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Western New York Region

Regional Center of Excellence Location Inpatient Services State OperatedCommunity Service

Hubs

Great Lakes RCE Buffalo, NY Adult, Child, Adolescent Elmira

Rochester

Buffalo

Western New York

Forensic Center of Excellence

Rochester, NY Forensic Adult

Central New York Region

Regional Center of Excellence

Location Inpatient Services State OperatedCommunity Service

Hubs

Empire Upstate RCE Syracuse, NY Adult Ogdensburg

Utica, NY Child and Adolescent Binghamton

Utica

Syracuse

Central New YorkForensic Center of Excellence

Marcy, NY Forensic Adult, SOMTA Statewide Outpatient inPrisons

Ogdensburg, NY SOMTA

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Hudson River Region

Regional Center of

Excellence

Location Inpatient Services State Operated

Community ServiceHubs

Capital District RCE Albany, NY Adult Albany

Lower Hudson RCE Orangeburg, NY Adult, Child, Adolescent OrangeburgMiddletown

Poughkeepsie

Westchester County

Nathan Kline ResearchCenter of Excellence

Orangeburg, NY Adult

New York City Region

Regional Center of

Excellence


Community ServiceHubs

Greater New YorkChildren’s RCE

Bronx, NY Child, Adolescent Bronx

Queens, NY Child, Adolescent Queens

Brooklyn

Manhattan

Dix Hills (ServingNassau and Suffolk)

Bronx RCE Bronx, NY Adult Bronx

Upper Manhattan

Brooklyn RCE Brooklyn, NY Adult Brooklyn

South Beach RCE Staten Island, NY Adult, Adolescent Staten Island

Brooklyn

Lower Manhattan

Queens RCE Queens, NY Adult Queens

New York Psychiatric

Institute ResearchCenter of Excellence

Manhattan, NY Adult Washington Heights

Manhattan Forensic

Center of Excellence

Ward’s Island, NY Forensic Adult

Long Island Region

Regional Center of Excellence

Location Inpatient Services State OperatedCommunity ServiceHubs

Island RCE Brentwood, NY Adult Brentwood (Serving

Nassau and Suffolk)

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The Current New York State-Operated Mental Health System: Making the Case for Change

The mission of OMH is to promote the mental health of all New Yorkers, with a particular focus on

providing hope and recovery for adults with serious mental illness and children with serious emotional

disturbance. To achieve this, OMH has a dual role to: 1) set policy and provide funding for community

services; and, 2) operate inpatient and outpatient services. The OMH vision has evolved over time to

become much more community-oriented and recovery-focused; however, OMH’s “safety net” role as ahospital provider remains premised on a chronic disease and caretaker mentality from centuries past.

In any given year, 1 in 4 New York adults have a diagnosable mental disorder; while 1 in 17 have a

serious mental illness. In many cases, those with serious mental illness also suffer from a chronic

medical condition, such as diabetes, asthma, obesity, or heart disease. Today, the majority of individuals

with mental illness choose to access treatment in primary care settings. Approximately 715,000

individuals access care in specialty mental health settings each year. 10,000 of those individuals were

served in OMH inpatient hospitals in 2012, which now has a census below 4,000 and once stood at

93,000 in the 1950’s. That leaves more than 700,000 New Yorkers being served in the community.

Despite significant reforms to become more recovery-oriented, OMH remains overly reliant on extended

inpatient hospitalization for those with serious mental illness. This reliance comes at a great cost. Over

$1.3 billion per year is spent on OMH hospital treatment and care for 10,000 individuals, while $5.3

billion is spent on mental health care in the community for a population of more than 700,000 people.

New York’s historical choice to maintain 24 State operated hospitals is no longer sustainable.

All other

settings

99%

OMH

hospitals

1%

People Served

All other

settings

80%

OMH

hospitals

20%

Gross Spending

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The undeniable forces of

healthcare reform; the

Affordable Care Act, Medicaid

Redesign, mental health parity,

and budget demands have laid

the groundwork for a more

efficient and effectiveconsumer-oriented model. The momentum of change cannot be halted and the moral force of recovery

cannot be denied. With its transformation completed, our whole New York State mental health system

can be equipped to enter the new world of healthcare delivery. The only other option is to avoid

change, and fail to be a player on the new healthcare field.

In short, OMH resources must be aligned with what is known to promote access, resiliency, and

recovery for the majority of people served. Shifting those resources to better support the needs of the

majority of people in the community- where they do, will, or should reside.

How OMH Inpatient Services Look Today

New York State spends one fifth of its overall mental health budget to maintain and operate the State’s

outsized psychiatric hospital system, which has 3 times the number of state-run hospitals compared to

the next largest state operated inpatient system

OMH’s inpatient capacity includes fifteen adult hospitals, four for children, three for forensic

populations, and several additional child and forensic units attached to the adult facilities. OMH also

operates two sex offender treatment programs, two research institutions, and dozens of community

outpatient, residential and care management programs.

The size and scale of the OMH physical plant is tremendous, with a capital portfolio of over 830 buildings

over 2,300 acres of land (and this only for buildings and land associated with currently operating

facilities). In keeping with New York’s long history of institutional operations, many buildings were built

over a century ago, and over 300 OMH facility buildings are over 50 years old. Maintenance and

extensive capital repairs are continual challenges and require constant maintenance and major financial

commitments. The OMH interest obligations alone for facility capital bonds are over $1 billion and the

annual debt repayment averages $230 million, exceeding some State agencies’ full annual budgets.

There are many indications that the “safety net” identity no longer works. Presently, in OMH operated

hospitals, overall census numbers are declining and the hospitals are challenged with treating two very

different populations: those persons with short-term stabilization needs and those persons who require

longer-term rehabilitation services so they can return to the community. In most adult facilities, census

declines are masking actual increases in admissions /discharges for individuals who need acute care and

are stabilized within three months. OMH’s inpatient services for children and youth also treat

significantly different populations, with one sector providing primarily acute care that should be

provided in the community, while the other group serves intermediate care needs for children

transferred from community hospitals. Both of these populations call for transformation of the mental

health system as a whole and to right-size and reform state hospitals in order to prevent disruptive

State PopulationNumber of State

Psychiatric Hospitals

New York 18 million 24

California 37 million 5

Texas 25 million 8

Michigan 10 million 3

New Jersey 9 million 4

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THE WIDENING GAP BETWEEN CENSUS AND COSTS

Total facility census has declined over the past decade by over 25%. This has

been driven primarily by reductions of adult facility census, which respectively

has been driven by a reduction in long stays.

