Public investments in mental health services are needed to deal with worsening mental health connected to, among other things, the pandemic, economic anxiety, rapidly changing technologies, and global geopolitical distress. On the latest episode of Policy Outsider, Rockefeller Institute Senior Fellow for Health Policy Courtney Burke and New York State Office of Mental Health Commissioner Ann Sullivan discuss the importance and timeliness of New York State’s $1 billion investment for mental health services in the 2023-24 budget. The conversation outlines what policies and programs will be enabled by the new funding and the people it will support.
Guests:
Courtney Burke, senior fellow for health policy, Rockefeller Institute of Government
Ann Sullivan, Commissioner, New York State Office of Mental Health
Transcript was generated using AI software and may contain errors.
Alexander Morse 00:04
Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Alex Morse. Demand for mental health services reached unprecedented levels during the COVID 19 pandemic. And despite the public health emergency formally declared over the need for mental health services continues to grow. To help meet the needs of New Yorkers, Governor Kathy Hochul proposed an investment of $1 billion in new resources, which was subsequently supported by the state legislature in the final enacted budget. To better understand the impacts of this historic investment, Courtney Burke, senior fellow for health policy at the Rockefeller Institute, and Ann Sullivan, Commissioner of the New York State Office of Mental Health, will outline many of the initiatives enabled by this investment, including the importance of adding new beds to provide necessary housing, innovative incentives to recruit and retain essential staff, and the state agency cross collaboration for the implementation of services for individuals with mental health needs, disabilities, substance use disorder, and much, much more. It’s a packed episode. So let’s dive right in and learn more about these continuing developments in mental health services. Coming up next.
Courtney Burke 01:35
Thank you, Commissioner for joining us today, it was very notable this year to see an investment of this size in mental health services. So I’m glad that you could join us today to talk about that investment in more detail. So why don’t we start with housing and the new beds that are coming online over the next couple of years, if you could tell us more about those beds, how many there are going to be where they’re going to be at anything else we should know about them.
Ann Sullivan 02:03
First of all, thank you so much for inviting me to talk about what I think it’s truly an incredibly exciting and historic budget from Governor Hochul. I mean, this investment in mental health I’ve never seen before. So I think that this is really exciting. And and housing, just as the first example, there are 3500 units of housing for individuals living with mental illness that will be coming up out of this budget. And that’s just extraordinary. The 3500 units kind of break down across the continuum of housing, from highly supervised housing, to really apartments in the community, where you can just maybe have a caseworker who comes by every now and then just make sure you’re doing okay, so it’s a full continuum of housing, which is really exciting. And one of the new pieces is a 900 of these slots will be for what we’re going to be calling transitional beds. And there’ll be for individuals leaving emergency rooms, leaving hospitals, and for some individuals may be coming directly from street homelessness into housing, something that’s called Housing First. And so that’s a new model that we’ll be putting out. All the beds will be across the state. And we’ve been looking at data as to where they’re most needed. And the RFPs, which we call request for proposals, for the beds will be coming out between the summer and fall of this year. So this is a rapid launch of these beds. And we’re just very excited about having really a safe and effective place for people with mental illness to live to recover, because housing is just so critical to recovery.
Courtney Burke 03:38
Absolutely. And it sounds like a full spectrum from how you described it from everything that you said for more intensive to really embedded in the community. So that’s exciting. And I guess we will look for that RFP that you mentioned this this summer. There were also some new capital investments and things like community residences, transitional step downs, comprehensive psychiatric emergency programs. Can you explain what those are in a little bit more detail?
Ann Sullivan 04:06
Yeah, across New York State, we’ve had something called a comprehensive psychiatric emergency program, which our emergency rooms focused on individuals with mental health problems. So basically, they are separate from a medical emergency room. And they have a whole host of services that are connected with them. For example, they have 72 hour observation beds, they have mobile crisis teams, they do follow up from the CPEPs, we call them CPEPs. And they’ve been highly effective in working directly with individuals with mental illness and taking some of the pressure off the medical emergency rooms. So we have money to expand those and we have over 20 across the state now we are going to be adding an additional 12 CPEPs and we’re looking at areas across the state where they could be most helpful. So I think that that’s also very exciting because it offers an opportunity for communities that have been struggling sometimes with overcrowded medical emergency rooms to have a separate space and place for a role called comprehensive psychiatric evaluation and includes adults, and then they can also include youth in CPEPs. So I think it’s those will be coming up throughout this year. And we’re working with, you know, preliminary discussions.
