and well-designed 4 expansion of both State-operated and State-licensed 5 children's behavioral-health services. 6 Currently, the existing safety net of 7 behavioral-health services for children and families 8 includes both State-operated and State-licensed 9 services providers. 10 Establishing better coordination and 11 integration of all available services will be 12 required to achieve a modernized, more responsive, 13 and more effective delivery system. 14 The coalition wants to emphasize that 15 State-operated inpatient services are a valued 16 component of existing safety net for children and 17 adolescents with seriously emotionally disturbed -- 18 disturbances. 19 That component is already a very weak link in 20 the capacity of behavioral-health services. 21 That component is already geographically 22 disbursed very far for children and families to 23 access. 24 People already travel very far distances to 25 access State-operated services. 1 We at the Coalition for Children's Mental 2 Health Services believe that services can be left in 3 geographic hubs, and those services can be more be 4 responsive to the communities. 5 We especially want the discussion to be 6 around alternative services that currently aren't 7 available in the system. 8 In New York City, between 2005 and 2010, 9 20,000 emergency removal calls were made from school 10 addresses to respond to the emotional disturbances 11 of students. 12 Less than 30 percent of those students who 13 were removed from school in an ambulance and taken 14 to an inpatient psychiatric hospital were admitted 15 to the hospital. 16 This is repeated in communities everywhere. 17 Maybe on a much smaller level, maybe not 18 quantified, but, children are brought to the 19 hospital every day and they're not admitted to the 20 hospital. 21 It could be that the cost of the hospital is 22 rejected by the managed-care company. 23 Or it could be that the child -- the severity 24 of the child's disturbance, even though their 25 families and their caretakers are so disturbed by 1 their behavior that they call an ambulance, are not 2 severe enough to be in an inpatient setting. 3 We need to develop appropriate alternatives 4 so that children can be safely observed, can be 5 safely evaluated, not precipitously returned to 6 their homes when they're not capable -- the family 7 and the child are not capable of it, but it doesn't 8 mean that it's an inpatient hospital bed. 9 The coalition believes the Regional Center of 10 Excellence process is not only about reducing the 11 number of State-operated inpatient beds, but it's 12 about identifying and planning for the alternative 13 services that should be State-operated and 14 State-licensed. 15 There is a network of residential treatment 16 facilities operated by non-profit organizations that 17 I represent. These 18 facilities are also 18 geographically disbursed around the state. 19 There is one in the Southern Tier: Stillwater 20 RTF. 21 These are a highly-regulated subclass of 22 hospitals that are hard to get into because of the 23 bureaucrat process. 24 We've built a lot of walls around keeping 25 people away from services as the Medicaid cost 1 containment over the last 25 years. 2 And as we move into a new venue where we're 3 trying to identify alternative services, part of the 4 next step that I urged the Legislature to get 5 involved in, is to try to break down the barriers 6 and all of the referral barriers that happen when -- 7 that keep people out of services. 8 The preadmission certification process to get 9 into an RTF can take as long as six months for a 10 child to be admitted to an RTF. 11 If they're not going to be admitted to a 12 State-operated inpatient hospital because they're 13 not sick enough, and it's gonna take six months for 14 them to get into an RTF, what services are available 15 to them as alternatives? 16 And that's where we need to work on better 17 regulations. 18 I think that crisis observation beds, crisis 19 respite beds, that could be left in every hub, that 20 could be operated either by the State or by RTFs, 21 will give a better option for kids that need 22 emergency services. 23 I also want to say something about the time 24 frame. 25 About the time that the RC plan 1 implementation is complete -- not when it begins, 2 but when it's complete -- an even more significant 3 transition will also be concluding: the transition 4 to Medicaid managed care for children who are 5 currently exempt from Medicaid managed-care 6 enrollment is set to be January 2016. 7 It's a very convincing reason for why reform 8 of the State-operated service system is necessary. 9 The services offered by the four 10 State-operated children's hospitals and six child 11 and adolescents' units represent a very high-cost 12 service, with the average daily cost over $1400 per 13 day. 14 OMH reports that families with children who 15 need hospitalization and aren't Medicaid-eligible 16 already have trouble having commercial insurance 17 approve an inpatient State-operated hospital bed. 18 That's because the commercial insurers will 19 not approve adolescent admissions to State-operated 20 facilities because of the cost. 21 Having a service close by when it's not 22 accessible by everyone who needs mental-health 23 services is not helping children and families. 24 When exempt children services are 25 transitioned to Medicaid managed care by 1 January 2016, the cost of services and the length of 2 stay will influence the Medicaid managed-care 3 organizations' ability to approve admissions. 4 If State-operated inpatient services cannot 5 craft a service that's affordable and effective, 6 then it's not going to be accessible to the kids 7 that need treatment. 8 Part of this reform needs to be part of that 9 reform. We can't do these things in isolation. 10 We're completely opposed to a scenario under 11 Medicaid managed care where taxpayer funds are used 12 the to subsidize State-operated children's services 13 to keep their costs competitive. 14 There was a meeting of the Children's 15 Medicaid Redesign Team last week. In the slide-deck 16 presentation of the Children's Medicaid Redesign, 17 was a bullet that indicated that State-operated 18 facilities will receive essential community-provider 19 status. 20 That essential community-provider status will 21 mandate that they be included into insurance 22 networks. 23 If they are mandated to be in the insurance 24 networks and their costs aren't competitive, then we 25 are going to be taking money that could be spent on 1 other and more different types of services in our 2 communities and we will be investing them into one 3 type of service. 4 Those decisions can be made, they're going to 5 be at your discretion, but I urge you to think about 6 the volume of services that are needed. 7 We already don't have enough capacity. 8 We need every dollar to be spent in the most 9 cost-effective way. 10 We strongly urge that the Regional Center of 11 Excellence process which has been -- is underway 12 now, which includes five members of my board of 13 directors and four of the different Regional Center 14 of Excellence planning teams, and they report to me 15 that the discussion is robust about regulatory 16 relief, about the need for mobile crisis clinics, 17 about the need for mobile clinics the way we have 18 mobile dental clinics, so that buses and sites and 19 staff can be moved to after-school programs and 20 serve kids more readily in they're accessible 21 communities, the need for changing regulations to 22 access higher-end services, like residential 23 treatment facilities, those discussions are taking 24 place in each community as part of the 25 Regional Center of Excellence teams. 1 When the report comes out in December, it 2 will have details about what services would be left 3 or developed in the hubs. 4 I hope that those recommendations will be 5 worthy of your consideration. 6 But if they're not, then I urge you to take 7 full opportunity, when the Governor recommends his 8 budget, to refine the proposal, but to really keep 9 in mind that we need to modernize children's 10 services, and we need to expand children's 11 mental-health services, and that it needs to be done 12 in a way that serves all children, Medicaid and 13 non-Medicaid. 14 Thank you. 15 SENATOR CARLUCCI: Thank you, Andrea. 16 We really appreciate your testimony. 17 I just had one question. 18 You referred to the regulations quite a bit. 19 What would be very helpful to us is if you 20 could pinpoint the regulations and the ideas that 21 you have. 22 Your testimony is very thorough, and it's 23 great. It would just be good to have those specific 24 regulations so that we could really try to tackle 25 those individually. 1 That would be extremely helpful. 2 ANDREA SMYTH: We commissioned a report by 3 Manatt Health Solutions to specifically identify 4 reform of the preadmissions certification systems. 5 So I have that report, and I'll share it with 6 you. 7 SENATOR CARLUCCI: Excellent. 8 And, then, when you talk about modernizing 9 children's services, could you just elaborate on 10 that just a little bit? 11 ANDREA SMYTH: Sure. 12 You know, we do have an array of services 13 that have been proven effective in keeping kids out 14 of hospitals: the home- and community-based waiver 15 program. 16 But like every other service in the 17 children's mental-health system, there's a small 18 number of opportunities; so they're -- we call 19 "slots opportunities," because the kids don't need a 20 slot, they need an opportunity to get treatment. 21 The waiver program has about 3600, I think, 22 OMH-licensed slots in it. 23 But, you know, we're coming from a system, 24 less than five years ago -- 25 I don't know, you know, you weren't the chair 1 of the Mental Health Committee, so, just one 2 digression to history. 3 -- OMH would not approve a new clinic -- 4 outpatient-clinic license unless the community could 5 show what other mental-health service they were 6 going to downsize, and how opening the clinic would 7 be cost-neutral. 8 So we have been suppressing -- you know, if 9 we want to talking about market share, and the 10 development of market, you know, -responsive 11 children's mental-health services, we have so many 12 regulatory barriers and rules that suppress demand 13 for children's mental-health services, that when 14 I talk about modernization, I really mean about -- 15 I really mean opening up completely new levels of 16 services. 17 We can't respond to the needs with the 18 existing services we have. 19 We have to identify new ones. 20 Crisis beds, where kids who are taken to the 21 ER, but aren't going to be admitted to the hospital, 22 can go someplace safe. They're not gonna sit in the 23 emergency room for three or four days and then just 24 get discharged without a service plan. 25 An observation bed is going to evaluate their 1 medications, it's going hook them up with a kids' 2 health home if we get there, or a case coordinator, 3 a family-support service...just some basic services 4 to wrap around a kid who clearly may not need to go 5 to the hospital, but isn't functioning well in the 6 community. 7 And those are more modern services. 8 SENATOR CARLUCCI: Thank you. 9 SENATOR O'MARA: I just have a couple of 10 questions, Andrea. 11 Thank you for being here. 12 With regards to private -- the privatization, 13 and the access across the Southern Tier region, 14 which is my primary concern in this endeavor of this 15 hearing today, we cover 15 counties that Binghamton 16 and Elmira services cover, and I understand there's 17 very few OMH-regulated private children's beds out 18 there. 19 In fact, I've been told there's only 6 in the 20 entire 15-county region, which leads me to believe 21 that we certainly have a need for those services. 22 And I'm all in favor of encouraging the 23 community-based organizations to do that, but it's 24 gonna take a long time to set those type of services 25 up, when we're looking at closure dates of next 1 July. 2 And, I'd be interested in knowing, in the 3 Southern Tier region, in this 15 counties that we 4 cover right now, what private facilities is your 5 organization involved with in the discussions on 6 these community-based services. 7 ANDREA SMYTH: Well, the agencies that are 8 members of my organization I mentioned in the -- 9 further east, Stillwater RTF, Hillside Family of 10 Agencies, which covers services in 27 different 11 counties, in both the Central and the Western 12 region, operate an RTF in the Finger Lakes region. 13 So I'm not sure what the 6 -- I'm not sure 14 what types of bed the 6 are, because I think the 15 Finger Lakes RTF has at least 16 24 residential-treatment facility beds. 17 SENATOR O'MARA: Do you know where those are? 18 ANDREA SMYTH: The town that they're in, 19 I can't recall at the moment, but I can certainly 20 get it to you. 21 I can get you the list of all of the RTFs and 22 where they operate. 23 And what I'm saying are -- is that -- and the 24 other type of service that my agencies provide, 25 which is in every single community, they provide 1 foster-care services, and there aren't residential 2 treatment centers in every single community, but, we 3 do need to look at the bricks-and-mortar that 4 already are in the communities before we determine 5 that we can't provide services. 6 There could be buildings. 7 There could be buildings at Elmira. 8 And what I'm saying is, there could remain in 9 the hubs State-operated beds, but they're not to the 10 level of inpatient hospital. They're more crisis 11 observation. Maybe they operate along the 12 regulations of the RTF as opposed to a hospital. 13 The RTF is a subclass of hospital. 14 So I think we have to look at all of the 15 options, including the availability of currently 16 vacant residential space, which could include 17 OCFS-licensed residential treatment centers and 18 OMH-licensed residential treatment facilities. 19 SENATOR O'MARA: You know, we have in this 20 region, in the Southern Tier, I think a retraction 21 of the services, rather than an expansion of the 22 services. 23 And we hear about it quite often, and most 24 recently, going on in Hornell, with the 25 St. James Mercy Hospital, has a CON pending to close 1 their entire psychiatric unit. 2 So, there's more private beds being 3 eliminated from the services. 4 And, you know, the figures you mentioned 5 about $1,400 a day for treatment, it's my 6 understanding that the inpatient cost of treatment 7 at Elmira is roughly half of that. 8 So, I'm not sure if you've taken a statewide 9 average, or if you -- and what I said in my opening 10 remarks, Elmira is a very efficiently-run 11 psychiatric center that is providing very 12 cost-effective services. 13 So, you know, I think if we throw a statewide 14 average, I'm sure there's areas of the state where 15 the costs are much higher, but I guess my point is, 16 Elmira is doing it very well. 17 And, have you been to the Elmira Psychiatric 18 Center to tour the facilities? 19 ANDREA SMYTH: Well, the number I'm using is 20 a "children's inpatient bed" number; and so 21 I have -- and I have not been to the Elmira 22 inpatient facility. 23 SENATOR O'MARA: Thank you. 24 SENATOR CARLUCCI: Assemblywoman Lupardo. 25 ASSEMBLYWOMAN LUPARDO: I actually agree with 1 most of what you're talking about, because having 2 worked in the mental-health field before my 3 election, I mean, we need these resources to go in 4 the manner you described. 5 I'd just feel a lot better about it if our 6 region hadn't been completely left out of the 7 geography. 8 I mean, when you mention that it's a valuable 9 component of the existing safety net, I agree with 10 you. 11 Do you have any reason to believe that the 12 community hubs could involve these crisis beds? 13 It's not clear to us because we haven't seen 14 the details. 15 ANDREA SMYTH: Yeah, I mean, I just know what 16 they're talking about, I know what the discussions 17 are like. 18 And the discussions are reaching; 19 far-reaching. 20 So, you know, I agree that the time frame may 21 not match with the wish lists that may come out of 22 the recommendations, but that is the job of the 23 people who control the resources, to match those 24 two things up. 25 And I hope that the -- I hope that there will 1 be a strong retention of services in every area 2 where there's a proposed closure. 3 And I hope that there will be expansion of 4 State-operated services that are currently in the 5 community. 6 So, for example, there are children's day 7 treatment. 8 Children's day treatment is a program for 9 kids who have been pushed out of public schools, 10 have been pushed through their BOCES program, who 11 cannot function in the public-school system. 12 And, so, whether through their committee on 13 special education or because of their mental-health 14 diagnosis, they've been referred to a day-treatment 15 program, or a special-ed school district operated by 16 a special-ed school district. 17 The State is the largest provider of 18 children's day-treatment programs. 19 There are currently 31 State-operated 20 children's day-treatment programs. 21 I am not proposing that we do not need day 22 treatment or that we do not need State-operated day 23 treatment. 24 I just think, from the perspective -- I know 25 that up in St. Lawrence, it's so far away. 1 You know, we went -- I went up to 2 St. Lawrence. There is a children's unit at 3 St. Lawrence. The beds aren't even full. 4 You have to ask yourself: Why are people not 5 being admitted to these even State-operated beds, 6 when, exactly, Senator O'Mara, the downsizing of the 7 general hospital inpatient units is tremendous? 8 In the New York City region, we are almost 9 out of children's private inpatient hospitals. 10 There used to be four. 11 There's one. 12 And, yet, the RTFs have vacancies. 13 The State-operated inpatient beds have 14 vacancies. 15 So, what's going on with the capacity? 16 Where are these children going? 17 And I think that that's where I get so 18 concerned about there not being a focus on the 19 expansion of community mental-health services, 20 because the kids are being forced into foster care 21 or they're being forced into juvenile justice 22 systems. 