Research: Topics: Health Care: Mental Health in New York State
Mental Health in New York State, 1945-1998
Endnotes
Mental Health in the Present Era
[132] Mental Hygiene Law, Laws of New York (1977), Ch. 978, § 1. Records pertaining to the reorganization of the DMH are held by the New York State Archives.
[133] Mental Hygiene Law, Laws of New York (1977), Ch. 978, § 41.15, subd. b.
[134] Mental Hygiene Law, Laws of New York (1977), Ch. 978, § 41.16.
[135] Mental Hygiene Law, Laws of New York (1977), Ch. 978, § 7.05. In 1982, these two advisory bodies and the OMH's Advisory Committee on Minority Affairs were merged into the Mental Health Services Council, which was given greater influence in shaping OMH policy; see Act of 27 July 1982, Laws of New York (1982), Ch. 724, § 1.
[136] Mental Hygiene Law, Laws of New York (1977), Ch. 978, § 41.10.
[137] Mental Hygiene Law, Laws of New York (1977), Ch. 978, § 5.07.
[138] Mental Hygiene Law, Laws of New York (1977), Ch. 978, § 41.17. The OMRDD and the OASA were to perform the same tasks.
[139] New York State Office of Mental Health, Annual Report 1979, 8, 20; New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1980 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1980), 4.
[140] New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1981 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1981), 3.
[141] New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1982 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1982), 3.
[143] New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1979 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1979), 4. In all likelihood, OMH staff shortages and time constraints made it impossible for staffers to perform the lengthy follow-up visits and devise the highly individualized treatment plans that policymakers desired
[144] On the NIMH Community Support Program, which was intended to improve coordination of services for the mentally ill, see Grob, The Mad Among Us, 305. In 1982, the OMH received NIMH funding for ongoing analysis of the effectiveness of CSS programs, and it is likely that these funds were made available under the auspices of the Community Support Program; see Office of Mental Health, Annual Report (1982), 15. The 1977 reorganization created five new regional administrative units: Western New York (Chautauqua, Cattaraugus, Allegany, Erie, Niagara, Steuben, Chemeung, Schuyler, Seneca, Yates, Livingston, Wyoming, Genesee, Orleans, Monroe, Ontario, and Wayne counties); Central New York (Tioga, Broome, Delaware, Otsego, Chenango, Cortland, Cayuga, Onondaga, Madison, Lewis, Hamilton, Warren, Jefferson, St. Lawrence, Franklin, Clinton, and Essex counties); Hudson River (Greene, Columbia, Schoharie, Albany, Rensselaer, Washington, Saratoga, Schenectady, Montgomery, Herkimer, Oneida, Rockland, Westchester, Putnam, Orange, Sullivan, Ulster, and Duchess counties); Nassau-Suffolk; and New York City. It is probable that this change was an effort to improve services in the rural parts of the state. The annual reports that the DMH published during the 1970's suggest that rural areas were persistently underserved; in fact, the old North Country region, which contained the Adirondack State Park, was barely mentioned in the DMH's reports even though it contained the St. Lawrence Psychiatric Center.
[145] New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1978 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1978), 14.
[146] New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1984 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1984), 9.
[147] A 1986-87 NIMH study of state-supported residential programs found that the overwhelming majority of them began in the second half of the 1970's, when federal legislation compelled CMHC's receiving federal funds to furnish appropriate outpatient care for the seriously mentally ill, and mushroomed during the 1980's. The study also found that relatively few agencies were involved in creating and running such programs and that slightly more than half were not-for-profit organizations; see Frances L. Rudolph, Priscilla Ridgway, and Paul J. Carling, "Residential Programs for Persons with Severe Mental Illness: A Nationwide Survey of State-Affiliated Agencies," Hospital and Community Psychiatry 42 (November 1991): 1111-14.
[148] Office of Mental Health, Annual Report 1979, 9.
[149] New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1987 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1987), 4.