High fixed costs, including administrative overhead, capital maintenance and

staffing requirements have increased per diem costs as census has decreased.i

5,275

3,869

0

1,000

2,000

3,000

4,000

5,000

6,000

2 0 0

4

2 0 0

5

2 0 0

6

2 0 0

7

2 0 0

8

2 0 0

9

2 0 1

0

2 0 1

1

2 0 1

2

2 0 1

3

C e n s u s a t S F Y E n d

Census Trend - All Facilities, 2004-2013

Total

Adult

Forensic

Children

$557

$802

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

2004 2005 2006 2007 2008 2009 2010 2011

A v e r a g e p e r - p e r s o n / p e r - d a y c o s t

Adult Facility Daily Cost of Services

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Who OMH Serves and Where They Are Served: Adult, Children & Youth, and Forensic Facilities

Adults

OMH currently operates fifteen (15) adult facilities that served 6,500 individuals with a census of 2,869

at the 2012-13 State fiscal year end.ii This represents a continuing census decline over the past five

years, due in large part to proactive transition planning, intensive care management, and strong

collaboration between facility staff and community providers. Two OMH PCs now operate with a census

below 100, even when including the children’s units in the count; the third is just over 100 when the

children’s unit is added.iii

OMH Adult Inpatient Facilities (15)

Western NY Central NY Hudson River New York City Long Island

Buffalo Greater Binghamton Capital District Bronx Pilgrim

Elmira Hutchings Rockland Creedmoor

Rochester St. Lawrence

Nathan Kline

Institute Kingsboro

Manhattan

South Beach

Psychiatric Institute

*Orange indicates adult & child/adolescent combined census under 120

*Blue indicates adult & child/adolescent combined census above 120

*Brown indicates a Research Institute. Psychiatric Institute includes the Washington Heights adult unit.

Quick Facts: Adult Facilitiesiv

Facilities 15

Census 2,869

Staff 9,567

Admissions 3,889

Average daily cost $802

Median length of stay by census 370 days

Median length of stay by discharge 72 days

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Children & Youth

OMH operates four (4) Children’s Psychiatric Centers (CPC) and six (6) units for children and youth

attached to adult facilities, which collectively served 2,038 children with a census of 405 at the 2012-13

State fiscal year end.v

OMH Children & Youth Inpatient Facilities (4) and Units (6)


Western NY CPC Elmira* Rockland CPC NYC Children's Center Sagamore CPC

Greater Binghamton* Bronx

Hutchings* Brooklyn

Mohawk Valley* Queens

St. Lawrence* South Beach*

*Indicates C&Y unit attached to adult facilities

Children’s facility census and overall capacity levels have been relatively stable, with only a moderate

decline in census and capacity over the past ten years. Meanwhile, admissions to children’s facilities

have increased over the past several years, a trend that has been absorbed by the rapid turnaround of

capacity: More children are being admitted, for shorter periods of time.

Many of the children’s facilities serve primarily acute care functions, similar to a community hospital. A

majority of admissions to children’s facilities, in certain regions of the State, are from emergency rooms,

signifying a considerable jump from little or no services to extremely intense, high levels of service - and

nothing in between. This indicates in part, a deficit in the appropriate community interventions and

supports that must be addressed. An improved vision of care for children will establish the appropriate

levels of intervention for children and families in the community, so children no longer need to enter

institutional settings, often far from home. We should reserve our children’s inpatient facilities for

specialty care, while acute interventions become more accessible and integrated into communities

across the State.

Quick Facts: Children & Youth Facilitiesvi

Centers (CPCs) 4

Units 6

Census 405

Staff 1,867

Admissions 1,873

Average daily cost $1,432

Median length of stay by discharges 32 days

Unit census length of stay <30 days 76.5%

CPC census length of stay <30 days 20.3%

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Forensics

OMH operates three (3) secure forensic psychiatric hospitals, two (2) regional forensic units, and two (2)

secure treatment facilities for sex offenders committed under Article 10 of Mental Hygiene Law.

Additionally, approximately 600 individuals under forensic status receive psychiatric care in OMH adult

facilities under particular circumstances. The forensic facility census (excluding sex offender and civil

facilities) at the 2012-13 State fiscal year-end was 654.

Secure Forensic Facilities and Regional Forensic Units


Rochester RFU* Central NY PC Mid-Hudson PC Kirby PC

Northeast RFU*

*Indicates a Regional Forensic Unit

Forensic facility census has remained relatively stable over the past ten years, with a moderate

downward trend. Overall admissions have been declining more sharply than the small drop in census,

which is likely the result of a changing admissions profile: individuals committed to forensic facilities

under Correction Law 402 (who typically have shorter lengths of stay) have declined relative to

increasing admissions of individuals found incompetent to stand trial with greater lengths of stay. The

net result has been a stable census number.

Forensic admissions are largely determined by courts, with the general purpose of forensic facilities

being specialty treatment for individuals involved in the criminal justice system. Some individuals are

treated in these facilities until they are deemed to no longer have a “dangerous mental disorder,”

whereupon they can move to a lower level of care. A second major specialty for these facilities is for the

competency restoration and treatment of acute symptoms and stabilization of inmates.

An enhanced forensic treatment model will focus on improved forensic evaluations, risk informed

treatment and transition planning, specialized programming for difficult-to-treat populations (such as

Axis II diagnosed individuals), and greater continuity of care through closer collaboration with

community providers. Such evidence-based reforms will allow us to reduce readmissions from the

community and to more efficiently assist in the transition of individuals to more appropriate levels of

care through effective treatment.

Quick Facts: Forensic Facilities

vii

Facilities 3

Regional forensic units 2

Total Forensic Facility Census 654

Forensic census all facilities 1577

Admissions (forensic facilities only) 936

Average daily cost $859

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DATA CITATIONS

iAdult cost data for this chart for quarters ending in December of each year noted.

iiOMH Statistical Tables, Inpatient Census as of week ending March 28, 2013.

iiiNot all facilities indicated in this table include children’s units, though all with combined census below 120 do.

ivData Note: Data used are not all from the same point in time due to data collection and processing lags between

categories. Attempts were made to obtain the most recent data and/or data that could be compared acrosspopulation categories. Census is as of week ending March 28, 2013. Staffing levels as of March 2012. Cost is for

quarter ending 12/31/11. Length of stay by census is for census on 4/1/13.vOMH Statistical Tables, Inpatient Census as of week ending March 28, 2013.

viData Note: Children’s data used are same point in time as for adults as indicated in endnote iv, with the following

exceptions: Cost data is for full fiscal year 2010-11. Length of stay by discharge is for 2012-13 SFY, and length of

stay over and under 30 days is for census as of 4/1/12.vii

Data Note: Data sources are the same as adult, with the exception of “forensic census all facilities” which are

from 4/1/13. These data do not include commitments pursuant to MHL Article 10.

