The Office of Mental Health (OMH) administers an extensive statewide mental health services network, including community-based mental health services, 17 State-operated psychiatric centers for adults, 6 State-operated psychiatric centers for children, three forensic psychiatric centers and two research institutes. The State-operated mental health system serves 9,700 adults and children annually. Outpatient services are provided to an additional 37,000 patients each year. There are more than 2,500 not-for-profit and proprietary mental health service providers in the community, meeting the needs of over 500,000 persons. All community-based providers are licensed by OMH.

Year-to-Year Change

The Executive proposes a net All Funds increase of $112,299,350, or 5.48 percent. On an All Funds basis, the State Operations appropriation increases by $8,882,000, or 0.8 percent. The Aid to Localities All Funds appropriation increases $62,802,350, or 8.1 percent. The Capital Projects budget increases $40,615,000, or 30.3 percent.

Legislative Changes

Re-estimation of program spending.

$(5,000,000)   ATL/GEN

An analysis of the Medication Grants Program shows that of $15,000,000 allocated for this purpose in SFY 2000-01, less than $10,000 has actually been disbursed. Based on this history, the Assembly estimates that a significant portion of the $15,000,000 allocated for the Medication Grants Program in SFY 2001-02 will not be expended and takes $5,000,000 in savings. The Assembly proposes that a portion of these savings be used to pay the total non-federal share of the costs associated with providing presumptive eligibility for Medical Assistance (Medicaid) for the same population targeted by the Medication Grants Program. The Medication Grants Program provides persons who are released from hospitals, jails and prisons, who have a history of mental illness, with screening and a referral for medications while their Medicaid application is being processed. Implementation of Medicaid presumptive eligibility would provide persons who are seriously mentally ill with coverage for mental health services as well as medications. Mental health support services are essential if persons who are seriously mentally ill are to succeed outside of an institutional environment.

Legislative Proposals

In State Fiscal Years (SFY) 1999-2000 and 2000-01, the Executive cut funding for the County Shared Staffing program. This program assigns State psychiatric center clinical staff to work for county-run or not-for-profit mental health service providers. In both prior years, the Legislature restored the Executive cuts to the Shared Staffing program and called for the Executive to develop a transition plan, in consultation with the affected counties, so that the impact on the locality of ending the program would be minimized. The Executive's most recent proposal would eliminate the Shared Staffing program over a period of three years, beginning with SFY 2001-02, and would shift funding support for the program from State psychiatric center budgets to those counties to which the staff had been assigned. At the end of the three year transition period, any State staff who do not choose to transition to county or voluntary agency employment would "move back" to the State psychiatric center from which they are funded. By March 31, 2004, the $12,271,000 that had supported 215 Shared Staffing positions would be fully transitioned to county control. The Executive's proposal would transfer the value of staff salaries, but does not include fringe benefits. The Assembly proposes a General Fund addition of $994,000 for the fringe benefit costs associated with the 57 positions projected to transition in SFY 2001-02.

The Assembly proposes an addition of $3,000,000 for an adolescent mental health demonstration project. Funds will be distributed via a request for proposal (RFP) process to not-for-profit providers to develop innovative residential and treatment and other necessary programs to address the unique needs of mentally ill adolescents up to the age of 21. The Assembly also proposes an appropriation of $125,000 for an independent study of the impact of prison life on seriously mentally ill inmates and the extent and quality of mental health services available to prisoners. Mental health agencies, like community-based voluntary providers in other human services fields, are plagued by staff turnover rates that run as high as 35 percent. The Executive has not taken steps to identify strategies that can assist voluntary providers to recruit and to retain the skilled staff needed to work successfully with persons who are seriously mentally ill. The service system cannot operate effectively with such consistently high rates of staff turnover. Therefore, the Assembly proposes an appropriation of $100,000, to be used in conjunction with funds to be appropriated to the Office of Mental Retardation and Developmental Disabilities, for an independently conducted workforce recruitment and retention study.

The Assembly concurs with the Executive's proposal to use the savings from discontinuing 625 adult psychiatric center beds to create a permanent funding stream to support sorely needed increases to the operational base of community, not-for-profit mental health service providers. The savings from bed closings will support a ten percent increase to the fixed Medicaid fees paid to community-based mental health outpatient service providers and a guaranteed 2.5 percent cost of living adjustment to the cost-based rates of residential and non-residential community providers. The cost of living adjustment will be applied each year for three years, beginning in SFY 2001-02. Further, the Assembly proposes that the new Community Mental Health Support and Workforce Reinvestment Act continue two set-asides from the Community Mental Health Reinvestment Act of 1993. Fifteen percent of the bed closure savings will be used to enhance staff to patient ratios in State-operated mental health facilities and seven percent of the remaining savings will support State mental health staff providing services in the community.

Furthermore, the Assembly proposes that a formal, detailed plan for the future use of all State-operated mental health facilities be submitted to the Legislature on or before October 1, 2001. The plan must document that the families of any children and adults who would be affected by a particular proposal have been included in a meaningful way in the decision-making process regarding the future use of any State-operated mental health facility. The plan must also demonstrate the means by which total physical separation of all children's facilities from adult facilities will be maintained. In addition, the plan must document that there will be no interchange of staff between a children's facility and an adult facility and that all children's services will be delivered by staff who are specialists in children's mental health. Furthermore, the plan must document, on a facility-by-facility basis, all purported capital and operating savings projected from any facility closure or co-location. The Assembly also proposes that any savings resulting from future facility closures or co-locations be used to increase funding to the Community Mental Health Support and Workforce Reinvestment Act.

In addition, the Assembly proposes support for various community-based voluntary providers in the amount of $2,000,000.

The Assembly accepts the Executive's proposal to shift County Shared Staffing funds to local control, with the inclusion of salary guarantees to any State staff who opt to transition to county or voluntary agency employment.

The Assembly accepts the Executive's proposal to create State-operated transitional housing for adults and crisis residences for children.

The Assembly rejects the Executive's proposal to close the Hutchings Psychiatric Center and the Middletown Psychiatric Center.

The Assembly rejects the Executive's proposal to co-locate the Queens Children's Psychiatric Center, the Rockland Children's Psychiatric Center, the Sagamore Children's Psychiatric Center and the Western New York Children's Psychiatric Center onto the grounds of adult psychiatric centers.

The Assembly rejects the Executive's proposal to co-locate the Kirby Psychiatric Center (forensic) with the Manhattan Psychiatric Center, both of which are located on Ward's Island.

ADOLESCENT SERVICES AND HOUSING DEMONSTRATION PROJECT. SUPPORT FOR COMMUNITY BASED SERVICE PROVIDERS. SHARED STAFFING-FRINGE BENEFITS. MH SERVICES IN PRISON - STUDY. WORKFORCE RECRUITMENT & RETENTION STUDY.

$3,000,000 $2,000,000 $995,000 $125,000 $100,000

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