23 They're not accessing their mental-health 24 services through the public mental-health system. 25 And I think that this planning process at 1 least gives us the opportunity to think about ways 2 to better address that problem. 3 SENATOR CARLUCCI: Thank you. 4 Appreciate it. 5 SENATOR O'MARA: Next, we're going to go out 6 of order here, quickly, to get to one of our 7 witnesses who has a conflict: Chief Mike Robertson 8 from the Elmira Police Department. 9 And, we'll also move up Alice Haskins from 10 the Ontario County Jail. 11 If you could both come up and testify 12 together, please. 13 CHIEF MICHAEL ROBERTSON: Good morning. 14 SENATOR O'MARA: Good morning, and thank you 15 for being here. I'm glad we could fit you in, 16 Chief, to be here. 17 If you each have some remarks you'd like to 18 make in regard to the subject of the hearing today, 19 we look forward to hearing them, and then we may 20 have a few questions for you. 21 CHIEF MICHAEL ROBERTSON: Okay, certainly. 22 I've been nominated to go first, so I will. 23 Chief Michael Robertson, Elmira Police 24 Department, just for those that don't know me. 25 And I appreciate you listening to us today. 1 I just want to speak briefly about the impact 2 that I feel that this potential closure, or 3 downsize, of the psychiatric center could have on 4 the city. 5 The city of Elmira has a -- quite a 6 considerable population of people with mental-health 7 needs, and, it takes up a considerable amount of our 8 resources, and our resources, like anyone else, are 9 ever-shrinking. 10 It seems to be the proverbial "do more with 11 less." 12 But I grabbed some stats this morning. 13 In 2011, my personnel handled 14 248 mental-health complaints; 15 2012, 286; 16 And 2013, year-to-date, is 209. 17 So we're right to that. 18 Now, these type of complaints here are 19 non-criminal complaints. 20 These are just suicidal-type people, or, 21 maybe, possibly somebody, you know, making threats 22 to another, but, that need some sort of services. 23 In addition to handling the calls and taking 24 the police resources of the time, then also what we 25 do, our protocol is to take them to 1 St. Joseph's Hospital which is the designated 2 facility, but that's also taking the officer time as 3 well, because we have to go there and, basically, 4 sit with them and, quote/unquote, baby-sit them, 5 until such time as they can be seen or turned over 6 to adequate security personnel. 7 And, if they're any type of violent person, 8 or anything, it could even be a longer time. 9 All in all, I think to take these -- to make 10 this move with the psych center and close it down is 11 going to, undoubtedly, stress our resources even 12 more. 13 Again, we handle these things every day, we 14 handle some sort of a mental-health complaint. 15 It may not show exactly in these numbers of, 16 but, again, these are not criminal in nature. 17 These numbers that I just provided you with, 18 or these statistics, these are just the cries for 19 help. 20 And then on the outside of that, and, 21 unfortunately, I don't have any statistics for that, 22 but as to the people that are out there, the 23 mentally ill, that are committing crimes against 24 other citizens of the city. 25 So I, as chief of police, and on behalf of 1 the City of Elmira, am opposed to any type of 2 downsizing of the Elmira Psychiatric Center. 3 SENATOR O'MARA: Alice. 4 ALICE HASKINS: I come from Ontario County, 5 New York. 6 I've work in corrections for 32 years. 7 Prior to that, I did work for a year at the 8 Rochester Psych Center. 9 Over the years, we've seen an increasing 10 number of people were mental illnesses coming into 11 the criminal justice system. 12 And, in fact, I think often of how Willard 13 used to have 1100 mental-health patients, and now 14 they have 1100 prisoners, and the mental-health 15 patients are in the jails. 16 The county jail is the first line of the 17 criminal justice system for incarceration. 18 We get people off the street. We don't have 19 their histories. We don't know what's going on. 20 We don't know if it's mental illness, whether 21 it's drugs; what's causing the behavior that has led 22 to their being arrested, so, it takes some time to 23 stabilize. 24 One of the misconceptions that we found in 25 the mental-health community, is that we somehow can 1 expedite getting people from jail into mental-health 2 services. 3 And, that, is not a reality. 4 The Commission of Correction, which has 5 oversight of jails, doesn't have any kind of 6 particular standard for the treatment and care of 7 people with mental illnesses, so, there's a lot of 8 variety in the way that a person coming into jail 9 might be treated. 10 But, we have been fortunate in the past to be 11 able to get people into mental-health services. 12 And, Elmira is one of the services that we do 13 use, even though we're located, you would think more 14 proximate to Rochester, a number of our people, 15 particularly from the Geneva and some of the rural 16 areas, have a history of using the Elmira Psych 17 Center. 18 And I think one of the things to keep in mind 19 with mentally ill people is that, they do have a lot 20 of mobility and they tend to migrate from one 21 community to the next. 22 So, that's another reason that some of these 23 people are familiar with services in an area such as 24 Elmira. 25 One of the things that is another fact, is 1 the people may go to a local hospital, an emergency 2 room, as the previous speaker just noted. 3 They're not admitted. 4 But, that doesn't mean there's not a problem, 5 because, a number of the people that come into jail 6 say they've been to the emergency room first, or 7 they've been at a local hospital the day before, or 8 whatever the circumstances were, and, these people 9 are coming into the jails. 10 The other thing that I would like to focus on 11 during this conversation is that, as moneys are 12 diverted from mental-health services into 13 restructure, some of that money needs to be planned, 14 set aside, somehow made available to jails for the 15 fact of safely transitioning people onto the 16 streets, because we can't just let somebody go. 17 If they have a mental-health problem, we 18 can't say you've served your time, you're going on 19 the street. 20 There has to be a way to place these 21 individuals. 22 And, one of the things I also would 23 appreciate the Senators watching is, as we downsize 24 the mental-health facilities, how much new 25 construction is there going to be in the county-jail 1 system? 2 And, this is not necessarily something that 3 the State cares about. 4 They've been able to rightsize the prisons; 5 they're proud of that. 6 But, are there ways that services that were 7 previously held by the mental-health system, the 8 prison system, be looked at into ways that people 9 can bring their expertise into the local-jail 10 setting? 11 We would be more than happy to have services 12 diverted to jails. 13 We need people with mental-health backgrounds 14 as employees. 15 We need training that isn't available. 16 So, even in looking at the ways that some 17 mental-health services are going to be downsized, 18 can some of those resources then be used in another 19 way to serve the exact same population? 20 And I just want to conclude with something: 21 I also attended, in Monroe County, the 22 Listening Tour on Mental Health in May. 23 And one of the things that was brought up at 24 that time, was that California was used as a model 25 for how they downsized their mental-health system. 1 And I want to tell you how they did it, in an 2 article that I received in July. 3 California built an $839 million health-care 4 facility, opened it July 15th, took the first inmate 5 into the 1722-bed facility, 57 buildings, serving 6 inmates on a 1.2-million-square-feet total building. 7 So the fact is, that people are going to end 8 up somewhere, and the quality, the level of 9 services, that are going to be provided need to take 10 into consideration, the interaction that evolves 11 with law enforcement, corrections, and then the 12 transition back into the community. 13 Thank you. 14 SENATOR CARLUCCI: Great, thank you. 15 I just have a question for Alice Haskins with 16 the Ontario County Jail. 17 Now, you talked about the waiting time for 18 placing people in the jail to the forensic beds. 19 What's going on with that? 20 What is the waiting period now, typical 21 Ontario inmate? 22 ALICE HASKINS: The last inmate that we tried 23 to place, we had to wait four to five weeks. 24 This was a man who was quite seriously 25 disturbed, playing with feces, unable to take care 1 of himself, and, had previous history of 2 hospitalization as well. 3 SENATOR CARLUCCI: And that four-to-five-week 4 waiting period, that was because there wasn't a bed 5 available, or was there other issues involved with 6 that? 7 ALICE HASKINS: It was waiting for a bed at 8 that time. 9 SENATOR CARLUCCI: Okay, and where did that 10 person wind up going? 11 ALICE HASKINS: He went to 12 Central Psychiatric in Marcy. 13 SENATOR CARLUCCI: Okay. 14 And just a question for the chief: 15 You talked about the mental-health 16 complaints. 17 Now -- and this is really for both of you -- 18 have there been any successful diversion programs, 19 or anything like that, that has been initiated in 20 the area? 21 CHIEF MICHAEL ROBERTSON: Elmira has a number 22 of services. You know, available family services, 23 the crisis program, the county mental-health 24 programs, and things like that. 25 Catholic Charities even offers an arm of, you 1 know, services. 2 To what extent, I don't know exactly what 3 each one does, I couldn't testify to that, but, 4 there are services out there. 5 SENATOR CARLUCCI: And out of the -- you 6 talked about, about 218 mental-health complaints 7 last year, I believe that was the number? Or around 8 that? 9 CHIEF MICHAEL ROBERTSON: Something like 10 that, yes. 11 SENATOR CARLUCCI: And you talked about going 12 to St. Joseph's -- 13 CHIEF MICHAEL ROBERTSON: 286. 14 SENATOR CARLUCCI: What's that? 15 CHIEF MICHAEL ROBERTSON: 286. 16 SENATOR CARLUCCI: 286? Okay. 17 Were those people that were actually taken to 18 St. Joseph's, or that was officers called out to 19 someone's home, or to an incident? 20 CHIEF MICHAEL ROBERTSON: Without having gone 21 through each of them, the bulk of them -- the vast 22 bulk would have gone to St. Joe's. 23 SENATOR CARLUCCI: Okay. And I issue there, 24 you were talking about, there's a waiting time to 25 get them evaluated and sent on to the psychiatric 1 center, or -- 2 CHIEF MICHAEL ROBERTSON: Either admitted 3 into the hospital, their behavioral-science unit, 4 or, sent to the psych center, correct. 5 SENATOR CARLUCCI: Okay, and is that a -- 6 something that's happening at St. Joseph's, in terms 7 of the waiting, or is that a backlog from the 8 psychiatric center? 9 What's something that can be done to make 10 that a smoother process? 11 CHIEF MICHAEL ROBERTSON: That, undoubtedly, 12 is a St. Joe's issue, I suppose. 13 It's waiting to get them admitted for their 14 evaluation, their mental-health evaluation. 15 But I just think that that speaks to the 16 shear numbers, though, that we're taking down there; 17 that it just is a tax on the department, as far as 18 providing the necessary patrols and stuff to the 19 rest of the community. 20 SENATOR CARLUCCI: Okay. 21 Well, thank you. 22 Other questions? 23 ALICE HASKINS: Ontario County, we do have a 24 CPEP team that responds. 25 However, a lot of times they're not admitted 1 to treatment. They're given a follow-up 2 appointment. 3 And between the time that they receive that 4 follow-up service and then go out into the 5 community, they've done something that's led them 6 into the jail. 7 SENATOR CARLUCCI: Okay. 8 Assemblywoman? 9 ASSEMBLYWOMAN LUPARDO: Chief, do you have 10 any idea how many people currently in the jail have 11 a mental diagnosis? 12 What percentage? 13 CHIEF MICHAEL ROBERTSON: I don't know. 14 The jail is operated by the county. 15 I'm with the city, so I don't know that 16 number. 17 ASSEMBLYWOMAN LUPARDO: Yeah, Broome County 18 testified it was quite high, two-thirds; so, we 19 would expect it to be similar, I would think. 20 CHIEF MICHAEL ROBERTSON: It could very well 21 be, yeah. 22 I'm not sure. 23 ALICE HASKINS: It is fairly similar across 24 the state. 25 And part of the issue is that, people tend to 1 stay longer in the system when they have a 2 mental-health problem, because there's conflict 3 between the reports. 4 We had, again, an individual who had to have 5 five different psyche evals because there was 6 conflict on accepting them, between the public 7 defender and DA's Office. 8 SENATOR CARLUCCI: Okay, thank you. 9 We really appreciate your testimony. 10 ALICE HASKINS: Thank you. 11 CHIEF MICHAEL ROBERTSON: Thank you. 12 SENATOR CARLUCCI: Next we're going to hear 13 from Public Employees Federation. 14 We have the president of PEF with us today, 15 Susan Kent. 16 Joining her is Dorothy Kurta, who is on the 17 executive board; Bonnie Wood, a regional coordinator 18 for PEF Region 2, and, Lynda Albert, council leader 19 of Division 223. 20 Good morning. 21 Good to see you. 22 SUSAN KENT: Good morning. 23 Thank you for having the Public Employees 24 Federation testify again at a hearing that you have 25 put together. 1 We very much appreciate what you have done 2 throughout the state. 3 We appreciate that you heard our call to make 4 sure that Elmira had an opportunity to talk about 5 the services that they provide to 11 counties, and 6 that they be included in these hearings. 7 As you said, I'm Susan Kent. I'm the 8 president of the Public Employees Federation. 9 We represent 54,000 professional, scientific, 10 and technical public employees. 11 In addition to being joined today by 12 Bonnie Wood, Dorothy Curda, and Lynda Albert, I'm 13 also joined by Secretary-Treasurer Carlos Garcia for 14 the union, and Chris Leo from our legislative 15 office. 16 We come, all together, to make sure that it's 17 clear that this is a statewide crisis that the 18 Governor has caused, for no reason. 19 That while today we will focus on the local 20 issues that this so-called "plan," which is nothing 21 more than an announcement, called "Centers for 22 Excellence," again, a nice catchy phrase that the 23 Governor has come to use for a lot of his poor 24 public-policy initiatives. 25 It is not a plan. 1 It is merely something that was thrown out 2 there, that now, unfortunately, is going to again be 3 used as a push and pull between what should 4 rightfully be public services that are provided by 5 the government -- that is the reason why we have 6 government; to care for individuals -- and, push and 7 pulled with privates. 8 That while we believe there is a natural 9 relationship between public and private, and Elmira 10 shows that, as does our other local facilities, that 11 this, already, I'm hearing -- I heard it up in the 12 North Country when we went to talk about 13 St. Lawrence, I heard it again today -- it might be 14 veiled, but it's there: it's an attack by saying 15 that State-provided services are not cost-efficient 16 and effective. 17 That is nonsense. 18 It is nonsense especially in this regard: 19 Elmira is a leader for adult services, for 20 children's services, and for cutting down on 21 readmissions. 22 They're very cost-effective, and they have 23 come up with ways to make sure that the rural 24 population and the poor population that they serve, 25 those parents can be involved in their children's 1 treatment, and they have come up with ways to 2 financially assist those families. 3 You've heard me say this throughout the 4 state: In order to be a very good therapeutic 5 model, you have to have families involved. 6 It holds true with adults, and it holds true 7 especially with children. 8 Today we heard people already have to travel 9 long distances. 10 What that is, it's a veiled attack on 11 State-provided services. 12 And I'm asking you to see through that, 13 please, and while we will never, ever argue against 14 the fact that not-for-profits should have the 15 funding that they need, we will not do it at the 16 expense of the vital, needed State-provided 17 services. 18 When we talk about the RCE teams, I pushed, 19 and we have a representative on each of those 20 RCE teams. 21 However, three meetings, "three meetings," to 22 come up with a plan in December when we talk about 23 the concept of a hub. 24 And, you asked questions about, "Will the hub 25 include inpatient beds?" 1 There is absolutely no proof to say that they 2 will, because there is no plan for what these hubs 3 will be. 4 I'm very, very, very concerned, that while we 5 do have representatives on the RCE teams, they have 6 no voting rights. 7 We're talking about government: your public 8 employees, we're public employees. 9 We believe in our separate branches of 10 government, and we believe in our voters' rights to 11 have a say in what will happen in their communities 12 in this country. 13 So why would you put professionally-prepared 14 people that do the work every day on a team and say: 15 You have a voice, you can give us some ideas in 16 these three meetings we're gonna have, but you have 17 no vote. 18 What is that about? 19 That is about acting as though people do have 20 a seat at the table when they really do not. 21 I will ensure, and my fellow leaders will 22 ensure, that our point of view on what is going on 23 with these RCE teams and this plan does come across 24 the Governor's desk, that you will all see it. 25 However, we have to continue to push for, 1 What kind of government do we really want? 2 And we all know what's gonna happen during 3 budget time. 4 And you are being pushed and pulled in a 5 thousand different directions, because there's never 6 enough money to go around for all of the people that 7 say that they have services that they want to 8 provide to the community. 