Ward Stories

Ward Stories

Organized by Dan Frey

Two poets are featured in the summer 2015 edition of ward stories: Craig R. Bayer and Sheryl. Craig describes his hot and cold relationship toward the King of the Universe and Sheryl's song encourages her (and all women) to be strong. Enjoy.

Untitled Poem

By Craig R. Bayer

God
You’ve blessed me with so much
A loving family
A privileged background
Charismatic rabbis
Great teachers and professors
A joyful and carefree youth
Yet you’ve seemingly cursed me, too
My family was ultimately cynical about religion and it stifled my early attempt at zealotry
You crippled my mother with mental illness
Took away my kindergarten playmate Teri (whom I thought I was destined to marry yet she declined to attend my bar mitzvah)
Deprived me of sex until I was in my twenties
Made a joke out of my attempts to find a career
Yet you saved me that postgraduate summer in Boston
When this bold artist and revolutionary couldn’t find a decent job or pay the rent
The stress was so intense that my ears heard the slightest of sounds
I was depressed and virtually psychotic
I thought I was under surveillance
My anger turned me from a peaceful democratic socialist into a potentially violent Marxist-Leninist
But then I read the biography of Martin Luther King: “Bearing the Cross”
And it described how his faith in You gave him comfort, direction and strength
And I gave my mind and soul back to You
And my inner turmoil subsided…
From that point on, it’s been a journey about how to properly serve You and the people
Should I remain a Jew
Or go Christian or Buddhist?
What if I don’t want to accept that Jesus is your son or that the world is what it is?
Should I give up Marxism, embrace capitalism?
Should I be a professor or rabbi or journalist or hack?
I always fall back on being Marxist Jew and poet
But I think that my journey will never ever be complete
All I know is that I need You for my sanity
Because secular life turned out to be bankrupt and traumatic.

Who You Are

By Sheryl

It's hard to be optimistic
Looking though an aged mirror
Not seeing the girl
I used to know
The smile hiding inside
Somewhere like a rose
Its leaves die

People say your pessimistic
Why can't you see the glass half full?
You would rather tip it over
Cry out yesterday a river
Distress eustress
Negative and positive
Where is the empowerment of 

the woman you use to be?
Has generativity after the break up
Confused you on commitment
Are you quality?

Chorus:
Procrastination will not bring you anything
What you're waiting for
It's time to open the door to today
Perfectionism is hard to attain in the past
The clock on the wall
Stop forgetting who you are
Who you are?

Stop meditation on the past You should be glad that it past Hypnosis on one guy Why wait and listen To the stranger's feedback They all are lies Why treat them like cognitive self talk Can you see the lack of self-esteem Keep your mind on who you are Rather than what people think you do Only you know the truth. Distress eustress Negative and positive Where is the empowerment of the woman you used to be? Has generativity after the break-up confused you on commitment Are you quality? Chorus: Procrastination will not bring you anything What are you waiting for It's time to open the door to today Perfectionism is hard to attain in the past The clock on the wall, stop forgetting who you are Who you are?

Meet the New Deputy Executive Commissioner

Meet the New Deputy Executive Commissioner

By Dan Frey, Editor in Chief

Crucial Issues to the Mental Health Community Discussed

On January 20^th 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.

Housing

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.

Criminal Justice

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.

Employment

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.

Peer Jobs

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.

Conclusion

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.

