NAMI-NYC working policies

Phone 212.684.3365 | Fax 212.684.3364 | Helpline 212.684.3264
505 8th Avenue, Suite 1103, New York, NY 10018

ACTION AGENDA

PARITY - Current health insurance practices are discriminatory, evidenced by limited coverage, punitive co-pays and restricted access to hospitalization during acute episodes. Serious mental illnesses are given severely limited coverage in most health plans. Persons with mental illness and their families are forced to spend their assets or go without treatment for treatable conditions. NAMI calls for passage of the Fair Insurance Treatment Act, A.4506 (Luster) and S. 5381 (Marchi). NAMI seeks full parity in both private (individual and employer-based) and public (Medicare, Medicaid and other government-sponsored) insurance coverage for mental illnesses. Legislation would call for monitoring to insure that parity laws are enforced and an appeals process for denied services that is fair and impartial. Special needs plans (SNPs) in managed care systems need to be strengthened for mentally ill persons and not exclude homeless, dually diagnosed and forensic populations.

HOUSING - Only 12% of persons with serious mental illness are in state-supported housing. NAMI-NYS calls for 1,000 more beds of supported housing each year. Community Residences are essential to persons who need intensive support for recovery. NAMI-NYS calls for three new community residences at $980,000 each. NAMI-NYS calls for the creation of a New York Cares II program for persons with serious mental illness. NAMI-NYC Metro seeks increased access to permanent housing and appropriate supports and services to allow persons with serious brain disorders to live in the community. In cases where services are linked to housing, such services should be flexible and based on an individualized plan that involves meaningful consumer and family input.

ADULT HOMES - Twelve thousand New Yorkers with serious mental illness live in adult homes, and although some reform measures have been announced, vigilance must be kept and more can be done. NAMI-NYS calls for $3.6 million more to raise the Personal Needs Allowance from $115 to $140 per month, another $3.6 million to add a $300-a-year clothing allowance for persons in adult homes, and another $1 million to support the Mental Health Law Project's legal advocacy efforts to improve conditions in adult homes.

BED CLOSURES AND COMMUNITY REINVESTMENT - The budget relies upon the closure of an additional 395 beds. NAMI-NYS calls for an immediate moratorium on the reduction of psychiatric center beds pending a nonpartisan and thorough assessment of the needs of those in New York State who require long-term and intermediate hospitalization, and a nonpartisan and thorough evaluation of the capacity and efficiency of the psychiatric center system. NAMI-NYS believes that the landmark 1993 Community Reinvestment Act should be restored only within the context of such a study and the implementation of its recommendations.

PACT - Assertive Community Treatment teams work and should continue to be supported. Because of its high rate of success, NAMI-NYC Metro seeks to increase the number of ACT teams. This "hospital without walls" serves the hardest to reach and treat 10 to 20% of persons with serious and persistent mental illnesses and has a 25-year track record of success in other states. While major steps have been made, ACT teams serve a minuscule number of mentally ill clients in the New York City metropolitan area compared to the thousands with similar needs.

EMPLOYMENT - Eighty-five percent of persons with mental illness do not hold jobs. With training and supported employment, many more can work and be productive members of society as they wish to be. overnment income-support programs (including SSI and SSDI) and the health care programs that accompany them (Medicare and Medicaid) often trap people with disabilities in poverty and dependence by preventing even part-time work if that puts them into an income bracket above that allowed by existing law. The Medicaid "buy-in" will allow such persons to work without losing their health coverage. NAMI attempts to work with public officials to develop work programs that meet the needs of those able to work—now calling for 1,500 supported employment slots in this year's budget, at an additional cost of $3.4 million.

MENTAL HEALTH WORKFORCE - Community mental health workers have not had raises in years and the turnover rate is over 50%. NAMI-NYS calls for the Legislature to fund an immediate 2.5% COLA and 10% Medicaid fee hike for community mental health workers in nonprofit programs. NAMI-NYS also calls for retention or direct funding of the 60 state shared staff positions at the county level that are to be eliminated in the governor's budget.