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So What’s Next Listening Tour

Date Location Time-Frame

April 3, 2013

Albany

ACL Board Meeting

Towne Place Marriott

1:00 PM-2:30 PM

April 9, 2013

Albany

CDPC

75 New Scotland Avenue, Albany

Large Auditorium

Facility Staff Meeting

CDPC

Large Auditorium

1:00 PM- 4:00 PM

11:30 AM-12:30 PM

April 10, 2013

CSEA

NYS & CSEA Partnership for Education and TrainingCorporate Plaza East - Suite 502240 Washington Ave. Ext. Albany, NY 12203

1:00 PM-4:00 PM

April 15, 2013

Rockland Co.

Nathan Kline Institute140 Old Orangeburg RoadOrangeburg, NY 10962

Auditorium


Nathan Kline Institute

Auditorium

10:00 AM-1:00 PM

1:00 PM-2:00 PM

April 18, 2013

Rockland Co.

Evening

Rockland Children’s PC

2 First Avenue

Orangeburg, NY 10962Auditorium

5:30 PM-8:00 PM

April 22, 2013

Binghamton

Greater Binghamton Health Center

425 Robinson Street

Binghamton, NY 13904

Auditorium


Greater Binghamton Health Ctr.

Auditorium

1:00 AM- 4:00 PM

11:00 AM-12:00 PM

April 23, 2013

Syracuse

Hutchings PC

620 Madison Street

Syracuse, NY 13210

Auditorium


Hutchings PC

Auditorium

10:00 AM-1:00 PM

2:00 PM-3:00 PM

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April 23, 2013

Syracuse

Evening

Hutchings PC

620 Madison Street

Syracuse, NY 13210Auditorium

5:30 PM-8:00 PM

April 24, 2013

Western Region

Rochester PC

1111 Elmwood Avenue, Bldg 16

Rochester, NY 14620

Auditorium


Rochester PC

Auditorium

9:00 AM-12:00 PM

8:00 AM-9:00 AM

April 24, 2013

Western Region

Buffalo PC

400 Forest Avenue, Butler Bldg

Buffalo, NY 14213

Auditorium


Buffalo PC

Auditorium

2:30 PM-5:30 PM

5:30 PM-6:30 PM

April 25, 2013

Albany

NYAPRS

Hotel Albany

1:30 PM-2:30 PM

April 29, 2013

Saratoga

CLMHD

Holiday Inn

Saratoga

10:45 AM-11:15 AM

May 2, 2013

Long Island

Pilgrim PC

998 Crooked Hill Road

West Brentwood, NY 11717

Rehab Building #102, Auditorium


Pilgrim PC

Rehab Building#102, Auditorium

1:00 PM-4:00 PM

11:00 AM-12:00 PM

May 3, 2013

NYC

OPWDD

75 Morton Street

NY, NY 10014

Activities Center


Activities Center

10:00 AM-1:00 PM

2:00 PM-3:00 PM

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May 7, 2013

Saratoga

ACL Membership

Hilton

Saratoga

NYS Rehabilitation Association

Holiday Inn

Saratoga

12:30 PM-2:00 PM

3:00 PM-4:30 PM

May 8, 2013

Albany

Evening

Capital District PC

75 New Scotland Avenue

Albany, NY 12208

Large Auditorium

5:30 PM-8:00 PM

May 9, 2013

PEF

PEF

1168-70 Troy Schenectady Road

Albany, NY 12212

1:00 PM-4:00 PM

May 15, 2013

North Country

St. Lawrence PC

1 Chimney Point Drive

Ogdensburg, NY

Unity Building

Facility Staff Meeting May 14, 2013

Unity Building

10:00 AM-1:00 PM

5:00 PM-7:30 PM

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OMH Regional Centers of Excellence

Many participants in the Office of Mental Health’s (OMH) Listening Tour remarked that the decision

regarding where to locate the Regional Centers of Excellence (RCE) would be a very difficult one. Indeed

it has been. These recommendations have been shaped by forces of reform, an analysis of the current

OMH state-operated system, regional health care systems, the unique needs of each region and the

extensive feedback OMH received through the Listening Tours held throughout April and May, 2013.

The release of this plan marks the start of a multi-year implementation, which will commence in July,

2014. The multi-year plan will result in the creation of 15 RCEs, including three Forensic RCEs and two

Research Centers of Excellence. It is important to note that the RCEs will employ State staff who will be

assigned to the inpatient program located within the RCE (hospital) or to a variety of community based

services that will be located across the region. Community services will have administrative support via

“hubs” located in communities with significant population and historical service use. Facility catchment

areas are no longer necessary, and individuals will be free to access RCE care anywhere in the State.

Accountability in Implementation

Successful change in the state psychiatric system requires an accountable and transparent process. The

Medicaid Redesign Team process was highly successful as a tool to build stakeholder involvement while

driving needed change. OMH will use this blueprint in the implementation of Regional Centers of

Excellence. Teams known as “RCE Teams” will be established in each of OMH's five regions: Western

New York Region; Central New York Region; Hudson River Region; New York City Region; and Long Island

Region. Each RCE Team will contribute to the RCE implementation workplan, identify regional priorities

for community service expansion, develop regional outcome metrics, and develop alternative use plans

for state property in consultation with Regional Economic Development Councils, within the state fiscal

plan.

Each RCE Team will have shared leadership co-chaired by: an OMH Senior Executive, a County

Commissioner of Mental Health/Director of Community Services, and a community representative; all to

be appointed by the OMH Commissioner. RCE Teams will have up to 15 members (not including the co-

chairs) appointed by the Commissioner who represent a wide variety of stakeholder interests in the

mental health system. The RCE Teams will begin work no later than August 1, 2013 and must submit

their reports with findings and recommendations to the Commissioner and the Statewide RCE Steering

Committee by October 1, 2013. If the RCE Team is unable to arrive at a consensus, the Commissioner

shall make the final determination of the community-mental health supports to be developed for that

region. The co-chairs from each RCE Team will constitute the Statewide RCE Steering Committee with

responsibility for assisting the Commissioner with development of a final implementation plan for RCEs,

inclusive of each region's plan. The Commissioner will choose RCE Team members among those who

express interest in serving in this capacity.