9 So I know that this will be a very, very 10 difficult budget season for you. 11 And we will do what we need to do to stand 12 with you, and to speak out, to make it easier for 13 you to ensure that whatever the final result of this 14 announcement becomes, that it will be one that 15 benefits the community. 16 It will make sure that the Southern Tier is 17 not completely left out of the mental-health system 18 in terms of the inpatient beds that are needed. 19 If this was to be done correctly, what would 20 have happened was, an expansion of what is already 21 working. 22 OMH's own statistics show that Elmira is a 23 leader. 24 So why would we try to talk about building 25 something else? 1 Taking that away which already works, and 2 then building an different model, that isn't how you 3 do good government, and that isn't how you do good 4 planning. 5 What you do, is you build on what existingly 6 already works. 7 And this already works. 8 This facility and my local leaders will tell 9 you that this facility already is the original 10 community mental-health provider. 11 In addition to the inpatient beds, they have 12 outpatient services. They have continuity of 13 services that allows the children and adults to go 14 from the very serious mental-health crises that 15 they're experiencing that cause them to have to have 16 an inpatient stay, to be able to go and be 17 integrated back into their community in their daily 18 lives. 19 They already have that. 20 Should it be expanded? Absolutely. 21 Do we call for that on a regular basis? Yes. 22 But that doesn't mean that you say, you take 23 away the inpatient beds and then we will build what 24 is needed. 25 One of the previous speakers talked about 1 modeling after California. 2 What you'll see in California is an expansion 3 of the prison system, and an expansion of the use of 4 the emergency room. 5 And I mean the expansion of the use of the 6 prison system, not the expansion of the prison 7 system. 8 We do not need people that do not have 9 criminal issues in the prison system. 10 And in no way was she calling for that, but 11 I just want to point out to you that the Governor is 12 using a very, very bad model. 13 Also, I talked to another labor leader from 14 New Hampshire. They went through this kind of a 15 transition last year, and what do we see there? 16 People are not getting the inpatient services 17 they need; and, instead, you're seeing children in 18 emergency rooms, and you're seeing the increased use 19 of prisons for mental-health issues. 20 This is not who New York is supposed to be. 21 A lot of my members have come in today with a 22 red T-shirt. 23 I urge you all to look at that red T-shirt, 24 because it is a visualization of what this Governor 25 has done in the time that he's been in office. 1 The front of the shirt shows all of the 2 places he's already closed or downsized. 3 The back shows the ones that are currently 4 under threat. 5 This Governor is talking about economic 6 development in this state, and he is devastating 7 communities, and devastating our hope in building 8 our middle-class, and our hope for those that are on 9 the lower tier of the socioeconomic ladder to be 10 able to attain middle-class lifestyle, because he's 11 eroding our good jobs and the services that 12 communities need to thrive. 13 So, I urge you to continue to do what you're 14 doing, and to let us know what we can possibly do, 15 so that when we get to budget time, it is a little 16 bit easier for you to do what you need to do, 17 because I know that you have finite ability to make 18 changes to that executive budget that's going to 19 come to both of your Houses. 20 And I want you to know that we are standing 21 with our community partners, we're standing with the 22 other unions, and we're standing with you, to make 23 sure that when this all shakes out, the people of 24 the state of New York are not the losers, and the 25 citizens of Elmira and those 11 counties that count 1 on these services are not the losers, in this year's 2 budget. 3 Thank you so very much. 4 I also want to tell you that our written 5 testimony will be provided to you. 6 And I encourage you to ask the local leaders 7 to give you any kind of information that you might 8 not yet have about the services that Elmira 9 provides. 10 I know that you've all been very much 11 involved. 12 And, Senator, you and I were both at the 13 community event last night, so I know that you have 14 already done a lot of the homework about what needs 15 to be done, but these local leaders are a wealth of 16 information for you. 17 Thank you. 18 SENATOR CARLUCCI: Thank you, Susan. 19 Is anyone else speaking on the panel? 20 No? 21 UNKNOWN FEMALE SPEAKER: No, we decided, she 22 combined our information. 23 SENATOR CARLUCCI: I see. 24 UNKNOWN FEMALE SPEAKER: And we're available, 25 on an ongoing basis, to fight to keep our facility 1 open so services are available for families. 2 SENATOR CARLUCCI: Well, thank you for your 3 advocacy and your commitment to serving your people 4 with mental illness, and we look forward to working 5 with you. 6 Any questions? 7 SENATOR O'MARA: No, just thank you for being 8 here. 9 And thank you for an excellent spaghetti 10 dinner last night. So, very good. 11 SENATOR CARLUCCI: Thank you. 12 Next we're going to hear from Sue Romanczuk, 13 the commissioner of the Tompkins County Department 14 of Health. 15 DR. SUE ROMANCZUK: Good morning. 16 My name is Dr. Sue Romanczuk, and I'm the 17 commissioner of mental-health services in 18 Tompkins County. 19 And I would like to thank both of you for 20 putting together this hearing today and allowing us 21 to speak. 22 Most of what I'll say today are things that 23 you've already heard, but I will say it anyways, 24 because I speak from the position of Tompkins County 25 and the Tompkins County Legislature. 1 While I appreciate that the State Office of 2 Mental Health needs to update its business model and 3 how it delivers services to the most seriously 4 mentally ill population, their current plan is not 5 fully developed, and by closing both 6 Greater Binghamton Health Center and 7 Elmira Psychiatric Center, they remove a crucial 8 element of the continuum of care for the treatment 9 of the most seriously mentally ill individuals in 10 the more rural areas of Upstate New York. 11 Many of the counties served by Elmira and 12 Greater Binghamton Health Center have been 13 designated by the federal government to be 14 federally-designated underserved areas, and by 15 removing more services, you leave these areas bereft 16 of the appropriate services. 17 During the past summer, the Tompkins County 18 Legislature and I thoughtfully reviewed the plan to 19 develop Regional Centers of Excellence along the 20 Thruway Corridor and into New York City and 21 Long Island. 22 We decided that there were a few flaws in the 23 plan. 24 The closure of all the units at 25 Greater Binghamton Health Center and Elmira removes 1 approximately 200 beds in a 15-county region for 2 children, adolescents, and adults before an increase 3 of bed capacity of the proposed Regional Centers of 4 Excellence has been built. 5 This is really irresponsible. 6 In Tompkins County alone, the mental-health 7 clinics served an unduplicated -- about 8 2400 unduplicated individuals in 2012. 9 Approximately 900 of them were identified as 10 seriously and persistently mentally ill. 11 At any given time, Tompkins County alone has 12 approximately 30 individuals receiving inpatient 13 care at either GBHC or Elmira. 14 OMH talks about our over -- that the 15 community is overly reliant on inpatient psychiatric 16 care, but it's really their psychiatrists who make 17 the determination on whether to admit or not admit. 18 So, is OMH saying that their own 19 psychiatrists are wrong when they admit people and 20 keep them for months at a time? 21 They're not wrong. 22 What they know, is that mental illness is not 23 always short-term; that people cannot always be 24 stabilized within 7 to 10 days, or 14 days, in a 25 community hospital, but sometimes it takes months 1 before the course of illness moves in such a way 2 that people are then stabilized. 3 At the same time that the State is planning 4 to close beds, a number of the community hospitals, 5 as you mentioned, in the western region are also 6 closing their inpatient psychiatric beds. 7 What I believe, is that these closings will 8 leave the six acute adolescent inpatient beds at 9 Cayuga Medical Center in Tompkins County as the only 10 adolescent beds available in the 15 counties 11 currently served by the two psychiatric centers. 12 OMH talks about access to care. 13 I have not heard any discussions from them 14 about what they consider to be appropriate time 15 frames, and how far people should have to travel in 16 order to access appropriate care. 17 The current proposal means that adults 18 residing in Tompkins County will have to travel 19 anywhere from 1 to 3 hours to receive medium- to 20 long-term inpatient psychiatric care, and that 21 children and their families will have to travel 22 between 2 1/2 and 3 hours to receive those same type 23 of services. 24 They talk about access. 25 They talk about person-centered care. 1 They talk about family involvement, peer 2 support; support of inclusion of people's support 3 group, whether it's family or friends. 4 How is this possible, if you're traveling 5 two to three hours away just to get the needed 6 services? 7 And who will pay for the transport of an 8 individual who needs to be hospitalized 9 involuntarily and the nearest hospital bed is 10 three hours away? 11 And who will pay for them to return home? 12 These are costs that have not been addressed 13 in the overall plan. 14 Again, OMH espouses the philosophy of 15 person-centered treatment, which, theoretically, 16 includes the individual's family or their support 17 system. 18 The greater the distance from the 19 individual's home community, the less likely that 20 loved ones will be able to participate in treatment 21 or discharge planning. 22 Many of our families in the more rural 23 counties have jobs that they cannot just take time 24 off whenever they want, and they don't have cars, or 25 they don't have money for gas, that will allow them 1 to make those travel -- to make that travel. 2 There's really no evidence at this point in 3 the plan that OMH has put out that they plan to 4 develop or fiscally support the development of 5 more-intensive wraparound services in the community 6 and to support people who are more unstable 7 psychiatrically. 8 We can talk about acute services, but as -- 9 again, some people remain in the community for a 10 long time when they're not stable psychiatrically. 11 The details are vague regarding what 12 personnel, what positions, or what dollars will be 13 reinvested into the community to assist in the 14 management and treatment of individuals who had 15 formerly have received treatment in a medium- to 16 long-term psychiatric inpatient unit. 17 It is known in our community, and many 18 others, that when an individual is unable or 19 unwilling to receive psychiatric care that they 20 often end up in the local jail. 21 You just heard that. 22 In the jail they're contained, but they're 23 not treated. 24 This is not a cost-savings for the State; 25 but, rather, a cost-shifting from one system to 1 another. 2 Every week I review several reports generated 3 as a result of the SAFE Act that indicate that 4 individuals are likely to cause harm to themselves 5 or others. 6 For the most part, these reports are 7 generated by either the local community hospital, 8 GBHC, or Elmira Psychiatric Center, and clearly 9 indicate that the individual has made threats or 10 attempts at harm to themselves or to others. 11 These individuals are currently hospitalized 12 because they're not safe to be in the community due 13 to these issues, and they need inpatient psychiatric 14 treatment to help them move past those internal 15 feelings. 16 In developing their plan, OMH ignored the 17 fact that both GBHC and Elmira have been identified 18 as two of the highest-performing psychiatric centers 19 by the Joint Commission OMH recertification and 20 CMS reviews; and, instead, chose poor-rated 21 psychiatric centers to become Regional Centers of 22 Excellence. 23 In addition, both GBHC and Elmira Psychiatric 24 Center already provide many of the services that are 25 identified as part -- as identified, that would be 1 part of the Regional Center of Excellence. 2 In closing, I would say that it appears that 3 the State is willing to dismantle the traditional 4 system of State-run inpatient care before a new 5 system of care for the most seriously mentally ill 6 individuals is fully developed. 7 In response, the Tompkins County Legislature 8 supports the development of a Southern Tier Regional 9 Center of Excellence that would serve the 10 Southern Tier and portions of the Finger Lakes. 11 I would urge that the State Legislature 12 request that OMH revise the current plan to include 13 the development of a Southern Tier Regional Center 14 of Excellence as a way of better serving the most 15 seriously mentally ill individuals within the 16 15 counties that are currently served by the 17 two hospitals. 18 Thank you very much. 19 SENATOR CARLUCCI: Thank you, Dr. Romanuk. 20 DR. SUE ROMANCZUK: Romanczuk. 21 SENATOR CARLUCCI: Romanczuk. 22 DR. SUE ROMANCZUK: Yes. 23 SENATOR CARLUCCI: Thank you, Dr. Romanczuk. 24 Any questions? 25 ASSEMBLYWOMAN LUPARDO: Thanks for your 1 testimony. 2 What impact do you think this would have on 3 your local hospital system? 4 DR. SUE ROMANCZUK: We already know that the 5 local hospitals are challenged by insurance 6 companies to only keep people for a short term, and, 7 they will be penalized for readmitting people within 8 a 30-day period of time. 9 So they're forced with some very difficult 10 choices, of either discharging people before they're 11 psychiatrically stable, or, holding on to people 12 that they do not get paid for while they wait for 13 the appropriate level of care, in terms of a bed to 14 open up at a psychiatric center. 15 I think that there will be more stress on the 16 local community hospitals. They are not designed to 17 provide medium- and long-term inpatient psychiatric 18 care. 19 ASSEMBLYWOMAN LUPARDO: Thanks. 20 SENATOR O'MARA: Thank you, Doctor, for your 21 testimony today. 22 And please pass along my thanks and 23 appreciation to the entire Tompkins County 24 Legislature for the resolution that they have 25 passed, and that you provided us with a copy of here 1 today. 2 Thank you. 3 DR. SUE ROMANCZUK: Yes. 4 SENATOR CARLUCCI: Great, thank you. 5 Next we're going to hear from some members of 6 the CSEA. 7 We have Rick Noreault; Joseph Howard, who is 8 the president of the Local 437; and David Tokar, 9 vice president, Local 437. 10 Good morning. 11 RICK NOREAULT: Good afternoon. 12 Unfortunately, our president, Joseph Howard, 13 is unable to join us, due to the fact that he has to 14 stay back at the psych center for some work 15 commitments. 16 So our vice president, who I will turn it 17 over to in a few minutes, will give his testimony on 18 his behalf. 19 Let me say that I'm pleased to be here. 20 I've been in Binghamton, I've been up north. 21 We've been all around. 22 I'm here to speak on behalf of our statewide 23 president, Danny Donahue; our region president, 24 Colleen Wheaton; and the entire CSEA family. 25 CSEA welcomes the opportunity to discuss 1 Governor Cuomo's plan to reconfigure mental-health 2 services. 3 It is apparent that the Governor's intent is 4 to devastate needed mental-health services across 5 the state, to leave the communities with no State 6 support, and to economically cripple communities 7 further by imposing financial burdens on families 8 and local taxpayers. 9 There is no evidence that the 10 Regional Centers of Excellence plan will meet the 11 needs of real people and communities. 12 Too many individuals and families have been 13 left without the help they need, and all this plan 14 does is exacerbate the problem. 15 I'm here today to express our strong 16 disappointment with regard to this plan, and ask for 17 your help in beating back a proposal embraced by 18 Governor Cuomo that will devastate New York's 19 ability to treat the mentally ill. 20 The Office of Mental Health (OMH) released a 21 three-year plan that will reduce the number of state 22 psychiatric centers and shift treatment to 23 community-based programs. 24 Under the plan, OMH will shift from long-term 25 inpatient treatment provided at 24 hospitals, to 1 15 Regional Centers of Excellence; or "RCE." 2 The Cuomo Administration is purposely 3 misleading the public about the impact of this plan 4 by packaging it with a nice-sounding name, without 5 providing any real detail about how services will be 6 provided or supported. 7 The only proposal we do know, is that the RCE 8 plan will reduce over 1,100 additional state 9 psychiatric beds by 2016, through closing and 10 merging various inpatient programs without bringing 11 up of community programs in a reasonable geographic 12 proximity to where families live. 13 For the past 20 years, the State of New York 14 has been reducing access to mental-health services. 15 In the earlier 1990s, CSEA was strongly 16 supportive of the Community Reinvestment Act to 17 ensure those who needed mental-health services would 18 have reliable access to quality care in the event of 19 a State-institution closing. 20 The law intended to protect existing programs 21 and bring up new services where they are needed. 22 Unfortunately, this never happened, and the 23 State has never fulfilled its promises; thus, 24 shortchanging community mental health. 25 There is now a lack of intervention and 1 overall community mental-health options available. 2 At the same time, there is absolutely no 3 evidence that the Regional Centers of Excellence 4 plan will meet the needs of real people in the 5 communities. 6 This plan is just another example of empty 7 promises. 8 Without any real detail or any dedicated 9 source of funds, it's impossible to put any faith in 10 the Administration's claim that this proposal will 11 make things better. 