Courtney Burke 05:23
And that’s, that’s really interesting. I also noticed that there are some new changes related to the integration of services for people. So they may not only have a mental health need, but they may have a disability they may have needs for substance abuse counseling, can you tell us a little bit more about how that integration is going to occur, and with which agencies and which services?
Ann Sullivan 05:49
This is an area that in some ways we haven’t been as effective as we would like to be to be able to really make sure that individuals that have occurring substance use problem or a developmental disability, and that we’re going to be working extremely closely with the officer and substance use services OASAS with the OPWDD, which is the agency for youth with development and adults with developmental disabilities. And we’re also working with OCFS, Office of Children Family Services, for some of our youth who have sometimes gotten involved in criminal justice activities, and how to help them have appropriate services, etc, as well as some of the high intensity youth that might be seen by OCFS in their assessments. So I think all those agencies are going to be working together. And we’re going to be working together across all of the funding. So for example, we have CCB, something called Certified Community Behavioral health centers in the state, those certified community behavioral health centers, right now we have 13, we’re going to triple that number, which is huge to 39, that will serve an additional almost 200,000 people and families. And those services are required to have this integration. And we will be doing some specialized training to make sure that those certified behavioral health centers are capable of working with individuals with dual diagnosis is what we call it, individuals have complex problems. But then on the higher end, there are also individuals with those complex problems who need very intensive services. So when we talk about assertive community treatment teams, or care coordination teams, some of those will be specialized in working with these very complex individuals and families and helping them really get all the services they need in one place, and tied together so that they can really access care in an effective way.
Courtney Burke 07:45
Now, it’s nice to see the cross agency collaboration, particularly for those complex individuals has, and you’re right hasn’t always gotten the the attention and investment that it needs, so it’s good to see. It was also interesting to see that there are a lot of new requirements related to private insurance coverage. for behavioral health services, it looks like private insurers now are going to be required to provide some services that weren’t necessarily required in the past, like mobile crisis, critical time intervention, post discharges, sort of community treatment, and school based mental health. And our audience may not all know what those things are like critical time intervention or mobile crisis or assertive community treatment. So if you could explain those services in a little more detail, I think it is important for people to know that those services are now going to be covered.
Ann Sullivan 08:35
Yeah, this is a major initiative in terms of making sure that not just Medicaid covers certain services, but also that commercial insurers cover services. Because as we know, a large percentage of individuals with mental health issues are under commercial insurance. So there’s a couple of big pockets where we have gotten agreement and legislation that may make this happen. When we talk about emergency support services, those being covered by commercial insurance. A mobile crisis outreach team is one of professionals. A social worker, could be a psychologist could be a psychiatrist would come out into the home or into the place where the person is to help do a an assessment of what the problem is, and then offer solutions and offer treatment. So it’s really the mobile ability in a crisis to be out there providing services, that’s what a mobile crisis is. The ACT teams are something we used to call clinics without walls, where individuals again, are mobile, and will follow someone over time have in their needs for therapy, their needs for medication, etc. Because they can’t really navigate the more complicated system. So those are ACT teams, Assertive Community Treatment teams. They’re also going to be some intensive care treatment and right wraparound teams, which we’re calling critical time intervention for individuals leaving hospitals, or leaving emergency rooms. And again, they will provide immediate support for individuals who have been in enough of a crisis to need a hospitalization or to go to an emergency room and provide that support in the community, may be in the person’s home, or maybe in the place where they’re living, or maybe they could come for some services, but they will meet them at home for others. So it’s that flexibility of service, all those crisis services where individuals need something immediately and right now, those will be covered under both Medicaid and commercial insurance, as of 2025. So there’s a little bit of a delay for that to happen. There’s a variety of reasons for that in terms of the insurance companies getting ready, etcetera, etcetera. However, anyone who has any kind of crisis now can always call 988 and get the services they need. And that will be worked out somehow. So don’t worry, please don’t feel you have to wait till 2025. But the coverage by commercial will be they fully in 2025.
Courtney Burke 11:14
And that’s helpful to know, in terms of the timing. I just to follow up on the insurance issue. I also noted that there was the elimination of prior authorization during the first 30 days that someone is in an OMH license hospital. That sounds important to me. And I just wanted you to elaborate on why you think it’s an important feature.