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TABLE: 2017 – Full Implementation of Regional Centers of Excellence

Western New York Region

Regional Center of

Excellence


Community Service

Hubs

Great Lakes RCE Buffalo Adult, Child, Adolescent Elmira

Rochester

Buffalo

Western New York

Forensic Center of

Excellence

Rochester Forensic Adult

Central New York Region

Regional Center of

Excellence


Community Service

Hubs

Empire Upstate RCE Syracuse Adult Ogdensburg

Utica Child and Adolescent Binghamton

Utica

Syracuse

Central New York

Forensic Center of

Excellence

Marcy Forensic Adult, SOMTA Statewide Outpatient in

Prisons

Ogdensburg SOMTA

Hudson River Region

Regional Center of

Excellence


Community Service

Hubs

Capital District RCE Albany Adult Albany

Lower Hudson RCE Orangeburg Adult, Child, Adolescent Orangeburg

Middletown

Poughkeepsie

Westchester County

Nathan Kline Research


Orangeburg Adult

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New York City Region

Regional Center of

Excellence


Community Service

Hubs

Greater New York

Children’s RCE

Bronx Child, Adolescent Bronx

Queens Child, Adolescent Queens

Brooklyn

Manhattan

Dix Hills (Serving Nassau

and Suffolk)

Bronx RCE Bronx Adult Bronx

Upper Manhattan

Brooklyn RCE Brooklyn Adult Brooklyn

South Beach RCE Staten Island Adult, Adolescent Staten Island

Brooklyn

Lower Manhattan

Queens RCE Queens Adult Queens

New York Psychiatric

Institute Research


Manhattan Adult Washington Heights

Manhattan Forensic


Ward’s Island Forensic Adult

Long Island Region

Regional Center of

Excellence


Community Service

Hubs

Island RCE Brentwood Adult Brentwood (ServingNassau and Suffolk)

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Western New York

The Western Region, which is bordered by Lake Erie, Lake Ontario, Pennsylvania, Canada and the

Niagara River, covers 13,000 square miles and has a population of three million people. Consisting of 19

counties, the region is a mix of urban, suburban and rural communities. The Western Region is alsohome to the Native American Nations of the Seneca, Tonawanda, and Tuscarora.

State Fiscal Year 2014-15: Establish the Great Lakes RCE.

Buffalo Psychiatric Center, Western New York Children’s Psychiatric Center and the Elmira Psychiatric

Center will be merged into one center known as the Great Lakes RCE. All adult and children’s inpatient

capacity will be located at the Great Lakes RCE at 400 Forest Ave, Buffalo, NY. The Great Lakes RCE will

have 158 adult inpatient beds, and 36 child and adolescent beds. Rochester PC will begin transforming

to a Regional Forensic Center of Excellence, merging adult inpatient capacity with both the Great Lakes

RCE in Buffalo and the Empire Upstate RCE in Syracuse; this action is to accommodate expected patient

choice in locations for accessing inpatient care. Outpatient and community services currently operatedby Buffalo PC, Western New York CPC and Elmira PC will be continued as community hubs of the Great

Lakes RCE. In fulfilling the vision to develop a strong network of highly specialized community services,

the Great Lakes RCE will look to expand services at these hubs located in Buffalo and Elmira as well as

Rochester. Community services will be targeted to individuals with the most complex mental illness and

may include mobile treatment, crisis services, respite, mentoring, employment and specialized housing

stability supports.

The Great Lakes RCE will be positioned as a national leader in providing best practices, research-based

care and a broad array of innovative psychiatric and addiction services for children, adolescents, adults,

and seniors at every stage of their recovery. The Great Lakes RCE can affiliate with the State Universityof New York at Buffalo’s academic medical center, as well as with other colleges and universities in the

region. It will be a training site for psychiatric residents, psychology doctoral interns, pharmacy doctoral

interns, and will provide advanced training and research opportunities for a wide variety of mental

health and related professions.

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State Fiscal Year 2015-16: Expand the Great Lakes RCE to include inpatient and community services

for the Greater Rochester area and establish the Western New York Forensic Center of Excellence in

Rochester.

Rochester PC will continue its transformation to a Regional Forensic Center of Excellence. Adult

inpatient and adult and child outpatient and community capacity at Rochester PC will be merged into

the Great Lakes RCE. The RCE will then have a total adult inpatient capacity of 208 beds located at theGreat Lakes RCE in Buffalo. Community and outpatient services will be operated by the Great Lakes RCE,

but will remain in the Rochester area. The Great Lakes RCE will continue to operate community and

outpatient services in community hubs located in Erie County, Elmira and Rochester.

The Rochester Psychiatric Center campus will be transformed into the Western New York Forensic

Center of Excellence operating 55 forensic inpatient beds in 2015-16 and 155 beds by 2016-17.

Central New York

The OMH Central Region consists of 20 counties with a combined population of nearly two million

people. This region is bordered by Lake Champlain and Vermont on the east, Canada and the St.

Lawrence River on the north, Lake Ontario on the west and the State of Pennsylvania to the south. 17 of

the counties are considered rural and 14 of those counties have a population of fewer than 100,000

residents. This region is also home to three Native American Nations (Oneida, Onondaga and St. Regis

Mohawk) as well as a very active and growing military base (Fort Drum).

State Fiscal Year 2014-15: Establish the Empire Upstate RCE and the Central New York Forensic Center

of Excellence.

The Greater Binghamton Health Center, Hutchings

Psychiatric Center and the Mohawk Valley

Psychiatric Center will be merged to form the

Empire Upstate RCE, extending from the

Pennsylvania State line to the Canadian border.

The Empire Upstate RCE will have two inpatient

campuses, one serving adults with a capacity of

185 in Syracuse and a second in Utica with a capacity of 75

beds serving children and adolescents. As discussed in the

overall plan, the elimination of catchment areas is expected

to result in more individuals from the easternmost counties

in the North Country choosing to receive inpatient care at

the Capital District RCE. In anticipation of this service migration,

one adult inpatient ward currently operated at St. Lawrence

Psychiatric Center will be moved to the Capital District RCE in

2014-15.

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The RCE will provide a rich network of specialized community services to residents throughout the

region when community and outpatient services operated by Binghamton, Hutchings and Mohawk

Valley merge into the Empire Upstate RCE. Importantly, community-based services will operate via hubs

located in Binghamton, Utica and Syracuse. Community services will be targeted to individuals with the

most complex mental illness and may include mobile treatment, crisis services, respite, mentoring,

employment and specialized housing stability supports. Empire Upstate RCE will build on the long

standing affiliation OMH has enjoyed with SUNY Upstate Medical University’s Department of Psychiatryfor training new psychiatrists in care for both adults of all ages and children. Also, this affiliation

provides opportunities for training nurses and social workers through annual rotations and internship

programs. In addition, with close proximity to Syracuse University, professional training and research

opportunities can be shared.

The current Central New York Psychiatric Center will be transitioned to the Central New York Forensic

Center of Excellence maintaining its inpatient and outpatient services.

State Fiscal Year 2015-16: Expand the Empire Upstate RCE to include inpatient and community

services for the North Country.

St. Lawrence PC will be merged with the Empire Upstate RCE. Inpatient capacity for children will be

expanded by merging child and adolescent inpatient services with a capacity of 90 beds which will be

located at the Empire Upstate RCE in Utica. Outpatient and community services currently operated by

St. Lawrence PC will be continued as a community hub of the Empire Upstate RCE. In fulfilling the vision

to develop a strong network of highly specialized community services, the Empire Upstate RCE will look

to expand services at these hubs located in Binghamton, Utica, Syracuse as well as Ogdensburg.

