OMH - Office of Mental Health - New York State

2005‒2009 

Statewide Comprehensive Plan 

for Mental Health Services 

January 2005 

New York State 

George E. Pataki, Governor 

Office of Mental Health 

Sharon E. Carpinello, RN, PhD, Commissioner

Message from the Commissioner 

O 

ver the past year, the hallmark 2004-2008 

Statewide Comprehensive Plan for Mental 

Health Services has created strong momentum 

toward advancing OMH's quality agenda. The 

intent of OMH to provide energetic, innovative 

and transparent approaches to quality and stakeholder 

collaboration has taken on new meaning. 

Participants in the planning process have 

applauded the data-rich content of the Plan. This 

new depth of information and the key questions 

posed in the Plan have created a platform for 

discussing actions necessary to address some of 

the more difficult challenges we face. For example, 

we participated with a NYC-based group of 

general hospitals to streamline the longstanding 

referral processes that impeded easy access to 

our State psychiatric hospital beds, we commissioned 

a broadly representative coalition of people 

who use mental health services to craft a 

first-of-its kind white paper, "Infusing Recovery- 

Based Principles into Mental Health Service," and 

we partnered with the Conference of Local Mental 

Hygiene Directors in their efforts to reach 

consensus about priorities for planning, target 

populations, and service needs. 

I have several new insights to share as a 

result of my personal efforts this year to reach 

out and engage the large community of those 

interested in the State's public mental health 

system. First, people are "hungry" for information 

and for their voices to be heard. Second, 

building a new, comprehensive, inclusive planning 

process in the State is not something that 

emerges quickly. It is a developmental process 

that we have made a strong beginning towards 

since the publication of last year's plan. Our 

challenge in this year's plan is to continue to 

fuel the positive energy and momentum we 

have built. The 2005-2009 Statewide Comprehensive 

Plan is meant to do just this. It is not 

intended as a stand-alone document, but as a 

complement to last year's work. While we have 

intentionally not resurfaced content that is readily 

available to you, I know that you will be 

pleased with this year's Plan. 

In this 2005-2009 Plan, OMH has operationalized 

the agency's strategic planning framework by 

creating a set of priorities that will guide its operations 

over this planning horizon and well into 

the future. This set of measurable goals is the 

agency's "strategic plan," which is presented for 

the first time in this year's Plan. OMH will seek 

public input for this initiative through our planning 

process and will regularly report on progress 

related to achieving its goals. Having a strategic 

plan does not preclude OMH from continuing all 

ongoing efforts at advancing key initiatives, but it 

does serve to focus attention on a concise set of 

pivotal activities to address our priorities. 

Our strategic plan serves as a guidepost for 

agency executives to develop and oversee a targeted 

set of management activities, several of 

which become the basis for resource allocation 

and initiation of new planning activities. By 

concluding our 2005-2009 Statewide Comprehensive 

Plan with our strategic plan and next 

steps for performance improvement, we intend 

to conclude with a new beginning-an informed, 

interactive planning process based on performance 

measurement. 

In each of its nine chapters, this document 

provides further evidence of OMH's commitment 

to quality and pursuit of excellence. The 2005- 

2009 Plan begins with restatements of the 

agency's commitment to quality. We then provide 

an overview of the public mental health 

system and describe 2004 planning outreach 

efforts and stakeholder input. We continue 

describing our commitment to quality by highlighting 

recent work done by OMH in basic, 

clinical and services research, and provide indepth 

explanations of growing policy interest in 

childhood anxiety and depression, in people 

who are in prison and require mental health 

services, and in preventing suicide. The Plan 

concludes with our approach to performance 

improvement through use of a strategic plan and 

an ongoing performance measurement process. 

As you read through this Plan, you may consult 

the 2004--2008 Plan which complements 

this document and serves as a valuable reference 

guide. We have released this 2005--2009 

Plan in conjunction with our agency's 2005-- 

2006 Executive Budget and legislative agenda. 

We anticipate your interest and encourage public 

participation in the important discussions that 

will surround this statewide planning initiative 

in the upcoming legislative session. 

Sharon E. Carpinello, RN, PhD 

Commissioner 

NYS Office of Mental Health

I 

Table of Contents 

Chapter 1 

Mission and Vision ....................................................................................................1 

Chapter 2 

Who is Served ..........................................................................................................13 

Chapter 3 

Collaborations to Strengthen Planning....................................................................21 

Chapter 4 

Basic and Clinical Research ....................................................................................35 

Chapter 5 

Services Research ....................................................................................................51 

Chapter 6 

Children and Depression ..........................................................................................81 

Chapter 7 

Forensic Services ......................................................................................................89 

Chapter 8 

Preventing Suicide ..................................................................................................105 

Chapter 9 

Implementing OMH’s Strategic Plan......................................................................113 

New York State Office of Mental Health 

2005–2009 Statewide Comprehensive Plan for Mental Health Services

II 

2005–2009 Statewide Comprehensive Plan for Mental Health Services New York State Office of Mental Health

Chapter 1: Mission and Vision 1 

Mission and Vision Chapter 1 

Introduction 


he New York State Office of 

TMental Health (OMH) is committed 

to enhancing the quality of our 

State’s public mental health system. 

During 2005-2009, the agency’s fundamental 

goals are to continue 

maximizing access to quality mental 

health services for adults with serious 

mental illness and children with 

serious emotional disturbance, and 

to continue promoting the mental 

health of all New Yorkers through 

public education and advocacy. 

Maximizing access to appropriate 

and effective mental health services 

is central to promoting recovery for 

individuals with mental illness so 

they can live full and productive 

lives in their communities. Recent 

research shows high rates of recovery 

for people with even the most 

serious diagnoses, and new studies 

document the effectiveness of selfhelp 

and rehabilitation. Collectively, 

these studies demonstrate that 

people with psychiatric disabilities 

can and do recover and services 

can be designed to enhance this 

process. This emphasis on recovery 

oriented services is central to 

achieving quality outcomes and to 

advancing OMH’s mission, vision, 

and values. 

Leaders in health and mental 

health care including the World 

Health Organization (WHO), the 

U.S. Surgeon General, and the 

President’s New Freedom Commission 

on Mental Health have identified 

a need for a public mental 

health approach to mental illness 

that expands efforts beyond treatment 

for the most severely affected 

individuals. OMH also recognizes 

this need and will continue to pursue 

initiatives to educate people 

about using health promotion and 

disease prevention interventions 

designed to improve and enhance 

quality of life. 

This 2005-2009 Statewide Comprehensive 

Plan for Mental Health 

Services is intended to be read and 

utilized in conjunction with the 

2004-2008 Plan. In the 2004-2008 

Plan, OMH provided an extensive 

discussion of how we are applying 

our strategic planning framework 

to promote the agency’s commitment 

to quality. This continues to 

be the basis for addressing trends 

and challenges during the 2005- 

2009 planning period, and OMH 

will continue its commitments in 

these areas. Although the planning 

framework is not rearticulated in its 

entirety in this 2005-2009 Statewide 

Comprehensive Plan, last year’s 

presentation of agency initiatives in 

the context of the strategic planning 

framework can be found in 

Chapter 10 of the 2004-2008 Plan 

on the OMH Web site at http:// 

www.omh.state.ny.us/omhweb/ 

statewideplan/. 

This 2005-2009 Statewide Comprehensive 

Plan complements last 

year’s plan by expanding the 

strategic planning framework into a 

2005 agency strategic plan. It pres- 


2 Chapter 1: Mission and Vision 

ents new and expanded information 

on emerging topics central to 

moving the quality agenda forward 

based on input from our 2004 public 

forums. It also provides comprehensive 

overviews of selected segments 

of the public mental health 

system which have not been fully 

addressed in earlier plans. 

