Tag Archives: mental health

Testimony at NYC Council Public hearing on DoITT Open Data


Note: The NY City Council held a hearing to get comments from the public on the first anniversary of the new Local 11, 2012 Open Data law, a law ‘championed’ by Mayor Bloomberg to have a centralized website for all city agencies to publish their activities, rules etc.  The purpose is “transparency” in NY city government. Well, if you believe that Mr. Bloomberg and our city agencies are interested in “transparency”, good for you.

From something which probably was conceived to create profit,  something very positive can be achieved. To create ‘jobs’ (a benefit of this ‘initiative’  claimed by the mayor) somebody has to get a contract to do the IT of this law, in other words, somebody is getting a huge profit from the city, which is the essence of ‘doing business as usual with the City’. Without implying impropriety, the mayor’s business is precisely information technology   and media, so he knows what it takes for doing business here.

But the “people” can turn this around and make this law a power tool for the regular citizens of this city.

That’s what those who testified yesterday are doing. It was an impressive hearing. My salute to Council members Mrs. Brewer and Mr. Cabrera for helping steering this ‘initiative’ the right (shall I say ‘progressive’) way. And to all those (young!) experts on digital, computing and information technology for the outstanding, let me repeat it, OUTSTANDING work they are doing to turn this fictional ‘transparency’ effort into a real transparency tool.

Information is power, go get it boys and girls.

As usual, I was  the one testifying with the least experience or knowledge  about the issue. What follows was my testimony.

Testimony presented by Lourdes Cintron for The Citywide Mental Health Project

New York City Council

                            Public Hearing on Oversight:

DoITT’s Administration of New York City’s Open Data

                                             November 20, 2013

Good afternoon. My name is Lourdes Cintron, the founder of The Citywide Mental Health Project, a grassroots group of recipients of mental health services, their friends and relatives striving to empower consumers to learn to monitor the quality of services they receive in their community mental health programs, among other goals.

We appreciate this opportunity you grant us to contribute our feedback on the topic of the NY City’s Open Data ‘initiative’. There is no data on mental health issues.

 

Technical aspects:

The website is confusing and, in my view, (as it is now) useless for the purpose stated in the law. For example:

a)       The icons for selecting data-format presentation are not ‘user friendly’, meaning they are ‘not enjoyable’. It requires high levels of computer and research skills to figure out which one to select, and once selected, the format is still confusing. I could not use it, even though I do have computer skills.

b)       As it is now, most of the members in my group do not have the skills to navigate this website’s graphical user interfaces if they needed to access the information supposedly available.  This website was designed for researchers, not for the general public.

Transparency issues:

Searching in the “Data catalog” box for mental health data is an exercise in futility. The search for either “mental health’ or “department of health and mental hygiene” gives you, both of them, “NYC’s famous Baby names” and “food vendors without permit”

Also, a search on “311” shows not a single call requesting information about mental health services or a single incident related to it. Almost all 311 reports since 2010 are related to vermin and rats. A researcher could easily conclude that rat infestation has no impact in the city’s mental health. This could matter for policy and budget purposes.

Finally, how is transparency achieved by publishing the names and addresses of citizens who committed minor infractions, e.g. names street vendors without permit, but neglecting to publish the names of big companies CEOs who have defrauded the city in the millions of dollars, like Mark Mazer’s of City Times, for example?

If ‘transparency’ is going to be dependent on reported meaningless data, and if (quoting from the law) “the city does not warrant” the “completeness, accuracy, content or fitness for any particular purpose” of the data published, then this new law is nothing but a…let me just call it a mistake.

Let’s be realistic: there has been not a single government agency in this nation history which welcomes ‘transparency’, especially since 9/11. This website, as it is now, is the latest addition to that historical fact.

Thank you for your attention.

Respectfully,

Lourdes Cintron

Citywide Mental Health Project

Email: citywidementalhealthproject@live.com

Phone: 718-561-8415

Address: 480 East 188th Street, Apt. 7M

Bronx, New York 10458

Violeta Parra – mental health in the Latin American arts


In this song, famous Chilean folk singer-author of the 1950-60s, Violeta Parra muses on how hard live has become for her. (The song is interpreted by her sister, Isabel Parra.) Instead of engaging in sociological or existential commentary about the pain of living, she simply describes how mother nature has, apparently, decided to withhold from her the things that she needs the most.

As we know that she eventually ended up committing suicide,the last verse in this poem  is not just kind of funny. It’s a door to her mood and consciousness, sort of an announcement of what was to come. I guess it’s all about ‘context’; the end of the poem makes sense when we learn that she was contemplating taking her own life.

