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Improving Care for People With Mental Illnesses and Addictive DisordersMichael B. Friedman, the public policy consultant of the MHAs of Westchester and New York City and Director of the Metropolitan Center for Mental Health Policy and Analysis, gave this testimony at a public hearing held by the Mental Health Committee of the New York State Assembly Committees on Alcoholism and Substance Abuse and Mental Health, Mental Retardation and Development Disorders on October 10, 2003. My name is Michael Friedman, and I am the Director of the Center for Policy and Advocacy of The Mental Health Associations of New York City and Westchester. Both of these organizations are dedicated to advocacy, community education, and direct services to meet the needs of people with mental illnesses and to promote mental health. People With Co-Occurring Disorders are Central Challenge to SocietyWe are very pleased that you have convened this hearing to call attention to the continuing unmet needs of people with mental illnesses and substance abuse disorders. People with co-occurring serious mental illness and addictive disorders are a central challenge to our society. Of the people with mental illnesses, they are the most likely to:
Despite the clear social importance of serving people with co-occurring disorders, too few people get the help they need. Various research studies have shown that:
These dismal findings reflect:
New York State on the Right Track in Serving Those with Co-Occurring DisordersTo its credit, New York State has taken a number of steps to address problems in serving people with co-occurring disorders. We know that this population needs stable housing, and the Office of Mental Health (OMH) has designated some of its housing programs to serve people with co-occurring disorders. We know that this is a population that needs aggressive outreach services, and OMH has recently expanded Assertive Community Treatment services and a variety of case management services for the “hard to serve” population, virtually all of whom have co-occurring disorders. We know that addressing the needs of this population requires changing the clinical cultures in both the mental health and substance abuse fields, and OMH has introduced its Winds of Change initiative to help to spread the use of state-of-the-art practices, of which integrated mental health and substance abuse treatment is assuredly one. We also know that the mental health and substance abuse systems need to collaborate to avoid pushing this population into the cracks of bureaucracy and to serve them effectively. OMH and Office of Alcohol and Substance Abuse Services (OASAS) established a task force for this purpose some years ago. But It Is Not EnoughThe interagency task force has moved very slowly. Breaking down regulatory barriers can and should be done more rapidly. Shortages of specialized housing result in lack of stability in the lives of people with co-occurring disorders and also result in backlogs in local and state hospitals. Limited program capacity leaves many people unserved, and shortages of trained personnel leave many others poorly served. And the absence of a long-term plan based on a reasonable assessment of unmet need raises doubts about whether NYS will ever confront this issue effectively. Time for the Legislature to Take the LeadFor the past three decades, New York State has vested the responsibility to confront the problems of people with co-occurring disorders in the state administration. Perhaps it is time for the Legislature to take the lead. For example it could take statutory action to eliminate regulatory barriers to good service such as:
The Legislature can also take budgetary action to provide funding for increased housing, case management, outreach, assertive community treatment, and integrated treatment services. We appreciate the opportunity to testify today and thank you, again, for drawing attention to this critical social issue. Return to the top of the page.
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