12 Access to long-term inpatient care has eroded 13 over the last 20 years, resulting in treatment for 14 the mentally ill being provided in state prisons and 15 county jails. 16 Local taxpayers will continue to foot the 17 bill for the State's failure to ensure appropriate 18 services in what amounts to an unfunded mandate. 19 There has never been available community 20 resources for the mentally ill, and under this plan, 21 there never will be. 22 The State's lack of commitment to the 23 mentally ill has turned our county jails into county 24 psychiatric centers. This has become the new 25 treatment model for the mentally ill. 1 County jails are expanding rapidly to keep up 2 with mental-health inmates at the expense of local 3 property taxpayers. 4 That means the burden is on local-government 5 taxpayers while the State walks away with the 6 promise of community services that never 7 materialize. 8 And let me just say that, I'm from 9 Onondaga County, and, when this plan first came out, 10 it was said, Oh, this is great, this is wonderful, 11 it's going save the State $24 million. 12 Well, one example, just one example, in 13 Onondaga County, they're now looking at building an 14 extension to their county jail, for the mentally 15 ill, at a price tag of $30 million. 16 So the State's saving $24 million with the 17 overall plan, and just one of our counties is 18 looking at a $30 million bill to try to deal with 19 the situation; the situation currently at hand, not 20 even prior to any of this even coming into being. 21 So, you know, let's talk about where the cost 22 shift is going and who's gonna be paying here. 23 By some estimates, more than half the inmates 24 in county jails and correctional facilities have 25 some form of mental illness. 1 The State has emptied out the state 2 psychiatric centers, but has failed to follow the 3 individuals who leave these institutions to ensure 4 appropriate and needed services are available. 5 If the past two decades of mental-health 6 reinvestment are any indication of the commitment to 7 community reinvestment of these services, there will 8 surely be no new services established in our 9 communities. 10 Ignoring the reality of seriously ill people 11 in need of intensive health ending up on the street 12 or in county jails, at local taxpayer expense, 13 because the State has shirked its responsibility and 14 no other appropriate care is available, is not 15 making things better. 16 The people of New York would be far better 17 served by an actual plan, detailing how service gaps 18 will be addressed, community by community. 19 This plan must include recognition of the 20 State's obligation to provide appropriate long-term 21 and intensive care for people with serious and 22 persistent mental illness. 23 Perhaps the most disturbing part of the 24 Regional Centers of Excellence plan is that 25 Governor Cuomo would consolidate children's services 1 far from home. 2 Forcing families to travel long distances to 3 other communities for access to care isn't a step 4 forward. 5 CSEA feels that it is disingenuous for this 6 Administration to allow youths who have committed 7 serious crimes to be sent close to home for 8 treatment; yet those in need of mental-health 9 services have to be shipped all over the state. 10 People who need mental-health services must 11 have access to services in close proximity to where 12 they live. 13 We need a blueprint, not press releases and 14 soundbites for building a new modern 15 mental-health-care system, that will ensure access 16 for all of New York's citizens who need it. 17 In addition, this mental-health plan is 18 further eroding the financial health of our local 19 communities by shedding middle-class jobs and 20 forcing families to leave their communities, small 21 businesses to close their doors, and contributing to 22 the decline of financial vitality in our 23 communities. 24 We cannot ignore the economic impact that 25 these public-sector job losses have had, and 1 continue to have, on local economies throughout the 2 state. 3 Governor Cuomo's insistence on gutting the 4 state workforce, having caused the loss of 5 19,000 public-service employees, has impeded the 6 ability of local governments to rebound financially 7 from the Great Recession, and has negatively 8 impacted the quality of service people receive. 9 Removing any money from the economy is 10 hurtful to our communities and our struggling 11 localities. 12 It is apparent that this plan is not a 13 well-thought-out model for delivering mental-health 14 services; but, rather, a continuation of a budget 15 policy with misplaced priorities. 16 Despite the fact that our communities are 17 continuing to lose good middle-class jobs, and the 18 State is expected to have a budget deficit of 19 1.7 billion, this Administration will still push for 20 a tax cut next year that will result in less 21 services to the most vulnerable and less revenue in 22 the community. 23 This Legislature should not stand by and let 24 this happen. 25 In closing, CSEA is well aware of the 1 Governor's unilateral authority in determining what 2 State services will be provided, but we ask you to 3 stand and fight with us for our communities who face 4 the lack of services and increasing burden of 5 unfunded mandates. 6 The budget presents opportunities for 7 negotiations and for all of our elected officials to 8 take a stand for their communities. 9 We can either take the route presented which 10 would further eliminate any semblance of the 11 services all New Yorkers rely on, or we can embrace 12 our commitment to good jobs with good wages and 13 benefits. 14 I strongly urge you to examine the impact 15 that Governor Cuomo's Regional Centers of Excellence 16 plan will have on the communities you represent, and 17 the state as a whole. 18 This is not the time to walk away from your 19 communities -- commitments to our most vulnerable 20 populations. 21 To allow a decrease of these services without 22 a definitive plan in place is irresponsible in light 23 of past promises made but not kept. 24 Let me just say, I've been doing this for too 25 long, for about 33 years now, and this is probably 1 one of the most politically arrogant, big-city 2 Thruway proposals I've ever come across. 3 The good people of Elmira, the good people of 4 the Southern Tier, deserve much better. 5 "Much, much better." 6 Perhaps the Governor needs to get off the 7 Thruway and actually drive around some of this area, 8 and get an idea of what it's like geographically, 9 what the location is, what people have to do; the 10 fact that we don't have the kind of mass-transit 11 systems that they have in the big city; the fact 12 that we're already economically depressed, and that 13 we cannot afford anymore loss of jobs. 14 Thank you. 15 I now turn it over to our vice president, 16 David Tokar. 17 DAVID TOKAR: Good afternoon. 18 First of all, let me say, I'm here 19 representing the 159 members of the Local 437 CSEA 20 that works hard every day for all the individuals 21 that need our care at the Elmira Psychiatric Center. 22 Honorable members of the New York State 23 Senate, local officials, consumers, and providers of 24 care: My name is David Tokar. 25 I'm presenting this for Joe Howard. 1 I represent the hard-working members of 2 CSEA Local 437, the Elmira Psychiatric Center. 3 Let me start by saying that we support the 4 concept of a more dynamic community-based treatment 5 for persons with mental-illness and the needs of our 6 community. 7 I worked for many years for Chemung ARC, and 8 before coming to OMH, the concept of recovery is 9 enthusiastically endorsed by our members, and we are 10 excited about being a part of it. 11 Furthermore, the obvious needs to reduce the 12 costs of so many hospitals present a huge challenge 13 for New York State, and we recognize and respect 14 this. 15 However, the challenge was met, not by a 16 serious examination of the nationally-recognized 17 health-care matrix, not by serious considerations 18 for further -- for rural-access issues, not with the 19 eye towards containing costs in the long term, but, 20 instead, by a short-term, politically-based urban 21 model is devoid of any substantial qualitative 22 analysis. 23 Furthermore, this challenge was met by a plan 24 that has treated the consumers, families, and 25 hard-working CSEA members of the Southern Tier as 1 disposable pawns in a predominantly political chess 2 game. 3 Although well-packaged and marketed, I pose 4 the following questions regarding the current plan, 5 and submit the following concrete OMH data in 6 support of the modifications in the great 7 Southern Tier region: 8 What will happen to consumers, families, who 9 have to travel six hours, round trip, for children's 10 services, acute or intermediate, because OMH has 11 failed to provide any local private-sector 12 children's hospitals anywhere in the region, if 13 Elmira and our sister agency of Binghamton are gone? 14 What will happen to the adults who don't 15 stabilize in seven days at the general hospital, but 16 have consistently been stabilized at Elmira in less 17 than two months? 18 Elmira has the third-shortest medium-length 19 of stay in the state, and virtually tied for the 20 smallest percentage of institutionalized patients. 21 Do they believe that CSEA members who care 22 about their jobs? 23 Well, of course we do; everyone does. 24 Well, I come here today to testify on behalf 25 of the CSEA members, that we currently -- that we 1 most certainly do not above -- about -- excuse me -- 2 [unintelligible] happen to our patients? 3 The RCE plan works for the patients -- 4 Excuse me. 5 Why would OMH transfer one of the most -- why 6 would OMH transfer out of the three inpatient beds 7 they currently serve in hospitals? 8 What would happen to those people who are not 9 dangerous, but do run into legal troubles at the -- 10 and get easily victimized? 11 Is OMH, the advocacy community, content to 12 allow the most challenging consumers who have 13 experienced decades of success in Elmira, return to 14 a future that promises county jails, state prison, 15 homelessness, and other forms of hidden or unspoken 16 institutionalization? 17 Based on the State's own data, and in my 18 testimony, I have compiled several graphs which show 19 that the top-three state hospitals, Elmira falls 20 within the parameters of all three of the data that 21 the State compiles. 22 I strongly encourage the consumers, 23 legislators, local governments, and the health-care 24 industry to work with OMH and with the Governor to 25 modify this well-intended proposal, reestablish our 1 faith in good government, provide us -- provide us 2 the -- first and foremost, the consumers of the 3 Southern Tier still matter, and we are not out of 4 sight or out of mind. 5 Finally, the hard working -- the hard work 6 and performance still means something in the 7 Office of Mental Health, New York State, and this 8 government -- Governor. 9 Thank you for allowing me this opportunity to 10 speak to you. 11 Thank you very much. 12 SENATOR CARLUCCI: Thank you, David. 13 Thank you, Rick. 14 We appreciate your testimony; very thorough. 15 And, we look forward to working with you on 16 strategies, to make sure that we're meeting the 17 needs of our mental-health population. 18 I thought the examples that you gave were 19 very telling and important to keep in mind when 20 these ultimate decisions are being made. 21 With that, are there any questions from the 22 panel? 23 SENATOR O'MARA: No. 24 I'll just say thank, you for being here, and 25 thank you for attaching these metrics that are 1 directly from the State, that clearly show that 2 Elmira and Binghamton are ranked Number 1 and 3 Number 2 in performance in New York State. 4 SENATOR CARLUCCI: Thank you. 5 RICK NOREAULT: Thank you. 6 SENATOR CARLUCCI: Next we're going to hear 7 from Brian Hart, the director of community services 8 for Chemung County. 9 BRIAN HART: I was going to say good morning, 10 but I guess we're afternoon now, so... 11 Good afternoon, Senators Carlucci and O'Mara, 12 and Assemblywoman Lupardo. 13 I appreciate you giving me the opportunity to 14 testify. 15 And, Assemblywoman Lupardo, thank you for 16 hearing my testimony again, as you heard me speak in 17 Binghamton to this point. 18 My name is Brian Hart, and I'm the director 19 of community services here in Chemung County, home 20 of the Elmira Psychiatric Center. 21 I wanted to talk briefly, as you will hear 22 very briefly, about another piece of the closure 23 that hasn't been brought up; and that is, the impact 24 of closing, not only Regional Center of Excellence 25 plan that closes OMH beds, but of the OPWDD plan of 1 closing beds in that system as well. 2 The impact for the Finger Lakes Developmental 3 Disability Services Organization closing its beds 4 last year had minimal impact our community as we are 5 rarely able to place individuals in that facility. 6 However, the same is not true of the proposed 7 Regional Center of Excellence, the plan that's put 8 before all of us by the Office of Mental Health in 9 New York State. 10 This plan will, undoubtedly, impact the 11 state, its communities, and most importantly, the 12 consumers, as you've heard this morning. 13 A large portion of the plan is devoted to 14 describing how many beds will be shifted to 15 Regional Centers of Excellence, and how many will be 16 eliminated. 17 I do agree that it is time for an updated 18 business model, as it is no secret that the 19 State-operated psychiatric beds are an extremely 20 expensive approach to addressing intermediate 21 psychiatric-treatment needs. 22 High personnel and facility costs make it 23 impracticable to become competitive in a 24 managed-care environment. 25 I understand the State's need to downsize 1 beds using a regional approach to accessing 2 intermediate care without catchment-area 3 restrictions, but I would suggest an alternative 4 approach, by privatizing or transferring a portion 5 of the services. 6 Much has been mentioned around that by 7 previous speakers. 8 This would be accomplished by conservatively 9 increasing bed capacity at hospitals with existing 10 inpatient psychiatric services, and assuring that 11 their rate of reimbursement is reasonable. 12 Otherwise, acute-care psychiatric units and 13 emergency departments across the state will be at a 14 standstill, unable to transfer individuals to more 15 intermediate care, and not having a safe discharge 16 plan to return to the community in an expeditious 17 manner. 18 Likewise, simply eliminating beds with a plan 19 of enhancing community services will likely increase 20 the burden on counties in the future when confronted 21 with the challenges of maintaining services lost to 22 state-staff attrition or when funding is eliminated. 23 Instead, I would recommend a strategic 24 investment equal to 80 percent of the savings, 25 rather than those savings be actual dollars or staff 1 reassignments. 2 Furthermore, when staff leaves service, 3 I strongly recommend a commitment be made to convert 4 those savings to dollars for investment in the 5 community-based services. 6 This is an important point that is not being 7 discussed by OMH at all. 8 No discussion of funds is on the table. 9 When considering existing services, I believe 10 it is also imperative to consider a qualitative 11 approach of reviewing admissions and continued 12 stays, such that medical necessity standards are 13 more readily complied with. 14 While the quick answer to this may appear to 15 be just handing this off to managed Medicaid 16 organizations, I submit that they often admit to not 17 having an understanding of local services, 18 consumer-utilization patterns, transportation needs, 19 and, access to primary care, amongst other 20 mechanisms, that can assist individuals in being 21 admitted, or significantly decrease their length of 22 stay. 23 This is where counties become crucial 24 partners. 25 We become crucial partners in the success of 1 making a realistic approach to changing the 2 mental-health system in a qualitative approach 3 versus a cost-savings manner. 4 Conceptually, I like the sounds of the 5 "Center of Excellence." 6 It sounds nice. 7 But I haven't read anything that describes a 8 plan for enhancing the knowledge base and/or 9 modifying the systemic approaches to care that will 10 attempt to achieve such excellence. 11 Instead, I submit that without a 12 well-designed approach, we will likely be left with 13 what we could call "regional centers without 14 access," as there's not a plan to increase beds just 15 to suddenly name them Regional Centers of 16 Excellence. 17 Such centers will, in the end, assure that 18 all services will shift to the right in a bell-curve 19 approach; that is to say, that while numbers alone, 20 those currently being served in State-operated 21 psychiatric centers will be served in acute-care 22 settings who, coincidentally, won't be paid for the 23 entire hospitalization, as the lengths of stay will 24 exceed what is considered to be medically necessary. 25 Those currently being successfully treated in 1 acute-care hospitals will only receive outpatient 2 programs, so on and so forth, until you get to those 3 individuals that won't be served. 4 And then what? 5 We will have a system that will likely 6 reflect Medicaid expenditure reductions, in exchange 7 for increased census in jails, elevated demand of 8 substance-abuse services, increased out-of-county 9 placement of youth, et cetera. 10 And we can't afford to take this approach. 11 Therefore, please, let's put our collective 12 expertise together and develop a systematic approach 13 to achieving excellence. 14 Look to hospitals with reasonable lengths of 15 stay, such as the Elmira Psychiatric Center, as well 16 as programs whose measurable outcomes can easily be 17 replicated in a gold-standard approach. 18 Develop and implement a training curriculum 19 that helps staff mold their mindset to one that is 20 truly conducive of becoming a center of excellence. 