In a recent petition effort NAMI-NYC members sent messages like this: I am very angry about the gross injustice being done to community mental health workers and programs regarding fair and living wages and Medicaid reimbursement fees. I am outraged that these vital programs are suffering and being cut back due to lack of funding and that community mental health workers have not received a wage increase for 10 years. And I find it unfair that all other hospital and community health workers have had increases and will be getting additional increases in this year's budget. There are community mental health agencies that are threatened with having to close because they cannot find qualified people to staff the agencies at the current wage rates. Other agencies have experienced staff turnover of more than 50% per year because of the wage inequities. The mental health of our families, friends and others is being compromised-all of this in the wake of 9/11 and at a time when the demand for mental health services has dramatically increased. Therefore, as responsible representatives of ALL citizens, I ask that you immediately enact wage increases for all community mental workers and provide a Medicaid fee increase for these programs to correct the gross inequity that now exists.

PRESUMPTIVE MEDICAID ELIGIBILITY - Persons with mental illness being discharged from jails, prisons and hospitals need access to their medications in order to transition safely into the community. Currently a 45-day gap exists between discharge and re-establishment of Medicaid eligibility. NAMI-NYS calls for passage of Medicaid Presumptive Eligibility Legislation, A. 0844 (Brennan) and S. 1212 (Marchi).

CRIMINALIZATION OF PEOPLE WITH MENTAL ILLNESS - Persons who have committed offenses due to states of mind or behavior caused by a brain disorder require treatment, not punishment. NAMI-NYS believes prisons or jails are improper therapeutic settings. Mental health courts, more and better police training, and diversion of non-violent offenders into treatment instead of incarceration are recommended. Also, NAMI-NYS calls for passage of legislation to prevent the use of "special housing units" (SHUs), also known as 23-hour lockdowns, the "box," or the "hole" for persons with mental illnesses. A. 2621 (Eve) and S. 1634 (Montgomery).

Criminal justice issues are taking on unprecedented proportions due to the transinstitutionalization of the mentally ill to prisons and jails after closure of state mental institutions, releasing patients to the community without adequate treatment systems in place. Treatment—not punishment—is NAMI-NYC Metro's remedy for persons who commit offenses due to a state of mind or behavior caused by a brain disorder. Rather than clinically inappropriate incarceration in correctional institutions which only contributes to exacerbated symptions and recidivism, NAMI-NYC Metro seeks ways to turn around current counterproductive practices toward the mentally ill in trouble with the law: (1) jail diversion programs to direct nonviolent offenders away from incarceration and toward treatment, (2) appropriate settings for mentally ill persons convicted of crimes with psychosocial rehabilitation and medication administered in settings separate from the general prison population, (3) suitable discharge plans and social services for the mentally ill who have completed sentences or are eligible for parole including immediate restoration of Medicaid, (4) instructional programs that train police officers to recognize symptoms and respond appropriately to people with mental illness without use of unnecessary force, (5) training of prosecutors and criminal court judges to help divert persons with mental disorders to treatment rather than prison, and (6) training of parole officers about the needs of the mentally ill and available treatment resources and benefits.

RESEARCH - The New York Psychiatric Institute and Nathan Kline Institute (NKI) are on the cutting edge of brain research and treatment for persons with mental illness. Although NAMI-NYS is grateful that the Executive Budget did not cut funding for these important institutes, NAMI-NYS believes that the current hiring freeze should be defrosted enough to give PI and NKI the flexibility to recruit important new staff in certain key areas. NAMI-NYS calls for legislators to voice these concerns to the Governor and OMH.

NAMI members strongly support mental illness research, including research involving human subjects, since this is essential to advances in treatment. However, research involving human subjects must be undertaken with the highest scientific, medical and ethical standards and must protect and honor the individuals and their families who make this contribution to scientific progress. Specifically, NAMI-NYC Metro argues that: 1) research subjects give truly informed consent and that they and their families fully understand the protocols and risks and benefits of the research; 2) there be independent and ongoing evaluation of research subjects' capacity to consent; 3) continual review of research protocols be made by independent review boards and include consumers and family members; 4) consumers have the right to withdraw from a study at any time without penalty and they be fully informed of that right; 5) at the end of a study or whenever a consumer terminates participation, ongoing effective treatment and aftercare be assured as well as feedback on the study results.

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