Email | Print

In past issues of New York City Voices, I have written about the new emphasis the Department of Mental Health, Mental Retardation and Alcoholism Services (DMH) has placed on developing innovative programs that integrate mental health, substance abuse, health, and social service concerns. With this issue, I would like to bring readers up-to-date on DMH initiatives to meet the needs of populations with multiple problems.

Interdisciplinary services seek to more effectively address the specific needs of consumers. They do so by moving beyond traditional models. Historically, mental health, substance abuse, health and social service programs have operated independently of each other. This has resulted in public agencies and providers with separate and rigidly defined service boundaries. Consumers frequently have problems that do not conform neatly to these parameters.

Historically, the mental health system's response to multiple-need populations has been slow and somewhat uneven. The Mental Health Special Needs Plan legislation, which sunsetted in June 2000, would have brought with it flexible Medicaid funding. This could have further facilitated integrated programming. This has not slowed down our commitment to integrated services. DMH has used Reinvestment funds to experiment with holistic recovery-oriented programs. Reinvestment has permitted a broad expansion of new mental health treatment approaches that deal concurrently with consumers' psychiatric and addiction problems. In addition, there are now programs for adults with mental retardation who also suffer from mental illness and/or alcoholism.

Movement towards integrated care has not occurred solely at DMH. Over the past few years, New Yorkers with significant health and mental health needs increasingly have been served by programs that link primary care with mental hygiene treatment. An example of such a program is the City Department of Health's (DOH) highly regarded DOT or Directly Observed Therapy Program. The originators of DOT quickly discovered that a disproportionate number of DOT patients who would not take their medication had a dual diagnosis of TB and mental illness. For this reason, DOT became more than a medication management program. Health care workers, like the case managers in mental health programs, learned to help patients get social services, income supports, housing and mental, substance abuse and other health-related services.

New York is not alone in recognizing the need for interdisciplinary programming. Last year, Surgeon General David Satcher issued two groundbreaking reports on mental illness and suicide, defining both as serious public health concerns. Similarly, the U.S. Centers for Disease Control encouraged integrated efforts by awarding grants to states, localities and providers interested in developing integrated service models. The same focus exists at the Substance Abuse and Mental Health Services Administration (SAMHSA). In its most recent funding announcement, SAMHSA again sought programs that integrate mental health, substance abuse treatment and substance abuse prevention activities.

Locally, the Department continues to foster the kind of cooperation among City agencies and the Health and Hospitals Corporation that resulted in the Cumberland Family Health and Support Program. Staffs from both DMH and the Department of Health participate in a planning group to ensure that programs incorporate behavioral and social science methodologies. With time, the efforts of our two public health agencies, both of which serve the same disadvantaged communities, will be increasingly entwined.

Other examples of new or planned integrated programs in New York City include a DMH/Department for the Aging pilot program through which mental health clinicians conduct assessments on-site providing an opportunity for seniors to access mental health services; a Break-Free program based in the Bronx that helps teens who need drug/alcohol and mental health treatment; a clubhouse in Brooklyn that now serves those with a dual diagnosis of mental illness and mental retardation; and a comprehensive Healing Services and Treatment Clinic in Manhattan which is targeted to women with serious mental illness who also have problems associated with health, substance abuse, and domestic violence.

Consumers are better served through approaches that meet their needs, rather than by approaches that fit into existing and confining systems. Mental illness is a public health issue. It can no longer be placed in its own box and dealt with in isolation, separate and apart from the broader health and social service systems.

The SNP process unified the disparate components of our community in a way not seen since Reinvestment was passed in 1993. While the SNP process lies dormant, the sense of unity and common purpose it engendered must prevail. As always, I invite consumers to help us make the most of what we've learned, so together we can continue building a system to support the building blocks that promote recovery.


Postscript: I know that my colleagues at the Department of Mental Health join me in expressing our deep sadness at the passing of Ken Steele. Ken energized many of us with his ideas and vision of how to construct a better mental health system. Although he is no longer here, his ideas will continue to inspire us. To honor Ken's memory, the Department has named its annual media award the Ken Steele Media Award. Recipients of this award are judged by their commitment to reporting that educates the public about mental hygiene issues and helps reduce stigma. These are standards that are very much in line with Ken's lifework. I wish Danny Frey and the staff at New York City Voices well, as they continue the work Ken started.