Category Archives: privatization of public health system

NYS OMH’s Multicultural Advisory Committee (MAC) meeting


I participated, together with other members of The Citywide Mental Health Project (Bert Coffman was wearing his many hats), in the MAC meeting (via phone conference) this last Tuesday. What follows is my personal take on the meeting discussions. These are the headings:

Who attended the meeting?

Where are the consumers?

Topics discussed

SH, crime in SH and licensing

Changes to the SH Guidelines = No CAB (consumer advisory boards)?

Who attended the meeting?

Ms. Moira Tashjian, Director of OMH’s Housing Development department attended the meeting by invitation of the committee, although I have the distinctive feeling that OMH wants her to be in this cultural committee, even though housing per se is not a ‘cultural’ issue directly. If I understood correctly, she will be attending the monthly MAC’s phone conferences. I welcome her participation and consider it a plus for us to be able to ask questions directly to officers of the OMH.

There were three (?) providers of supported housing (SH) services from different NY regions: Mr. Huygen from the NYC area, I didn’t get the names of the others, sorry.

Where are the consumers?

Apart from me and my group (Bert Coffman was wearing his many hats), there were no other recipients of services or their representatives. This is a salient point given that this ‘advisory’ committee, as all State and citywide mental health ‘consumers advisory boards’, are for the purpose of ‘giving recipients a voice in our mental health-policy-making system’. I’m sure you can guess why I put those words in curly marks. Read my document The elephant in the NY State mental health system if you can’t guess it.

The lack of consumers (I will call them ‘recipients’ from now on because ‘consumers’ does not describe what we are in this system) participation, in my view, make these boards de facto tools for the providers. Do they need these policy tools when they already have trade organizations and high paid lobbyers, and when they DIRECTLY help write many of the rules that affect us?

I know that Mrs. Frances PriesterMoss (coordinator) is trying to increase recipient’s participation in the committee. I have some ideas that would guarantee participation, but it requires for Ms. Tashjian to help us with the CABs in the programs. More on this below.

Topics discussed

SH, crime in SH and licensing

Ms. Tashjian informed us about all the new projects for housing for the mental health community. I believe her report will be made available soon for public information. She also went over what I call OMH’s SH ‘licensing’ scheme. As some of you know, I have asked her to explain to the public why more than three-quarters of housing are being privatized by un-licensing them, and to tell them that unlicensed means not regulated and no legal rights for the ‘tenants’ in it.

I didn’t get the answer I was awaiting from her. Actually, the whole enchilada about SH and unlicensed housing got more entangled when she discussed the issue of what level of ‘functioning’ is required for each category of housing.

Some of the providers brought the issue of recipients with history of violence been referred for SH. Ms. Tashjian alleges that a history of violence and low functioning are not impediment for acceptance into SH. I claim she is in the wrong there.

OMH is as explicit about levels of functioning requirement for each housing modality as its contradictory actual practice is. Just go online and read OMH’s RFP (request for proposal), each requests spells what type of ‘population’ a particular SH project is made for. This issue of housing people with severe mental health problems in SH, which is for people more ‘stabilized’ and able to function in the community with less supervision (that’s why OMH makes them ‘unlicensed’)  has been discussed in court many times, the last time was in the DAI v. NYS OMH case.

I didn’t want to raise the issue due to not enough time, but I did mention that this policy of housing people with violent history makes the CABs in the programs a necessity so that we can help the providers develop ways to cope with the situation.

I asked her if she was aware of the May incident where a recipient of SH in Brooklyn was murdered INSIDE the building by the woman’s also SH recipient lover. She said she ‘heard’ about it. Did anyone blink? Was the incident reported, as mandated,  to her for investigation on quality of services (could it have been prevented, etc.)?

Look, there is not enough housing to comply with OLMSTEAD, so OMH has been ‘dumping’ (excuse the expression) everybody everywhere. Just as it did when the people demanded to close the chambers-of-torture called psych hospitals of the 1970s; the state dumped the patients to the street. Now, they dump everybody in the few housing. OMH doesn’t care about the ‘unintended’ consequences of its policies. The courts tend to protect them.

There is not enough housing (money goes to ‘stupid wars’), it’s a policy issue. We NEED to discuss this policy as a community.

 Changes to the SH Guidelines = No CAB?