The Strategic 

Planning Framework 

I 

n the 2004-2008 Statewide Comprehensive 

Plan, OMH described a 

strategic planning framework to 

guide agency operations and to support 

its commitment to quality. This 

framework consists of two components. 

The first includes the agency’s 

mission and vision statement, its values 

and the “ABC’s” of mental health 

care, which are core operating principles 

governing the conduct of agency 

business. The second is OMH’s commitment 

to recovery as a guiding 

principle for agency operations. 

These two components comprise the 

framework for developing specific 

long and short term goals and for 

implementing solid action plans to 

achieve them – a process which is 

referred to as strategic planning. 

OMH has a strong commitment to 

strategic planning requiring that 

managers act “strategically,” meaning 

that they develop and use a targeted 

approach to achieving measurable 

goals and that they 

continually “check and correct” 

progress toward goal attainment. 

The OMH Strategic Plan appears in 

Chapter 9, however, it is not possible 

to have a strategic plan without 

first having a strong framework to 

direct agency initiatives toward “true 

North” – a compass point intended 

to guide managers at all levels of 

the system as they integrate strategic 

planning into daily management 

operations. Having a “true North” 

helps OMH to consistently reflect 

on the degree to which operations 

are aligned with our organization’s 

cultural norms and expectations. 

OMH’s Mission, Vision, 

and Values 

n emphasis on recovery-orient- 

services is central to advanc- 

Aed 

ing OMH’s mission, vision, and values, 

and achieving quality 

outcomes. 

Figure 1.1 

Mission and Vision and Values 

Mission 

The mission of the New York State 

Office of Mental Health is to promote 

the mental health of all New Yorkers 

with a particular focus on providing hope 

and recovery for adults with serious 

mental illness and children with serious 

emotional disturbances. 

Vision 

The New York State Office of Mental 

Health will work toward a more effective 

public mental health system, which values 

recovery, hope, excellence, respect, 

and safety. 

Values 

◆ Recovery is the process of gaining 

control over one’s life in the context 

of the personal, social and economic 

losses that may result from the experience 

of psychiatric disability. It is a 

continuing, non-linear, highly individual 

process that is based on hope 

and leads to healing and growth. 

◆ Hope is the belief that one has both 

the ability and the opportunity to 

engage in the recovery process. 

◆ Excellence is the state of possessing 

superior merit in the design, delivery and 

evaluation of mental health services. 

◆ Respect is esteem for the worth of a 

person including recognition of dignity, 

diversity and cultural differences. 

◆ Safety is an environment free from 

hurt, injury or danger. 



OMH is pursuing its mission and 

vision by focusing on accountability, 

best practices, and coordination 

of care to plan and manage performance 

in its day-to-day operations. 

Known as the “ABC’s of 

mental health care,” they are: 

◆ Accountability for Results, 

whereby a clearly defined entity 

or individual is responsible for 

the effectiveness of services 

delivered. Services are designed 

and delivered to achieve specific 

outcomes, which are measured 

by performance indicators. 

◆ Best Practices, whereby service 

design and delivery is based on 

the best research and evidence 

available and best practice guidelines 

are incorporated into treatment 

practices. Adherence to 

these guidelines is measured as 

part of the accountability process. 

◆ Coordination of Care, whereby 

coordinated, comprehensive networks 

of providers deliver a balanced 

array of medical, self-help, 

social, supportive and rehabilitative 

services and programs. 

These services are focused on 

rehabilitation and recovery, and 

individualized service plans are 

designed around the needs and 

desires of the individual. 

Commitment to Recovery 

Oriented Services 

MH’s commitment to expanding 

Othe recovery-oriented approach 

to service design and delivery is 

grounded in empirical data demonstrating 

that people can and do 

recover from diagnoses of serious 

mental illnesses. 1 Recovery-oriented 

services are characterized by a 

commitment to promoting and preserving 

wellness, to expanding 

choice and eliminating coercion, 

and to providing the least intrusive 

services in the most integrated environments. 

This approach promotes 

maximum flexibility and choice to 

meet individually defined goals and 

to permit person-centered rather 

than program-centered services. 

The recovery-oriented approach 

is influenced and informed by people 

who have been diagnosed with 

mental illness, recognizing that 

they have valuable knowledge and 

insights about healing, coping, and 

recovery that can help shape service 

delivery systems. The agency’s 

commitment to a quality improvement 

agenda is only meaningful 

when viewed against a recovery 

“lens.” Recovery provides the perspective 

for hope and meaning in 

each person’s life, and also for a 

system of care which sees itself as 

instrumental to improving the quality 

of life for individuals and their 

families. While quality improvement 

activities exist in all business 

domains, the role of OMH as the 

State mental health authority is to 

promote the recovery “lens” within 

its own constituencies and elsewhere 

in State government. 

The recovery “lens” and OMH’s 

mission, vision, and values are 

yardsticks for leaders to use in 

developing and prioritizing goals 

and management strategies to 

guide the public mental health system 

toward enhanced quality and 

improved outcomes. The strategic 

planning initiatives which emanate 

from this framework serve two purposes. 

First, they help managers 

improve the quality of their work 

in day-to-day operations, and second, 

they provide a structure 

where management and planning 

activities can merge to effectively 

respond to changing needs inside 

and outside of our organization. To 

fulfill the OMH mission, it is essential 

that there is organizational 

capacity to chart a course of strategic 

direction which is responsive to 

changing conditions and needs. 

Blending the management of daily 

operations with strategic direction 

Notes 

1 Harding CM, Brooks GW, Ashikaga T, Strauss 

JS, Breier A. (1987).The Vermont longitudinal 

study of persons with severe mental illness, 

I: Methodology, study sample, and overall 

status 32 years later. Am J Psychiatry, 

144(6):718-26. 




Notes 

2 OMH’s New York State Psychiatric Institute 

also provides a small number of inpatient 

services in its Washington Heights Community 

Service division. 

is generally referred to as a strategic 

management approach. 

OMH’s intent to move toward a 

strategic management approach 

begins by describing who we are 

as an organization, in terms of the 

agency’s strengths, and challenges. 

As one of the nation’s largest mental 

health authorities, OMH can best 

be understood within the following 

discussion of roles and functions. 

The Office of Mental Health’s 

Role as State Mental Health 

Authority 

MH has two primary functions 

Oas State mental health authority: 

to ensure access to high quality 

services for adults with severe 

mental illness and children with 

serious emotional disturbance and 

to promote overall public mental 

health through education and 

advocacy for all New Yorkers. 

These dual functions are carried 

out as OMH conducts integrated, 

results-oriented oversight of State 

and Local resources. Management 

decisions are guided by accurate 

and timely performance measurement 

focused on the key areas of 

access to services, service quality 

and appropriateness, outcomes, 

and cost. To effectively meet 

agency responsibilities, day-to-day 

operations are organized in four 

lines of business: 

1. Regulation, Certification, and 

Oversight of New York’s Public 

Mental Health System 

MH is responsible for the regu- 

and licensing of all mental 

Olation 

health facilities and programs in the 

State other than private practices 

and Federal facilities. In this role, 

the agency provides oversight to 

the State’s 62 counties and more 

than 2,500 mental health programs 

operated by Local governments and 

private agencies that provide mental 

health services to the people of 

New York State. The services provided 

by locally operated programs 

include inpatient, outpatient, emergency, 

residential, and community 

support. While certain policy, funding, 

regulatory, and management 

functions are centrally administered, 

actual program administration takes 

place on the Local government 

level. Each year approximately 

588,000 individuals receive services 

in County operated or not-for-profit 

mental health programs. 