Community services will be targeted to individuals with the most complex mental illness and

may include mobile treatment, crisis services, respite, mentoring, employment and

specialized housing stability supports. The St. Lawrence Psychiatric Center sexual

offender program will continue operating in Ogdensburg but will be operated by the

Central New York Forensic Center of Excellence.

Hudson River Region

The OMH Hudson River Region consists of 16 counties, representing a total

population of 3.4 million people. The region is comprised of a highly

concentrated metropolitan area in its southernmost counties, with a less

densely populated northern region surrounding the Capital District and the

City of Albany.

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State Fiscal Year 2014-15: Establish the Capital District RCE, the Lower Hudson RCE and the Nathan

Kline Research Center of Excellence.

The Capital District RCE will be created in Albany. This RCE will expand the inpatient capacity available in

Albany to 161 beds. This will be accomplished through the relocation of one adult inpatient ward from

St. Lawrence PC to accommodate an anticipated increase in the number of North Country residents

likely to choose inpatient care in Albany due to the greater ease in traveling via the AdirondackNorthway. Albany will also serve as a community hub, providing services for adults and children for the

northern part of the Hudson River Region, and beyond as needed.

Rockland Psychiatric Center and Rockland Children’s Psychiatric Centers will merge to form the Lower

Hudson RCE located in Orangeburg. Inpatient service capacity at the Lower Hudson RCE will stand at 430

for adults and 45 for children and adolescents. Outpatient and community services currently operated

by RPC and RCPC will be continued as community hubs of the Lower Hudson RCE. In fulfilling the vision

to develop a strong network of high specialized community services, the Lower Hudson RCE will look to

expand services at these hubs located in Middletown, Poughkeepsie, Westchester and Orangeburg.

Community services will be targeted to individuals with the most complex mental illness and may

include mobile treatment, crisis services, respite, mentoring, employment and specialized housing

stability supports.

OMH will establish the Nathan Kline Institute Research Center of Excellence through conversion of NKI,

also in Rockland County, which is closely affiliated with New York University. This facility has earned a

national and international reputation for its pioneering contributions in psychiatric research, especially

in the areas of psychopharmacological treatments for schizophrenia and major mood disorders, and in

the application of computer technology to mental health services.

Both the Capital District RCE and Lower Hudson RCE will benefit greatly from previously established

academic affiliations with Albany Medical Center, and through a unique academic research collaborationwith New York University. There may also be opportunities for collaboration with the nearby Veterans

Affairs Hospital in Albany.

State Fiscal Years 2015-16 and 2016-17: Continue transition at Lower Hudson RCE. Shift Mid-Hudson

Forensic PC capacity to the Western NY Forensic RCE and the Manhattan Forensic RCE.

Mid-Hudson Forensic Psychiatric Center currently operates in a facility that is nearing the end of its

useful life, with an estimated capital reconstruction cost of $220 million; an option that OMH and the

New York State taxpayers cannot afford. To maximize the use of high quality existing space and to

provide greater geographic coverage for forensic services, OMH will shift the inpatient capacity from

Mid-Hudson to Forensic Centers of Excellence located in Rochester and Manhattan in 2016-17. Mid-

Hudson will no longer operate inpatient services.

The Rockland PC Residential Care Center for Adults (RCCA) will be converted to two Transitional

Placement Programs (TPPs) in 2015-16.

Lower Hudson RCE will operate with a capacity of 405 adults at full implementation in 2016-17.

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New York City

* Community hubs will be located throughout the boroughs

New York City consists of five boroughs, each of which is a county of New York State. With a population

of approximately 8.3 million individuals within just more than 300 square miles, this is the most densely

populated major city in the US. As many as 800 languages are spoken in NYC and 36% of the city’spopulation is foreign-born.

State Fiscal Year 2014-15: Establish the Greater New York Children’s RCE, the Bronx RCE, the Brooklyn

RCE, the Queens RCE, the South Beach RCE and the New York Psychiatric Institute Research Center of

Excellence.

The New York City Children’s Center (NYCCC) – which involved the merger of the Brooklyn, Bronx and

Queens Children’s Psychiatric Centers in 2012-13 – was developed ahead of its time. In essence, NYCCC

already serves as a RCE for children, by reducing reliance on institutional inpatient care and expanding

outpatient services to meet the needs of children and their families in the community. The NYCCC and

Sagamore Children’s Psychiatric Center will merge to form the Greater New York Children’s RCE (GNYC

RCE) with a total inpatient capacity for children and youth of 172 beds located in Queens and the Bronx.

Outpatient and community services currently operated by NYCCPC and Sagamore CPC will be continued

as community hubs of the GNYC RCE. In fulfilling the vision to develop a strong network of highly

specialized community services, the GNYC RCE will look to expand services at these hubs located in

Bronx, Manhattan, Queens, Brooklyn and Dix Hills. Community services will be targeted to individuals

with the most complex emotional disturbances and may include mobile treatment, crisis services,

respite, mentoring, employment and specialized housing stability supports.

Given the population size and the borough-based health care delivery system in New York City, OMH will

establish a RCE for adults in each of the outer boroughs of New York City. This will result in the following

RCEs being established with the following inpatient capacity for 2014-15: Brooklyn RCE, 140 capacity;

Bronx RCE, 156 capacity; Queens RCE, 344 capacity; South Beach (Staten Island) RCE, 300 adult and 12

children’s capacity; and New York Psychiatric Institute Research CE, with a 62 bed capacity. Manhattan

Psychiatric Center will begin the transition of adult inpatient and outpatient capacity to other New York

City RCEs for adults and begin the transition to a Forensic Center of Excellence.

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To achieve a shift from an over-reliance on inpatient care to community-based care, the newly created

RCEs in each outer borough will also serve as hubs for community services throughout each respective

borough. Additionally, the Bronx RCE will also serve as a hub of community services for northern

Manhattan and South Beach RCE will serve as community hub for lower Manhattan. The RCE Team for

this region will consider the unique service needs and assets throughout New York City’s boroughs to

develop effective community hubs.

In anticipation of developing a Forensic Center of Excellence, Manhattan PC will begin to merge its

inpatient capacity to RCEs in other boroughs of New York City, and will have an adult inpatient capacity

of 153 beds in 2014-15.

OMH will establish a Research Center of Excellence through conversion of the New York State

Psychiatric Institute in Manhattan, which is closely affiliated with Columbia University. This facility has

an international reputation as a leader in mental health research. New York City RCEs will also continue

to strengthen ties with academic institutions throughout the City to train medical professionals in

mental health treatment settings and transfer research-driven and evidence based practices to mental

health service settings.