The SH Guidelines will be “updated”, according to Ms. Tashjian, (shall we say) ‘modernized’ to live up to the new millennium (my words). Are the current ‘guidelines’ that state that providers of SH must allow for consumers to participate, this is a direct quote, “in the policy making of the program” to be eliminated?

Ms. Moira brought this information about the changes when I asked her if she could help us to make providers comply with that guideline. She said that she needed to do more “research” about these CABs. I asked her directly to tell me if she was intending to eliminate that particular guideline; her answer was that she couldn’t answer at this point until she reads the guidelines.

When I asked her if she is mandated to inform the recipients about these changes or call for public comments before making the changes, she said that “the providers will be informed”. The context of the answer is that the “SH Guidelines” is for the providers. Whatever changes made will affect you without your consent or knowledge.

I think I also told her that I would consider eliminating the CAB provision to be a BETRAYAL to us recipients of mental health services. I may have used the word “BACKSTABBING”, I don’t remember which one I used. I was just blown away when she mentioned the changes to the guidelines. You can imagine.

None of the providers took a stands to protect the CABs.  I hope they were as blown away as I was and will stand with us if OMH tries to eliminate the CABs provision.

But, more than anything, I hope that Ms. Tashjian has the presence of mind to NOT take a step that will be construed as an attack on our right to have a voice in the programs.

In a time when we are been blamed for the violence in our society, we need to INCREASE our voice, NOT TO HAVE IT SILENCED.

The CABs inside the programs would allow us to reach out for the recipients that OMH supposedly wants to be integrated in the policy decision-making system; it would allow us also to spread information to them. With the problem of lack of housing and having to mix recipients with differing ‘functioning levels’ CABs make more sense as a tool to help maintain quality of services. Working with the providers, the CABs could save $$ to the state by using the rich human power energy and experience currently going to waste and untapped in these programs. Voluntarism can be organized through CABs to improve quality of services.

The only reason I can see for OMH to eliminate the CABs is if they are afraid that we will bring to light all the issues of abuse, disrespect and neglect in the SH programs of all types.

Should they do it, it will confirm my claims that our mental health system functions within a culture of abuse.

Let’s work together to stop the stigmatization and abuse of people with mental disabilities.

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New York State Lags on Firing Workers Who Abuse Disabled Patients


In this NY Times article, Mr. Hakim seems to have understood that there is no point in arguing against the mental health system, or OMH/OPWDD. He threw the proverbial towel on them and is now focusing on the unions. The state came with a new law (Justice Center) that is more of the same loopholes to protect everybody but leave us VOICELESS. It’s a SCAM is what it is. The unions are the tip of the iceberg of the culture of abuse in the NYS mental health system.

Let’s be fair: the mentally ill is food for the big and small sharks equally.

Look, in ALL of the mental health system’s rules, old and new, the MANAGEMENT and PROVIDERS are off the hook from responsibility for abuses on the recipients of services. Abuses happen in their watch. Some of them are directly responsible for abuses, and most of them ENABLE the abuses. It’s what I call ‘the culture of abuse in the mental health system’.

Under those conditions, I too would want the union to stand for me if the supervisor, who knows what I do and laughs at it, is going Scot free.

The Justice Center was intended to stop the NY Times ‘complains’ AND to avoid the federal government from doing an investigation on the state’s practices. That explains why the Justice Center is WORSE than what we had before: now people THINK that SOMETHING was done with the issue of abuse when in actuality it’s worse.

Nothing was done. It just made it MORE DIFFICULT for us to report, and it provides MORE protection to the ‘providers’ and workers. There is LESS transparency.  See my comments to the Justice Center law in this blog.

OMH privatization of the mental health system, Cuomo’s surrendering the functions of government to the private sector, THAT’s where the problem is, politically speaking.

A policy system per logic has to put the responsibilities of failure of the policy on those who write and enact them. In this case, the NYS OMH/OPWDD system. Privatizing, reducing the mental health workforce and reducing their salary and benefits is a recipe for disaster. You can’t write ‘moral codes’ (as Justice Center pretends will do)  for those workers you hire  because, them been the lowest of the lowest, you know they are the cheapest.

I think Mr. Hakim should take a closer look at how the system protects the providers and managers. They are the one who must respond for their ENABLING abuses.