She also wrote one of the most beautiful odes to life and living I have ever heard, Gracias a la Vida, just before taking her life. It was a good-bye song that moves even the rocks. I’ll upload after this one.

Thanks to Antonio Fidel for uploading and translating.

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)

Privatizing NYS public mental health system, one rule at a time. Part 1


This is the first of a series about NYS OMH’s and the Department of Mental Health’s licensing policies. This is intended for my ‘peers’, to share what I have learned in my dealings with the mental health system. It took me a long long time to understand and put this together. Thus, I want to save the time to others.

Note: I am not a lawyer or paralegal. This information can’t be taken as legal advice (better believe it) nor as reliable for any legal purposes. In other words, I’m not responsible for the misuse of the information on this post.

Some topics I will cover this week  are: ‘best practices’, OMH report last year advocating using unlicensed workers (case managers) to provide the equivalent of psychotherapy, and the SAGE report. Let’s start.

NYS Mental Hygiene Law (MHL)
Title E, Article 31: Regulation and quality control of services for the mentally disabled

Section 31.02 Operating certificate required.

Some judges in our State’s courts have alluded to the simplicity of the title of that section 31.02: ‘operating certificate required’ (op cert here on). It flaunts purpose and determination: ‘op cert required, period.’  It is a declaration of State policy. It is a mandate. So why has OMH de-certified more than half of our mental health programs and providers, basically privatizing our public system?

According to the New York State Consolidated Budget and Claiming Manual there are a total of 90 types of mental health programs under OMH. Of those, 22 are licensed and 68 are unlicensed. OMH reported in 2012 that of a total of 6759 programs, 4646 were unlicensed and 2113 licensed.

Source: “Reports on the Workforce From State Agencies”   (OMH”s report)                                    March 2012

Source: “Reports on the Workforce From State Agencies” (OMH”s report)  
  March 2012

Do these figures matter to the consumers and to the public, who may one day find itself tagged as ‘client’? Let’s take a look at what a licensing policy accomplishes.

By the way: do you know how many license categories OMH has?

1. Licensed
2. Unlicensed
3. Not-licensed(!)
4. Certified
5. Operated by OMH
6. Regulated by OMH
7. Approved by OMH
8. Funded
9. By auspice
(From various sources, including the New York State Consolidated Budget and Claiming Manual)
 

Putting licensing policies in perspective:

safetynetA State’s licensing system reflects  its policy towards the issue it is licensing; it is part of the policy system.

Policy is the decisions and actions taken by the state:

  • to fix a social problem,
  • to protect and
  • to offer a better quality of life for its citizens.

The golden rule of all policies is ‘first, DO no harm’. It is so golden that it is alluded to in OMH’s ‘Rule 501.3 Waiver’:

(2) The commissioner may grant a waiver of a regulatory requirement…if he/she determines that:

(i) the rights, health and safety of clients would not be diminished; (The commissioner’s discretionary powers can’t be used if they  cause harm. Well, at least in theory.)

All policy systems have a feedback mechanism for those who receive the benefits of the policy. Through it they let the policy-makers know how effectively and efficiently it is working. Our state’s mental health policy is in NY Code – Mental Hygiene, Title B MENTAL HEALTH ACT. Consumer advisory boards (CAB) are the feedback mechanism, including for feedback to providers in the programs where the consumer is receiving the services.

The three characteristics and purpose of a licensing system:

  • To protect the public from dishonest practices and bad quality of services, and from violations of consumers’’ rights.
  • To regulate the profession or business in question. In our case, it regulates the (mental) health services industry. As a regulatory tool, it has the state’s police-power behind it: violators can be arrested and prosecuted.
  • It is a mandatory credentialing process that prohibits anyone not licensed to practice the profession or business in question.

We see all this in: “NYS Mental Hygiene Law, Article 31: Regulation and quality control [to protect] of services Section 31.02 Operating certificate required [the mandate].

Without its licensing policy, the state can’t protect, regulate or monitor its system. And the courts know it:

Hirschfeld v. Teller, NY 2010

Here, OMH decided that licensure was not required. Because only OMH is authorized to determine whether a facility is required to have an operating certificate and MHLS’s jurisdiction is expressly limited to licensed facilities…defendant it's the lawnursing homes are entitled to summary judgment dismissing the complaint.