21 When it comes to community-based services, 22 the Office of Mental Health looks to develop a 23 business plan for success, and has assembled a group 24 of regionally-based stakeholders. 25 Many of them you heard about today. 1 This separate and distinctive part of plan 2 charges the committees with making recommendations 3 of how resources might be appropriated differently. 4 I respectfully encourage starting with the 5 County 507 plans as a framework for determining such 6 regional needs; thus, emphasizing the planning, from 7 the bottom up, is the more logical approach using 8 the front-line knowledge as a driving force for 9 change. 10 This boots-on-the-ground approach, if you 11 will, will encourage county partners to, 12 undoubtedly, save Medicaid expenditures, and in a 13 more realistic manner, it will simultaneously allow 14 the State to make a real commitment to enhancing the 15 necessary community services. 16 Such a commitment should include, but not be 17 limited to, adequate and affordable housing 18 developed through collaborative funding, 19 reimbursable peer supports, integrated case 20 management through health-home models, or similar 21 approaches. 22 And let us not forget the veterans who are in 23 our communities that have such a high need for 24 mental-health services. 25 All of these types of services, and many 1 more, should be on the table for consideration of 2 what the system should look like, when the -- when 3 all is said and done with this process. 4 If we don't push for such, then simple things 5 like transporting individuals to the state hospitals 6 will place a financial and safety burden on our 7 communities, as well as make it next to impossible 8 for families to be actively involved in the care of 9 their loved ones. 10 To that end, I have attached a list of 11 recommendations to this written testimony, that 12 reflects the collective opinion of my office, and 13 that of my community-services board. 14 In closing, I recognize that we proceed 15 through this journey, we will have a different 16 system than exists today. 17 And I wholeheartedly -- and -- and I know 18 wholeheartedly, that, collectively, we will find a 19 way to meet as many of the needs of the consumers 20 and families as possible. 21 Thank you for your time. 22 I look forward to our collaborative efforts 23 in achieving this excellence. 24 25 1 SENATOR O'MARA: Thank you very much, Brian, 2 for being here today, and for having taken the time 3 to go down to Binghamton to testify at the 4 Assembly Mental Health Committee on this issue. 5 One of the topics you brought up, that hasn't 6 been mentioned yet, and I have heard quite a bit 7 about, and want to get your feel for, the veterans 8 that you mentioned. 9 And I think we're seeing, likely, at least 10 anecdotally, I hear, an increase in the need for 11 these services for our returning veterans from the 12 wars that we've been involved with. 13 What are you seeing in your -- in our 14 community here, in your services, with regards to 15 veterans, and with the -- what troubles there are in 16 their access to mental-health care? 17 BRIAN HART: Absolutely. 18 It would be anecdotally. I don't have 19 numbers prepared to give you. 20 But, certainly, as you're well aware, we're 21 having more and more veterans returning to the 22 community, the majority of which are dealing with a 23 new brand of posttraumatic stress disorder that is 24 different than anything in the past, because it's 25 not just to their experience, but the media coverage 1 of their experience that continues to exacerbate the 2 problem. 3 Compile that with a VA system that is 4 overloaded, and a system that also doesn't serve 5 their families, but relies on the community 6 mental-health system to meet those needs. 7 When that system is already overburdened, 8 then they're turning to us. 9 So, at a time when we decrease services, or 10 propose to decrease services, we're doing a 11 disservice to those who have served our country so 12 well. 13 SENATOR O'MARA: Thank you. 14 ASSEMBLYWOMAN LUPARDO: A similar question to 15 what I asked earlier: Can you talk about the impact 16 this would have on your local hospital system? 17 BRIAN HART: Absolutely. 18 Here in Elmira, much like in Binghamton, we 19 have an acute-care hospital, and, at 20 St. Joe's Hospital, they serve approximately 21 1,000 individuals per year, the majority of which 22 have a length of stay of less than 7 days. 23 The outliers are those that await transition 24 to the Elmira Psychiatric Center, who is, quite 25 honestly, very capable and very responsive to those 1 needs, and as you've heard previously, has a very 2 short length of stay themselves. 3 But with this proposal, we're talking about 4 sending adults to Buffalo and kids to Utica. 5 Buffalo critically has an issue with not 6 being able to admit people, so I have no assurances 7 that we will be able to get anyone out our 8 acute-care facilities in a reasonable fashion, if at 9 all, to either of those facilities. 10 In fact, what I anticipate is, they will sit 11 dormantly, receiving ongoing services that won't be 12 reimbursed by any insurance company, as they sit at 13 the acute-care facilities. 14 And those facilities, you know, will do the 15 right things; they'll continue to provide the 16 services, but they will continue to have losses, and 17 those losses have impacts. 18 You've heard about some of the impacts 19 earlier, with the closure of St. James Hospital. 20 There are others in the western region that are 21 closing. 22 There was one from, Assemblywoman, your area 23 that closed a couple of years back, in Oneonta. 24 These are crucial issues to be paying 25 attention to. 1 It's not as simple as, Let's just take beds 2 out of the state system, and everything will be 3 good. 4 ASSEMBLYWOMAN LUPARDO: My one hospital 5 reported a $5-million-per-year loss. 6 As it is, you said they will continue to do 7 the right thing, but, it's not clear how sustainable 8 that might be over the long term. 9 BRIAN HART: Absolutely. 10 They'll do the right thing for as long as 11 they're able to stay open. 12 Absolutely. 13 SENATOR CARLUCCI: Thanks. 14 BRIAN HART: Thank you. 15 SENATOR O'MARA: Next we have two family 16 members to testify before us: Fred Betschen, and 17 Heather Mott. 18 HEATHER MOSS: Hello; good afternoon. 19 SENATOR O'MARA: Thank you for being here. 20 HEATHER MOSS: Thank you. 21 My name is Heather Mott, and I'm here today 22 to share my story with you, in hopes that it will 23 impact the future of Elmira Psychiatric Center. 24 I'm a high school history teacher, that grew 25 up in a family where both of my parents were 1 professionals in the medical field. 2 My mother was a 30-year OR nurse, and my 3 father, ironically, was a 30-year psychiatric nurse. 4 A little over ten years ago, my father 5 suffered a nervous breakdown that changed our lives 6 forever. 7 He was diagnosed as a bipolar manic 8 depressive. 9 And as if this wasn't tragic enough for my 10 family, my mother passed shortly thereafter from a 11 brain aneurysm. 12 And from that point on, my brother and I were 13 found taking over my father's treatment, which in 14 the world of mental-health is no easy feat. 15 If you know anything about mental illness, 16 you will know that there's often no easy cure. 17 Treatments for mental illness take time. 18 They take the care of professionals, and they 19 take the facilities like EPC, in order to do so. 20 To understand my story, you have to know what 21 a vital and critical role EPC has played in my 22 father's treatment, and the fact that he is able to 23 function in society today. 24 I truly believe that had we not have had 25 access to a facility like EPC that provides the 1 quality of care that they do, my father would not be 2 sitting here with me today, and I can guarantee you 3 that he would not be playing the active grandfather 4 role that he is in his grandchildren's lives. 5 As I mentioned earlier, this disease can be 6 so dehabilitating [sic], that my father was unable 7 to function in a normal capacity within society. 8 It is the reoccurrence of this disease cycle 9 that requires an inpatient care facility like EPC. 10 Without this inpatient facility during these 11 most dire of times, it becomes impossible for me and 12 my brother in the task of seeking out the right 13 treatments, as mentioned of these acute facilities, 14 these stays with only four or five durations. 15 It wasn't until my father was treated at EPC 16 did we start to see positive results. 17 On a daily basis, I was on the phone with the 18 key stakeholders involved in any father's treatment. 19 The doctors, the nurses, the counselors, the 20 social workers, they all knew my name. 21 I was able to schedule and attend meetings to 22 play an active role in making sure he was receiving 23 the best treatment possible. 24 Friends and family were able to visit, and 25 trust me, this is part of the treatment process. 1 There can be very dark days when dealing with 2 mental illness, and the only thing that brought 3 comfort to myself and to my brother, and to my 4 father's friends and other family members, was that 5 my father was at a facility like EPC, under the care 6 of professionals that were working diligently to 7 help my father return to an outside life with some 8 sort of quality. 9 My father's most recent admission, a little 10 over a year ago, was probably at an all-time low in 11 his life. 12 At the time of his admission, through a 13 mental-health arrest, my father had stopped taking 14 his current medicine due to fact that it made him 15 feel worse. 16 The medicine made him shake so tremendously 17 he could not function at a daily -- through daily 18 routines. 19 And come to find out, through the care of 20 EPC, and their diligent work, it was the wrong 21 medicine for him to begin with, a feeling that I had 22 all along. 23 My father, as a last resort to medical 24 effort, agreed to electroconvulsive therapy. 25 This treatment plan came after numerous 1 discussions, but at the end, we had felt that it was 2 the best for him and would offer the best results. 3 And it did. 4 My father is the best he has been in 5 ten years. 6 More people say to me that they often see the 7 old Roger than ever before. 8 I have a great deal of experience when it 9 comes to knowing the type of care and facilities 10 that are available to those that suffer from mental 11 illness. 12 It will be a detrimental to people like my 13 father if you limit access to facilities that have 14 proven time and again to help. 15 In closing, I would just like to say, again, 16 that treating mental illness, it is a process. It 17 is a long process. 18 It requires the time of doctors, nurses, 19 social workers, to understand, to diagnose, and to 20 treat, in cooperation with the family members and 21 the patient. 22 It is critical for us in Upstate New York, 23 and in this region, to have access to facilities 24 like EPC. 25 Thank you. 1 FRED BETSCHEN: Good afternoon, and thank 2 you, Senator O'Mara, for hosting this event. 3 Appreciate it. 4 I feel bad that Senator Carlucci is not here 5 to hear from family members, but, maybe he'll take 6 due diligence in reading what we have presented. 7 SENATOR O'MARA: He certainly will. 8 FRED BETSCHEN: Thank you. 9 During my 38 years as professional educator, 10 I had the wonderful privilege of serving as a 11 teacher at all levels, and in various administrative 12 positions, including superintendent of the schools. 13 I had the opportunity to observe the worst 14 and the best of institutional functioning. 15 Building facilities and programs, closing 16 facilities and downsizing programs; developing and 17 implementing long-range plans, total quality plans, 18 strategic plans; watching programs succeed, and 19 watching programs fail, are all part of the 20 experience. 21 I got to observe mental illness at its worst, 22 and mental wellness at its best. 23 More important, however, to today's 24 testimony, is my additional experience as a family 25 member dealing with an individual classified as 1 "seriously persistently mentally ill"; or commonly 2 known as "SPMI." 3 We have observed mental illness in the family 4 at its worst, and growth to mental wellness at its 5 best, for an SPMI individual. 6 As you probably know, the SPMI disorder 7 cannot be cured, but it can be managed through 8 incredible, more-recently developed medications, and 9 proper treatment programs. 10 Our family knows firsthand from experience 11 and training the appropriate care and treatment that 12 brings wellness to that ill person to the degree 13 that they become a productive, contributing members 14 of the community. 15 Our family member was diagnosed over 35 years 16 ago, and is now one of the success stories of the 17 Elmira Psychiatric Center. 18 This individual is now a longtime participant 19 in a part-time supervised work program, and is a 20 continually-producing creative visual artist, thanks 21 to appropriate family support, and the continuing 22 services of the Elmira Psychiatric Center. 23 We know that immediate and continuing 24 appropriate social interaction and family -- with 25 family and friends is a key to good mental health. 1 We know that quality inpatient care and 2 outpatient services are required for a path toward 3 wellness and the ability to properly function in the 4 community. 5 Some years ago, as you heard previously, a 6 State Office of Mental Health plan was developed to 7 close down numerous psychiatric centers throughout 8 the state. 9 Thanks to new medications and treatment 10 plans, numerous facilities were no longer needed. 11 The idea was, that the money saved by closing 12 facilities would be redistributed, reinvested, to 13 communities across the state, to provide appropriate 14 outpatient services and mental-wellness programs to 15 handle the needs of the mentally ill population. 16 Regional Planning Advisory committees, called 17 "RPACs," consisting of clients and family members 18 and mental-health professionals and service-provider 19 organization representatives, were established to 20 assist in the planning and implementation stages. 21 I served on the Western RPAC, which developed 22 detailed plans for 18 counties, in providing access 23 to high-quality inpatient, outpatient, and 24 community-based services and programs. 25 While parts of these plans were successfully 1 implemented, a great deal of the funds saved by 2 close of facilities never reached the intended 3 areas; and, therefore, the plans were not fully 4 achieved. 5 We are now at a time when the State again 6 plans to close facilities and reinvest the savings 7 into community-based services and programs. 8 The problem here is that distance one must 9 travel to receive inpatient services is totally 10 inappropriate and unworkable to achieve intended 11 results. 12 These so-called "Regional Centers of 13 Excellence," requiring mentally ill adults to travel 14 to Buffalo and youth to Utica for inpatient services 15 will result in following: 16 1. They'll place patients in unfamiliar 17 environments far away from their own community; 18 2. Extremely limit family and friend access 19 to provide immediate and necessary and needed 20 support because of distance; 21 3. Create resistance to participate in 22 needed care by clients, because of distance and 23 unfamiliarity with health environment; 24 4. Create longer periods of inpatient stays 25 because of greatly reduced visitation interaction 1 with family and friends; 2 5. Create higher costs for individual 3 inpatient care; 4 6. Reduce communication between providers of 5 inpatient services and families when it is most 6 needed; 7 7. Increase homelessness among mentally ill, 8 because of resistance to travel significant 9 distances for inpatient services; and, 10 8. It will increase jail incarceration for 11 the mentally ill, as you've heard earlier. 12 I carefully read the Commissioner's 13 mental-health introduction to the 2012-2016 14 Statewide Comprehensive Plan for Mental-Health 15 Services. 16 Very interesting. 17 I also read through the six-page document 18 that OMH presented at your hearing in Farmingdale, 19 New York, on September 9th. 20 The information contained in these documents 21 correctly identifies much of what needs to be 22 accomplished to greatly improve mental-health 23 service in our state. 24 What's here is a lot of good stuff. 25 However, these documents don't specifically 1 address closure of identified facilities. 2 The "what" of the plans are excellent, but 3 the "how" of the specific RCE plans is totally 4 inadequate in meeting the needs for providing 5 quality inpatient services. 6 As they say, the devil is in details. 7 You can downsize the usage of local 8 facilities to properly match current utilization 9 data. 10 You can assign unused portions of these 11 facilities for other purposes, for both public and 12 private enterprises. 13 Closing down local inpatient service may save 14 money, but will result in significantly affecting 15 the quality of care for the individual and the 16 needed support from the family. 17 In effect, what this plan creates is regional 18 centers of incarceration. 19 As rated among the top facilities in the 20 state by the Office of Mental Health, we already 21 have, quote, Regional Centers of Excellence here in 22 Elmira for adults, and in Binghamton for 23 adolescents. 24 Let us ensure that we keep it that way by 25 retaining local inpatient services. 1 In the past, I have served at the state, 2 regional, and local levels, to assist the 3 mental-health system as a family member. 4 Now that I'm retired, I can offer my services 5 to serve in any capacity that may helpful at this 6 point. 7 So we urge you to pursue this endeavor with a 8 great deal of zest. 9 Thank you. 10 And I'll answer any questions that you may 11 have as a family member. 12 SENATOR O'MARA: Yeah, I thank you both for 13 coming here and sharing your stories. 14 And I know that they are emblematic of the 15 family involvement that takes place with the 16 treatment, both on an inpatient and an outpatient 17 basis. 