 

Cuomo Agrees to Plan for Housing Mentally Ill, Ending Legal Battle


This is breaking news in the NY Times. Cuomo Agrees to Plan for Housing Mentally Ill, Ending Legal Battle

This is an agreement to ´right´the wrongs committed by many NYS adult homes providers and that NYS judge that made that appalling decision in the case DIA v NYS-OMH etc in April last year. This agreement is a step forwards towards moving the people in those ‘homes’ of horrors to the community.

Am I personally happy and satisfied with this? I don’t go jumping with joy without first taking a quick glance to the text of the so-call ‘agreements’ and new laws to ‘protect’ people with disabilities of all kind. Why? Because one thing are the sound bites we get in the media about how great a new law is, another is the TEXT and the IMPLEMENTATION.

Now, with this agreement, everybody relaxes and forget about it. Just like with the Justice Center, we will assume that the government is looking to protect us. Nothing happens unless you threaten the government. Not even this agreement, the result of years of court battle with the state.

OK. I will NOT sour your joy. IT IS A STEP in the right direction.

I will tell you where we must put caution in this agreement.  You can read the agreement on your own here courtesy of Judge David L. Bazelon Center for Mental Health.

Suffice it say that the agreement WARNS those Adult Homes providers previously caught abusing the mentally ill that they should not interfere with their residents in this process of moving them out, or they ‘will be punished’. Adult Homes are going to lose $$ and they want to keep their houses of horror filled. That there is a NEED for a warning to them should tell you a LOT. (See page 8, part 4 in the agreement.)

First quick notes:

From “definitions” (pages 4 and 5):

1. You have to be 65 years old or under to qualify for the benefit of the agreement.

2. The agreement MAY take 4 or 5 years to be completed. If you are 62 now and you HAVEN’T been relocated within the next two years, you may not qualify anymore. Or at least the agreement doesn’t clarify that. This is a question that those of you in Adult Homes (AH) MUST ask the people involved in this agreement.

3. As usual, the agreement applies to AH that are LICENSED, per Social Services Law Article 7. If you are in an unlicensed one, you may have problem qualifying for the agreement. YOU MUST SEEK CLARIFICATION ABOUT THIS.

4.  AH with LESS than 80 beds do not qualify for the agreement. It (“transitional AH”) has to have 80+ beds AND  a “mental health census” of 25%. If you are in a small AH, you may want to confirm that it qualifies for the agreement.

5. “Impacted” AH are those in NYC with 120 beds or more AND a mental health “census” of 25%  of the population of the AH.

MENTAL HEALTH STATUS: Not so fast baby.

To qualify, a mental health evaluation to measure your level of functioning will be implemented. This is where the ENACTING may go astray, leaving people who are not dysfunctional ‘enough’.

1. Must have a mental diagnosis based on THE MOST RECENT DSM book.  I would say, tread with caution here.

  • ‘what if I my diagnosis is not in the book anymore? They removed some and added new ones.’ See my point?

2.  Excluded from the agreement are people with developmental disabilities, mental illness due to brain damage, and “SOCIAL CONDITION”. I’m as lost as you are on that last one. Looks like a loophole to keep people in. Must check the DSM bible for clarification.

3. “Must have a  SUBSTANTIAL FUNCTIONAL disability WITHIN the PREVIOUS 24 MONTHS before the date of the agreement.” Do you know what a “substantial”  functioning disability means? I suggest you look it up if you want to get out of there. Plus, it is ‘within’ the last 24 months of the agreement. Better check it out how that may affect you too.

4. Who will determine your disability, your substantial functional levels that will ALLOW them to put you in a supported housing?

  • a determination by SSA that you receive benefits due to mental illness will not be enough.
  • A “Health Home agency” AND a  MLTCP (managed long-term care Plan) will be in charge of the process of evaluating your qualification for the agreement. Even if SSA says you are disabled, these people may determine that you are not ‘substantially‘ dysfunctional and may disqualify you. See #5, subsections (b) i and ii on page 5.

So don’t assume that you automatically qualify to be relocated out of the AH just because you are there.

“PERSON-CENTERED PLAN”. Where have I heard that before??

Right, those of us in Supported Housing (SH) are struggling with “person centered support”. Welcome to our struggle. But, I will NOT deny that chances are that, if you make it to a SH, you may be better off than there. Just don’t come here thinking ‘wow, I made it. I’m out of danger’. Nope.