And our state legislators, who are aware of the problem of licensing un-compliance, stated in law bill  S4858A-2011:

Lack of progress on licensure has a direct consumer impact. Without full implementation of the law, New York’s seniors cannot age in place and cannot take advantage of the numerous protections and disclosures contained in the statute.

That’s why it says “op cert required”. Once you choose to practice a regulated profession or business you can’t choose to be or not to be regulated, or both.

 But wait a minute!! With OMH you CAN be BOTH!

In a Q&A about request to run a business for housing for the mentally ill, the question was whether OMH would accept unlicensed units in a licensed program. But of course, why not? Hey, it’s not like the tenants care that you misrepresented the program as licensed but they are actually in de-regulated ‘units’. ‘It’s all about funding requirements, don’t worry, be happy. Trust me.’

And you can also report, with OMH,  as unlicensed a licensed program, and the other way around. For example, in the State’s Consolidated Budget Report, OMH’s:

1510 – School Program Co-located with Clinic Treatment Program (Non-Licensed Program if reported under this code) This program cannot be used to report expenses or revenues associated with services provided by the licensed Clinic Treatment Program (2100). [Parenthesis from the quote, highlight by me.]

2600 – CPEP Crisis Beds (Non-Licensed Program) This program is one of four program components which, when provided together, form the OMH licensed Comprehensive Psychiatric Emergency Program (CPEP). [Which is a licensed program.]

Tomorrow I will comment on the license policies of both the Department of Mental Health and of OMH.

“For families struggling with mental illness…” and How to save a life


As I was reading this interesting new article in the New York Times about lawyers for families with mental illness, this video came to my mind. Most of you know this song; it’s sad (it’s about suicide)  but there’s hope in it.  It’s called ‘How to save a life’  by The Frey. I’m pasting here the lyrics and way down some info from  wikipedia about the song. The link to the NY Times article is here.

“How To Save A Life”

Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
And you begin to wonder why you cameWhere did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a lifeLet him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you’ve told him all along
And pray to God, he hears you
And I pray to God, he hears you

Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you’ve followed
He will do one of two things
He will admit to everything
Or he’ll say he’s just not the same
And you’ll begin to wonder why you came

Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

How to save a life

How to save a life

Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life

From wiki:

According to lead singer, pianist and songwriter Isaac Slade, the song was composed and influenced by his experience while working as a mentor at a camp for troubled teens:

One of the youngsters I was paired up with was a musician. Here I was, a protected suburbanite, and he was just 17 and had all these problems. And no one could write a manual on how to save him.

Slade claims that the song is about all of the people that tried to reach out to the boy but were unsuccessful. As Slade says in an interview, the boy’s friends and family approached him by saying, “Quit taking drugs and cutting yourself or I won’t talk to you again,” but all he needed was some support. The boy was losing friends and going through depression. He lost his best friend and could not deal with it. The verses of the song describe an attempt by an adult to confront a troubled teen. In the chorus, the singer laments that he himself was unable to save a friend because he did not know how.

While this was the original intent of the song, the band has opened the song to interpretation. They created a website where fans were welcome to submit music videos they had made for the song. This arose from the response that Slade got from the song:[3]

I got a lot of e-mails about it (…) One boy died in a car accident, and I guess it had been the last song he downloaded from his computer. They played it at his funeral, and some of his friends got Save a life tattooed on their arms. The response has been overwhelming.

From an interview with Slade by Bob Wilson in Sauce, Slade was asked, “‘How to Save a Life’, was apparently inspired by an experience you had as a mentor to a boy who had a drug problem. What’s the story behind that?” Slade answered:[4]

Well there’s a group home here in Denver called Shelterwood, and it takes in teens who’ve had a tough time; their parents don’t want to send them to jail, but they can’t keep track of them themselves… A friend of mine was actually the president for that particular school, so he asked Joe and I to come up for one of their weekend retreats… I was paired up with one boy in particular. His story was just amazing – all the relationships that he had put at risk because of the decisions he made, and eventually losing the relationships… the cost of his lifestyle and his choices, and kind of relating them to my own life and my own stories; seeing all the relationships I’ve threatened for one reason or another. It was a really inspiring weekend.

NY Times article: Focus on Mental Health Laws to Curb Violence Is Unfair, Some Say


 

For those of you who read my comment at the NY Times, find here  the report I mentioned in the comment, then click on ‘Office of Mental Health’.