OMH oversight includes administrating 

a Prior Approval Review 

(PAR) process for the establishment 

of new programs, establishing rates 

of reimbursement for licensed programs, 

and administering a State 

aid to Local governments funding 

program. The agency uses certification 

standards to improve clinical 

service and quality. OMH ensures 

that public mental health services 

are responsive to local needs by 

collaborating actively with the New 

York City and county departments 

of mental health, and evaluating 

performance of the public mental 

health system on an ongoing basis. 

2. Direct Provision of State-operated 

Inpatient and Outpatient 

Mental Health Services 

MH is a major provider of inpa- 

and outpatient treatment 

Otient 

with a broad array of services. 

Intermediate and long-term inpatient 

services are provided in a network 

of 26 psychiatric centers that 

include 20 psychiatric centers serving 

adults with severe mental illness, 

three of which serve adult 

with mental illness involved with 

the criminal justice system, and an 

additional six serving children with 

severe emotional disturbances. 2 

Appendix 1 contains maps which 

describe the locations of all New 

York State adult, children, and 

forensic psychiatric centers and 

research institutes, as well as the 



locations of children’s inpatient 

programs throughout the State. 

State-operated inpatient services 

are typically utilized by individuals 

who require longer lengths of stay 

than what is offered in locally 

operated community hospitals. 

State-operated outpatient services 

are similar to those provided by 

locally operated agencies, and are 

primarily used by individuals who 

also use State-operated inpatient 

services. This includes an active 

caseload of prison inmates who 

receive mental health services 

while incarcerated in Department 

of Correctional Services’ facilities in 

over 33 sites statewide. 

3. Mental Health Research to 

Advance Prevention, Treatment, 

and Recovery 

MH research is an important 

Opart of agency efforts to identify 

scientifically based, effective interventions 

and incorporate them into 

mainstream practice throughout the 

public mental health system. 

Research in basic science to better 

understand the biochemical and 

genetic mechanisms underlying 

mental illness is conducted primarily 

at the Nathan S. Kline Institute 

(NKI) in Orangeburg New York, 

and the New York State Psychiatric 

Institute (NYSPI) in New York City. 

Researchers at the institutes conduct 

clinical trials to develop and 

evaluate new treatments and services 

as well, and have been participants 

in numerous collaborative, 

multi-site clinical trials that have 

led to U.S. Food and Drug Administration 

(FDA) approval of new 

medications for schizophrenia, 

bipolar disorder, depression, and 

anxiety disorder. OMH researchers 

also focus on outcome studies to 

determine better methods of service 

delivery, and recognize the 

importance of involving consumers 

from diverse cultural communities 

at every stage of the process of 

recovery. OMH research is 

described in greater detail in Chapters 

4 and 5. 

4. Promoting Mental Health 

through Public Education 

s part of our commitment to 

Aenhancing quality throughout 

our public mental health system, 

OMH promotes mental health 

through education and advocacy 

for all New Yorkers. OMH is 

increasing the general public’s 

awareness and understanding of 

mental health by developing and 

distributing information about the 

nature and impact of mental illness, 

effective treatments and services, 

useful preventive and coping strategies, 

and how to get help when it 

is needed. The agency’s information 

dissemination strategies are 

designed to reach as many New 

Yorkers as possible, with a particular 

focus on high-risk groups. As 

public awareness of the scale and 

scope of the impact of mental illness 

has increased, a corresponding 

increase in societal desire and 

expectations for an effective mental 

health system is emerging. More 

information on specific public mental 

health promotion strategies 

regarding suicide prevention is presented 

in Chapter 8. 




Notes 

3 The Winds of Change campaign is now in its 

fourth year and is described in more detail 

on the OMH Web site at 

http://www.omh.state.ny.us/omhweb/ebp/w 

inds_of_change.htm. 

4 Carpinello SE, Rosenberg L, Stone J, Schwager 

M, Felton CJ. (2002). Best Practices: 

New York state’s campaign to implement 

evidence-based practices for people with 

serious mental disorders. Psychiatr Serv., 

53(2):153-5. 

Enhancing Quality 

in Our Public Mental 

Health System 

efore an organization can devel- 

a set of goals and manage- 

Bop 

ment strategies it needs to assess 

its strengths. OMH has made four 

major structural inroads in the past 

year which can provide significant 

support to its management initiatives 

and attainment of goals. First, 

OMH has a continuing commitment 

to quality as well as the 

nationally recognized “Winds of 

Change,” a campaign dedicated to 

providing access to mental health 

services that are based on the best 

available evidence. 3 Second, OMH 

has adopted a population-based 

planning approach to the design 

and delivery of public mental 

health services. Third, OMH is 

increasing stakeholder input to the 

State and Local mental health planning 

process. Fourth, OMH has initiated 

a performance measurement 

system as a critical component of a 

quality and strategic planning 

framework. These efforts are all 

enhanced by OMH’s extensive, 

multi-year commitment to the 

development of a decision support 

infrastructure that is accessible to 

both State and county mental 

health planners. 

Continuing Commitment 

to Quality 

MH is a leader in the national 

Omental health quality improvement 

agenda and our commitment 

to quality is the cornerstone of all 

agency planning initiatives. In last 

year’s 2004-2008 Statewide Comprehensive 

Plan, OMH affirmed its focus 

on quality and articulated the 

agency’s strategy for advancing the 

quality agenda. In this 2005-2009 

Statewide Comprehensive Plan, 

OMH reaffirms our commitment to 

this multi-year quality agenda, which 

includes the “Winds of Change” campaign 

to integrate evidence-based 

practices into routine care. 4 Much of 

this 2005-2009 Plan chronicles steps 

in this quality agenda to improve 

access to and quality of mental 

health services in New York State. 

OMH’s quality agenda is consistent 

with a sweeping national 

agenda for improving quality in 

health care which envisions a 

health care system with a renewed 

focus on innovation and quality, 

based on scientifically proven ‘evidence-based’ 

treatments and practices 

as the foundation of routine 

health care. This agenda is also 

integral to the promotion of recovery 

and community integration for 

individuals with mental illness, 

because without quality services 

and appropriate access to care, it is 

unlikely that the full potential for 

recovery can be realized. This 

national mental health quality 

agenda has been developed with 

contributions from nationally 

respected institutions and individuals 

including the Institute of Medicine 

of the National Academies, the 

President’s New Freedom Commission 

on Mental Health, the federal 

Substance Abuse and Mental 

Health Services Administration 

(SAMHSA), the U.S. Surgeon General, 

the Joint Commission on 

Accreditation of Healthcare Organizations 

(JCAHO), and the Schizophrenia 

Patient Outcomes Research 

Team (PORT). 

The national quality improvement 

agenda recognizes that although 

medical leaders and research scientists 

make discoveries every day to 

improve the quality of health care, 

routine medical practice does not 

rapidly assimilate these advances. 

As a result, gaps often exist 

between what research has identified 

as state-of-the-art health care 

and the care that is actually delivered 

in day-to-day medical practice. 

In the mental health care system, 



there is a need for substantial 

reform to fully implement a science 

to practice quality agenda. Through 

our ‘Winds of Change’ campaign, 

OMH is collaborating with the 

research, academic and clinical 

communities to effectively bring 

proven evidence-based practices 

into day-to-day clinical settings. 

Over time, these interventions, if 

available and utilized, could 

improve the opportunity for individuals 

with serious mental illness and 

serious emotional disturbance to 

lead more productive, satisfying 

lives in their communities. Examples 

of OMH achievements in this area 

are presented throughout this Plan. 

Population-based Planning 

s part of our commitment to 

Aquality improvement in mental 

health care, OMH is utilizing a 

population-based planning 

approach in the design and delivery 

of public mental health services. 