Now, I couldn’t find the dates for the agreement. If any of you find that info, please, forward it. It’s important to you, if you are in one of those homes,  because of the transition schedules. You don’t want to be left out.

My take about this:

1. This is a good step forward.

2. ALL THESE PEOPLE who are coming to the community are going to face the reality of what we have here: SH is over 80% unlicensed. This means, you have NO LEGAL PROTECTIONS there. People centered treatment does not exist. It’s a craps shoot.

3. the ‘culture of abuse’ that exists in those AH will relocate in the community, following our new ‘freed’ peers, with those workers who will get jobs from there to here.

4. TODAY MORE THAN EVER  we need to ORGANIZE our people. For ‘people centered ‘ services we NEED TO BUILD THOSE CABs.

5. Never has the state given ANYTHING without a fight. The NYS WILL BE crying ‘BROKE’ to avoid completing this agreement and creating housing for them. If you want to trust them 100% despite what history shows us, fine.

This is my first reaction to the agreement. Sorry if I sour your joy. I doubt it, though.

CONGRATULATIONS TO THE FORMER DIA.

GOOD WORK.

Welcome And good luck for those of you moving here to the community ‘with us’.

Like we used to say in the ’60s: the struggle continues.

The elephant in the NY State mental health system’s room.


elephant

At the invitation of Mr. Stephen Freeman, CEO of the YAI, I made a presentation at their YAI International Conference here in NYC on May 7. The topic I chose, of course, was what I call the ‘culture of abuse’ in the NY state mental health system. I thank Mr. Freeman for inviting our group to the conference. Personally, this was my first experience participating in an activity of this importance. It was a learning experience for me, and a pleasant one too.

What follows is the material I handed out (revised) in the presentation. It is also in word format in the ‘our documents’ tab on the top of the page.

THE CULTURE OF ABUSE 

INTRODUCTION

The Citywide Mental Health Project is a recently created New York City grassroots group of consumers of mental health services and their supporters. Our work is focused on:

a) stamping-out the culture of abuse and mistreatment that exists like a tattoo in the body of our state’s mental health system (MHS), and

b) Opening a public discussion about how this culture of abuse is enabled and legalized by the regulatory policies enacted by our state’s mental health agencies.

Why the focus on abuse and not on any other of the many problems in the system, like funding cuts?

1. Because, as we speak, the culture of abuse is inflicting, with impunity, horrific abuses, mistreatment and humiliation upon many of us, people with all types of disabilities, in some programs and residences where we go seeking mental health services, not abuse. People have actually been killed in the hands of callous providers of ‘mental health services’.

2. Because the mental health agencies have made it a taboo in our community the discussion of the problem of ‘institutionalized abuse’. This taboo denies credibility to the victims of these abuses and mistreatment who come forward to tell their experiences.

3. Because this public silence dis-empowers us, it denies us the right to self-advocate to protect our physical and mental integrity, our personal, civil and human rights, and literally for our lives. It still rings true what was said in the 1980s: “silence = death”.

Yes, services and funds are needed, but must we suffer harm and humiliation, or die in order to get them in the programs? Our community is doing an excellent work at addressing the other problems. The problem of the culture of abuse needs to become a priority too, exposed as part of a broken system that wants to hide the fact that it has killed people and continues to threaten our lives with its indifference to our pleas for fairness in treatment.

Are people with disabilities more vulnerable to abuses and mistreatment than other groups of people in our society?

Yes. Our own state legislature stated it clearly in the beginning of its new Protection of people with Special Needs Act passed last year:

they are vulnerable because of their reliance on professional caregivers

 to help them overcome physical, cognitive and other challenges.”[1]

The Citywide Mental Health Project believes to eliminate this culture of abuse we need to start by breaking the taboo.

Breaking the taboo: exposing the culture of abuse

Apart from The Citywide Mental Health Project speaking up about this, there is neither public conversation nor outrage in our community about the following outrageous facts:

Fact #1: For nearly ten years (2003-2012) the NY Times have been writing about abuses and corruption in our mental health system, culminating with their investigative series ‘Abused and Used’. Those abuses took place in both licensed and unlicensed facilities run for the state by both non-for-profit and for-profit providers. In other words, the abuses are embedded in the mental health system. We have found no reports or investigations by the NY state about those articles.