State Fiscal Year 2015-16: Establish the Manhattan Forensic RCE and expand South Beach RCE,

Brooklyn RCE and Queens RCE.

Manhattan Psychiatric Center will complete the merger of all adult inpatient capacity to other New York

City RCEs for adults and, together with Kirby Forensic PC, begin the transition to the Manhattan Forensic

RCE. The Manhattah Forensic RCE will have a capacity of 368 beds located on Ward’s Island by 2016-17.

Brooklyn RCE will have inpatient capacity of 165 beds and Queens RCE will have 394 bed capacity by

2015-16. South Beach RCE will develop further through 2015-16 with a capacity of 275 adult beds

beginning in 2016-17.

Long Island

Long Island consists of two counties, Nassau and Suffolk, accounting for 2.8 million people; it is also

home to two Native American Nations, the Unkechaug , and the Shinnecock. Nassau County borders

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New York City, and has a highly concentrated population extending to the eastern portions of Suffolk

County. There is a great deal of movement between counties on Long Island, and between Long Island

and New York City, which has allowed for a highly developed and rich provider network. Its fixed borders

have contributed to high urban concentrations in many areas.

State Fiscal Year 2014-15: Establish the Island RCE and Combine Children’s Inpatient and Community

Services with the Greater New York Children’s RCE.

Pilgrim Psychiatric Center will be transitioned to the Island RCE, reducing the historic over-reliance on

long term inpatient care with a capacity of 335 beds in 2014-15. This will also involve expansion of

services through a community hub in Brentwood to serve Nassau and Suffolk county residents, to build

upon the large State/community network established in Long Island in accordance with

recommendations from the RCE Team. Pilgrim is well situated as the Island RCE, as it provides a

continuum of inpatient and outpatient psychiatric, residential, and related services serving Nassau and

Suffolk Counties.

All inpatient services currently provided by Sagamore Children’s Psychiatric Center will be merged into

the Greater New York Children’s RCE to be located in Queens and the Bronx. Outpatient and communityservices currently operated by Sagamore CPC will be continued as community hubs of the GNY RCE in

Dix Hills. In fulfilling the vision to develop a strong network of highly specialized community services,

the GNY RCE will look to expand services at these hubs in Dix Hills, serving Long Island. Community

services will be targeted to individuals with the most complex mental illness and may include mobile

treatment, crisis services, respite, mentoring, employment and specialized housing stability supports.

To further its development, the Island RCE can strengthen its ties with the nearby State University of

New York at Stony Brook’s Department of Psychiatry to enhance psychiatric training and research

opportunities. It will also re-engineer its inpatient programs to provide more short term, state of the art

care for complex psychiatric cases with quick discharge to supportive community services whererecovery will continue in a person-centered, strength-based environment.

State Fiscal Year 2015-16: Continue to develop the Island RCE.

Island RCE will expand community services; adult inpatient capacity in Brentwood will be 310 by the end

of 2015-16. The RCE Team for Long Island will focus in part on community residential options for the

many individuals with chronic medical issues and extended lengths of stay who would be better served

in residential settings with integrated physical healthcare and nursing services.

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Forces of Change - Challenges and Opportunities for New York State

We can offer far more to New Yorkers with mental illness by breaking down the walls between facilities

and communities, and focusing on collaborative and integrated care that utilizes the strengths of our

workforce and those of the community provider system. This contrast is perhaps most evident in looking

at those who are served: 717,000 New Yorkers receive mental health services from the public mental

health system each year; only 10,000, or 1.4% of those receive care in our state psychiatric centers,

while accounting for 20% of OMH spending.

While much great work has already been done to make our inpatient facilities more responsive to the

needs of all those we serve, we face many additional challenges beyond the day-to-day operation of the

largest psychiatric hospital network in the nation. Our entire state and national healthcare delivery

system is shifting beneath our feet, and it is our collective obligation to take this opportunity to align

state psychiatric services to succeed in this rapidly changing environment. Not only is adapting-to-

change a necessary business strategy for any 21 st century care provider, but there are many key

opportunities and innovations that may - for the first time - allow us to move beyond an acute diseasesafety-net model, to one truly person-centered and recovery-oriented system of care for all New

Yorkers.

Challenges

The challenges in operating and sustaining the current OMH facility system increase with each passing

year. While State budget appropriations have remained nearly flat since 2008, operating costs naturally

rise due to built-in cost inflators and long-term contractual obligations. This means that each year,

reductions in spending on OMH State Operations must occur to avoid cuts to the community. Such State

costs include maintenance, rehabilitation, and construction of facilities to maintain hospital

accreditation and insure the safety and well-being of staff and individuals served. However, reductionsto State Operations have reached a tipping point – it is no longer sustainable to operate and maintain

state inpatient care in its current form. Every year that true reform and transformation of the State

facility system is delayed, even larger out-year budget gaps are created, which then limits our ability to

invest more substantively in the mental health system as a whole. As providers, consumers, families,

and governments; we are really all in this together.

“Oneida County’s response to the closure of two adult wards at the Mohawk Valley Psychiatric

Center and the transfer of one ward to Hutchings Psychiatric Center in Syracuse has demonstrated

that opportunities often come gift-wrapped as challenges and also that when dedicated state and

local professionals work as a team, the end result of their diligence is success.”

Linda Nelson, Commissioner- Oneida County Department of Mental Health, on the 2012 restructuring

of adult inpatient services in the Mohawk Valley

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New York State is also under tremendous pressure to rapidly and radically transform the way we serve

people with disabilities of all kinds, in order to comply with the United States Department of Justice’s

enforcement actions pertaining to the Supreme Court’s 1999 Olmstead v. L.C. decision. As of April 2013,

there were forty-four (44) federal litigation matters in twenty-three (23) different states by the Justice

Department to enforce the law that people with disabilities be not only served in the most-integrated

setting appropriate, but also that states’ policy and financing plans promote independence and equal

treatment for people with disabilities as a whole.1 New York is one of those twenty-three (23) states,

and as part of a broader strategy, Governor Cuomo created the Olmstead Implementation Cabinet via

Executive Order #84 to develop an Olmstead Implementation Plan for the State of New York.

Transforming New York State’s mental health system around the principles of most-integrated-settingservices and supports is not only clinically and morally imperative; it is also the law of the land.

Challenging the efforts to support independent community living, many New Yorkers with disabilities

have been “priced out” of affordable housing, as fair market rates for studio and one-bedroom

apartments have surpassed most SSI recipients’ entire monthly stipends. While many on SSI cannot

afford an $800 per month rent, at what point did it become preferable or acceptable to instead provide

these same individuals with housing in a psychiatric institution at a cost of $800 per day? The answer to

this question, relating to affordable housing and residential development will factor largely in the effort

to transform the State mental health system.