OMH’s population-based planning 

goals include determining: 

◆ The current and future mental 

health care needs of priority 

populations. 

◆ The types of mental health care 

services across the continuum 

that will be required to meet 

these needs. 

◆ Where mental health care services 

should be located throughout 

our communities and mental 

health care system. 

◆ What types of facilities and 

providers are needed to accommodate 

these services. 

◆ What quality of life outcomes 

are experienced by service recipients 

within these populations. 

Today, population-based planning 

provides the most productive 

method of looking at the public 

mental health system. It begins 

with geographically-based analysis 

of population characteristics such 

as demographics (e.g., age, gender, 

race, ethnicity), in conjunction with 

data related to mental health such 

as estimates of the prevalence of 

mental disorders, inpatient and outpatient 

service utilization patterns, 

and service outcomes data. Stakeholder 

input to the populationbased 

planning process is critical 

for providing important information 

on how individuals access mental 

health care services, their perception 

of service gaps and unmet 

needs within their communities, 

and comments on improvements 

that are needed in mental health 

care delivery. 

Continued movement toward a 

population-based planning system 

is necessary to fulfill both the State 

and national commitments to 

improving the quality of mental 

health services by focusing on the 

needs of each individual. OMH is 

using population-based planning 

methods that promote focused 

attention on care coordination 

across diverse groups as the foundation 

for customized, culturally 

competent care. More information 

about population-based planning is 

included in Chapter 3. 

Increased Public Input 

into the State and Local 

Planning Process 

strong collaboration between 

Athe State, Local governments 

and stakeholders is integral to 

implementing quality mental health 

initiatives. OMH’s review of feedback 

received during the 2004-2008 

mental health planning process 

identified a call from multiple 

stakeholders to revitalize the planning 

process by emphasizing a 

commitment to Local planning 

input and data driven approaches. 

The 2004-2008 Comprehensive 

Statewide Plan was developed 

using these approaches and has 




CHIEVING RESULTS- 

“A Integral to effective 

government management is 

the continuous need for 

agencies to justify the 

investment choices made to 

fund programs and services. 

Governor Pataki has 

challenged agency leaders 

to establish an outcomefocused 

management culture 

that examines the basic 

operating assumptions, allocation 

decisions and 

accepted business practices. 

Limited resources are a 

reality and agency managers 

are expected to meet 

the challenge of operating 

in ways most beneficial to 

the State and citizens.” 

Excerpt from the 2004-2005 

Executive Budget Overview 

received broad stakeholder 

endorsement. In 2004, OMH conducted 

an expanded series of 

events and opportunities for stakeholder 

input on how to build on 

the progress made in the 2004-2008 

Comprehensive Plan. Chapter 3 

describes the stakeholder involvement 

that occurred during 2004. 

Performance Measurement 

he 2004-2008 Comprehensive 

TPlan also described OMH’s commitment 

to creating a performance 

measurement system, the extensive 

accomplishments already achieved, 

and the strategic direction for the 

future. Efforts made in 2004 to 

advance the performance measurement 

approach are consistent with 

the leadership provided by Governor 

Pataki which was reiterated in 

the 2004-2005 Executive Budget. 

Throughout 2004, OMH has continued 

to develop its information technology 

and data infrastructures and 

core components of performance 

measurement. 

OMH believes that a next important 

step in advancing the quality 

agenda is to enhance and integrate 

the performance management 

framework. Relying on the continued 

leadership from Governor 

Pataki regarding an outcomesfocused 

management culture, OMH 

has consolidated our achievements 

to date with extensive stakeholder 

input to create the conceptual 

framework for the next iteration of 

the agency’s performance management 

system, which is articulated 

in Chapter 9 of this document. A 

major goal of the 2005 planning 

cycle will be receiving and reviewing 

stakeholder input in response 

to the performance measurement 

framework presented. 

Addressing Challenges - 

Continuing to Advance 

the Quality Agenda 

he fundamental challenge that 

Tconfronts New York State and 

the rest of the nation is reshaping 

the public mental health system 

from an institutional to a community-based 

system of care that utilizes 

evidence-based services and supports, 

and financing that transition 

in a challenging financial environment. 

Advances in psychopharmacology 

and mental health treatment 

interventions have made living in 

integrated community settings a 

realistic possibility for most individuals 

with serious mental illness or 

emotional disturbance. New York 

State, under Governor Pataki’s 

leadership, has engaged in a sustained 

effort to achieve that goal. 

In New York State, the transition 

away from institutionally-based care 

has been made possible by 

increased investments to strengthen 

and expand community-based services. 

These increased investments 

were made possible by reinvesting 

resources associated with unneeded 

State psychiatric center inpatient 

capacity, fully utilizing non-State 

resources, and achieving administrative 

consolidations and efficiencies. 

These investments were further 

advanced by Governor Pataki’s 

Enhanced Community Services 

package, which provided more than 

$125 million in new funding for key 

community support services. 

New York is recognized not only 

as a national leader in mental 

health quality improvement, but 

also as a leader in investing in 

mental health care. A recent 

national survey conducted by the 

National Association of State Mental 

Health Program Directors showed 

that New York State leads all other 

states in its financial investments in 

major sectors of mental health service 

delivery, including inpatient 

care, mental health residential serv- 



ices, and psychiatric research, and 

ranks second among states in total 

investments in community-based 

mental health care. 5 

While OMH's strategic direction 

is well defined and substantial 

progress has been made, fundamental 

challenges must continue to 

be addressed to move forward and 

achieve an even more comprehensive 

system of care. OMH recognizes 

the realities of New York 

State's structural budget imbalance 

and the need to evaluate strategic 

objectives against fiscal realities. 

The challenge is how to align these 

realities and the OMH mission to 

achieve the very best outcomes. 

OMH will retain its commitment to 

the following two fundamental 

goals as these efforts continue: 

1. Maintaining the Structural 

Integrity of Existing Service System 

Capacity, and 

2. Providing Targeted Service System 

Expansion Where Needed and 

Supported by the Evidence Base. 

The agency recommends proceeding 

on a course in which continued 

redirection of savings and new 

investment in these planning priorities 

take place as fiscal realities 

allow. Generally, initiatives to 

reestablish or maintain the structural 

and financial integrity of existing 

service providers and capacity take 

precedence over program expansion. 


Adult Psychiatric 

Center Trends and 

Opportunities 

oday, the New York State psy- 

center system, by far the 

Tchiatric 

largest in the nation, continues to 

support unneeded infrastructure. 

Table 1.1 describes how New York 

State's adult psychiatric centers 

have decreased in size as the locus 

of care shifted to the community. 

During the 1950s, New York State 

operated 20 psychiatric centers 

with a total inpatient census of 

approximately 93,000. 

The public mental health system 

has changed dramatically since that 

time. Since advances in psychopharmacology 

and mental 

health treatment interventions have 

made living in integrated community 

settings a realistic possibility for 

most individuals with serious mental 

illness or emotional disturbance, 

New York State and the rest of the 

nation have engaged in a sustained 

effort to transition the public mental 

health service delivery system 

from institutional to communitybased 

settings. 

In New York State this transition 

has included a substantial expansion 

of community-based services, 

including housing, case management 

and other supports, which 

have made the decrease in inpatient 

census possible. The existing 

community-based residential system 

currently supports almost 27,000 

operating beds and another 4,100 

beds are in various stages of planning 

and development. Including 

the beds authorized in this year's 

Executive Budget, the total number 

of community beds will be 31,100. 

New York State continues to 

operate more psychiatric centers 

than any other state in the nation, 

and inpatient bed utilization also 

Notes 

5 Additional information regarding this national 

comparative information is contained on 

the NASMHPD web site. 