Fact #2:  In response to the articles, the Federal Commissioner of the Administration on Developmental Disabilities investigated and concluded in her December 2011 report[1] about the NY State’s protection and advocacy (P&A) system that:

  • People with developmental disabilities (pdd) and their families were excluded from the state’s P&A board.
  • That no efforts were made to reach out to them.
  • That the state has failed to protect its pdd from abuse and mistreatment.
  • That the state is in violation of the Developmental Disability Act.

Fact #3: The state agencies mandated to protect people with disabilities, ignored all those years theirs and their families pleas for help, even as the abuses were being made public. Yet, all agencies reported, and continue to report in their ‘evaluation’ of quality of services and other reports[2], that “90%” of consumers are ‘happy’ with services and with the “multiple layers of protection”[3], even in facilities where abuses are rampant.

Fact #4: State agencies like the Office of Mental Health (OMH) and the Department of Health (DOH)  appears frequently in court as co-defendant with abusive providers[4], or defending them.

Our governor confirmed indirectly that the culture of abuse has continued 40 years after Willowbrook by saying the following as he celebrated the creation (in response to the federal report) of the new NY State Protection of People with Special Needs Act:

New Yorkers with disabilities and special needs for too long have not had the protections and justice they deserve.”[5]

Who else but the state and the state’s courts could have denied them that protection and justice to which they have a right?


[5] http://www.governor.ny.gov/press/05072012-first-to-protect-special-needs

Explaining the taboo: money, but of course!

Taboo: a social custom that does not allow people to talk about matters that are considered embarrassing or offensive to others for fear of retaliation or punishment.

It is the state of NY who would be embarrassed if its citizens started to discuss publicly how it continues to abuse its people with disabilities years after Willowbrook.

Legally enabling abuse

The New York State’s constitution obligates the state to protect its people with disabilities, and the federal government also mandates it to do so as a condition to receive their funds. The state created its mental health agencies to carry out that obligation. But these agencies have failed miserably, decade after decade, to comply with their obligations.

In what could be considered a violation to the NYS mandate to license all providers of mental health services[1], the Office of Mental Health (OMH) have passed regulations to un-license (de-regulate) more than half of all the providers. It does it to relive the agency of its oversight and monitoring duties. OMH has also passed regulations reducing the providers’ accountability for their bad quality of services by legally eliminating the standards of care: from ‘high’, as mandated by the NYS mental health laws, to ‘minimum’ standards[2].

And here it is:

These agencies distribute the federal and state funds to all non-for-profit “care givers” as payment for their services. Who dares, at the risk of losing their funds or jobs, to speak up publicly to denounce these agencies as enablers of the abuse in which some callous providers engage, and sometimes as complicit with them? Mr. Jeffrey Monsour, for one, dares.[3]

“He was one of the people interviewed and featured in   a 2011 series of articles by The New York Times examining problems of abuse and corruption within the system.
Since then, the state has pursued a tenuous disciplinary case against Mr. Monsour, and it also tried to pressure the State Senate to disinvite him from a panel discussion. In an editorial last year, The Times Union of Albany criticized the state for its “muzzling” of Mr. Monsour. “

The taboo in our community to discuss the culture of abuse is the result of the fear of losing funds, jobs and prestige.

To be fair to many of our state legislators and some good judges in our courts, they cannot keep up trying to patch up the holes that these agencies continue to put in the intentions behind much good legislation. It is in the implementation by these agencies where the problems start.

[1] see on-omhs-unlicensed-policy https://thecitywidementalhealthproject.wordpress.com/our-documents/

[2] As above.

[3] http://www.nytimes.com/2011/08/22/nyregion/cuomo-administration-continues-to-pursue-case-against-jeffrey-monsour.html

Outcomes from the culture of abuse

“People with developmental disabilities [PDD] and their families were excluded from the state’s P&A board; no efforts were made to reach out to them.”Disempowerment through exclusion

Social exclusion is a process that leaves individuals or entire communities (like the disabilities community) systematically blocked from exercising their rights, from opportunities and from consistent access to resources. Healthcare, civic engagement, democratic participation and due process are considered ‘resources’. These are normally available to members of society and are the key to social integration.

For example, federal laws mandate that the board of the state’s protection and advocacy system be composed in its majority of people with disabilities and their families. This right gives these people the opportunity for ‘civic engagement’, to take part in the decision-making process about how the state is to protect them. But the state denied these people this opportunity when it purposely excluded them from the board, as we saw in the federal report, denying them the right to protect their interests.