A final threat to the sustainability of OMH’s institutional footprint is the need for OMH facilities to

become financially viable and sustainable as Medicaid Redesign and the Affordable Care Act move

individuals with mental illness into managed care plans - a move toward achieving the “Triple Aim” of

better care, better health, and lower costs in health and behavioral healthcare delivery. OMH inpatient

facility services will become part of the managed care benefit package for people requiring these levels

of care in 2014, but they must offer a value worthy of the price. Unlike the current arrangement in

which New York taxpayers continually “deficit fund” the operating losses incurred by both government

and private providers, managed behavioral healthcare will not be expected to pay for care that does not

offer sufficient value with the limited dollars that will be available to pay for a beneficiary’s care. Under

the future “capitated” payment system, a managed care organization will be allocated a set amount of

1Bagenstos, S. (2013). Presentation to NYAPRS Executive Seminar, Albany NY, April 25, 2013.

While many on SSI cannot afford an $800 per month rent, at what point did it

become preferable or acceptable to instead provide these same individuals with

housing in a psychiatric institution at a cost of $800 per day?

Every year that true reform and transformation of the State facility system is

delayed, even larger out-year budget gaps are created, which then limits our

ability to invest more substantively in the mental health system as a whole.

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funds to provide all health and behavioral health services necessary for each individual for whom they

are responsible. As managed care plans will be responsible for securing any services an individual may

need, it is unlikely that they or the covered individuals will be able to afford the current price of state

facility care for extended periods of time.

While it is uncertain whether $800 per day will be the market price for inpatient mental healthcare inthe future, it is clearly unlikely that outcome-driven managed care organizations will pay this rate month

after month as the State currently does for hundreds of individuals who spend months, if not years in

facilities. As we aim to “level the playing field,” in the mental health services sector, State psychiatric

center services will not be exempted from the financial and quality demands of a managed care

environment. If world class mental health services are the expectation for the hundreds of thousands of

New Yorkers whose lives are touched by mental illness each year, we must find a way to provide such

care within the new realities of a rational healthcare financing system.

Opportunities

Accountable Care Management and Mental Health Parity

While the transition to managed care will apply financial and programmatic pressures in all service

sectors, it will now be done so to reward quality care and outcomes. This is an incentive for

collaboration rather than isolation; for recovery, rather than service-in-perpetuity. As much as it is a

challenge, it is also a great opportunity. In addition to the regulatory flexibility afforded under a

managed care “waiver,” which will allow for the coverage of less conventional non-medical model

supports, there will also be clearer lines of accountability for care which will create incentives for

managed care entities to coordinate care, and monitor quality and consumer satisfaction. These effortsto create a more accountable and coordinated system of care are underway not only in mental health,

but across all health services, including physical health and substance use disorders. Under these new

structures, individuals will experience their health care in a whole new way, benefitting from increased

communication among health care providers, more seamless referrals, improved access to care, and

more effective care coordination and management.

The movement to managed behavioral healthcare is not new, nor is it an abrupt shift for New York

State. Many behavioral health services have been and currently are managed by traditional managed

care organizations, including outpatient mental health and rehabilitation programs. Secondly, OMH,

with the Office of Alcoholism and Substance Abuse Services and the Department of Health have been

ramping up the management and monitoring of behavioral health treatment and coordination services

with Health and Recovery Plans (HARPS)- a multi-phase initiative to prepare individuals with mental

health or substance use disorders for transition into a care management environment. The first phase

of the initiative has focused both on educating OMH, local governments, providers of mental health

services and insurers about the components of high quality managed care for individuals with serious

mental illness and substance use disorders; and also on improving coordination among providers of

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physical and behavioral health services. The second phase will involve moving into a risk-based care

management environment, set to take place in 2014.

Managed behavioral healthcare has also become a more urgent policy matter as New York implements a

Health Insurance Exchange pursuant to the Affordable Care Act (ACA), which will provide insurance to

an estimated additional 1.7 million New Yorkers through premium subsidies, public insuranceexpansion, and enrollment assistance. The Exchange is a federally-mandated, standardized marketplace

and eligibility clearinghouse for health insurance that will be required under the federal “individual

mandate” for most New Yorkers beginning on January 1, 2014. The Exchange is relevant to mental

health service transformation because all Exchange plans are required to offer mental health services at

parity - in accordance with New York State’s Timothy’s Law and the federal Mental Health Parity and

Addiction Equity Act. New York is building a statewide strategy for affordable and accountable managed

behavioral healthcare that should benefit all New Yorkers, regardless of the name or logo on their

insurance card. Under the ACA, a whole new set of doors are opening that will allow thousands of

additional New Yorkers to obtain access to mental health coverage for the first time.

The movement to full managed care is only one of the broader reform opportunities for addressing

prevention, treatment and recovery of mental illness. In fact, there are many initiatives currently in

progress or fully implemented at this point, which set the stage and provide a broader community

safety-net for the transformation of our mental health system of care and the creation of Regional

Centers of Excellence. These include Health Homes which will transform and expand the role of care

managers for people with mental illness while integrating physical health treatment and chronic disease

management. Also, through the early detection and intervention strategies deployed under the

Collaborative Care initiative and Project TEACH, primary care physicians will play a stronger role in

helping prevent and manage mental health issues before they become serious and chronic. Through our

major efforts to develop and cultivate peer support, employment, and housing, our entire mental health

system of care has worked tirelessly to pave the road to recovery and independence for the thousands

of people we serve.

Mental Health Parity

Mental health parity refers to the concept that mental health disorders and the treatments they

require should be afforded the same level of coverage and cost-sharing as for physical health. New

York State has a State parity law (Timothy’s Law) which requires coverage for mental health disorders

for all commercial group plans, and also sets minimum requirements for such coverage. Consumers

are also protected under federal parity laws, which extend even greater protections for policyholders

in New York while expanding the reach of both the State and Federal parity requirements to all plans

provided under the upcoming Insurance Exchanges.

While Parity has advanced access, individuals continue to struggle with the quality and availability of

provider networks and service authorization processes.

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Continuity of Employment and Leveraging the Skills of the OMH Workforce

There are many assets within the State operated system upon which Regional Centers of Excellence can

be built; including a highly skilled workforce, world-class scientific research, and a service infrastructure

that can offer more value to consumers in regionally and locally-integrated settings.