Ann Sullivan 11:33
And just to clarify on the previous statements, on why we’re getting commercial insurance to now, hey, those services are available now. And some of them are actually funded by state aid, for example, the crisis, the CTI teams, crtical time intervention will be funded by state aid until we get the coverage. So I don’t want anybody to feel that those services aren’t there. But the big thing that happens in the budget was getting a commercial payer as of 2025, to actually pay for those services, which is really important. But the services are there for everybody. So please don’t think that. In terms of I just forgot, with the prior authorization, what’s really important about that is for the hospitals, to feel comfortable with admitting people and being ensured that they will be well paid, and that they will not be asked for information on a regular basis, which is really not necessary when someone wants a clinical decision has been made that someone needs to be in a hospital. This is not done on the medical side. And this is something that had become a practice that became pretty regular on the behavioral health side. So it became a parity issue, in essence, that hey, for behavioral health services should be similar to the way you pay for you know, going in for your appendix out or going in for a hip replacement. And there shouldn’t be a disparity in how that’s dealt with. So this enables that to be more clear, to insurers that basically, you don’t have to have a prior authorization to go into a psychiatric hospital in a crisis where you need to be there. And that you don’t have to give extensive information about why you’re there for up to a period of time. And that’s 30 days, which is perfectly reasonable. And I think most of the insurers who are working with us on medical necessity criteria, which we now have to approve, etc. I think this will just help reinforce that, that basically, we a psychiatric admission shouldn’t be treated very much like other admissions to the hospital.
Courtney Burke 13:34
Agreed. So another important topic is the mental health of new mothers outcomes for maternal health in the US are not good. I saw that there’s a provision to create a maternal mental health workgroup. Can you tell us more about what that group is likely to focus on and when it will be convened?
Ann Sullivan 13:53
Yeah, we know that up to 15% of women. Postpartum depression can be sized 15% of women who have a baby. And basically, it can be mild to moderate or it can be very severe. So it postpartum depression is something that we have to work for everywhere. And we have to make sure that we do appropriate screenings, and then we have appropriate treatment. So the the maternal health workforce will be working on those issues. This year, we already had a task force that worked on screening issues on trying to get out the information about how to best screen for maternal depression. screenings are paid for, for maternal depression, both by commercial insurers actually and by Medicaid. So basically, screening is step one. And I think that the workgroup will be looking at that and making sure that we have the right screening tools and the right information out there. The workgroup will also probably focus on stigma a bit because it’s still difficult sometimes for people to come for help even if they are feeling increasingly depressed or stuck or not able to feel like Everybody can be a little bit blue after birth. But you know, this is something which would last for days and weeks, um, individuals often feel disconnected from the baby feel like they can’t do it, they feel probably guilty all kinds of anxiety etc, those moms should have help readily available. And they should be able to talk with their pediatrician when they bring the baby for a checkup or to their OBGYN after they had the baby. And basically, the other thing which we set up is for the provider community too. You know, there are medications for depression that are perfectly safe during pregnancy and postpartum. And there’s sometimes there can be confusion about that. So something which we have established is something called Project TEACH, which means that any OBGYN can call and say, you know, would this be safe for my patient if I prescribe this? Any psychiatrists can call to double check if they’re not aware, any primary care doctor when they’re treating someone who’s had recently comes back for their primary care checkups, so that basically what’s safe when I’m breastfeeding, what’s safe when I’m pregnant, and that is free consultation that anyone can get. So it goes, we really want to make sure that because sometimes there have been outcomes that have not been good, because people have stopped certain treatments, because they think there’s risks to the baby, and there may not be. So I mean, if you were pregnant, and if you haven’t, you should really talk with your, either your OBGYN, if you have a psychiatrist or even with your pediatrician about how you’re feeling, and then get a consult. And maybe even if medication was something that might be interested in. Also therapy. There are other things that can be done, that there are very many safe ways to get very good help.
Courtney Burke 16:38
It’s nice to see attention to this issue, because it’s obviously very important. And what you mentioned was everything from screening to services to education. So that’s really great to hear. So another topic that’s been both a state topic and a national topic is staffing and the workforce shortages in healthcare more generally. So what is this budget do to invest in staffing?