Mayor De Blasio Pledges to Implement Crisis Intervention-Team Model

Mayor De Blasio Pledges to Implement Crisis Intervention-Team Model
By Carla Rabinowitz, Community Organizer, Community Access, Inc.
Police Can and Should Handle People in Crisis with More Care
Three years ago Community Access and a few organizations formed the Communities for Crisis Intervention Teams in NYC (CCITNYC) to improve relations between the New York Police Department (NYPD) and New Yorkers with mental illness.
Our goal is to encourage the police to implement a new model of police training where police can identify someone in crisis and respond in a way that de-escalates the crisis, and recognizes that the person in crisis is mentally ill and not a criminal. We now have more than 75 organizations supporting us.
Fortunately, the mayor shares our vision and will create two centers where police can drop off people in crisis and will train 5,500 of the city’s 35,000 officers on identifying mental health symptoms and de-escalating crisis situations.
This is part of the mayor’s new Task Force on Criminal Justice and Behavioral Health. Other areas of change include post-booking diversion, CIT-like training for correction officers, and more help when people leave prison and re-enter the community. In all, the mayor has pledged $130 million for this effort.
A CIT (Crisis Intervention Team) is a method of policing that provides officers with the tools they need to respond to incidents involving people in emotional distress. CITs ensure safe and respectful interactions between mental health recipients and law enforcement.
CITs require coordination between the public health system, police departments and the mental health community. Police need a place to quickly drop off people in crisis and return to other police calls. This is why the mayor’s centers are so important. Without them, police could sit for hours in emergency rooms with each person in crisis.
CITs are needed because the NYPD responds to 150,000 calls of those in mental health crisis a year. They call these calls EDPs (Emotionally Disturbed Person calls). And today NYPD officers receive little training on how to handle these calls.
So what happens? A family member or a housing agency calls for an ambulance if a person is in crisis. Police show up and go into their routine training model of “Command and Control,” proving police are in control. Police may start shouting commands or say to the mental health recipient “do you want to do this the easy way or the hard way?”
Right away the encounter escalates, and the mental health recipient who is in crisis becomes more upset. Sometimes all that happens is a long wait at a hospital or city jail. Sometimes, these encounters take a turn for the worse. In the last two years there have been several fatalities and beatings of mental health recipients by the NYPD. There are also the financial costs.
New York City has set aside $674 million to cover claimants' cases against it and expect to pay $782 million in 2016. Police misconduct, injury and civil rights allegations against the NYPD make up more than 1/3 of claims against the city. Just one of those shootings could cost a city millions of dollars.
The benefits of a CIT program are:
1. Less time for officers in between crisis calls. Chicago reduced this down time from eight hours to 30 minutes;
2. Fewer injuries to police and mental health recipients. San Antonio, which has trained 92% of officers, has not seen one use-of-force case since 2008. Houston, which trained 50% of its 5,200 officers, also reported a drop in cases of force;
3. Improved perception of police by mental health recipients and staff at mental health agencies. Many times families or mental health providers are the ones who call the police. They need to know they can trust how police will treat the people they are helping to care for;
4. Law enforcement’s better view of mental health recipients and better confidence working with mental health recipients;
5. More positive media relations for the NYPD and the mayor. In response to one recent police shooting of a person in crisis, the mayor said that he was going to put new training into place to better help address these incidents; and
6. Lends prestige to NYC. Before the mayor’s plan was released, NYC was the only one of the seven largest cities in the USA without CIT training of police.
Some cities like Houston and Los Angeles have social workers riding along with police. Houston has the social worker co-responder model, but does more. Houston trains all of its officers in the traditional CIT 40-hour training and has a telephone line for officers who are not trained in CIT to call in and get advice when the officer is handling an EDP call.
CITS are a win-win for police, the mental health community and the general public. I am excited that the mayor has embraced better training of police and more interactions with mental health community leaders.

Emotional Support Dogs and Service Dogs for People with Mental Illness

Emotional Support Dogs and Service Dogs for People with Mental Illness

By Cissy Stamm, Co-Founder, New York Area Assistance Dogs

You Too Can Benefit from Animal Companionship

The Basics

Something happens when humans and animals interact. For millennium we’ve been aware of it. Now the science is developing. Much of the effect of human/animal interaction appears to be the result of the release of the hormone oxytocin, often called the bonding hormone between mother and nursing child. It now appears that the release of oxytocin may be mutual, meaning both the animal and the human experience it.

For the research on the reasons behind the beneficial effects of human/animal interaction and what those benefits are, a summary of the research can be found at: Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408111/

This is good information to give to any healthcare provider if you are considering getting an emotional support animal (or service dog), especially if you live in “No Pets” housing.

One of the first things that need to be clarified is proper and legal terminology.

Therapy Animals

A Therapy Animal is an animal that provides comfort to a person other than its owner. The animal can in addition act as an emotional support animal for its owner. Therapy dogs usually have to go through special training for this kind of work, be certified and have insurance, normally provided through the organization that trains therapy animals and arranges pet visitation in various venues.

Emotional Support Animals

An Emotional Support Animal is an animal that provides comfort and support to a person with a psychological disability. They need not have any specialized training, and are not considered pets for the purposes of most housing pet limitations. They are legally covered under the Federal Housing and Urban Development (HUD) regulations and are considered “reasonable accommodations” so that people with disabilities can have enjoyment of their homes equal to that of people without these conditions. A request for reasonable accommodation must be given to one’s landlord in “no pets” housing or housing that has pet weight limits (which your animal may exceed) if your animal is for emotional support. A letter from a healthcare provider stating the need for the animal is required. It need not state the nature of one’s disability. It is important to note that Emotional Support Animals do not have public access with their handlers, except under certain conditions, on airlines. Emotional support dogs must not create a nuisance in housing. A sample request for accommodation letter for a landlord can be found at Fair Housing Information Sheet # 6, Bazelon Center Right to Emotional Support Animals in "No Pet" Housing: http://www.bazelon.org/LinkClick.aspx?fileticket=mHq8GV0FI4c%3D&tabid