Table 1.1 

The Shrinking Size of New York’s State Adult Psychiatric Centers 

1955 (Peak) Dec. 31, 1993 Dec. 31, 1998 Oct. 1, 2003 

Total Census 93,197 10,162 5,309 4,223 

Number of Psychiatric Centers 20 21 17 17 

Average Census of Psychiatric Centers 5,178 484 312 248 

Largest Psychiatric Center Census 14,325 1,167 1,077 703 

Smallest Psychiatric Center Census 2,164 107 95 71 

Workforce 24,500 20,900 13,600 11,225 

continues to exceed that of other 

mid-Atlantic states. Today, New 

York operates 20 State adult psychiatric 

centers, three of which serve 

forensic inmate-patients. The 17 

non-forensic adult psychiatric centers 

currently have a total inpatient 

census of less than 4,200. With the 

number of people requiring inpatient 

psychiatric treatment only a 

fraction of the size it once was, 

there is no longer a need to continue 

operating this many facilities. 

With an estimated adult inpatient 

census of less than 4,100 by the 

end of the 2006 State fiscal year, 

New York must continue to examine 

the role of State-operated inpatient 

care within the broader context 

of community-based treatment, 

rehabilitation and support services 

available in each area of the State. 

The benefits of maintaining the 

State adult psychiatric center infrastructure 

at the present level for 

the number of individuals being 

served does not justify current 

associated costs or anticipated 

future costs. 

To continue the transition to evidence-based 

adult and children's 

services that are delivered in the 

community, maintain community 

access to inpatient services, and 

avoid investing in unneeded adult 

psychiatric center administrative 

and infrastructure costs, OMH has 

identified the following criteria for 

the consolidation of adult inpatient 

capacity: 

◆ Substantial administrative savings 

could be realized and reinvested 

in community-based services; 

◆ Large capital expenditures could 

be avoided that would support 

unneeded inpatient infrastructure; 

and 

◆ Inpatient beds could be transferred 

to a nearby psychiatric 

center where adequate unused 

physical space exists. 

OMH has concluded that Middletown 

Psychiatric Center meets 

these criteria and has recommended 

its closure; transferring Middletown's 

inpatient beds to the Rockland 

Psychiatric Center; maintaining 

existing State outpatient services in 

their current communities; and 

reinvesting 100% of the associated 

savings to expand State-operated 

community services in Orange and 

Sullivan Counties. These actions 

will be taken without eliminating 

any inpatient capacity. 

Several key factors were considered 

in reaching these recommendations. 

Middletown Psychiatric 

Center is serving a small number of 



individuals and this number continues 

to decline: although Middletown 

once had over 3,000 inpatient 

beds, it now has only 115. It is difficult 

to justify the $28 million capital 

investment that would be 

required to maintain certification 

compliance for a psychiatric center 

of this size. There is sufficient 

unused physical space at nearby 

Rockland Psychiatric Center to relocate 

Middletown's inpatient services. 

Finally, adults and children in 

the current Middletown catchment 

area will be better served by the 

expanded new State-operated community-based 

services. 

2005-2006 Executive 

Budget Actions 

T 

he 2005-2006 Executive Budget 

for the Office of Mental Health 

advances the Governor’s transformation 

of New York’s public mental 

health system by continuing to 

redirect resources to community 

settings, provide funding for targeted 

service expansion in sciencebased 

treatments, and provide 

funding to preserve and reinforce 

the existing service system. The FY 

2005-2006 budget continues the 

advancement of an agenda that is 

integral to the promotion of recovery 

and community integration for 

individuals with mental illness. The 

Executive Budget strengthens key 

community programs and maximizes 

access to quality mental 

health care, while still achieving 

the necessary efficiencies to ensure 

the most cost-effective use of all 

resources. 

Additional information regarding 

the 2005-2006 Executive Budget is 

included in Appendix 11. 





Chapter 2: Who is Served 13 

Who is Served Chapter 2 

Introduction 

n 2004 OMH made a major com- 

to increasing opportunities 

Imitment 

for public input into the planning 

process. 2004 stakeholder input 

identified planning priorities for the 

continued provision and refinement 

of planning data. These priorities 

include using a population-based 

approach to organize data regarding 

adults served in the public mental 

health system to focus on priority 

sub-populations including young 

adults and older adults. 

This Chapter provides the latest 

data available from the 2003 Patient 

Characteristics Survey (PCS). 1 This 

system-wide data is two years more 

current than the 2001 data provided 

in the 2004 Comprehensive 

Plan, and can be compared to that 

data to look for emerging trends. 

As one might expect, changes over 

a two-year period may not be striking, 

but can provide an indication 

of potential trends that may require 

continued monitoring. Chapter 2 

presents PCS data using a population-based 

approach to describe 

sub-populations of interest by 

demographics and diagnosis. 

The Statewide 

Perspective 

E 

ach year, more than 600,000 persons 

receive services in New 

York’s public mental health 

system. 2 Of this total, approximately 

22% are children aged 17 years 

or younger. At least two-thirds of 

all individuals served have both a 

mental disorder and severe functional 

impairment resulting from 

their disorder. This combination of 

a mental disorder and severe functional 

impairment is referred to as 

serious mental illness. In the U.S., 

mental illnesses rank first among 

illnesses that cause disability. The 

disabling effects of mental illness in 

adults can result in homelessness, 

joblessness, health problems, and 

social isolation. In children, the 

effects are often serious and long 

lasting, leading to poor academic 

achievement, failure to complete 

high school, substance abuse, 

involvement with the correctional 

system, lack of vocational success, 

inability to live independently, and 

health problems. Additional information 

about the disease burden 

and costs of mental illness is 


Specifically, in New York State 

66% of adults served have serious 

mental illness and 72% of children 

and adolescents served have serious 

emotional disturbance. These 

proportions are consistent with 

Notes 

1 OMH derives its estimates of the number of 

people served annually by the public mental 

health system from its Patient Characteristics 

Survey (PCS). The PCS, which is administered 

every other year, gathers information 

about the demographic and clinical characteristics 

of persons receiving mental health 

services in programs operated, funded, or 

certified by OMH during a one-week period. 

The one-week data are then used to estimate 

the total number of people served 

annually and their characteristics. OMH uses 

estimates rather than actual counts because 

the variety of administrative data systems 

used today in the public mental health system 

does not allow a complete enumeration 

across all service sectors of the number of 

persons served. For simplicity, point estimates 

are reported in this document. The 

range for estimates will vary by size of the 

population, but is typically less than ±5%. 

The data presented in this chapter are 

derived from the 2003 PCS, which is the 

most recent available. 

2 Services provided in New York’s public mental 

health system include those delivered by 

programs funded, certified or operated by 

OMH. They do not include mental health 

services provided by private practitioners or 

physicians or mental health services provided 

by programs operated by other State 

agencies, for example, the Office of Children 

and Family Services. 



14 Chapter 2: Who is Served 

reported U.S. averages of 65% and 

62% respectively. 

The diversity of the population 

served in New York’s public mental 

health system emphasizes the need 

for population-based planning. 

Twenty two percent of this population 

is under 18 years of age, 9% 

are young adults aged 18-24, 13% 

are adults aged 25-34, 29% are 

aged 35-49, 17% are aged 50-64, 

9% are over 65 years of age, and 

for 1%, the age is unknown. Across 

age groups, approximately 50% are 

male and 50% female. This racially 

diverse population is 55% White, 

24% Black, 17% unknown race, 2% 

Asian, and 2% another race or 

multi-racial. Hispanic ethnicity is 

reported separately from race. 

Twenty-one percent (21%) are ethnically 

Hispanic, including many of 

those whose reported race was 

unknown. 