OMH employs thousands of direct service and support staff within the twenty-four (24) facilities, and

thousands more are serving consumers in community-based clinic, care management, and residential

programs across the State. This workforce is skilled, experienced, and diverse - they will be extremely

valuable in redirecting service and support resources from facilities into communities to offer all

consumers best-in-nation care through a smaller inpatient footprint and a broader community system of

care. Additionally, OMH’s two world-class research institutions can support these transitions by assisting

all programs with the development and implementation of evidence based practices, such as AssertiveCommunity Treatment (ACT), Wellness Self-Management (WSM), and Individual Placement and Support

(IPS), to name only a few. While some retraining of the current workforce will be necessary to align the

current skill sets to a more community-integrated and recovery-oriented regional system of care, OMH

has the technological and scientific resources, along with the motivated workforce to accomplish this

goal.

Conclusion

It is important to recognize that the forces of change are already well upon us, and the failure to adaptand change ourselves will result in far fewer opportunities to help people with mental illness realize

recovery and their potential. With the help of a strong peer and recovery community, people with

mental illness are empowering themselves to determine their own fate and path to recovery - in

whatever terms they choose. As a State, we have already made many changes to the way we operate

and where we make services and supports available, in part because most people do not want to live in

large institutions. They want choice and control over where they live, work, socialize, and access

services. This lowering of demand for institutional services is also the result of many years of thoughtful

planning and policy which has reduced the primary need for institutional care, through the development

of local services and supports that help people stay where they are rather than remove them from the

community: mobile crisis, peer bridgers, respite services, community support teams, and a range of supportive housing and residential programs.

With Regional Centers of Excellence, OMH will further enhance these community networks, while

including state facilities and staff in this broader network of care to acknowledge the reality that the

majority of individuals impacted by mental illness can pursue recovery effectively in the community.

Through the enhancement of initiatives to improve mental health care quality and the provision of

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supports in the community, the reliance on inpatient, specialty care will continue to diminish. New

York’s Regional Centers of Excellence will move our State from the “casualty model” of mental health

care that waits for problems to arise and then offers expensive and extensive treatment in inpatient

settings. Instead, mental health care in New York will continue its inexorable evolution toward a more

accountable, coordinated, early intervention model that supports people to live successfully in the

community through the highest quality mental health care and supports.

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Be the Change Spotlight- Oneida County

by Linda Nelson, Commissioner- Oneida County Department of Mental Health

Oneida County’s response to the closure of two adult wards at the Mohawk Valley Psychiatric Center and

the transfer of one ward to Hutchings Psychiatric Center in Syracuse has demonstrated that opportunities

often come gift-wrapped as challenges and also that when dedicated state and local professionals work as

a team, the end result of their diligence is success.

“What has impressed me about the work done by the Oneida County Department of Mental Health and

the state Office of Mental Health is the tremendous focus on making this transition work for the people

who depend upon the mental health system. What I have seen from their work is that our community has

made a very big step in the transformation from the era of institutionalization of patients to a well-

developed community care system. I know there is always more work to be done, but the work done to

date is an outstanding example of service to the community,” said Oneida County Executive Anthony J.

Picente, Jr.

Roughly one year ago, upon learning of the change, Oneida County embraced the opportunity to closely

analyze the impact this would have on the continuum of care and the provision of services. We were

particularly concerned about the impact on the three area 9.39 hospital inpatient units. We gathered data

on admission rates, length of stay and overall occupancy rates. To date, there has been only a slight

increase in these areas. We did, however, have several issues to resolve in learning how to better partner

with Hutchings given that they were further away and new players and processes were required. The

Department of Mental Health continues to facilitate meetings to assist our local hospitals.

The overall question that we were forced to tackle initially was; where could we best intervene within the

outpatient system to divert patients from long term, expensive hospitalization?

With helpful, consistent technical assistance from the OMH Syracuse Field Office, it was determined that

there were two points in service delivery where we could make a difference in avoiding emergency room

visits and long term inpatient stays. The two points are at the crisis level and the forensic level given that

patients who do not receive adequate care end up either in the emergency rooms or in jail.

Based on our analysis and data, we proposed that additional funding would be required to meet these

shortages that would emerge as a result of the closures.

We proposed hiring four additional staff for the Mobile Crisis Assessment Team (MCAT). Expanded

coverage at the 911 Emergency Response Center would place a crisis worker there for the majority of

hours to be available to the dispatchers and callers to diffuse the situation and determine if law

enforcement or the crisis team or both need to be activated. Additional MCAT staff is used to stabilize

and prevent crises from re-occurring, provide suicide prevention and intervention and a variety of peer

supports. We will measure effectiveness of these efforts and the desired outcomes include: a reduction in

the number of individuals re-hospitalized within less than 30 days, improved cross systems response to

crises, improved training for crisis responders, and an increase in utilization and compliance with

outpatient mental health services.

Resources were also allocated to support a transportation program for family members from Oneida

County visiting patients at Hutchings Psychiatric Center.

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At the forensic level, we proposed expanding services to support diversion and post-release services and

case management within the Utica Mental Health Court. Discharge planning done at Oneida County jail

will be followed up by forensic case managers who pick up where the jail discharge planners leave off.

We anticipate that this will improve the compliance rate for engagement in community supports, reduce

homelessness, reduce recidivism rates and re-involvement with the criminal justice system and reduce

emergency and inpatient treatment. These staff are not housed at the jail but in the community. Theyarrange transportation, home visitations, attend case management consultations with providers and serve

as the liaison between providers and mental health staff at the jail and monitor the court process. A

specific and specialized Mental Health Court case manager performs assessments, refers accepted

candidates to appropriate service providers (including mental health, addictions, housing, medical,

financial), develops and implements individualized service plans, attends case consultations, and acts as

the liaison with the broader mental health system and Mental Health Court.

Additionally, Oneida County will enhance the Adult Single Point of Access and Accountability

(ASPOA/A) services to function in a more coordinated, efficient manner which will serve to divert

unnecessary referrals to emergency departments and inpatient admissions. We will accomplish this

through coordinating and managing related data and developing an integrated database and reportingsystem to coordinate services based on an analysis of the data. This integrated data set will include the

receipts, distributions, openings and closing of over 1,000 referrals annually for care coordination and

residential services, approximately 2500 annual hospital admissions and discharges, reports on Mental

Hygiene Law 9.41, 9.45 and 2209 custody transports which together totaled over 1433 in 2011. The

department is also responsible for the oversight of approximately 20 Assisted Outpatient Treatment

referrals, and approximately 55 Criminal Procedure Law 730 examinations annually.

This integrated database will provide an accurate view of the service history of the most vulnerable

individuals. The county department of mental health will serve as the “Hub” of critical information to be

available to the larger community to coordinate services.

The people we serve are those who benefit from these enhancements, which have been funded by the

State Office of Mental Health and implemented in a partnership that does not worry about turf, only

results. We continue to operationalize the various components as partners. We look forward to measuring

the effectiveness of our efforts and will make needed adjustments. What has been developed by the state

and the county is a major step forward for not only our agencies, but above all for our communities and

the people in them.

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Documents

rceplan