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Mike Hogan, Ph.D., Commissioner, OMH With Appreciation:

How are People with a Mental Illness Faring Today vs. 50 Years Ago? And What Should We be Doing in NYS?. Mike Hogan, Ph.D., Commissioner, OMH With Appreciation: Better But Not Well : Mental Health Policy in the United States since 1950 Richard G. Frank and Sherry A. Glied.

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Mike Hogan, Ph.D., Commissioner, OMH With Appreciation:

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  1. How are People with a Mental Illness Faring Today vs. 50 Years Ago? And What Should We be Doing in NYS? Mike Hogan, Ph.D., Commissioner, OMH With Appreciation: Better But Not Well : Mental Health Policy in the United States since 1950 Richard G. Frank and Sherry A. Glied. Johns Hopkins University Press. July 2006.

  2. “We must act to bestow the full benefits of our society to those who suffer from mental disabilities; to prevent occurrence of mental illness…to provide for early diagnosis and continuous care in the community …; to stimulate improvements in the level of care …in our State and private institutions…; to reduce …the persons confined to these institutions; to retain in and return to, the community the mentally ill… and there to restore and revitalize their lives through better health programs and strengthened educational and rehabilitation services…” Kennedy, J.F., Message from the President of the United States Relative to Mental Illness and Mental Retardation, Washington D.C.: USGPO, 1963.

  3. In Sum, People with Mental Health Problems ARE Better Off • More likely to be receiving treatment • Treatment more likely to be effective • Lower financial burden • Better living conditions • More resources • More rights • Somewhat less stigma

  4. More People Report MH Treatment(Epidemiological Diagnosis) Source: NCS and NCS-R

  5. Quality of Care Received has Improved - Schizophrenia Source: Frank and Glied

  6. Quality of Care has Improved – Via “Exnovation” • Insulin shock • Psychosurgery • Unproductive institutionalization • Miltown • Minor Tranquilizers

  7. Reduced Financial Burden(Out-of-Pocket Share of Expenses per Person with Dx)

  8. More People with SMI are living Independently or with Family Source: Frank and Glied

  9. Total Medical Sector MH Spending has not Grown

  10. Why Has Well-being For People With Mental Disorders Improved? • New and better treatments? For most conditions, clinical trial data suggest new treatments are NOT more effective than older treatments.

  11. Therapeutic Advances: How Much Efficacy Impact?

  12. Growth in Health Insurance Based Financing

  13. Perhaps “Better”…But Not Well • Many people still lack care • Most care is suboptimal • Incomplete insurance coverage • Homelessness/incarceration • Poverty is the norm for people with SMI • Very low rates of employment • Continued stigma

  14. Share of SMI (NCS) not Receiving Treatment in 1996 Source: NCS-R

  15. Many People Continue to Receive poor Quality Care - Schizophrenia Source: Frank and Glied

  16. More People are Homeless or Incarcerated Source: Frank and Glied

  17. Mental Illness and Poverty • Total bundle of benefits for SMI does not lift an individual above the FPL (<$10,000) • Mental illness continues to lead to reductions in work; unemployment is the norm (rates about 85% for people with SMI in care) Is this the greatest embarassment in mental health care?

  18. How Does NYS Compare? --Patterns of resources and services --Hydraulics of financing --Opportunities for change

  19. Comparative Mental Health Spending By State Per Capita SMHA Spending 2002: --NY ranks #2 on state hospital spending --NY ranks #3 on community care spending --This does not include DOH mental health spending of $2.5B

  20. Challenges: Mental Health in NYS • Poor access: • Poor detection • Stigma of • Insurance coverage limits: uninsured, benefits, “management” • “Dosage” of treatment often inadequate (e.g. depression) • Care is episodic, but conditions are mostly long term/relapsing • Over-reliance on inpatient care • Most individuals with SMI/SED need multi-modal care (e.g. Rx + psychotherapy, housing, (re)habilitation, AOD treatment, chronic illness management….but most care is “one-sized”) • In most settings, no one beyond the provider is responsible; responsibility is diffuse and services “siloed” and fragmented • Medicaid is core reimbursement approach, but services have been developed based on “what’s reimbursable” not what is needed or effective

  21. Top Priorities at OMH • “Keep the trains running”…a demanding first priority • Deal with what comes up adaptively • Develop capacity: • OD strategy for OMH • Revitalize hospitals • Implement successfully: • Kids mental health reform: Clinic Plus • DAI settlement—prison mental health care • Sex offender legislation • Housing expansion (Use new resources to change existing ones, partner with mainstream developers and providers: HFA, DHCR, OTDA) • Shape strategies for systemic challenges: • Include mental health in next generation Medicaid reform • Inadequacies in kids mental health care (with schools, pediatrics, etc) • Clinic financing a mess • Explore/deploy multiple strategies to fix responsibility: hospitals, counties • Accelerate rehabilitation services (PROS) • Erosion of non-Medicaid services • Work with peripheral vision

  22. Thank You!

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