How do the demographic characteristics 

of individuals served in the 

public mental health system compare 

with those of New York’s general 

population? Figure 2.1 

describes persons served annually 

in the public mental health system 

with a population-based approach 

Figure 2.1 

Number of Persons Served Annually, 

Rate per 1,000 Persons in the General Population 

60 

that utilizes 2003 U.S. Census data. 3 

On an annual basis, 31.63 females 

per 1,000 females in the general 

population and 33.15 males per 

1,000 males in the general population 

receive services in our public 

mental health system. By age 

group, the rates are highest among 

13-17 year olds (51.71) and 35-49 

year olds (40.82), and lowest 

among children aged 12 years or 

younger (21.59) and those 65 years 

and older (21.48). By race, the rates 

are highest among individuals who 

are Multi-racial (43.05) and Black 

(42.23), and lowest among Asians 

(7.36) and American Indian or 

Alaskan Natives (9.44). Rates for 

persons with Hispanic ethnicity 

were nearly as high as the Black 

and Multi-racial groups (41.55). 

These data show that although individuals 

who are 35-49 years old 

comprise the largest group of service 

recipients and that the majority 

of service recipients are White, 

services are delivered at the highest 

rate to individuals who are 13-17 

years of age and to members of the 

Black and Hispanic populations. 

50 

51.71 

40 

33.15 

31.63 

30 

20 

21.59 

28.73 31.15 40.82 

33.42 

21.48 

43.05 42.23 41.55 

25.21 

23.72 

10 

9.44 7.36 

Notes 

3 The rate is the number of persons served per 

1,000 persons in the general population having 

the same demographic, 

0 

MaleFemale 

0-12 13-17 18-24 25-34 35-49 50-64 65 & Multracial 

White 

Pacific 

Black Hispanic 

older 

Gender Age in Years Ethnicity Islander 

Am Asian 

Ind./ 

AL Nat. 



Age Groups Served 

Children Aged 17 and Under 

y diagnosis among children 

Bserved, the largest proportions 

have attention deficit disorder (24%) 

or adjustment disorder (19%). Smaller 

numbers have conduct disorder 

or bipolar/major depressive disorder 

(16% each), 12% have some other 

disorder, 8% have anxiety disorder, 

and 3% each have either schizophrenia/ 

psychotic or personality or 

impulse control disorder. 

Young Adults, Aged 18-24 

mong individuals served who 

Aare aged 18-24, 36% are diagnosed 

with bipolar disorder or 

major depression, 22% with some 

other disorder, 13% each with 

schizophrenia and related disorders 

or an adjustment disorder, 8% with 

an anxiety disorder, 5% with a 

delusional or psychotic disorder, 

and 3% with a personality or 

impulse control disorder. 

Schizophrenia/ 

Psychotic (3%) 

Adults Aged 25-64 

mong adults served who are 

Aaged 25-64, 40% have either 

bipolar disorder or major depression, 

24% have schizophrenia and 

related disorders, 15% have some 

other disorder, 9% have anxiety 

disorder, 6% have adjustment disorder, 

4% have delusional and 

other psychotic disorder, and 2% 

personality or impulse control 

disorder. 

Older Adults 

mong adults served who are 

Aaged 65 and over, 40% are 

diagnosed with either bipolar disorder 

or major depression, 18% with 

schizophrenia and related disorders, 

13% with organic brain disorder, 

10% with some other disorder, 

7% each with an adjustment or 

anxiety disorder, and 5% with a 

delusional or psychotic disorder. 

These data show that bipolar disorder 

is the most common diagnosis 

among adults served regardless 

of age group. In each adult popu- 

Figure 2.2 

Primary Mental Disorders Among People Served in the Public Mental Health System 

Personality/ 

Impulse (3%) 

Attention 

Deficit (24%) 

Adjustment 

(19%) 

Conduct 

(16%) 

Anxiety 

(8%) 

Other (12%) 

Bipolar/Major 

Depressive 

(16%) 

Personality & 

Impulse Control 

(3%) 

Delusional & 

Other Psychotic 

(5%) 

Other (22%) 

Adjustment 

(13%) 

Anxiety 

(8%) 

Bipolar/Major 

Depressive (36%) 

Schizophrenia 

and Related 

(13%) 

Personality & 

Impulse Control (2%) 

Delusional & Other 


Adjustment 

(6%) 

Children, Aged 17 and Under 

Anxiety 

(9%) 

Other (15%) 

Schizophrenia 

and Related 

(24%) 

Adults, Aged 25-64 

Bipolar/Major 

Depressive (40%) 

Organic Brain 

Disorder (13%) 

Delusional & Other 


Adjustment 

(7%) 

Young Adults, Aged 18-24 

Anxiety 

(7%) 

Other 

(10%) 

Schizophrenia 

and Related 

(18%) 

Bipolar/Major 

Depressive 

(40%) 

Older Adults, Aged 65 and over 




lation, diagnoses of bipolar disorder 

and schizophrenia together 

comprise nearly half or more of all 

diagnoses: 49% of all diagnoses 

among adults aged 18-24; 64% 

among adults aged 25-64; and 58% 

among adults aged 65 and over. 

Where are People Served? 

Figure 2.3 

Persons Served Annually 

by Program 

70% 

60% 

50% 

40% 

30% 

65% 

20% 22% 

10% 

15% 14% 

0% 

6% 

Outpatient Inpatient Residential 

Community Emergency 

Support 

o live successfully in our com- 

most individuals with 

Tmunities, 

serious mental illness need both 

treatments that control or eliminate 

their psychiatric symptoms and a 

range of support services that meet 

the complex needs caused by the 

disabling effects of their illness. 

Public mental health services are 

grouped in four major categories 

across the health care continuum: 

community support, outpatient, 

inpatient, and emergency services. 

◆ Community support helps 

individuals diagnosed with serious 

mental illness live as independently 

as possible in the 

community, and helps children 

with serious emotional disturbance 

to remain with their families. 

These programs provide 

case management, vocational, 

self-help, residential and other 

support services. Although the 

specific array of community support 

services differs for adults 

and children, the goal is always 

to support successful and full 

community living. 

◆ Outpatient services provide 

treatment and rehabilitation in an 

ambulatory setting, including clinics, 

partial hospitalization treatment 

for children, continuing day 

treatment for adults, Assertive 

Community Treatment (ACT), 

Prepaid Mental Health Plan 

(PMHP) and the soon to be 

implemented Personalized Recovery-Oriented 

Services (PROS). 

◆ Inpatient services provide 

acute stabilization and intensive 

treatment and rehabilitation with 

24-hour care in a controlled 

environment. They are the programs 

of choice only when the 

required services and supports 

cannot be delivered in community 

settings. 

◆ Emergency services provide 

rapid psychiatric and/or medical 

stabilization and ensure the safety 

of individuals who present a 

risk to themselves or others. 

These programs include a range 

of crisis counseling and residential 

services, as well as comprehensive 

psychiatric emergency 

programs. 

In New York State, both State 

and locally operated programs provide 

services in each of these categories. 

The overall goal is to promote 

recovery and full community 

living for individuals with serious 

mental illness, while preserving 

public safety, and ensuring that 

respect, empowerment, and quality 

of life are incorporated into every 

aspect of care. 

On an annual basis, among persons 

receiving services in New 

York State’s public mental health 

system, 65% are served in outpatient 

programs, 22% in community 

support programs, 14% in emergency 

programs, and 15% in inpatient 

programs. Six percent are also 



Figure 2.4 

Program Participation by Age 

70% 69% 60% 

66% 

60% 

58% 

Ages 0-17 

Ages 25-64 

Ages 18-24 

Ages 65 + 

50% 

40% 

30% 

20% 

17% 17% 

23% 23% 

19% 

16% 15% 

16% 

22% 

13% 12% 

1% 

10% 

11% 

8% 

4% 

3% 

0% 

Outpatient Community Support Inpatient Emergency Residential 

served in residential programs, a 

community support service. The 

total exceeds 100% because individuals 

may receive services from 

more than one category depending 

upon need (Figure 2.3). 

