If people with mental illnesses are going to lead productive and successful lives, they need three things: housing, medication and employment, according to the executive director of the National Alliance on Mental Illness-New York State.
Gov. Eliot Spitzer’s proposed 2008-09 budget touches upon all three of these areas.
It increases housing for people with mental illnesses and makes a small investment in vocational training for the mentally ill, two moves that are strongly supported by mental health advocates. But the budget also looks to save money — about $18 million — by restricting the antidepressants doctors can prescribe to mentally ill patients, a proposal mental health advocates oppose.
Overall, the budget recommends $3.7 billion for the state Office of Mental Health, a $1.4 billion increase over 2007-08.
“We’re very positive about the budget, especially given the financial climate of the state,” said Glenn Liebman, CEO of the Mental Health Association of New York State. “What’s impressive about the budget, given the financial issues that have occurred this year, is that the governor has clearly identified social services, especially mental health, as a priority.”
A place to call home
The budget calls for 1,500 new units of supported housing — permanent housing with support services for the mentally ill — and 500 new efficiency apartments for people with mental illnesses who want more independence. It also includes capital funding to purchase adult homes for conversion into Office of Mental Health housing.
In addition, Spitzer has proposed a new $400 million Housing Opportunity Fund that would fund new affordable and supportive housing; some of this housing — the state has yet to determine how much — will be for people with mental illnesses.
“The governor has done a lot to advocate for mental health housing,” said Jill Daniels, a spokeswoman for the state Office of Mental Health. “Right now, there’s just a need for affordable housing.”
This year’s budget included 2,000 new housing units of housing for the mentally ill.
Advocates for people with mental illnesses praised the housing piece of Spitzer’s budget. Right now, they said, many people with serious mental illnesses such as bipolar disorder and schizophrenia are hospitalized, homeless, in jail or living with aging parents.
“If a person has no place to live, then their recovery has no chance of happening,” said Trix Niernberger, executive director of the National Alliance on Mental Illness-New York State.
She said the new housing proposed by Spitzer would only make a dent in the need — an estimated 40,000 mentally ill New Yorkers lack decent housing.
“There’s such a huge need that we’re very pleased [with the proposal],” she said. “But it’s not going to begin to meet the need of 40,000 people.”
She added that the number of housing units funded by the Office of Mental Health amounts to about 6.2 percent of the 600,000 New Yorkers with serious mental illnesses.
“There’s not enough housing for people with mental illnesses,” Liebman said.
NAMI-NYS also supports the creation of a mental health waiting list bill that would require the state Office of Mental Health to keep local waiting lists of people with mental illnesses who are eligible for housing with services but have not received housing with services. The group believes that this would enable the state to better determine the need for housing for the mentally ill. Niernberger said that the state Office of Mental Retardation and Developmental Disabilities maintains a waiting list for housing and that that list has worked well.
The budget also includes $800,000 to expand access to the vocational educational services provided by the state’s Personalized Recovery Oriented Services program, which helps people with severe and persistent mental illnesses attain employment and housing and improve their overall functioning.
About 85 percent of people with severe mental illnesses are unemployed, Liebman said.
“There’s some funding for employment,” he said. “We’d like to see more.”
“There’s more that we could be doing in terms of services for those with mental illnesses,” Niernberger said. “For years and years, there weren’t many opportunities, so we’re grateful, but there’s still such a dearth.”
NAMI had wanted the budget to include $500,000 for a pilot program that focuses on cognitive rehabilitation — improving the brain function of people with schizophrenia in the hopes that they’ll have an easier time finding and retaining a job.
Major medicine issue
Mental health advocates plan to fight one of the governor’s mental health proposals. This proposal would create a preferred drug list for antidepressants, meaning that doctors would only be able to prescribe the antidepressants on the preferred drug list to patients on Medicaid.
As of now, doctors can prescribe the antidepressants that they think patients need without worrying about whether the drugs are covered by Medicaid.
Advocates for the mentally ill worry that patients won’t get medication they need if a preferred drug list is adopted.
“Mental illness is diagnosed by symptoms,” Niernberger said. “We don’t always know [why people respond to a certain drug].”
She said some people may respond to one drug, but not another. And generic drugs may not be as effective, in some cases, as brand-name drugs.
Support system boost
Mental health advocates also lauded the budget’s investment in the mental health work force. The budget will fund the third year of a cost-of-living adjustment to the salaries of mental health human services workers, as well as a 2.5 percent cost-of-living adjustment each year through 2011-12, an investment of almost $400 million.
A better-paid work force will improve treatment and services for the mentally ill, Liebman said.
“There are a lot of issues with being able to recruit and retain quality staff in mental health,” Liebman said. “The salaries and benefits are not as good. The working conditions can be difficult. You can create the best system of care in the world, and if you don’t have anyone to implement it, it becomes very difficult to run a program.”
The Mental Health Association of New York had hoped the governor would include funding to help defray the health care costs of mental health workers in the budget.
“When you’re making $18,000 to $20,000 a year, if you get a stipend of $350 a year for co-pays and deductibles, that’s certainly very helpful,” Liebman said.
According to the state Division of Budget, the state’s mental hygiene agencies — the Office of Mental Health, Office of Mental Retardation and Developmental Disabilities and the Office of Alcoholism and Substance Abuse Services — will serve more than 1 million people in 2008-09, including 600,000 people with mental illnesses.
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