The result of this exclusion from participating in our state’s mental health system is always disempowerment and alienation of the people with disabilities. Is the ADA and Olmstead still alive? If the answer is ‘yes’, then it seems as if the state has violated both. With the doors closed on them, the state escapes scrutiny and, as a domino effect, the whole system falls into lawlessness. But you don’t have to see it; it’s all behind the curtain of ‘lack of information’.

We, The Citywide Mental Health Project, believe that our ‘disabilities’ do not come from whatever illness we may have. They come from a mental health system that perpetuates with its own actions the stigma that people with physical or mental illnesses are inferior people who must be excluded from participation in the democratic process, denying them the right to protect their interests. This must change.

The opposite of ‘exclusion’ is ‘inclusion’: let’s get in!

The evidence that we are excluded from the system and its P&A is there. It shows that this exclusion is at the root of our two main problems: been abused and lack of voice in the system. We need to be included in order to change all of this. But included to do what and where?

We want to have a voice in the programs we attend so that we can protect ourselves from unprofessional practices passed as ‘quality of services’. We want to do the following in our programs through our Self-Advocates groups or Consumers Advisory Boards (CABs):

Policy-making in action

1. Give feedback about the quality of the services we are receiving from the program.

  • To identify persistent problems we and our peers are experiencing in accessing the services, and to present solutions
  • To identify what is working appropriately and to our satisfaction.
  • To discuss how the goal of person-oriented services is working.
  • To let the providers know how they are succeeding in achieving their stated mission and goals.

In organizing their own feedback process, the Self-Advocates will learn the real meaning of programmatic requirements such as “quality of services”, “compliance with regulations”, and other important terms.

2. Review an existing grievance procedure or develop one if none is in place in the program:

  • A grievance procedure must be meaningful, capable of addressing and resolving our complaints in a timely fashion.
  • It must guarantee that we can discuss problems about interactions with the staff or the administration without fears of being humiliated, ignored, or punish for coming forward with a complaint.

In reviewing the grievance procedures, the Self-Advocates will have the opportunity to learn important information about their rights and how to make them count.

All of the above describes exactly what ‘policy-making’ is all about. All of that and more is what the various laws invite us to do. The only barriers on the Self-Advocate’s path to learn to do this are: that people underestimate our capacity to learn how to be an active citizen, and that our mental health system does not want us to take part in this process. ‘Accountability’ is a term despised by the agencies and by some providers, but it is in our interest to learn to hold them up to it.

You CAN learn this and more. Your Self-Advocate group can prepare a plan to self-train each other on how to monitor and evaluate the services you receive. You will need to work with other groups and professional advocates who can help you prepare your self-training about policy and the feedback process.

Self-Advocates learn and keep updated by sharing information in their group, and at their own pace. But learn they do!

Gov. Cuomo’s new Protection and Advocacy System: Do we REALLY need to be protected??


I asked myself that question while I was at the state-wide video hearing last Friday about the Gov Cuomo’s proposal to create a  new P&A system. From the Metro area,  The Citywide Mental Health Project were the only ones there. More than shocked or upset, I was saddened by the lack of interest in our community and the public at large on the issue of abuses perpetrated on people with disabilities.

You would have thought that, after all the brouhaha about abuses and the gun control laws that promise to curtail the few rights we have left, after all those state reports about privatizing the functions of our government, which will make abuses a mere ‘collateral damage’ that comes with the imperative to make profit, you would have thought that after all that there would be a long line to get inside the conference room. Nope.

The situation I described was the same in other state counties: few brave souls showed up to speak up their minds. Many were able to articulate their lack of hope in the ability and willingness of this new system to protect people with disabilities. DIA was there, in another county; some people with developmental disabilities stood up to speak up  for themselves. The father of a son who was killed in one of this institutions was there. I wish I could speak to him; his comment was stripped of pleasantries and went to the root of the matter. His statements were very much what we at the Citywide have been saying about how the system is failing us.

Where is our community? It seems that our community and the society at large trust that the Governor, because he is a democrat, is doing everything right to help us.

Anyone who knows about politics knows that ‘trust’ in politicians is like trusting ice will keep your water cool for a long time. (Think about simile.)

Even if I grant good-will in the intentions behind this new P&A system, politicians make (GULP) mistakes. And one thing is the INTENTION behind the policy, another is the IMPLEMENTATION.