Service Animals

A Service Animal is a dog who has been trained to do tasks to mitigate an ADA-covered disability. A description of a service dog and the laws covering its use can be found at: Revised Service Animal Brief http://www.ada.gov/service_animals_2010.htm

It is very important to note that most individuals are not qualified to train a service dog and will need professional help. People using service dogs have access with their dogs to places the public can normally go. Service dogs are expected to behave appropriately in public and not bark, bite, to be house-broken, and not interact with other people or dogs without the handler’s permission.

Another thing that must be considered when thinking about a service dog is one’s ability to deal calmly with situations in which one is denied access because s/he is accompanied by their service dog. This can happen at any time whenever you encounter an employee or owner who isn’t familiar with or doesn’t care about the law. If you are not prepared for the possible stresses of public access, you might be better served not considering a service dog.

In either case, one needs to be able to afford to feed a service dog (food allowance under SNAP still being tested), and veterinary care and training if necessary.

Reasonable accommodation as described for emotional support animals should also be requested for service dogs in no-pets housing.

Persons with questions on emotional support animals or service dogs in housing can contact their local HUD office. Questions on service dogs in employment and places of public accommodation can be answered by the ADA hotline: 800-514-0301 (Voice) and 800-514-0383 (TTY) or you can contact Cissy Stamm at New York Area Assistance Dogs for free information and advocacy at 212-677-4383.

Pullout: “An Emotional Support Animal...provides comfort and support to a person with a psychological disability...need not have any specialized training, and are not considered pets for the purposes of most housing pet limitations.”

Ward Stories A column organized by Dan Frey, Interim Poetry Editor

Ward Stories
A column organized by Dan Frey, Interim Poetry Editor
For this winter 2015 edition, we feature three poets, each with their own style and message. R. Martinez Jr. makes addiction real for his readers in Love is a Drug. Paul Chipkin grows into a peaceful man through his poem I Am That I Am. Beryl Khabeer explains that our soul is beyond the material world in her poem Brooching SOUL. I hope that you enjoy as much as I have.

Love is a Drug
By R. Martinez Jr.
I need a quick fix
I'm addicted to you
feeling high feeling low
what am I to do?
an aphrodesiac
affection in a sack
I can feel you in my veins
but Im stuck without a track
I'm drowning in a bottle
of absolute sorrow
if I cant have you now
there will be no tomorrow
Pure euphoria
when I'm with you its ecstasy
I take so much of you in
that I can't even see
I might have to quit cold turkey
I might have to ween
Love is a drug
you already proved it to me.

I Am That I Am
By Paul Chipkin
I am the very one
Who did those things
That I can be the one
Who is growing into
Who I am today
Because I am who I was
And have seen complexity
As I strengthened
Growing
And making peace better.

Love appears here,
Sprouts anew there…
Goodness greets me
In response to faith.

Divinely-inspired liberties
And holy trust
Bring me to pray
That those
Who I hurt along the way
Are exercising forgiveness,
(Believing in that eases my burden
as I stand in this present moment
loving my fellows with developing confidence).

Having fought off hoplessness,
I hold an optimistic vision
For the salvation of individuals.

Now, as it always was,
I am grateful for all that I have!

Brooching SOUL
By Beryl Khabeer, M.A.
The body is just the shell I live in.
I am no sensation; I am no senses.
I am a living  S O U L.
The beat of my environ touch my true self,
Touch my  S O  U  L
And echo through the senses.

Knowing and using the senses
For only the senses’ sake
Is to abridge Creation and Creator.

Wellness Fair to Enhance Peer Health

Wellness Fair to Enhance Peer Health

According to data from The National Survey on Drug Use and Health (NSDUH), adults aged 18 or older with any mental illness (AMI) or major depressive episode (MDE) were more likely than adults without these mental illnesses to have high blood pressure, asthma, diabetes, heart disease, and stroke. Adults with serious mental illness (SMI) were more likely than adults without SMI to have high blood pressure, asthma, and stroke. Those with AMI, SMI, or MDE were more likely than adults without these mental illnesses to use an emergency room and to be hospitalized.

Our peers therefore need education and screenings on physical health issues to improve their overall health and quality of life. With that in mind, the New York City Department of Health and Mental Hygiene's division of mental hygiene's Office of Consumer Affairs organized a Wellness Fair to kick off Wellness Week.