18 I would like to just get your thoughts 19 briefly, if I could, from your own experiences, if 20 you can imagine that the Elmira Psychiatric Center 21 didn't have the inpatient facilities for the 22 travails that you went through with your family 23 member, and if you would have had to interact with 24 that family member's treatment, going back and forth 25 to Buffalo, New York, 2 1/2 to 3 hours away, for us, 1 on how that would have impacted, if you can imagine 2 that scenario, and your involvement in the whole 3 course of treatment of your family member? 4 FRED BETSCHEN: First of all, that distance 5 of travel is a real burden, as you can understand. 6 There's no way that our family members could 7 be close by our family member when they were in 8 great need like this. 9 And the greatest need, of course, is when 10 they're inpatient, is that constant social 11 interaction, that's positive and supportive, that's 12 what it's all about. That's what leads to wellness. 13 And, so, while we know that, when you take 14 medications, it takes up to 8 weeks of the system to 15 get in the body's system to be effective. 16 And at the same time, when they stop 17 medications and become non-compliant, for whatever 18 reasons, within 8 weeks they're back inpatient. 19 You need, immediately, family access for 20 support. 21 Of course, you also need family training of 22 how to give that support, and that's part of the 23 local service program. 24 But without that, you're going to have longer 25 incarcerations, and that's what I call them, and 1 that's what they are. 2 If you've been with a family member while 3 they're inpatient, it feels to them, and the family 4 member, like incarceration. 5 That's my response. 6 HEATHER MOSS: I would have to agree with 7 Fred. 8 I mean, I couldn't honestly say, if my father 9 was in Buffalo, that he would be here today, out of 10 that hospital. 11 I mean, it is the constant contact, and, even 12 given the distance, Elmira is 45 minutes from my 13 home. 14 But, Buffalo is almost three. 15 And -- 16 [Technical difficulties.] 17 HEATHER MOSS: -- so being, just trying to be 18 a close-knit, trying to be part of the medical 19 process, trying to understand everything that goes 20 on with a loved one in these facilities, distance is 21 key, and you need to have that interaction. 22 They need to have that interaction. 23 You know, we need to be able to be present to 24 offer, at times, a glimpse of hope that, you know, 25 inpatient is needed, but they're -- you will resume 1 your normal life, given the adequate care. 2 And, so, it is critical. 3 It's critical. 4 FRED BETSCHEN: And the other part of it is, 5 keeping the services, starting when the first onset 6 happens. 7 And this whole idea of moving adolescent 8 inpatient services so far away -- and I can say this 9 as a former superintendent of schools, because I saw 10 a lot of it -- if you don't have a local crisis team 11 and a local place for inpatient service immediately, 12 so that you can get the family support you need, and 13 train those families to give the support they need, 14 you're gonna have serious problems that lead to 15 greater problems later on. 16 And the longer process, the longer the 17 process will take for healing and wellness that's 18 needed for that person to function in society. 19 That's the problem. 20 It's going to be catastrophe. 21 SENATOR CARLUCCI: Thank you. 22 SENATOR O'MARA: Thank you. 23 SENATOR CARLUCCI: Next we're going to hear 24 from Dr. Richard Hamling, who is on the board of 25 visitors. 1 DR. RICHARD HAMLING: Thank you for this 2 opportunity. 3 First of all, I should give you a bit of 4 background. 5 I serve on the Board of Visitors at Elmira, 6 and prior to that, I was on the Board of Visitors at 7 Willard Psychiatric Center. I was first appointed 8 in 1989, I believe. 9 And relevant to the proceedings today, as I'm 10 listening to our speakers, part of what's relevant, 11 I'm here also as a family member, and a board of 12 visitor, but I'm also a clinician. 13 My family was dominated by mental illness, 14 all of my life. 15 To add, I'm also a licensed mental-health 16 counselor, in private practice in Canandaigua, and 17 I've been doing this for 43 years; however, my 18 experience with mental health spans 65 years. 19 And from the time that I was born, my mother 20 was hospitalized at Willard. 21 I met her at the age of 8. I had three 22 visits. 23 I never knew her. 24 Her care at Willard was excellent. The 25 problem was, she could not benefit from the 1 medication. 2 In fact, some of her providers are here. 3 She had over 200 ECT treatments 4 (electroconvulsive treatments.) 5 And when she was discharged in 1964, she was 6 in and out of acute hospitals, but remained 7 psychotic from the time of her discharge from 8 Willard. 9 This resulted in me leaving home and being on 10 the streets at 15. 11 There's no question that the mental-health 12 system has to be reorganized, restructured. 13 As we've heard from family members, and 14 prison officials, as it stands, it's inconceivable 15 that this plan could be put into action. 16 It -- I attended the "listening" meeting in 17 Rochester, and had reserved time to speak, but was 18 not provided that time without insistence. 19 I'm not sure how that happened. 20 But I ask that you take the testimony that 21 everyone is saying here, not just my own, but 22 everyone's, with the most sincerity. 23 These are true stories, and this is about 24 real people, and mental illness is much more than 25 just an inconvenience. 1 I believe some of the pressing issues have 2 been addressed by many, many people. 3 I mean, Elmira serves 11 counties -- I'm from 4 the Canandaigua area -- and provides services to 5 about 16 percent of New York State, and has access 6 to -- and serves 740,000 people. And if you were to 7 include Binghamton, it also serves, then, 8 1.2 million people. 9 We need to keep in mind that people with 10 serious and persistent mental illness do need 11 services 24/7. 12 The system, as it presently is, is often 13 without services -- comprehensive services on 14 weekends. 15 I should add, also, that at any given time, 16 24 to 26 percent of the American population has a 17 diagnoseable mental illness. 18 We only have to look at the newspapers each 19 week. 20 The access to care, as it's being presented 21 by the acting commissioner -- or, the previous 22 acting commissioner, is dreadfully complicated. 23 And to ask someone with a serious and 24 persistent mental illness to navigate that system, 25 that's filled with obstacles and hurdles, simply 1 lacks common sense. 2 It's hard to imagine that this plan could 3 have been put into the form that it's in by someone 4 who is intimately familiar with mental-health 5 services. 6 At the present time, Elmira has -- its 7 licensed for 18 beds. It presently has 22 children 8 in the unit. 9 There's an expectation that private 10 practitioners will absorb the overload of people 11 requiring psychiatric services. 12 This is an error. 13 This is a serious error. 14 For someone like myself, I am not a 15 physician. I do not have nurses in my office. I do 16 see very sick people, but I work in collaboration 17 with psychiatrists. 18 These are psychiatrists that do not provide 19 therapy, but simply provide prescriptions. 20 They're doing the best they can with what 21 they have. 22 At the present time, in the United States, 23 there is between 48,000 and 50,000 shortages of 24 psychiatrists. 25 One major medical school, last year, 1 graduated one psychiatrist. 2 Economically, it's not one of the premier 3 medical specialties. 4 Private hospitals simply cannot absorb the 5 overload. 6 And as was mentioned earlier, the hospital in 7 Hornell is closing -- has put in a request to 8 close -- and that's after putting four to 9 five million dollars into their psychiatric unit, 10 but they can't keep it open, because of the hurdles, 11 the obstacles, and difficulties with insurance 12 providers. 13 One psychiatrist told me, in adhering to 14 SAFE Act, asked the patient -- the insurer asked if 15 the psychiatrist had inquired about the -- guns, and 16 he had; he asked the patient if he had guns. 17 The next question from the insurance provider 18 was, "Does he have bullets?" 19 General practitioners, family doctors, 20 emergency rooms, and general hospitals simply are 21 not equipped to handle the serious and persistently 22 mentally ill. 23 I can tell you personally from my own 24 practice, horror stories. 25 And this is no indictment of general 1 practitioners. I sincerely believe they're trying 2 to do the best they can; however, they're not 3 equipped to deal with the serious and persistently 4 mentally ill, and in doing so, they error in their 5 judgment in providing some medications. 6 I've had patients prescribed medications 7 without a thorough psychiatric history; and I mean, 8 a comprehensive, thorough psychiatric history. 9 I've had some patients who have been 10 prescribed medications that have put them into a 11 manic episode. 12 One boy jumped into a pool of water and broke 13 his back. 14 Another, prescribed inappropriately, went 15 through his graduation ceremony, and disrobed. 16 Regional treatment facilities are not 17 hospitals, like Hillside. 18 Access to care and the plans for Centers of 19 Excellence does not take into account family 20 involvement. 21 I can attest to that. 22 As I said, I met my mother when I was 8 years 23 old. I had three visits with her during the course 24 of her consecutive hospitalization from 1949 to 25 1965. 1 And I fear that the plan, as it stands, is 2 simply a step back in time. 3 There is no textbooks on mental health or 4 psychiatry, I dare say, that does not include family 5 involvement. 6 The acting commissioner stated we needed to 7 get away from a position of support and move towards 8 a position of empowerment. 9 Any proper care, "any proper care," even care 10 25 years ago or longer, 65 years ago, included 11 support and empowerment, and some of it is very hard 12 to notice. 13 We cannot expect people from the Elmira area, 14 or other areas, the Pennsylvania border, or even the 15 Canadian borders, to drive the distance that they're 16 being asked, and to be a part of their family 17 member's care. 18 Once again, this, I think, is an example of a 19 very ill-informed plan. 20 Mental health is approached in present day as 21 a biopsychosocial event. 22 We need to take into account all factors. It 23 simply is not a matter of prescribing medications. 24 Patients that are at the biggest risk, the 25 greatest risk, of recidivism is -- are the patients 1 that aren't getting the support, the psychological 2 and the social factors, and careful, "and careful," 3 monitoring of their medication. 4 Closing Elmira will add to our jail and 5 prison populations, there's no question about that. 6 It's been attested by Chief Alice Haskins, 7 who I have spoken with periodically. 8 In fact, the largest providers of psychiatric 9 care in the United States, it's well-known, the 10 largest providers of psychiatric care are the 11 LA County Jail, and the Cooks County Jail. 12 How we can permit our jails to become an 13 alternative for treatment is unconscionable. 14 Mental illness should not be a crime, when it 15 is simply a fact of life. 16 I surveyed the area of mental-health clinics 17 several weeks ago, and there was a two- to six-month 18 waiting list for services. 19 Some of those people were, actually, also 20 referred to my office, which I could not see because 21 I'm not equipped to see people with a severity of 22 their illness. 23 And some people were turned away because they 24 weren't ill enough. 25 It's a sad state of affairs that this is what 1 we are doing to people. 2 I think, one, we need to revisit the hospital 3 closures as they're spread. 4 I think we also need to understand, at 5 emergency rooms, police, general practitioners, and 6 non-mental -- medical mental-health people, cannot 7 accommodate what will be overwhelming need for 8 service. 9 I can tell you at this time, I know of one 10 patient who has been in a hospital, at the cost of 11 $1,000 a day; and, today, is his 105th day. 12 And the taxpayers are paying for that. 13 There isn't a place for him. 14 And the courts are involved as well. 15 I believe there also should be a task force, 16 since it seems that there hasn't been careful 17 examination. 18 I believe there should be a task force to 19 troubleshoot the Centers for Excellence. 20 I think clinicians, community leaders, and 21 patient advocates would be a part of this. 22 Wherever there's room for breakdown in a 23 system, it will break down. 24 We're already in a system that is filled with 25 flaws, but as is proposed, it's far more dramatic. 1 I think we also need to educate the public, 2 and prepare the public for what's ahead of them. 3 Little talk is brought forth about mental 4 illness in the schools, or elsewhere. 5 Mental illness remains society's illegitimate 6 child. 7 Restructure and refinement of the 8 mental-health system in New York is necessary. 9 It must be approached thoughtfully, taking 10 into a full account the patient's care, with 11 sensitivity to economics. 12 The present plan is profoundly flawed. 13 Many people have noted it. 14 Restructuring is achievable when approached 15 with sensitivity for the needs of the patient, the 16 families, and our communities. 17 I believe, and my board members also believe, 18 that the Centers for Excellence plan, as it's 19 presenting, will be devastating. 20 I believe, also, that New York State has an 21 opportunity to be a leader in mental-health reform. 22 To follow other states in failed attempts at 23 reform, by data that does not address the real 24 issues, is simply without integrity. 25 Our country encounters tragedies each week, 1 with direct links to poorer mental-health care and 2 concerns. 3 I respectfully ask that your Committees 4 carefully consider the positions of being a leader 5 versus a follower in the care of the mentally ill. 6 And thank you very much for this time. 7 SENATOR CARLUCCI: Thank you, Dr. Hamling. 8 We appreciate your testimony, and your 9 service on the Board of Visitors, and all the other 10 good work that you do. 11 We look forward to working with you over the 12 coming months, to make sure we have the best level 13 of care for people with mental illness. 14 And I couldn't agree with you more about the 15 need in our schools to teach about mental health. 16 And it's something that we're working on in 17 the Mental Health Committee, to make sure that we 18 have that information available; that we teach math 19 and science, but, we rarely talk about mental 20 health. 21 And by doing that, I think it will make such 22 a difference, because the other things that we teach 23 are really not important if we don't have a stable 24 foundation of mental health. 25 So -- 1 DR. RICHARD HAMLING: That's true. 2 And I think it's also a step towards the 3 access to care, when people understand they're going 4 to be more liable to seek services, and, perhaps, 5 not become a persistent mentally ill individual. 6 SENATOR CARLUCCI: Thank you. 7 SENATOR O'MARA: Thank you. 8 SENATOR CARLUCCI: And I know, we have the 9 Steuben County Sheriff is with us. I know they have 10 to run, so we're gonna get them in now. 11 Sheriff David Cole, and 12 Undersheriff James Allard, and, Matthew Whitmore, 13 who is the jail superintendent for Steuben County, 14 are all with us today; 15 And, Sheriff Bill Schrom. 16 SENATOR O'MARA: Undersheriff Bill Schrom 17 from Chemung County. 18 Thank you all for coming this afternoon, and 19 we look forward to your testimony. 20 SHERIFF DAVID COLE: Good afternoon. 21 I brought the undersheriff, and the major 22 from the corrections, Chemung County Jail, just in 23 case they had anything to say, or if there were any 24 questions. 25 The first thing I want to say, my name is 1 Sheriff David V. Cole. I was elected sheriff 2 January 1st of this year. 3 I've been in law enforcement for 40 years: 4 With the state police for 23-some years; 5 And I was also a school resource officer for 6 4 years: 7 Undersheriff for 9 years; 8 And I was just elected sheriff. 9 When I was first elected sheriff, I was 10 amazed, in January, at the SAFE Act that came out in 11 the law, which I believe actually violates the 12 Second Amendment, and it protects criminals in 13 gun-free zones. 14 And, there were a lot of amendments made to 15 the law, to permit police officers to enter the 16 school grounds with weapons. 17 And so my idea was to help with the violence 18 in the schools, was to place school resource 19 officers in most of the schools in Steuben County. 20 It made more sense than what the SAFE Act 21 said. 22 And what I'm basically trying to say is, the 23 new changes with the mental-health law, as far as 24 the changes of changing Elmira Psych Center, taking 25 them out of the mix, I wanted to make a few comments 1 that I wrote down real quickly this morning. 2 The closing is a failure to recognize the 3 fundamental importance of the Elmira Psychiatric 4 Center to the 11-county regions -- region. 5 The Elmira Psych Center is an irreplaceable 6 cornerstone of the region's and state's 7 mental-health system. 8 There simply isn't a network of 9 community-based organizations across this region to 10 take the place for the Elmira Psych Center. 11 If programs and services -- its programs and 12 services have long stood as the first responder for 13 treatment, as well as the front-line of defense 14 against the firearms-related and other tragedies of 15 violent -- of the violent mentally ill. 16 New York State's Office of Mental Health 17 Commissioner Michael Hogan and Governor Andrew Cuomo 18 say patients will get the same services elsewhere. 19 Some will, most won't. 20 The impact of this insane "let them loose to 21 fend for themselves" policy is cruel to the people 22 with mental illness who desperately need and want 23 treatment, and it's also dangerous to the public. 24 The Office of Mental Health is simply 25 transferring the seriously ill to the criminal 1 justice system. 2 New York incarcerates 14,000 people with 3 serious mental illness, largely because Office of 4 Mental Health only has beds for 3600 in the state. 