We are still here, the Citywide, trying to keep the issue in the open. The discussion of abuses is TABOO in our mental health system; we need to break that taboo.

Waiting for a miracle will not change things. We need to stand up and start speaking about this issue.

And if you are happy and have not experience abuses and mistreatment then, let those who have and want to denounce the abuses in the system do their work.

We can’t continue to cry ‘foul’ every time some story of abuse is published in our mainstream media and then go back to our state’s  ‘councils’ where nothing is done about anything without the consent of OMH or the city.

Organizing to secure funds for programs is a priority, but so is our lives and mental health.

We need to organize to make the system SAFE for us. It will not happen by magic.

Lourdes

Gov. Cuomo’s ‘Intent to redesignate the Protection and Advocacy Systems’ proposal


For those of you interested on this, there’s a copy of the proposal on  ‘Our documents’ tab up there for you to download.

The Citywide Mental Health Project will, hopefully, make a testimony on this proposal on April 9.

Happy readings.  (smile)

Pay for Success: A ponzi scheme?


This is a follow up to my post Unmasking Pay for Success . Here, I think I have succeeded on showing that this  is nothing but a Ponzi Scheme. It’s based on how pay-for-success has been applied in the UK. It’s dry material and, as usual, long. But if you bumped into this post and don’t read it, don’t say later that you weren’t warned about the truth behind ‘pay for success’.

I still have another part on this next week. It’s about how Pay for success is being applied here in the USA. I hope you find this interesting and informative. Links are at the bottom.

“PAY-FOR-SUCCESS”: ANATOMY OF A PONZI SCHEME

“UK building integrated impact investment marketplace”

Over there they call it “outcomes-based financing”.

“These contracts allow the government to outsource the provision of a service [privatize the functions of government] to impact businesses or other private-sector contenders and only pay for that service once a defined set of outcomes is delivered.”

Now, who in its right mind would want to get into that type of business: you get paid only if you deliver, for example, a sober alcoholic? Sure, it started with services for the unemployed and released prisoners, but it is moving to ALL social services, including mental disabilities and children and alcoholism services. Social services and human behavior cannot be shaped into ‘asset instruments’. Somehow, though, Wall Street will find a way to do it.

“Changing government procurement practices: Outcomes-based financing”

[I had to look it up: procurement = acquisition of good and services from an external source. Very complicated topic too.]

Payment-by-results contracts

 The suppliers – those companies that will be commissioned to find employment for the target populations – are paid on a staggered basis, reflecting achieved outcomes: there is an upfront fee, a job outcome fee once the individual is employed, and a sustainment fee once the individual has maintained the employment for a given period.”

The “upfront fee” is an issue for me. How much is it? How about the “sustainment fee”?

“Importantly, the sustainment fee is meant to make up a “substantial” portion [quote provided by JP] of the total amount the government will pay5, and the government will not pay anything should the outcomes not be delivered.”

There’s another scheme, more ‘attractive’ than that one:

Social Impact Bond

Creating the social malady and then profiting from the pain?

Creating the social malady and then profiting from the pain?

“raising GBP 5mm in a bond whose payout is linked to the government savings achieved by reducing recidivism at Peterborough Prison. Notably, unlike traditional bonds, investors stand to lose their full principal should there be no reduction in recidivism6 since, similar to the Work Programme contract, the government will not make any payment if the defined outcomes are not achieved.

Wait! Don’t run yet to Wall Street to buy these bonds. A bond is a bond. It means that the government is BORROWING. Bonds are DEBT the government owes. Caught in a lie once again. Our government says that ‘pay for success’ is a ‘win-win’ situation because it takes care of social services without engaging in debt. Yeah, right.

But let’s see how JP gets out of this unattractive risky bond business where you are bound to lose everything if you play with them

Risk transfer.

.

“Understanding the risk transfer inherent in outcomes-based financing”

You can bet on it: there’s INHERENT risk in ‘pay for success’. And it gets “transferred” to somebody by somebody. To whom down the pyramid do you think the transfer is more likely to be passed on? Think, then read.

“Transferring risk to the right recipient”

“The Social Impact Bond transfers the impact delivery risk (and hence the risk of financial return) from the government to third-party investors who provide capital to the service providers and take the risk that outcomes may not be achieved.