Ann Sullivan 17:03
As you said, Courtney, this is a national problem, and usually would affect one profession, one group of individuals, but this time, it’s kind of reflecting the workforce in general. So there are a couple of things in the budget. First of all, this is the first time we’ve had to back to back COLAs, cost of living increases in our public mental health system, because these dollars go out to the clinics and etc, that we that we provide. So the first last year was 5%. This year, it’s 4%. So it’s a total of 9%. Over two years, while inflation has been significant. But really, that’s the commitment that back to back when we haven’t had COLAs for many years and not certainly not successive ones, is a commitment to the workforce. The other things we’re doing is a program enrollment forgiveness for individuals who will then work in the public sector, if they get their own forgiveness dollars. And we have, it’s about $9 million for and psychiatrists and nurse practitioners. But in this year’s budget, that was also an additional $5 million for social workers, psychologists, all the other professions to get loan forgiveness, and they get basically they get a certain stipend that pays off their loans. And then they work in the public sector. So that’s another incentive for them to work with us for a few years, post getting the dollars. And we’ve already put out almost two thirds of the first bunch for psychiatrists and nurse practitioners and these other dollars will probably come out sometime in the summer or fall for people to be able to access. So that’s one way to recruit people in. The other we’ve increased rates, clinic rates, we’ve increased and rates across the board for a lot of for pro for X those x teams, I was talking about four other things, and that was increasing rates help to bolster also the system. And then lastly, we’re doing some trainings, you know, people often come to a job because it’s a learning experience, especially younger individuals. So we’re working with the clinic system to decide what kinds of trainings we can provide. So for example, with youth on there’s something there’s a series of evidence based trainings, that focus on families, and they’re costly, you have to pay the person who developed them, and then you have to do the training. And then you have to do supervision. So we would pay for that pieces of it. We’re sending out an RFP for the clinics to apply for this. And then we would pay for that training part and the cost in order to get the rights to do the treatment center. That’s an incentive to keep people in the system and incentive for them to stay with us because we offer things like that. So there’s multiple pieces. And the last is that we are doing some scholarships with SUNY and CUNY for a diversity focused on trying to improve from people from marginalized and minority communities to join the workforce and then maybe give us some time afterwards and those scholarships We’ve already sent out some of them, and we’ll be continuing to send out those dollars. So there’s a number of initiatives to try to build the workforce. And also retain them keep people interested and wanting to work with us because they get education because they can get a reasonable salary. And they can also get some tuition reimbursement or some availability of scholarships to move on to other levels, etc. And then the last is to work on in how do we do better with expanding the workforce with paraprofessionals. And DOH actually got a title that will be paid for by Medicaid, which is, I don’t want to give it the wrong name. But it’s a paraprofessional, tied to something like a community worker. And we’re looking at how that might be also applicable to expand some of our ability to do some basic outreach and connection with people and maybe some mental health coaching of some sort. On that which we’re working on this so that social workers and psychologists they can work to the highest level of their license, and that they and then they can work maybe with a paraprofessional to assist in some of what they’re doing. So that’s another way to kind of expand the workforce much like physician assistants.
Courtney Burke 21:06
No, that’s quite a long list because it is a complex problem. So I’m not surprised that you had so many different approaches between the loan forgiveness, the increase in rates, the new titles, the training, the scholarships, all of that, which is, which is really great to see. So I don’t want to forget about a very important population, which is children’s services. And I think we saw during the pandemic, an increase in the need for mental health services for the youth population. So can you tell us a little more about what’s in the budget for children’s services?