This is the comment itself:

In a 2012 NYS report about a survey on compliance with state’s licensing rules, OMH said “more than half of the agencies responded they employed titles that can be “licensed or certified” however were reportedly filled with unlicensed staff”, including psychologists and social workers. Also, that “a total of 414 nonlicensed staff were also reported as providing psychotherapy”. Then it said “OMH does not find a material difference in the quality of services provided in programs which also employ unlicensed staff”. Of 6759 OMH programs, 4646 are unlicensed and 2113 are “licensed” (whatever that means in OMH’s parlance). OMH concludes that more unlicensed programs and unlicensed staff performing as licensed are better because they save money and, well, who needs a psychiatrist or social worker when a case manager can do ‘the same work’ for less? The point: it’s not the mentally ill, it’s the system. Any increase in funding will go to over-priced non-for-profit CEOs salaries, we will use prisons as hospitals, and will pass laws to deprive people of their civil rights all in the name of ‘safety’ for the victims of the NRA’s propaganda: you and me. Quality of services have been reduced, punishment increased. Mental health industry is an industry like any other, filled with waste of tax payer money. The next time you read about a ‘crazy’ killing people, think ‘who was the case manager-acting-as-psychiatrist dealing with him?’ END.

I would like to add that the focus  at this point in the discussion generated by the NRA and those unfortunate killings must move away from the emotional plane to a rational one. We could move away from ‘somebody, stop these lunatics’ to ‘why is the system ‘fragmented’ and what it has to do with these killings?’

What do we achieve by arguing whether the killers in those massacres are mentally ill or not? What is the next step if the answer is ‘yes’? If the answer is ‘no’? Can the answer be a rotund ‘yes’ or ‘no’? Is the issue that simplistic and clear, no gray areas?

We are in a society saturated with violence, from the top down: the violence inflicted to the populace by corrupt politicians and lawmakers, by agencies administrators, by some judges; by the violence of a corporate world that has lost a sense of proportion, who sees no difference between profits and financial crimes as a source of profits. Violence from the ‘entertainment’ industry that demands the right to create ‘games’ that give you the close-to-reality feeling that you are killing or raping…

As a society, we come with awesome ideas to fix problems; the problem is at the implementation level. For example, it was not easy but ‘we’ came with the idea of housing for the homeless mentally ill with services and connections to the community. But then, the State said ‘good idea, let’s empty the psych hospitals and we save money’, and sent the patients to the streets without putting the money for services in the community. A mess developed, we blamed the homeless mentally ill for crimes and went after the ‘squeegee’ criminals, those cleaning car windows for a quarter at street corners.

Look, the money is going for what a friend calls “the poverty pimps”. There’s your mentally ill in action.

Follow the money, not the mentally ill. You’ll find the problem and the solution that way. If you accept as dandy OMH’s statement that, for money-saving purpose, there is no difference between the  service delivered by a psychiatrist or social worker and a case manager, don’t come crying to me later if someone slaps you in the face because his ‘psychiatrist’ didn’t do his/her ‘job’.

You are being conned, as in con-game, confident game, etc.

I will soon be posting a through comment about OMH’s licensing practices. Please, keep in touch.

NY new Gun law: the good, the bad and the ugly.


This new gun control law stamps an indelible stigma on ALL people who have a diagnose of mental illness and on the developmentally disabled by the mere fact of opening the Act as a policy directed at reducing a right exclusively on those people.

Missing from the Act is the usual ’findings’ or ‘purpose’ that introduces the reasoning behind a government bill. That would have been the place to explain that this bill would not tolerate prejudice against mentally ill  people as a means to calm a fearful population. It seems to me that our legislators and governor were in a rush to pass something, anything related to the Sandy Hook massacre outrage, I guess, to gain political points at our expense.

This bill creates an automatic association between the mentally ill (who has committed no crimes) and criminals and the criminal justice system. It sanctions the stereotypical believe in our communities that ONLY mental illness and the mentally ill causes mass killings.

It also surreptitiously takes care of mentally ill people who the mental health professionals may ‘guess’ can kill without guns. The insistence on amendments to the AOT law points to that possibility, considering that it only deals with the when and how to get a person into the program.

We ought to know by now that involuntary commitment leaves its victim with a permanent stigma.  ‘You are in the AOT program? They carted you away against your will? Wow, you must really be crazy.’ Circumstances don’t matter to the public, whether it happened one time, as a result of a mistake or prank by a disgruntled relative, whether you are fine now, whether you were right in refusing medication (wait until you get there, pal)…

But let’s not be so negative, let’s find the good in the bill. The good is that SOME weapons were ‘controlled’. Also, that it addressed the issue of violence against spouses and partners. I know nothing about guns, thus I assume that this bill puts a little scratch on the NRA’ self-esteem. But that’s about the entire positive I can find here.

