Meet the New Deputy Executive Commissioner
By Dan Frey, Editor in Chief
Crucial Issues to the Mental Health Community Discussed
On January 20th at Fountain House clubhouse in Hell's Kitchen, members of New York City's mental health community met the new Executive Deputy Commissioner for the New York City Department of Health and Mental Hygiene (DOHMH), Division of Mental Hygiene: Gary Belkin, MD, PhD, MPH. The event was organized by the DOHMH Office of Consumer Affairs whose mission is to ensure that the consumer perspective is heard and integrated at all levels of government. Carlton Whitmore is the director of this office and Teena Brooks, LMSW, assistant director.
Dr. Belkin responded to questions from a planning committee whose members were: Wendy Brennan, Lynnae Brown, Angela Hebner, Carla Rabinowitz, Samene Reid, Rachel Saloman and Moneer Zarou. Topics ranged from housing and criminal justice to employment and managed care. Some topics listed in the evening's program such as cultural competence and the assisted outpatient treatment program were barely touched upon.
On housing, Dr. Belkin said that governor Cuomo might approve funding for around 5,000 units of housing for New York State's homeless, mental health, HIV/AIDS, substance abuse, and domestic violence populations, including families and youth. The campaign for supportive housing, known as NY/NY 4, requested 30,000 units for these disadvantaged groups in New York City over ten years.
On criminal justice, Dr. Belkin said that, in response to the unnecessary death of a mentally ill Rikers' inmate, mayor de Blasio's criminal justice taskforce will address issues of mental illness and substance abuse at every stage of the criminal justice system, including proper discharge planning from jail to the community. He said “drop-off centers” will be created as alternatives to incarceration for people with mental illness, with the first one to roll out in the fall of 2015 in upper Manhattan. These drop-off centers should offer an array of services to help keep our peers out of the justice system. As part of a comprehensive plan, corrections officers and police officers will receive training on “deescalation” and understanding behavioral health issues similar to what other states have been doing with good results.
The unemployment rate among people with serious mental illness is a staggering 90%. Dr. Belkin said his department funds 15 different employment programs and continues to advocate for more peer hiring. He said that in the future managed care environment, providers will be held accountable for improved employment outcomes and that peer services will be Medicaid reimbursable. He said an “RPC” or regional planning consortium will be created that brings advocates and stakeholder groups together to discuss issues of standardization, performance, service planning, and resource allocation.
Medicaid Managed Care
On the future of service delivery in a Medicaid, managed care environment (see “Medicaid Managed Care: Rising to the Challenge” by Briana Gilmore, Winter 2015 edition), Dr. Belkin said “HCBS” (home and community-based services) will be offered through the “HARP” (health and recovery plans) for individuals with significant health and behavioral health needs. Fully integrated dual advantage plans (FIDA)will be available for people with both Medicaid and Medicare who use community-based long-term care services.
There was a concern among those in attendance that peer workers who lacked a GED or high school diploma, which is currently required to become a certified peer specialist, would lose their jobs in this new billing environment, but Dr. Belkin assured us that not all services will be billable to Medicaid and some will continue to receive funding from the city. The smaller provider organizations will receive technical support to help them make the transition to Medicaid billing. He said he was unsure how many city contracts, if any, will be displaced by the shift to Medicaid billing.
Although Dr. Belkin and his senior staff were weary from a long day at the office, we were glad that they made it to the forum that evening. His liberal use of acronyms was a bit off-putting, but he did his best to explain some difficult concepts. The crowd seemed pleased with the event, but I was left wondering how much influence we would have on future policies that will affect our lives. Most of us don't even know how to speak the language that large bureaucracies use, let alone how to affect change within them. For those of us who do, I hope you step up to the plate and get involved. We desperately need representation with sensitivity, intelligence and strength.