On September 12^th from 10AM to 4PM, attendees were treated to nutrition, yoga, and drumming workshops, health screenings for blood sugar, blood pressure and body mass index, resource tables, exercise and fitness, smoking cessation, social and cultural activities, education resources, diabetes management and a healthy and satisfying lunch.

For more information, you can contact the Office of Consumer Affairs via phone or email: 347-396-7194 and bnovack@health.nyc.gov

Self-Direction in Medicaid for Well-being and Empowerment

Self-Direction in Medicaid for Well-being and Empowerment
By Briana Gilmore, Public Policy and Advocacy Director, NYAPRS
Self-direction is a strategy in organizing and delivering Medicaid-funded services and community supports that can dramatically enhance opportunities for people living with disabilities. The process transfers some of the funds typically afforded through Medicaid payments directly to the consumer, who develops a plan to utilize the money for services and supports for increased engagement and well-being. Hundreds of thousands of people experiencing developmental disabilities already utilize the approach, and many states have implemented or are seeking pilots to bridge the method to the behavioral health recovery community.
In New York, the Office of Mental Health (OMH) selected self-direction as a new service to implement through a Health and Recovery Plan (HARP) for Medicaid recipients with enhanced BH (behavioral health) needs. Implementing the program thoughtfully will take some careful planning; therefore the program will be piloted for a few years before being brought to scale statewide as a benefit for eligible recipients.
Any self-direction model must take into consideration the particular recovery needs of the community for whom it’s modeled. For people with physical needs, funds are often self-directed to health aides, house modifications, or other consistent supports. A model to support the behavioral health needs of a community must take into account social needs that span employment, education, community inclusion, well-being, and traditional rehab supports. New York is looking at an approach that would allow recipients to buy services like habilitation (services that help a person learn, keep, or improve skills and functional abilities that they may not be developing normally) and supported employment, but also direct funds to community wellness supports like gym memberships and yoga classes, college classes and bus passes.
The implications of self-direction are vast; it is the most flexible way for consumers to take ownership over their recovery and invest in chosen supports. The success of a self-directed recovery plan is largely dependent on the relationship between each recipient and a support broker, who is a chosen navigator that helps to maximize an individual budget. A recovery plan is based on current capacities and supports, and incorporates wellness goals for overall health. A recipient uses the plan as a tool to guide their spending. Purchases of traditional services and community supports are now typically made with smart debit cards that can track allowable services and be refilled directly by the payer.
There are many considerations that go into creating a self-directed design that benefits people with BH needs. The plan must take into account accessibility and enrollment processes, ensure culturally competent approaches, and allow for creative community-based solutions for enhanced well-being. The design must also plan for a relationship between a recipient-driven recovery plan, and a treatment plan that is supported by a Medicaid Managed Care Organization. Support brokers—who in most models are peer specialists or recovery-trained life coaches—should be supported by an infrastructure that can foster innovation and adaptiveness within the model. And ultimately, the financial process has to offer an efficient transfer of funds from the state Medicaid program.
I’ve been involved in a planning process with NYAPRS and the Columbia Center for Practice Innovations to help OMH develop a draft model for BH self-direction. The team has worked for eight months to review research, meet with experts in the field from around the country, and engage Medicaid recipients, DOHMH (dept. health mental hygiene), and other stakeholders to develop a strategy for implementation. The process will continue in the coming months as OMH explores the best framework and negotiates the process with other state agencies, Managed Care Organizations, and recipients.
NYAPRS (New York Association for Psych Rehab Services) has been advocating for a self-directed model in New York for nearly a decade. It’s exciting to know that the model could be offered to tens of thousands of Medicaid recipients with BH needs in the coming years. The state agencies, particularly through the Medicaid Redesign process, recognize that innovative approaches like self-direction can contribute to long-term savings and system benefits. These gains will be as a result of quality of life improvements like reduced hospitalizations and increased community engagement, as well as better overall satisfaction with the Medicaid program. A New York State pilot will include a strong research component to look at how recipients of different ages, backgrounds, and with different geographic living settings use and benefit from self-direction.
Barriers do remain, particularly in the appropriate financing of the approach. It’s also essential that appropriate protections be in place for both consumers and insurance companies before the design is implemented as a standard benefit. The design may provide a truly fundamental shift in Medicaid programming and consumer rights, if stakeholders on both sides continue to work together to actively improve the design through emerging best practices.
Look for opportunities in your area to participate in a self-direction pilot in 2015, as well as information about how you can get involved in the state’s planning process.