Figure 2.4 describes program participation 

by age group. Among 

children 17 or younger, 69% participate 

in outpatient, 17% in community 

support programs, 11% in 

inpatient, 16% in emergency, and 

1% in residential programs. Among 

young adults aged 18-24, 60% participate 


support programs, 19% in 

inpatient, 22% in emergency, and 

4% in residential programs. Among 

adults aged 25-64, 66% participate 


support programs, 16% in inpatient, 

13% in emergency, and 8% in residential 

programs. Among adults 65 

and over, 58% participate in outpatient, 

23% in community support 

programs, 15% in inpatient, 12% in 

emergency, and 3% in residential 

programs. As depicted in Figure 

2.4, the totals exceed 100% 

because individuals may receive 

services from more than one category 

depending upon need. 

Across age groups, the largest 

proportion of individuals (approximately 

60% or more) participate in 

outpatient services. 




Infrastructure 

Development 

to Support 

Local Planning 

I 

n 2000, OMH, New York City and 

Local mental hygiene directors 

formed a multi-year partnership to 

improve access to information systems 

and enhance data-driven decision 

making. The group targeted 

data systems that, given improved 

local access, could assist Local 

directors in managing service delivery 

and provider performance. In 

response, OMH initiated a Webbased 

information portal containing 

Medicaid services and expenditures, 

patient characteristics, and 

adult housing admissions. In addition, 

a State/Local workgroup collaborated 

to define the systems’ 

specifications for the Child and 

Adult Integrated Reporting System 

(CAIRS), a local management information 

system designed to track 

specialty, housing and case management 

services to high-need, 

high-risk populations. 

CAIRS is a dynamically generated, 

Web-based application that 

enhances the ability of Local 

providers to access information, 

generate performance management 

reports, and carry out care coordination 

activities. By the end of 

2004, more than 3,000 individuals 

from over 1,100 program units 

statewide were authorized to use 

CAIRS. Furthermore, nearly 140,000 

records exist in the CAIRS system 

as of December 31, 2004. Children’s 

programs that are required 

to report on CAIRS information 

include residential treatment facilities, 

family-based treatment, teaching 

family homes, community and 

crisis residences, the Home and 

Community Based Services Waiver, 

Home-based Crisis Intervention, 

intensive, supportive, and blended 

case management, mobile mental 

health teams, and school-based 

mental health. Adult programs 

reporting include Assertive Community 

Treatment, Assisted Outpatient 

Treatment, adult housing, and 

family care providers. 

OMH’s Enterprise Data Warehouse 

is a repository of data from 

a wide variety of sources and a 

cornerstone of the agency’s 

increasing capacities for data-driven 

Figure 2.5 

People Receiving Services During Patient Characteristics Survey Week 

per 1,000 General Population. 1999 vs. 2003 

14 

12 

1999 2003 

12.5 12.4 

10.9 10.7 

Per 1,000 General Population 

10 

8 

6 

4 

5.8 5.8 

9.5 

8.9 

5.6 

5.1 

8.4 

7.8 

5.8 

5.2 

2 

0 

Under 12 

13 to 17 18 to 24 25 to 34 35 to 49 50 to 64 65 and older 

Age in Years 



performance-based management. 

Data marts in the Warehouse 

organize all relevant and available 

recipient level information to provide 

a comprehensive and integrated 

view of the needs and treatment 

of users of mental health services 

in New York State. Financial data 

marts provide reporting and analysis 

capability in the areas of payroll, 

personnel, and financial transactions. 

The Data Warehouse 

organizes and integrates these data 

to facilitate rapid ad-hoc analysis 

and reporting. 

Due to successful data infrastructure 

development, OMH is able to 

track services across time and 

providers, enabling the agency to 

measure performance in such critical 

areas as inpatient readmissions 

and time to first outpatient service 

following discharge from hospital 

settings. By integrating data from a 

variety of sources, OMH is able to 

detect trends in services delivery. 

For example, Figure 2.5 shows 

the increase in the number of persons 

served from the 1999 to 2003 

surveys by age group. To control 

for differences in the general population 

by age, the figure shows 

rates of persons served per 1,000 

persons of the same age group in 

the population. Increases were 

observed in the adolescent and 

young adult groups. These trends 

are notable and are one reason 

why adolescents and young adults 

are receiving focused attention. 

Further discussion of agency priorities 

regarding this population 

group is found in Chapter 3. 

Using Geographical 

Information Systems 

(GIS) to Support 

Population-based 

Planning 

MH population-based planning 

Oefforts are supported by a Geographic 

Information Systems (GIS) 

initiative, products of which 

include: 

◆ A repository of geo-coded data 

(providers, location of services, 

recipients, prevalence estimates, 

census information). 

◆ Easily reproducible “geomaps” 

that are used to describe and 

compare information across and 

between geographic areas (e.g., 

counties) including service use 

and expenditures and prevalence 

of mental illness versus treated 

prevalence. Geomaps are excellent 

tools for population-based 

planning and are also used to 

support analysis of “what-if” scenarios 

in addition to actual public 

mental health system characteristics 

and modeling. 

An example of how populationbased 

planning efforts can be supported 

by geo-mapping technology 

is presented in Figure 2.6, which 

uses 2004 U.S. Census estimates 

and prevalence rates of serious and 

persistent mental illness (SPMI) to 

describe the estimated number and 

locations of adults aged 18-54 with 

SPMI in New York State. Statewide 

the estimated prevalence of SPMI 

among adults ages 18-54 is 2.6%. 

The population’s density is plotted 

on the map by zip code. Using 

geomaps of this type, OMH is able 

to determine correlations between 

estimated SPMI prevalence and 

mental health program locations. 




Figure 2.6 

Geomap: Estimated Number of Adults with SPMI Ages 18-54 (Prevalence rate 2.6%) 


Chapter 3: Collaborations to Strengthen Planning 21 

Collaborations 

to Strengthen Planning 

Chapter 3 

MH believes that a high quality 

Opublic mental health system can 

only be sustained with a strong, 

ongoing collaboration between the 

State, Local governments and 

numerous stakeholder groups in 

the planning and delivery of quality 

mental health services. To this 

end, OMH continues to create new 

opportunities for ongoing dialogues, 

stakeholder input, and 

planning collaborations. 

Chapter 3 provides a brief 

overview of planning activities and 

collaborations carried out since the 

release of the 2004-2008 Statewide 

Comprehensive Plan for Mental 

Health Services. Included are references 

and links to related documents 

describing planning activities 

carried out during 2004. The Chapter 

also describes progress made in 

a number of specific, important 

planning collaborations during the 

past year. 

2004 Planning 

Activities 

O 

MH has made a major commitment 

to improve and strengthen 

the statewide mental health planning 

process. In 2004, the agency 

continued this commitment by substantially 

expanding opportunities 

for stakeholder input in response 

to the 2004-2008 Comprehensive 

Plan. For the first time, interactive, 

informational briefing sessions 

were held in all five OMH regions. 

Briefings were attended by stakeholders 

including recipients, families, 

providers, advocates, and 

county mental health directors and 

their staff. During these briefings, 

participants were encouraged to 

identify and discuss issues of local, 

regional and statewide importance 

regarding the adult and children’s 

mental health systems. Topics 

included the planning process, and 

areas of the public mental health 

system requiring ongoing attention. 

Public hearings to obtain formal 

public response to the 2004-2008 

Plan were also held in all five 

regions. Individual testimony given 

at the five hearings varied widely 

in content and focus, but 

addressed virtually all aspects of 

the public mental health system. 