5 There are more mentally ill persons in a 6 single jail, Rikers Island, than all of the state 7 hospitals combined. 8 The New York State Association of Chiefs of 9 Police found law enforcement is being overwhelmed by 10 this policy change that, in effect, removed the 11 daily care of our nation's severely mentally ill 12 population from the medical community and placed it 13 within the criminal justice system. 14 Hospital closures mean you are now more 15 likely to be arrested for having a seriously 16 mentally ill illness than to be hospitalized. 17 One would think ensuring the seriously 18 mentally ill get the treatment would be the core 19 mission of the Office of Mental Health. 20 For Michael Hogan, as appointed commissioner 21 of -- who drives his hospital-closure policy with 22 the fact that he's saving money. 23 Facts on federal spending, approval of a 24 $535 million loan guaranteed to Solyndra, a 25 now-defunct solar company; yet, we walk away from 1 mental-health care. 2 But it's harder to understand how Cuomo 3 doesn't recognize the impact people with serious 4 mental illness, and how Hogan's efforts to save 5 Office of Mental Health money, are costing the 6 criminal justice system and the state much more 7 money. 8 Finally: 9 Number one: The closing of 10 Elmira Psychiatric Center, this closing disrupts the 11 effective treatment regimens for the long-term 12 mentally ill; 13 Second: Patients' families will be forced to 14 travel long distances to visit their loved ones; 15 And, three: Patients may be pushed into 16 prisons, when they could access -- when they could 17 easily access hospital care here. 18 Not sure what the next step is, but, 19 probably, we'll be looking a legalizing marijuana as 20 another good idea in New York State. 21 Thank you very much. 22 SENATOR O'MARA: [Inaudible.] 23 UNDERSHERIFF WILLIAM SCHROM: Yes, 24 Bill Schrom, undersheriff, Chemung County Sheriff's 25 Office. 1 I agree with a lot that's been said. 2 I've had an opportunity to listen to a few of 3 the other speakers as well, concerning the shift of 4 responsibility from the mental-health institutions 5 into the correctional facilities, which really isn't 6 the place for these people to be. 7 When you look at the smaller correctional 8 facilities within the state, the county level 9 specifically, we just don't have the services to 10 provide these people that need at a much higher 11 level than what we'd be able to provide them. 12 Currently, we only have a part-time 13 mental-health counselor within the facility, 14 five days a week, but only four hours a day, 15 basically, to triage and troubleshoot some of the 16 minor issues that come up with some of these 17 inmates. 18 We're currently dealing with about a 19 30 percent population of our facility that have 20 mental-health issues, and, a smaller percentage of 21 those actually get referred to a doctor who has a 22 little bit more ability to do a more deep assessment 23 of these people. 24 So, obviously, our concern is having a larger 25 population coming into the local facility, creating 1 different problems than we're already facing in the 2 jail, with your regular inmates and the disciplinary 3 problems that deal with them. 4 The mental-health aspect certainly presents a 5 more of a unique challenge. Oftentimes, we find 6 these types of inmates on constant watch a lot 7 longer. 8 For those who don't understand what 9 "constant watch" is, it's a one-on-one observation 10 of an inmate with the correctional officer. 11 A lot of times that constant watch is done at 12 a time-and-a-half rate. 13 Because these -- we don't have enough 14 officers in house to take them off line, you know, 15 to cover these posts, so, you have to hire 16 time-and-a-half. 17 It's just a big cost that's incurred to the 18 County, to deal with these people. 19 So, I think the impact, at a local level, 20 especially the county facility, is significant, 21 compared to, you know, what we're dealing with now. 22 Not to mention, just having some of these 23 people back on the street, and the problems that's 24 gonna present to the first-line officers that are 25 out on their on-road patrol. 1 SENATOR O'MARA: Thank you, 2 Undersheriff Schrom. 3 And, if I could get a little comment to the 4 Steuben County's Jail situation; the makeup of 5 inmates, and the mental-health issues that you're 6 involved with there on a day-to-day basis, and how 7 much of a burden that is already on your jail 8 system. 9 And, what you would anticipate seeing, with a 10 reduction in inpatient services here locally. 11 SHERIFF DAVID COLE: I think that the 12 population will be picked up -- well, I think one of 13 the things, and I don't want to sound negative, but 14 sometimes, with the police officer, it's almost 15 easier to arraign them on a criminal charge than to 16 pursue the necessary mental health -- Mental Hygiene 17 Law section. 18 And I think that's one of the things that 19 might result from it. 20 The fact is, that you're removing a 21 mental-health facility, mental-health help, from 22 Steuben County, from an 11-county area. 23 And I was a road trooper for many years, and 24 took a lot of people that needed help to the 25 psychiatric center in Elmira, rather than make 1 arrests which weren't appropriate and shoving them 2 in a jail just to get them out of the way. 3 But, remember, now you have a transport all 4 the way to Buffalo, or Cleveland, it's one of two, 5 I'm not sure what's been set up, but, quite a 6 distance away, which is absolutely unacceptable. 7 SENATOR O'MARA: Thank you. 8 SENATOR CARLUCCI: Thank you. 9 We appreciate your testimony. 10 Next we're going hear from Charles Blount. 11 CHARLES BLOUNT: Good afternoon. 12 I would like to thank you for your time, and 13 to testify as to my experiences, and things such 14 thereof. 15 Good afternoon. 16 My name is Charles Blount, and I am here to 17 attest to my own personal experience for the 18 extraordinary need for the inpatient mental-health 19 services in the -- in the Elmira community. 20 Upon my arrival to Elmira in 1999, and 21 getting to know people in the community, I began to 22 realize that there are a great number of people in 23 this area that are on mental-health medications. 24 It wasn't until January 10, 2006, that 25 I realized how important the services offered in 1 Elmira are, and how they would impact my life 2 directly. 3 It was on that day that I committed a crime 4 while off my prescribed medications and under the 5 influence of drugs. 6 I spent one year in county lockup; was then 7 transferred to a forensics hospital at Mid-Hudson 8 for three years, away from all my supports. 9 It was three years before I was transferred 10 back to the Elmira community, to the 11 Elmira Psychiatric Center. 12 Before I was hospitalized, I was diagnosed 13 with paranoid schizophrenia, and I gained the truth 14 that I needed to maintain my mental-health and 15 manage my illness. 16 I also gained faith in myself and in my 17 recovery to move forward, and assist others that are 18 suffering from mental illness. 19 I am a true success story from 20 Elmira Psychiatric Center. 21 I worked my way through their program. I 22 gained confidence in myself through my treatment and 23 my work programs. 24 Now I am happy to say that I am a titled 25 state employee at the Elmira Psychiatric Center, as 1 a therapy aide. 2 I get to use what I gained at this facility, 3 and assist other patients in their -- at their 4 weakest times. 5 This is how I know -- this is how I know, 6 this is how I can attest to, the extreme need for 7 long-term psychiatric inpatient services in the 8 Elmira community. 9 It was because I have lived that need. 10 I know what it is like to be transferred far 11 away from your friends and family who do not have 12 the means to visit you. 13 I also know that it was here, in my own 14 community, where I began to flourish and work 15 towards my recovery. 16 Excuse me for sweating, I'm a little nervous. 17 It would be a travesty, not only to the 18 friends and family of these patients, but to the 19 patients themselves. 20 It is harder to adapt to the unknown scary 21 realities of the mental-health system when the 22 familiar is so very far away. 23 Without the love and support of family, 24 friends, and the community supports, it would be 25 harder for patients to put effort into their 1 treatment and have the drive to work towards 2 recovery. 3 Family supports play a key role in recovery. 4 This is something that I can attest to. 5 So, please, reconsider this plan. 6 It would devastate this community, and 7 further damage our mental-health system. 8 It is not a plan that promotes recovery. 9 Inpatient services are direly needed in the 10 Elmira community and Southern Tier of New York. 11 Thank you for your time, and hearing my plea. 12 SENATOR CARLUCCI: Great, thank you, Charles. 13 We really appreciate your testimony. 14 And, thank you for your courage to stand up 15 and share with us your experience, and your trials 16 and tribulations. 17 And, you never know how your experience or 18 your example will really impact someone, so, please, 19 continue to advocate for these services, and share 20 your story. 21 It's very powerful, and it means a lot. 22 And, you know, you said in there to think 23 about this plan. 24 And, you know, we want to tell people, and 25 everybody here, that this is not a done deal, as far 1 as we're concerned. 2 And that's why we're here today; to hear the 3 stories from you, and from community members, as to 4 why this is important, and what needs to be done, to 5 make sure that people living with mental illness get 6 the best treatment possible, and the services 7 possible. 8 So, Charles, thanks again. 9 CHARLES BLOUNT: Thank you. 10 SENATOR CARLUCCI: Okay, next we're gonna 11 hear from Henry Chapman, who is the director of 12 community services for Steuben County. 13 DR. HENRY CHAPMAN: I'm Dr. Henry Chapman. 14 I'm the DCS for Steuben County. 15 Thanks for meeting with us here today. 16 I'll keep my comments brief. 17 As you know, the State Office of Mental 18 Health announced the Regional Centers of Excellence 19 plan in July. 20 This plan calls for the consolidation of 21 New York's 24 state psychiatric hospitals in the 22 15 regional centers. 23 It is important to note, that although five 24 regions are included in the plan, the Southern Tier 25 is omitted. 1 As a result, the Elmira Psychiatric Center 2 will be closed, requiring residents of Steuben and 3 Chemung counties who are in need of inpatient 4 psychiatric services to travel to Buffalo. 5 For the majority of individuals and families, 6 this distance is too far. 7 It is important to note, that in addition to 8 the proposed closure of the Elmira Psychiatric 9 Center, St. James Mercy Hospital located in 10 Hornell is the process of closing their acute 11 inpatient psychiatric-care units for adults and 12 adolescents. 13 Hospital administration anticipate that the 14 units will be closed by the end of December 2013. 15 Based on 2012 data, approximately 450 (or 16 52 percent) of the adults, and 130 (or 31 percent) 17 of adolescents, admitted to St. James inpatient 18 units were Steuben County residents. 19 Similarly, on any given year, approximately 20 20 percent of VPC's inpatient population reside in 21 Steuben County. 22 This closure, combined with the proposed 23 closure of the Elmira Psychiatric Center, will truly 24 cripple Steuben County, as residents will lose 25 access to both private and state inpatient 1 mental-health services within the region. 2 Although I agree that New York State needs to 3 upgrade its business model in regards to inpatient 4 psychiatric services, I'm opposed to the State doing 5 this in a manner that shifts its cost burden onto 6 the counties, and will require rural, often poor, 7 residents of the counties to travel hours to urban 8 areas for inpatient care. 9 Specifically, elimination of inpatient beds 10 in the Southern Tier will cause Steuben County costs 11 to significantly increase in areas involving crisis 12 management, forensic services, and secure transport 13 of individuals to psychiatric facilities via local 14 law enforcement. 15 In general, increasing the availability of 16 community-based supports offered through State OMH 17 to compensate for the reduction of inpatient beds is 18 not a viable solution for this region. 19 In an effort to offer solutions to this 20 situation, I recommend that the State consider a 21 reduction of inpatient beds at the 22 Elmira Psychiatric Center, rather than an 23 elimination of the beds altogether. 24 This would offer more of a balanced approach, 25 as we would continue to have inpatient services 1 available locally, and still give the State an 2 opportunity to reinvest in community supports 3 provided by EPC. 4 Examples of this approach would include 5 applying more dollars to existing programs, such as 6 ACT, intensive case management, and supportive 7 housing, to increase the number of individuals that 8 could be enrolled in such services. 9 Similarly, the creation of mobile crisis 10 teams to help to divert hospitalizations would also 11 be beneficial. 12 So in summary, given the unique geographic 13 and economic challenges that most communities face 14 within the Southern Tier, I urge state officials to 15 rethink the proposal to eliminate inpatient services 16 provided by the Elmira Psychiatric Center. 17 Thank you for your time and consideration. 18 SENATOR CARLUCCI: Thank you, Mr. Chapman. 19 We appreciate your testimony. 20 Do you have any questions? 21 Thank you. 22 Next we're going hear from Mary Beth Gillis, 23 a psychiatric-nurse educator at Elmira College. 24 MARY BETH GILLIS: Good afternoon. 25 I have given you a written testimony, along 1 with some attachments, so I'm just going to kind of 2 not read it; just kind of talk. 3 I work at Elmira College, which is a local 4 4-year liberal-arts college, and, my background is 5 that of a clinical-nurse specialist. 6 I have, about, a little over 30 years' 7 experience with Elmira Psychiatric Center. I worked 8 there before I taught. 9 I've been watching the psychiatric center for 10 a long time. 11 I've watched lots of different 12 administrations, different services, how they've 13 changed things. 14 And, if I personally had a family member, or 15 what I've dealt with in the past 20 years, a 16 student, I would favor them going to the psych 17 center, as opposed to other places that I've exposed 18 to, for a couple of reasons. 19 One is, from my perspective, the psych center 20 provides amazing inpatient and outpatient 21 experiences. 22 Clients are tested soon after they get there. 23 They're evaluated, so that their diagnosis 24 can be correct, and followed through with. 25 They provide a program that -- I haven't seen 1 the same type of program elsewhere. 2 It's pretty inclusive. 3 It helps patients know their diagnosis, their 4 medications; what they need to do to be successful; 5 what their triggers might be once they're out. 6 But it also deals with things, like, 7 substance abuse; or, leisure skills, where a lot of 8 consumers get into trouble if they have too much 9 time, unscheduled time, on their hands. 10 So I would never have a problem with family 11 members going there. 12 The other thing that is seen is a 13 multi-disciplinary approach, and it's not really 14 what you read in a book. 15 You know, you actually see it, where teams 16 gets together, and they include everyone. 17 From a teaching perspective, that is crucial 18 to me. 19 You can talk about it, any clinical setting, 20 but, this is the one that students actually see. 21 I personally understand, far too well, the 22 Centers of Excellence concept. 23 While there are a lot of positives to it, 24 I can personally attest to traveling elsewhere to 25 deal with medical issues. 1 While I value expert opinions, it is very 2 costly for me to go see my expert. 3 Traveling: I mean, regardless of time, but, 4 money-wise, traveling, the gas, the tolls, the 5 "where do you stay?" 6 Those types of issues. 7 The other thing is, I communicate quite a lot 8 with my physician via computer. 9 And if I'm looking at people who have serious 10 mental illnesses that are in acute phase, the 11 ability to do that might be difficult for them. 12 From a teaching perspective, I really -- 13 I teach in the bachelorette program, and I, 14 basically, am teaching nurses -- or, students that 15 are going to take care of you and I. 16 So I have a -- the older I get, the more 17 vested interest I have in them, in some ways, 18 because they're going to be taking care of me, not 19 my parents. 20 I have used the psychiatric center for a lot 21 of years, and there's a lot of benefits. 22 One is, students are given the opportunity to 23 see a State-run facility, and, their preconceived 24 ideas are usually squashed by the time the clinical 25 rotation is over. 1 I get to bring students to one facility, they 2 can see the continuity of care between inpatient and 3 outpatient, and it's very clear. 4 The staff are really good with students. 5 They are very patient with them, and they encourage 6 them to be actively involved. 7 One of my goals is not just to have them fill 8 out the requirements that we need for clinical from 9 the State, but the other piece is, they will deal 10 with people with psychiatric problems regardless of 11 what specialty they go into. 12 And if I can help them in dealing with people 13 that are acutely ill psychiatrically, so that they 14 can deal with them in the general hospital, that's a 15 real advantage to them, because a lot of people are 16 pretty scared of people with mental illness, and 17 it's -- my experience is, it's mostly because of 18 misunderstanding. 19 I think they get a very clear picture of who 20 people are, and to be able to treat them as people, 21 as opposed to their illness. 22 The -- I've read through some of these 23 Regional Centers of Excellence publications from 24 July. 25 And it was stated that the Western Lakes 1 facility will be an area for medical residents, 2 psychology doctorals, interns, pharmacy doctoral 3 interns, et cetera. 