One of the ‘bad’ in the bill is that it was written behind closed doors. It probably has to do with the NRA’s representatives working with our ‘leaders’ in casting all the attention on the mentally ill: guns don’t kill, only the mentally ill kills, according to them.

Of course, that we live in a society were gun violence is our favorite entertainment (video games and in the movies – the bigger the gun A’nold carries in the movies, the more ‘manlie’ he is) does not matter to anyone as a link to gun violence in our streets.

Nor that our current wave of violence may be related to the nation’s economic woes, as is usual in times like these. It may have something to do with how our citizens are responding with violence and depression (suicide) to the pressures of losing their jobs and their housing to foreclosure. And there’s no mention either to fixing the broken mental health system.

Those are huge issues, difficult to handle; the class of ‘mentally ill people’ is easier to manage, although controlling them will not fix the problem.

Another bad is that the law is  to control not only SOME guns, but also the lives and the civil liberties of the people less likely to kill with guns: the developmentally disabled, and those who seek but fail to get mental health treatment. In many cases, the result of neglect or reduced services is deterioration, which leads to forced treatment and commitment later. It is so much easier and inexpensive to let you break down and then pick up your pieces, not.

The bill also controls ALL prisoners before they are released. The Act mandates that they be ‘assessed’ to see if these soon-to-be ex-cons need the services of an AOT program.

Why would our legislators make that requirement? Why ‘examine’ those who were imprisoned for un-armed crimes like theft or lying to get more food stamps? Simple answer: it’s an acknowledgment that our prisons are the psychiatric hospitals of the new millennium.

The purpose of that provision is not to ‘catch’ the criminals who may pose a threat to you out there, but to hold the mentally ill who is there because our budget cuts have closed psychiatric hospitals and there is not enough resources in the community to comply with federal mandates about placing them in the ‘least restrictive setting’.

This secondary gain of this bill can’t be officially mentioned; it would be to confess how broken our mental system is. It’s not me saying that it’s broken; it was the NY Medicaid Redirect Team who said that the system is ‘fragmented’, meaning ‘broken’. The chances of you passing a test to assess that you need  an AOT  program are high considering that you are coming out from prison, where violence is the rule.

With the amendment to the AOT law, the state will keep you longer under its control. The amendment extends  from six months to one year now the period of  ‘observation’ on restricted civil liberty.  A better name for this  bill would be ‘an Act to control the mentally ill and the developmentally disabled’.

And then there’s the ‘ugly’: The FBI list of the mentally ill and the developmentally disabled.

First, notice that there is not a list in our nation of people who committed crimes with guns. There’s the list of sex offenders, with its ugly consequences of including innocent people and those whose crime was to go to a porn parlor for adults, and the spending money tracking them once in the community. And then, there’s the Department of Homeland Security’s list of “terrorists”.

We should have learned by now the dangers of any “list” made to brand people as this or that. Initially, the “terrorist” list was meant for a few ‘suspects’, now it includes hundreds of thousands of people and groups whose ‘crime’ is their dissent of some government actions. And once in the list, you cannot expunge your name from it even if you are there by mistake.

But this new FBI list is only for the mentally ill and the developmentally disabled. Even one involuntary commitment is enough to put you in  that list. The potential of the list being used later for something else, or ‘hacked’ and used by insurance companies to deny you services and coverage is high. Never heard of incidents like that happening anywhere in the USA?

I find it difficult to believe that anyone would want their kids or parents in a FBI list for ANY reason, let alone as members of a class deemed a threat to “the safety” of the community because of their illness. Will we soon be labeled a “threat” to national security too? History tells me that when the government brands you as a threat, you start to lose your civil rights. Remember the Japanese camps during the Second World War?

So, being ill is now a reason to diminish your status as a citizen.

The implications of this Act are too subtle to be noticed by our regular citizen who has no experience with the mental health system. This bill is a knee jerk reaction to a complex situation, the mental health system in our state and our nation.

People continue to refer to us, the mentally disabled,  in the third person, we still don’t have a voice to tell the story of our experience in the mental health system. We can talk about how it feels to be depressed but not about the abuse  and neglect received from those hired to help us. This bill makes things more difficult for us with its stigmatizing rules.

Because it stigmatize people with mental disabilities and people with developmental disabilities, we should all be ashamed of this bill.