Did you get that? The big financial institutions who provide the capital is the one [gulp] who stand to lose their money in the bond scheme. What are the chances that JP will want a piece of that losing action? Of course not. JP compares this bond thing with the other scheme:

“By contrast, the Work Programme’s payment-by-results contracts transfer the impact delivery risk from the government to the service provider.”

Uhm, “the provider”? Does that means YOU, Community Access? Aren’t you laughing yet? Let’s see what JP says is necessary before signing the dotted line for these contracts, given these risks:

Both working capital and risk capital are required to win these contracts

“…delivering on these contracts requires working capital to cover operating costs until payments are received, and risk capital to cover the risk that outcomes are unsuccessful (and no program payments are received).”

THE PONZI SCHEME

And from where do you, my little small- business -entrepreneur -non-for-profit get that money?

“each procurement contract is meant to engage a Social Investment Partnership comprising a financial sponsor (or consortium of sponsors) who will then engage one or more service provider8. This arrangement enables the impact business to transfer the risk to investors,

Follow King Midas.

as in the case of the Social Impact Bond. The next natural question is: how much risk are investors willing to take on these new

THE NATURAL QUESTION??! HELLO! No wonder Bloomberg said that he and his billionaire pals HAVE to infringe on our freedom! PLEASE DO! Don’t let me INVEST THERE! We don’t know what we are doing!…………….Ok, enough banter.

So, at the end, the risk was passed on to the low-level investor, not the ‘senior’ investor. Does Ponzi scheme come to mind? It should.

But no, it doesn’t end there. Keep reading.

OF PONZI SCHEME DREAMS YET TO BE REALIZED

“Finding the right risk and return profile”

[This is the part where the cookie crumbles.]

“Some market participants have anecdotally provided feedback that the pricing does not sufficiently capture the additional cost of the hardest to reach outcomes [IT’S NOT PAYING!], and some fear this will lead service providers to focus rather on the easiest to employ populations. In both instruments, the upside is capped while the downside is not, and the probabilities of realizing the impact are yet to be determined.

Broken dreams.

Broken dreams.

It’s not working. No ‘social impact’ = no meaningful jobs created and recidivism not reduced = no payment to small investors = no money saved: a loss-loss situation.

And what do you think the big financiers will ask the government to do with this losing ‘initiative’?

“More risk-sharing with the government could reduce the downside exposure,”

This “pay for success” will end up with ALL  the risks being passed on to the government, the small level investors and the service provider, and of course, to what is left of  the middle class. The government is there to serve and protect the financial market. This is the JP evidence:

“Engage cornerstone investors, like Big Society Capital”

“With the aim of growing the impact investment sector more generally, the government established Big Society Capital (“BSC”) in July 201112. Backed by a projected GBP 600mm in capital, this organization is designed to provide financing directly into impact investments and also to invest in infrastructure and initiatives that would encourage faster market growth.”

When a government ‘invests’ 600 million bucks to help ‘big capital’ (the ‘society’ in between Big and Capital is there to cover ‘big capital’), you know it is doing EVERYTHING and ANYTHING for them. The government will buckle down and take the risk and put no controls, as they do today when privatization comes with no monitoring.

ON WALL STREET BUILDING YOUR BUSINESS…WITH GOVERNMENT $$

Now, all of this business is supposed to save “tax payer” money by asking businesses to take on the functions of government and to be willing to be paid if and when the service delivers the outcome. No money ahead, supposedly. Well, take a look at how the government will have the responsibility of building a business, from the ground up, take loans for this business, take the risks eventually and let the profits go to the big capitals. If no profits, we lose, financial markets will be protected by the government.

“Ensuring impact businesses are ready to compete

“While the prospect of capital [provided by the government] will help to ensure that impact businesses can financially manage payment-by-results contracts, for example, they also need to be “investment ready” in order to access that finance.”

Basically, the government will put billions of dollars in the seed money, hire big corporations to “teach” the little ones (paid by the government)t and “de-risk” (JP’s term)  these adventurous capitalists by providing the money that will pay JP when the whole Ponzi scheme collapses.

I invite you to read that document. It’s lots of fun…not, but it IS interesting to see the calculating mentality of the greedy billionaires planning their next attack on the people.

This post may be revised later.

Links:

Goldman to invest in NYC jail program

The JP Morgan document:

Counter(Imp)acting Austerity: The global trend of government support for impact investment