[150] New York State Commission on Quality of Care for the Mentally Disabled, A Review of 32 Office of Mental Health Supervised Community Residences (Albany: New York State Commission on Quality of Care for the Mentally Disabled, 1988), iii, 3-17. New York State was not atypical in this respect. The 1986-87 NIMH study found that only one-third of the agencies that furnished residential care "offered more than one type of program" and that the "continuum of residential services" needed to furnish effective care apparently did not exist; Randolph, Ridgway, and Carling, "Residential Programs for Persons with Severe Mental Illness," 1114.
[151] Office of Mental Health, Annual Report 1980, 6.
[152] Office of Mental Health, Annual Report 1979, 5, Office of Mental Health, Annual Report (1981), 3.
[153] Office of Mental Health, Annual Report 1982, 2.
[154] Office of Mental Health, Annual Report 1978, 7.
[155] Office of Mental Health, Annual Report 1984, 17.
[156] New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1983 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1983), 18. The number of men who were between the ages of eighteen and thirty-four who were in state inpatient facilities increased by eighteen percent in 1983; in contrast, the percentage of those between the ages of thirty-five and forty-four declined by seven percent and those over by twenty-seven percent. Seriously ill young adults also constituted an increasing percentage of those treated at community mental health centers.
[157] It is difficult to tell from readily accessible OMH statistics whether the percentage of men being treated in inpatient facilities increased or remained constant; the question certainly bears investigation. The emergence of this patient cohort reflects a decline in the age of first hospitalization or onset of mental illness. In 1981, the OMH anticipated that the inpatient census might increase as the baby boom generation reached its thirties and forties, the age range that had historically produced high rates of hospital admission for schizophrenia and other serious mental disorders; see Office of Mental Health, Annual Report 1981, 21. In 1998, the National Alliance for the Mentally Ill noted that most people who have serious mental illnesses are diagnosed when in late adolescence or early adulthood; see National Alliance for the Mentally Ill, Things You Should Know: NAMI Facts, available [online]: <http://www.nami.org/about/thing.htm> [29 May 1998].
[158] Grob, The Mad Among Us, 296-300.
[159] Office of Mental Health, Annual Report 1978, 20. On the origins of the Mid-Hudson Psychiatric Center, see New York State Department of Parks, Recreation, and Historic Preservation, Bureau of Field Services, "A History of Mental Health Care Institutions in the United States and New York State," by Judith Botch, Albany, 1986, section II, part B, [ii], [iv]. (Photocopied.)
[160] Office of Mental Health, Annual Report 1983, 12; New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1985, 11.
[161] Insanity Defense Reform Act of 1980, Laws of New York,
[162] Office of Mental Health, Annual Report 1984, 8; Office of Mental Health, Annual Report 1985, 11.
[163] Office of Mental Health, Annual Report 1984, 8.
[164] New York State Office of Mental Health, Local Correctional Suicide Prevention Crisis Service Program, available [online]: <http://www.omh.state.ny.us/suicide.htm> [29 May 1998]. New York State Office of Mental Health, Police/Mental Health Coordination Project, available [online]: <http://www.omh.state.ny.us/police.htm> [29 May 1998]. The OMH and the Department of Correctional Services were linked in another way: unneeded buildings at the Pilgrim, Gowanda, and Utica Psychiatric Centers and the Craig Developmental Center were in many instances taken over by the Department of Correctional Services and turned into prison facilities; see New York State Governor's Task Force to Identify Mental Health Facilities to be Adapted for Prison Use, A Proposal to Make Adaptive Use of the State's Capital Plant to Meet Prison Space Requirements (Albany: New York State Governor's Task Force to Identify Mental Health Facilities to be Adapted for Prison Use, 1982).
[165] Office of Mental Health, Annual Report 1981, 18; Office of Mental Health, Annual Report 1983, 24; Office of Mental Health, Annual Report 1985, 6. It is hard to determine the extent to which external political pressure led the OMH to assess whether African-Americans and Latinos were being treated appropriately. African-American and Latino advocacy groups demanding better care for the mentally ill members of their communities do not seem to have existed; it is possible that pressure for improved services emanated from chapters of advocacy groups and mental health professionals working in areas with high concentrations of African-American and Latino people. The OMH's current mission statement affirms the agency's responsibility to provide "individualized services which respect . . . cultural differences"; see New York State Office of Mental Health, OMH Strategic Framework, available [online]: <http://omh.state.ny.us/framewrk.htm> [1 June 1998].