Ann Sullivan 21:36
Yeah, I think the governor’s is also particularly focused on making sure that youth get what they need, especially post pandemic. I mean, this has been a time when we have seen a jump in the anxiety, particularly anxiety and depression among youth, cross cutting across the nation, post the pandemic, and also an increased use of emergency rooms, for suicidal ideation, etcetera. So it’s a critical time that we get the services out there. And one of the major initiatives is school based programs. We already have school based clinics in 1000 schools across the state, and we’re going to be significantly increasing that with startup funds. And a critical piece of that is that we increased the rate significantly for school based so that he can be financially viable, but also commercial payers will now have to pay for school based services. And that will happen as of January of 24. So that was really close. And basically, they will have to pay at the Medicaid rate, which means that basically, it will be a robust rate that will go to the schools. And why is that important, because it’s not just the contact with the youth, it’s going to be the contact with the family, with the teachers, with everyone else. So there’s a lot of collateral work that goes on in a school based clinic. And we’re also setting up the new school based clinics and will affect the older ones as well, with OASAS together so that we’ll be doing work with them on Drug Prevention Center, as well as mental health. So really integrated clinics in the school. So that’s, that’s a major initiative. In addition, we have a lot of prevention, which is being paid for the budget in terms of on just mental health first aid, for example, there’s a mental health first aid for adults, there’s also something called Youth Mental Health First Aid, and Youth Mental Health First Aid teaches youth so they can can come forward, but also they can help each other. So Youth Mental Health First Aid is something that we’re going to also be expanding, you know, across the state as as a prevention. So there’s the prevention efforts. And then there’s the treatment efforts. And then for youth and families that are in the highest level of crisis, there is an increase in those services as well. So something called for example, home based crisis intervention, which is, we’re going to be going up to close to 2800 slots, almost doubling the number of homeless crisis intervention availability across the state. So all that is very exciting in terms of a continuum, again, of youth services, making sure that the clinic services are there, the school based and very, very important, because I think that gives a time and wage and reach out just to youth will also be expanding youth in the community behavioral health centers will be expanding some clinic spaces, and then we’re doing intensive services. Also Youth ACT. Remember I mentioned those Assertive Community Treatment teams were the first state in the nation to have something called Youth ACT, which is using the same model for youth in the age ranges of about 11, 12 to 21. So that that youth across the span, and that’s we started last year where it’s further expanding Youth ACT teams has been a tremendous response to that in the community, and people have felt it’s been terrific. So this again, the whole spectrum would youth services as well.
Courtney Burke 21:48
No, that’s great. And we have covered a lot of territory today. And I’m sure you’re very excited about the investments It’s good to see them because there’s clearly a need out there. Is there anything that we did not cover today that you would like to mention before we wrap up?
Ann Sullivan 25:06
I would just like to mention the the work that we’ve been doing with the mentally ill homeless on the streets began a bit last year being continued through and further enhanced in this year’s budget. And basically, these are called safe options support teams. And we’ve also opened up additional beds and state system of 50 beds in the state system to work with these individuals more intensely. And we’re beginning to see some results from the safe option support teams that are working on the streets and in the subways. It’s taken a little bit of time, but almost 160 individuals who’ve been on the streets, many of them for years into permanent housing, and the individuals leaving our program, on the inpatient side, we’ve had more intense needs, so far, have been staying in permanent housing. So I think it’s, it’s really engaging people and providing what they need, where when they need it, and helping them see that there might be an alternative to living on the streets. And these are the individuals with serious mental illness who have often been on the streets for a long time. So I think we’re very happy that this is moving forward in the way it is. And there’s more money in this budget to even further enhance it and now expand the safe options support teams upstate. Because homelessness is not unique, by any means to New York City and our upstate cities had the same issues. And now we will be able to do it and rural areas have it. So be able to expand those teams across the state.
Courtney Burke 26:34
Right. Well, thank you, Commissioner for joining us today. This was very informative, a lot of good information about what’s in the budget. And we will see how those investments roll out over the next few months. So thank you again.
Ann Sullivan 26:47
And thank you so much for having us because I really do believe this is a time where we can really make a difference in the lives of so many New Yorkers. This is an incredible investment by our governor in mental health.
Alexander Morse 27:01
Thanks again to Courtney Burke, senior fellow for health policy at the Rockefeller Institute and Commissioner Ann Sullivan of the New York State Office of Mental Health for sharing insights into the programs and policies New Yorkers can expect as a result of the state’s $1 billion investment into mental health services. If you’d like to learn more about the Office of Mental Health and their programs, please visit their website omh.ny.gov. If you liked this episode, please rate subscribe and share. It will help others find the podcast and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcasts and transcripts are available on our website. Special thanks to Rockefeller Institute staff Joel Tirado, Heather Trela, and Laura Schultz for their contributions to this episode. Thanks for listening. I’m Alex Morse. Until next time.
Alexander Morse 28:19
Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York state and the nation. Learn more at Rock inst.org or by following at Rockefeller inst. That’s Rockefeller i n s t on social media. Have a question comment or idea? Email us at [email protected]
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