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If 2001 was any indication of it, New York's mental health was in grave danger for 2002. As everyone is painfully aware, New York's already strained mental health system was given the ultimate test with the terrorist acts of September 2001. The toll of the terrorist attacks on, not only New Yorkers, but all Americans, will not be fully known for years. Much less publicized was the significant blow New York's mental health system took on September 30, 2001, with the expiration of the Community Mental Health Reinvestment Program.

Without 'reinvestment,' community-based mental health programs would no longer be able to secure funding for the expansion of services from money captured by state-operated inpatient psychiatric bed closures. Instead, at least $38 million that would have gone to ensure New Yorkers with mental illnesses receive the community-based mental health services they need, will instead go to pay for prisons and jails, to fill potholes and to build baseball stadiums.

Thankfully, through a series of negotiations and compromises, legislation authorizing a new 'reinvestment' program has passed both houses of the Legislature. The Community Mental Health Support and Workforce Reinvestment Program is similar to the old 'reinvestment' in that it captures money from the downsizing of the state-operated inpatient system. However, under the new 'reinvestment' law, money will be focused on staff recruitment and retention.

By passing the new 'reinvestment' law, the Assembly and Senate made a commitment to the provision of community mental health services. The Governor has not yet joined the Legislature in committing to ensure that the community-based mental health workforce remains viable. Hopes are high that that he will sign this bill into law before the December 31st deadline.

The state's authorization of a health care reform package focused primarily on addressing the current shortage of health care workers was very bittersweet for the mental health community. Sweet was the inclusion of the 'Medicaid Buy-In,' which provides disabled individuals the opportunity to purchase Medicaid benefits on a sliding scale, depending on their income. Bitter was that New York's mental health direct care workforce was completely left out of this health care reform package. However, the legislature, recognizing that mental health services are only as good as the direct care staff and agencies providing those services, went about to remedy this by providing the mental health system a similar package in the budget.

The NYS 2002-2003 budget included a long sought 3% cost of living adjustment for mental health direct care workers and a 10% Medicaid fee increase for service providers, both effective December 1st.

Significant progress has been made at the federal level in Congress regarding mental health parity, through the hard work of US Senators Domenici and Wellstone, and with President Bush's endorsement of the concept of parity. The mental health community in New York was very hopeful that parity's momentum in Washington would provide the opportunity to pass mental health parity legislation in New York. Not only would this issue suffer yet another year of stagnation in New York due to the State Senate's failure to consider such legislation, but this issue would take a much harder hit when US Senator Paul Wellstone of Minnesota, one of the most ardent proponents of parity, was killed in a plane crash just before the November election.

While the federal parity law of 1996 was recently extended for another year, hopes are very high that as a tribute to Senator Wellstone and his unending work on behalf of individuals with mental illness, comprehensive parity will soon become a reality not only in New York, but throughout the US.

In late April, many New Yorkers were shocked when The New York Times published a series of articles exposing the squalid conditions in some adult homes. With nearly 1/3 of the total population (12,000 to 15,000) of adult home residents suffering from mental illnesses, these articles set off a flurry of activity and attention paid to the entire mental health service delivery system. A few administrative changes have been adopted to immediately address the enforcement of health regulations, the issuance of fines, and the removal of adult home operators found in violation of health codes.

Through the NYS Assembly's public hearings and the Governor's workgroup on adult home reform, a multitude of long-term legislative fixes were proposed. Most prominent is the development of alternative housing and treatment options in a much less restrictive setting than the institutional-style adult homes. As of yet, none have been passed into law.

The New York Times' reports of scandals regarding the state's provision of services for individuals with mental illnesses has continued with articles about nursing homes with locked wards for people with mental illnesses, and about shipping individuals from state-operated psychiatric facilities to nursing homes with locked wards in other states.

The Mental Health Association of New York State and many other advocates believe that the adult home and nursing home scandals, parity, workforce issues and many other issues we face are the result of one deficiency; the state's failure to develop, implement and properly fund a plan to provide a seamless system of community-based mental health care. Concerted efforts will be made in the upcoming year to urge the state to develop and implement such a plan.

Without a plan, we will continue to face increasing homelessness, restrictive institutional style housing situations, the inability to pay for mental health services, incarceration of individuals with mental illnesses, workforce recruitment and retention issues, and a myriad of other unnecessary results.