[166] Office of Mental Health, Annual Report 1980, 10. In 1980, roughly half of the state inpatient population was over the age of sixty-five. However, the percentage of elderly patients ranged from five percent in some new facilities to more than seventy percent in some older rural centers.
[167] Office of Mental Health, Annual Report 1981, 8.
[168] Office of Mental Health, Annual Report 1987, 5.
[169] Alliance for the Mentally Ill of New York State, About AMI-NYS, available [online]: <http//:www.crisny.org/not-for-profit/aminys/About.html> [29 May 1998]; Alliance for the Mentally Ill of New York State, Affiliate List, available [online]: <http//:www.crisny.org/not-for-profit/aminys/affilate.html> [29 May 1998].
[170] Families' anger at not being able to have mentally ill relatives placed in state facilities for lengthy periods of time stemmed from a number of sources. A few probably wanted to be rid of troublesome kin. However, others caring for deinstitutionalized family members had good reason to fear violence from their mentally ill loved ones or watched helplessly as family members repeatedly improved as a result of drug therapy administered in inpatient programs and then declined after they were discharged and refused to take their medicines. See Issac and Armat, Madness in the Streets, 272-76, and Johnson, "Unravelling of a Social Policy," 373-75, 433-34, 486.
[171] Office of Mental Health, Annual Report 1981, 8.
[172] Grob, The Mad Among Us, 284-86.
[173] Richard Frank and Thomas MacGuire, "Health Care Financing and State Mental Health Systems," in Health Policy, Federalism, and the American States, ed. Robert F. Rich and William D. White (Washington, D.C.: Urban Institute Press, 1996), 129.
[174] Grob, The Mad Among Us, 286-87.
[175] Grob, The Mad Among Us, 300-02. The administration had hoped for a savings of $218 million by 1985, but the Social Security Administration projected that some $3.5 billion would be saved by that time.
[176] New York State Governor's Select Commission on the Future of the State-Local Mental Health System, Final Report of the New York State Governor's Select Commission on the Future of the State-Local Mental Health System (Albany: New York State Governor's Select Commission on the Future of the State-Local Mental Health System, 1984), 6. For a complete list of commission members, subcommittee members, and others involved in the Select Commission's work, see pp. i and 45-48.
[177] Frank and MacGuire, "Health Care Financing and State Mental Health Systems," 129.
[178] Office of Mental Health, Annual Report 1982, 2.
[179] Governor's Select Commission on the Future of the State-Local Mental Health System, Final Report, 6.
[180] Office of Mental Health, Annual Report 1983, 5.
[181] New York State Division of Audits and Accounts, Department of Audit and Control, "Re: Audit Report AL-Misc-3-83, Medicare Recovery of Outpatient Service Costs" (20 September 1982); Office of Mental Health, Annual Report 1982, 12, and Office of Mental Health, Annual Report 1983, 22.
[182] Office of Mental Health, Annual Report 1987, 7. The OMH's share of block-grant monies was relatively small: the House Committee on Energy and Commerce concluded that by the early 1990's New York State was directing only ten percent of its block-grant funds to mental health programs. See U.S. Congress, House, Committee on Energy and Commerce, Community Mental Health and Substance Abuse Services Improvement Act of 1992, H. Rept 102-464 to Accompany H.R. 3698, 102d Congress, 2d sess., 1992 (Washington, D.C.: Government Printing Office, 1992), 53
[183] Office of Mental Health, Annual Report 1984, 4-5; New York State Office of Mental Health, Annual Report 1987, 4;
[184] On the roots of the problem of homelessness in New York City, see Johnson, "Unravelling of a Social Policy," 399-410, and Governor's Select Commission on the Future of the State-Local Mental Health System, Final Report, 6.
[185] Office of Mental Health, Annual Report 1983, 4-5.
[186] Office of Mental Health, Annual Report 1985, 32; Office of Mental Health, Annual Report 1987, 27.