4 While I have definitely heard testimony today 5 that that is needed, I think that OMH is very 6 short-sighted in the aspect that they don't include 7 nurses in there, because nurses are the ones that 8 are there 24/7, and every single day of the year; 9 and that's the nursing staff. 10 The other thing that is incredibly perplexing 11 to me, and I gave you a lot of attachments that 12 I received from Mark Stephanie [ph.], is that 13 I don't really understand, and I'm not a business 14 person, but why the center that, on average, is 15 ranked the highest, why they are targeted to be 16 closed. 17 It doesn't make any sense to me. 18 If they're the ones that are -- they recently 19 had a joint-commission survey, and was stated that 20 they're one of the highest rating in the country. 21 It just doesn't make sense to me. 22 The other piece is the financial piece for 23 EPC, and that -- I believe that they cover 24 87 percent of their costs; and that includes the 25 costs of supporting OMH, and other things. 1 If they had to just cover their own 2 particular costs, they would be well over 3 100 percent. 4 And it doesn't seem like that has crossed the 5 mind of the people who have set forth this proposal. 6 I have a real concern about 15 counties not 7 having a facility available to them, and the travel 8 that many people have already talked about. 9 The acting commissioner says that choice in 10 health care is paramount. 11 On some levels, I think that choice is 12 paramount; however, it needs to be reasonable 13 choices. 14 And I don't know that, from a rural 15 community, that three hours away is reasonable. 16 I agree with some of the people that have 17 spoken about, it seems like, if you live in a rural 18 area in New York State, that services are actually 19 removed from you. 20 I know that there's a mindset, a little bit 21 different way than textbook, to deal with people 22 from rural areas because of all the complications. 23 And think that, over the years, EPC has 24 really, uhm -- they know how to do that. 25 And I'm not convinced that someone in an 1 urban area knows that. 2 I can't speak to Binghamton, because I don't 3 know much about the center, but... 4 I don't know, really, what I'd do with my 5 students, once it -- if they follow through with 6 closing, but, we're putting lots of thought into 7 that. 8 I do know that they -- I don't believe 9 they'll get the same experience. 10 SENATOR CARLUCCI: Very well. 11 Thank you, Mary Beth Gillis. 12 We appreciate your testimony. 13 SENATOR O'MARA: Yeah, I would say, thank 14 you. 15 And I would say you're right on the mark, and 16 it doesn't make sense, why to close two of the 17 highest -- the two highest-rated facilities in the 18 state. 19 So, it doesn't just not make sense to you; it 20 doesn't make sense to me, and it doesn't make sense 21 to many people across the Southern Tier, of why this 22 course of action has even been proposed, let alone 23 being seriously considered. 24 Thank you. 25 SENATOR CARLUCCI: Thank you. 1 Next we're hear from John Harmon, Jr., who is 2 the vice president of law enforcement for the 3 New York State Correctional Officers Benevolent 4 Association. 5 JOHN HARMON, JR.: First, I would like to 6 take the opportunity to thank you for allowing me to 7 appear in front of you guys again. 8 Kind of, unfortunately, seems like I've been 9 following either former Commissioner Woodlock or 10 State Senators and Assemblywomen across the state, 11 to get an idea of, actually, what is going on with 12 this plan. 13 First, my first question for this area is: 14 Does the Governor -- does Governor Cuomo care about 15 the residents of Elmira? 16 I would say no. 17 And I would say no, not just for Elmira; 18 Binghamton, Ogdensburg, Middletown...you can keep 19 adding to the list if you like. 20 They say actions speak louder than words. 21 Right now, the Governor's actions could not 22 be clearer. 23 Despite the region's high unemployment and 24 poverty rates, the Governor's continued to actively 25 pursuing policy that eliminates jobs, and forces 1 families to not only reconsider where they might 2 live because of job elimination, or they might live 3 to get the needed services for their family. 4 For example, Elmira Psychiatric Center 5 employs over 350 people; 6 Binghamton PC, over 370; 7 Broome Developmental Center, almost 700. 8 Many more, if you consider the ancillary 9 services and businesses in the areas. 10 If the Governor has his way, and only the 11 State Legislature can stop this, all of these people 12 will relocate to different regions for employment in 13 the systems that are most vulnerable, and in need, 14 will be forced to not only change services, but look 15 for them elsewhere. 16 Is this what the people of this region needs? 17 With Elmira's high unemployment rate, high 18 foreclosure rates, and many municipalities 19 struggling to balance their budgets, the last thing 20 Elmira, Binghamton, or any other affected areas 21 needs is massive layoffs that will kill already 22 fragile economies. 23 So it's troubling that Governor Cuomo intends 24 to pursue a misguided plan to shutter mental 25 facilities and cut good-paying jobs across the 1 state, including right here in Elmira and 2 Binghamton. 3 Recently, the Governor's Office of Mental 4 Health released a 3-year plan to reduce the number 5 of state psychiatric centers and shift treatment to 6 community-based programs. 7 Under this plan, OMH will shift from 8 long-term inpatient treatment services at over 9 24 hospitals, to 15 ill-defined Regional Centers of 10 Excellence. 11 In other words, OMH will shut down 9 out the 12 24 state psychiatric programs, cutting hundreds of 13 jobs and leaving many areas without access to 14 OMH services. 15 This includes facilities slated to close 16 and/or be consolidated in Elmira and Binghamton. 17 Any conversation about the future of 18 mental-health services in New York must include the 19 stakeholders that will be impacted by a radical 20 restructuring that threatens to decimate jobs and 21 upend a fragile recovery. 22 Particularly upstate, Southern Tier, up 23 north, seems it's all the economies that already 24 need help are gonna be decimated even further. 25 Three crucial stakeholders have been left out 1 of the Governor's back-office meetings: the OMH 2 employees, the towns that host OMH facilities, and 3 advocates for the mentally ill. 4 We represent the OMH employees, and our 5 employees safety and security officers deliver the 6 most crucially important aspect of any facility: the 7 24/7 safety and security of the grounds, employees, 8 and most importantly, the residents of the facility 9 and community. 10 Every day, the employees I represent put 11 their own safety and security in the back seat in 12 order to drive the safety and security of everyone 13 else. 14 Safety and security officers serve on the 15 front lines, protecting the public and the mentally 16 ill under incredibly difficult circumstances. 17 Without any consultation, they could be 18 facing pink slips. 19 The Governor's restructuring plan erodes the 20 financial health of our local communities by 21 eliminating decent middle-class jobs and forcing 22 families to move far away from the communities where 23 they live. 24 It will impose devastating new financial 25 burden on families and local taxpayers. 1 If we do not develop a new plan, OMH, for all 2 intents and purposes, will close Elmira Psychiatric 3 Center, Binghamton PC, and many more, dealing a huge 4 blow to especially this Elmira-area economy and 5 Binghamton. 6 Can the area take the hit? 7 Probably not, given Elmira's unemployment and 8 poverty rates are higher than state average. 9 The per capita income in Chemung County is 10 just above $18,000, well below New York State's 11 average of $45,000. 12 Binghamton's is even lower. 13 Losing these jobs threatens the livelihood of 14 small businesses, and undermines the 15 administration's overall economic goals of growth in 16 many upstate communities. 17 Many people will move away. 18 Those who remain will find their property tax 19 bills rising, as municipalities attempt to fund 20 their school systems and other crucial 21 infrastructure at a diminished tax base. 22 Governor Cuomo's goal of reducing government 23 spending is a worthy one, and one we all agree with, 24 but his mental-health plan is better as a PR sound 25 bite than as a policy. 1 Closing statement: 2 The health facilities just transfers 3 mental-health costs from the State to counties and 4 municipalities. 5 It causes seriously ill people in need of 6 help to wind up on the street, or in county jails. 7 Either of those options is far more expensive 8 than psychological treatment. 9 Even if it were cheaper to let mentally ill 10 languish in county jails than be treated in state 11 facilities, which is it isn't, [unintelligible] be 12 unconscionable; yet the unconscionable is already 13 happening. 14 According to reports, more than 50 percent of 15 inmates in New York's county jails and correctional 16 facilities suffer from some form of mental illness. 17 Many of these inmates would not have been 18 incarcerated if they were needed or available -- if 19 the care they needed were available in their 20 communities. 21 The State's failure to properly treat the 22 mentally ill has transformed our county jails into 23 county psychiatric centers. 24 It is not believable to think that OMH which, 25 right now, is letting thousands of mentally ill 1 people fall through the cracks, will do a better job 2 reaching out if it closes nine regional health 3 centers across the state. 4 No one should have to travel hundreds of 5 miles for psychiatric care, but they'll have to, 6 unless OMH reconsiders its wrong-headed plan. 7 The State's failure to promote sustainable 8 economic development upstate and in the 9 Southern Tier makes its unilateral decision to 10 destroy hundreds of upstate jobs all the worse. 11 There will be nothing to replace these jobs, 12 nothing to replace the lost tax revenue, and 13 consumer spending. 14 The only thing Chemung County will see more 15 of is mentally ill inmates at our county jail, paid 16 for by the Chemung County taxpayers. 17 Listen to the stakeholder, Governor Cuomo. 18 Let's work together to protect the mentally 19 ill who need treatment, and the jobs that are 20 necessary to grow our economy. 21 I'm now asking you, our elected 22 representatives, to systematically halt the 23 Governor's mental-health plan, and do what is right: 24 rethink, retool, and reconsider this ill-fated, 25 job-eliminating, community-killing, and 1 family-destroying plan. 2 I would like to add that, personally, as a 3 disabled vet, and a father, who is 100 percent 4 disabled for PTSD, that this hits home. 5 It's very difficult when you have a father 6 that deals with this. 7 And this has taken, the veterans, this is 8 hurting them. There is not enough services 9 currently in this state to encounter the influx of 10 veterans coming home. 11 I have met personally with OMH three times. 12 I'll make this clear: 13 They have no logistics on this plan. They 14 have no plan, period. 15 And they have no clue what they were doing. 16 Thank you for your time. 17 SENATOR CARLUCCI: Very well, John, thank you 18 for your testimony. 19 And I want to thank the correctional officers 20 of New York State for the work that you're doing, 21 and for showing up, and testifying at this hearing, 22 and at other hearings around the state. 23 And like I said before, this isn't a done 24 deal. 25 This is something that we've got to make sure 1 that we have all those details in place before we 2 move forward with this project. 3 So, again -- or this proposal. 4 So I want to thank you, and thank the 5 correctional officers of New York, for being here 6 and testifying at these hearings. 7 Thank you. 8 Is Art Johnston here? 9 Okay, we have Teresa [ph.] and Edward 10 Woodland. 11 TERESA WOODLAND: Hi, my name is 12 Teresa Woodland. And I have here, Ed Woodland. 13 EDWARD WOODLAND: And I'm Ed Woodland. 14 TERESA WOODLAND: I'll make this very short, 15 because we've been here a long time. 16 But, I was showing the gentlemen up there a 17 picture of my daughter who is in the Elmira Psych 18 Center right now. 19 And she -- you would never believe she was 20 mentally ill, but, she has been in and out of 21 hospitals in the state of Arizona, Vermont, Georgia, 22 and Florida. 23 And it is only that she is in Elmira Psych 24 Center that she is alive today. 25 They have done a wonderful job with her, and 1 I didn't mean to cry, but it's very hard when you're 2 the mother of a sick child, and you have people that 3 are caring, loving, and really trying to help her. 4 And, right now, we're looking at, you know, 5 we have home visits, life is good, and that she has 6 the possibility of having a life. 7 And being a young, attractive adult, it's 8 very scary to let her out on the streets. 9 And so they -- I mean, they have really done 10 a beautiful job of working with her medications, 11 working with therapy for her. 12 And without that, she would absolutely not be 13 with us today, without the Elmira Psych Center. 14 You know, they talk about closing the psych 15 center, and the other psych centers are short on 16 beds. 17 People like my daughter, if they are not 18 helped properly, they are either put out on the 19 streets, they die, or they go to jail. 20 And, I would hate to see my daughter in the 21 jail system, because there's no help there. 22 And, so, I just pray that Governor Cuomo does 23 not close our psych center here, because my daughter 24 needs the psych center, and Elmira. 25 And I would like to thank all of the people 1 there that are so caring, and have taken care of my 2 daughter for the last -- over a year. 3 So, anyways, that's all I want to say. 4 And, I will pray. 5 SENATOR CARLUCCI: Well, Mr. and 6 Mrs. Woodland, we appreciate your testimony, and 7 your courage to share your story with us. 8 It's so important that you do put a face on 9 this issue; this important issue. 10 So we ask you to continue your advocacy and 11 share your story, so that legislators, our 12 colleagues in Albany, can make the right decision 13 for the people in New York State. 14 So, thank you so much. 15 TERESA WOODLAND: I just think that sometimes 16 people forget that the mentally ill have beautiful 17 faces, and we think that they are all just people 18 out on the street, you know, bums. 19 And, it is not true. 20 SENATOR CARLUCCI: It doesn't discriminate, 21 it affects everyone, every part of society, that's 22 for sure. 23 TERESA WOODLAND: Right. 24 SENATOR O'MARA: Well, thank you for being 25 here and sharing your story, and attesting to the 1 quality of service at Elmira. 2 It's not ranked Number One, by the State's 3 own metrics, for doing a poor job. 4 It is there because they do excellent service 5 there. 6 TERESA WOODLAND: We're blessed. 7 EDWARD WOODLAND: I would just like to add 8 that, as Teresa said, our daughter has been in many 9 institutions. 10 She was admitted to a place down in Florida 11 11 times within inside of less than a year. 12 And I had asked the director of that 13 institution -- because, what was happening, she was 14 just going through the turnstiles, in and out. 15 72 hours later, you know, she would be drugged up, 16 and they put her out on the streets. 17 I asked him why the state of New York had a 18 law, I believe it's called the "Kindred [ph.] Act," 19 and Florida has a similar law. 20 And his response to me was -- and during that 21 time, I cited that there had been -- that the state 22 of New York had enacted that law over 4,000 times; 23 4,000 patients. 24 During that same period of time, the state of 25 Florida had used the law seven times. 1 And I asked him, what was the discrepancy? 2 And his answer to me was, they just didn't 3 have the facilities there, they didn't have the 4 beds. 5 And, so, to eliminate any of the facilities 6 that you have in New York is a real mistake. 7 TERESA WOODLAND: Start building the jails. 8 SENATOR CARLUCCI: Thank you. 9 And that's it for people testifying today. 10 We want to thank everyone for coming out and 11 participating in this very important hearing. 12 And like I said before, this is the fourth 13 hearing that we've had around the state. 14 And the idea is, to hear the stories that we 15 heard today, so that we can bring them to our 16 colleagues in the Legislature, to make sure that we 17 do get every detail before moving forward with this 18 plan. 19 And the testimony that we heard today was 20 very insightful, and we want to thank everyone for 21 participating. 22 And thank the County Executive for opening up 23 the chamber today. 24 And thank Senator O'Mara for inviting me to 25 Chemung County to have this important hearing. 1 It was very insightful, and I look forward to 2 working with all of you, as partners, to make sure 3 that we provide the best level of care for the 4 mentally ill in New York State. 5 And we said -- it was said numerous times 6 that we do need to modernize our mental-health 7 system, and we need to make sure that it's done the 8 right way. 9 So, I look forward to working with all of you 10 to do that over the next coming year. 11 So, thank you. 12 And, Senator O'Mara? 13 SENATOR O'MARA: Thank all for being here, 14 your time and attention to this extremely important 15 issue. 16 And I want to thank Senator Carlucci very 17 much, for his bringing the Senate Committee on 18 Mental Health public hearing to Elmira today. 19 (Whereupon, at approximately 2:05 p.m., 20 the public hearing held before the New York State 21 Senate Standing Committee on Health and the 22 New York State Senate Standing Committee on 23 mental-health and Developmental Disabilities 24 concluded, and adjourned.) 25

Public Hearing: To Investigate the Impact of the Office of Mental Health'S Regional Centers of Excellence on Community Based Services, Access to Inpatient Care, and the Effect on Local Communities, Consumers and Family Members

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