[187] The prevalence of mental illness among homeless people has been the subject of protracted debate. Estimates have ranged from twenty to more than fifty percent, and funding considerations may have colored efforts to equate homelessness and mental illness. One New York City mental health worker subsequently recalled that the state labeled homeless people mentally ill because it could use the existing CSS program to finance their care and thus avoided having to pass legislation that would furnish funds through the Department of Social Services; see Johnson, "Unravelling of a Social Policy, 407-09.
[188] Chris Koyanagi and Howard H. Goldman, "The Quiet Success of the National Plan for the Chronically Mentally Ill," Hospital and Community Psychiatry 42 (September 1991), 903.
[189] U.S. Congress, House, Committee on Energy and Commerce, Community Mental Health and Substance Abuse Services Improvement Act of 1992, H. Rept 102-464 to Accompany H.R. 3698, pp. 2-8, 57-58.
[190] Koyanagi and Goldman, "The Quiet Success of the National Plan for the Chronically Mentally Ill," 903.
[191] Grob, The Mad Among Us, 305. In 1989, the NIMH dedicated the Community Support Program solely to measuring the effectiveness of state programs.
[192] State Comprehensive Mental Health Services Plan Act of 1986, Statutes at Large 100, sec. 501-03, 3794-97.
[193] See note 19 for discussion of the creation of the SAMHSA.
[194] Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, The Center for Mental Health Services Information Page, available [online]: <http://www.samhsa.gov/cmhs/cmhs.cmhs.htm> [29 May 1998].
[195] Mental Health Parity Act of 1996, Statutes at Large 110, sec. 701-03, 2944-50. The MHPA, which expires on 30 September 2001, does not compel companies to offer mental-health coverage, apply to those that have fewer than fifty employees, or extend to treatment for substance abuse and chemical dependency. In addition, corporations that could prove that parity implementation would raise their insurance costs by at least one percent could apply for exemptions. The passage of the MHPA also brings to the fore a subject of particular interest to those seeking to document the development of mental health policy and programs: the history of private insurance coverage of mental illness. Information on this aspect of mental health policy is hard to come by, but it seems that mental health benefits began to develop in the 1960's and became more common in subsequent decades.
[196] See, e.g., National Alliance for the Mentally Ill, The Mental Health Parity Act of 1996, available [online]: <http/nami.org/update/parity96.htm> [1 June 1998].
[197] See National Alliance for the Mentally Ill, State Mental Illness Parity Laws, available [online]: <http://www.nami.org/pressroom/statelaws.html> [1 June 1998].
[198] At present, the only bill that would mandate improved coverage of mental illness is Assembly Bill 1379, which would compel insurers to cover serious mental illness. The bill was sent to the Insurance Department for study in January 1998; see New York State Legislature, Legislative Bill Drafting Commission, Legislative Digest 1998: January 7 to May 22, vol. 2, Assembly Introduction Record, 81.
[199] Act of 12 June 1991, Laws of New York, Ch. 165, § 8;New York State Office of Mental Health, OMH Quarterly 2 (March 1996), available [online]: <http://www.omh.state.ny.us/qvol2no2htm#anchor1348229> [9 June 1998].
[200] New York State Office of Mental Health, OMH Quarterly 3 (December 1997), available [online]: <http://www.omh.state.ny.us/qvol3no3.htm.#anchor1482785> [9 June 1998].
[201] New York State Office of Mental Health, Statewide Comprehensive Plan for Mental Health Services 1994-1998 (Albany: New York State Office of Mental Health, 1993), 1-2.
[202] New York State Office of Mental Health, OMH Quarterly 3 (June 1997). Available [online]: <http://www.omh.state.ny.us/qvol3no2.htm.> [9 June 1998].
[203] Community Mental Health Reinvestment Act of 1993, Laws of New York, ch. 723, § 2, § 12, subd. a-i, § 24. The relevant provisions of the act expire on 31 March 2000.
[204] For the circumstances leading to the creation and passage of the CMHRA, see Robert N. Swidler and John V. Tauriello, "New York State's Community Mental Health Reinvestment Act," Psychiatric Services 46 (May 1995): 496-500.
[205] Office of Mental Health, OMH Strategic Framework.