This year, for the first time ever, 

OMH is providing the full text of 

this testimony on our Web site at 

http://www.omh.state.ny.us/ 

omhweb/Statewideplan/testimony/ 

index.htm. 

OMH has long considered input 

from its advisory committees (Multicultural 

Advisory Committee, Recipient 

Advisory Committee, Commissioner’s 

Committee on Families, Mental 

Health Planning Advisory Council, 

and Mental Health Services Council) 

to be critical elements that are vital to 

the planning process. Building upon 

the positive results from advisory 

committee input, OMH has put into 



22 Chapter 3: Collaborations to Strengthen Planning 

place a number of formal and informal 

methods to cultivate ongoing dialogue, 

obtain public comment and 

suggestions, promote the cooperative 

sharing of information, and ultimately, 

promote recovery. 

Figure 3.1 

Statutory, Oversight and Administrative Functions which Contribute to the Planning Process 

Judicial branch 

Executive branch 

Legislative branch 

Commission on 

Quality of Care 

for the Mentally 

Disabled (MHL- 

Section 45.07) 

Office of 

Alcoholism and 

Substance Abuse 

Services 

NYS 

Department 

of Mental 

Hygiene 

Inter-Office 

Coordinating 

Council 

(MHL- 

Section 

5.05 (b)) 

Office of Mental 

Retardation and 

Developmental 

Disabilities 

Policy Advisory 

Boards for: 

• Families 

• Recipients 

• Multicultural Issues 

• Boards of Visitors 

• (MHL-Section 7.37) 

Local 

Comprehensive 

Plans from 

Each County 

(MHL-Section 

5.07 (b) (1)) 

Office of 

Mental Health 

Statewide 

Comprehensive 

Plan 

Policy Advice from: 

• Oversight Bodies 

• Courts 

• Legislators 

• The Public 

• Stakeholder 

• Groups 

• Professional 

• and Trade 

• Associations 


Planning Advisory 

Council (PL-99-660) 


Services Council 

(MHL-Section 7.05) 

Statutory 

Planning Process 

(MHL Section 5.07) 



Highlights of 2004 Efforts 

to Promote Dialogue and 

Planning Collaboration 

MH has productive partnerships 

Owith stakeholder groups including 

the Conference of Local Mental 

Hygiene Directors (CLMHD), general 

hospitals that operate psychiatric 

units (known as Article 28 

hospitals), current and former 

recipients of mental health services, 

families and loved ones of those 

with a mental illness, culturally 

diverse communities and constituents, 

and advocates for special 

populations including children, 

older adults and adult home residents. 

These partnerships provide 

valuable insight and information 

for the planning process as OMH 

continues working toward a system 

of care that supports an individual’s 

personal path to recovery. Highlights 

are provided below. 

The Conference of Local Mental 

Hygiene Directors 

n ongoing collaboration 

Abetween OMH and CLMHD is a 

critical element of the revitalized 

planning process, and the two 

organizations continue to work 

together to develop and implement 

principles that will guide the planning 

process. A collaborative planning 

agenda was formally renewed 

in 2004 and an initial meeting was 

held in January. The two organizations 

are also working together to 

refine and strengthen the specific 

planning roles for the counties and 

for OMH. 

During the 2004-2005 planning 

cycle, a top planning priority for 

the Conference was a survey of its 

membership regarding issues 

impacting persons with mental illness 

and services in their localities. 

Findings from the survey have 

been shared with OMH and were 

considered in the formulation of 

this 2005-2009 Comprehensive 

Plan. A summary of the survey 

findings is included as Appendix 2 

of this document and can be found 

on the Web at http://www.clmhd. 

org/itemfiles/survey_0508_ 

planningpriorities.pdf. 

In the longer term, OMH and the 

Conference continue to collaborate 

to identify and develop ways to 

strengthen the planning process. 

Key areas to be addressed in 2005 

include the design and production 

of county planning templates, and 

the development of county strategic 

data sets. An agenda and “next 

steps” have been developed, and 

OMH has agreed to provide training 

and technical assistance to counties 

to facilitate the planning process. A 

draft County Planning Template is 

provided in Appendix 3. 

OMH is also beginning to work 

with some counties to identify high 

users of inpatient care, formulate 

service plans to help these people 

live successfully in the community, 

and develop approaches to link 

these individuals with intensive 

community mental health resources. 

As the utilization of inpatient beds 

by this group declines, inpatient 

bed days will be freed up and used 

to increase access to both Article 28 

and State hospital beds. 

Recipient Community Input 

MH's partnership with current 

Oand former recipients of mental 

health services is another example 

of expanded opportunity for collaboration. 

In addition to the ongoing 

communication and dialogue 

that flows through the Office of 

Consumer Affairs, the agency commissioned 

Infusing Recovery-Based 

Principles into Mental Health Service: 

A White Paper by New York 

State Consumers, which was presented 

to Commissioner Carpinello 

in August 2004. Over 10,000 recipients 

of mental health services from 

across New York State participated 

in the white paper, which presents 




a picture of what quality, recoverybased 

services would look like 

from a recipient's perspective. 

This white paper was an outgrowth 

of OMH's Winds of Change 

quality initiative, and agency efforts 

to incorporate the perspectives of 

recipients into the implementation 

of evidence-based practices (EBPs). 

As part of that process, an EBP and 

recovery consumer/survivor steering 

committee was convened, and its 

members have participated in many 

of OMH's internal workgroups. 

The recipient community decided 

that rather than focusing solely on 

EBPs, they would take advantage 

of the opportunity to make recommendations 

to improve mental 

health services as a whole. The 

steering committee discussed the 

Institute of Medicine's Crossing the 

Quality Chasm: A New Health System 

for the 21st Century, and, using 

that document as a starting point, 

held a number of inclusive meetings 

with recipients to draft and 

explain ten rules for quality mental 

health services in New York State 

(Table 3.1). 

Table 3.1 

Recipients’ Ten Rules for 

Quality Mental Health Services 

in New York State 

1 There must be informed 

choice. 

2 It must be recovery focused. 

3 It must be person centered 

4 Do no harm. 

5 There must be free access to 

records. 

6 It must be a system based on 

trust. 

7 It must have a focus on cultural 

values. 

8 It must be knowledge based. 

9 It must be based on a partnership 

between consumer and 

provider. 

10 There must be access to services 

regardless of ability to pay. 

In its introduction, the white 

paper is described as “the first step 

to bring attention and gain support 

to infuse clear and measurable indicators 

of quality into all aspects of 

the mental health system that will 

guide individuals toward self-help, 

empowerment and self-determination. 

The idea [is] that no matter 

what kind of mental health services 

are delivered, if the new rules were 

applied, the recovery outcomes for 

people who use mental health services 

would increase....” 

After the paper’s formal presentation 

to Commissioner Carpinello, 

and the request that OMH partner 

with people who use mental health 

services to bring the white paper 

values into the mental health system, 

the Commissioner publicly 

supported the document and 

charged the Office of Consumer 

Affairs with implementing the white 

paper into all areas of service delivery. 

Additionally, Commissioner 

Carpinello requested that the group 

make recommendations for infusing 

the white paper rules into OMH’s 

policies, regulations, and licensing. 

The first meeting of the white 

paper implementation committee 

was held in November 2004 to 

examine how to accomplish this 

task. Sixty people who use mental 

health services met and reached 

consensus on concepts that will 

lead to the implementation of quality 

indicators. The meeting set forth 

an ambitious time line for a variety 

of implementation strategies that 

include multiple presentations, 

technical assistance offerings, and 

refinement strategies. Specific, 

actionable steps are currently being 

refined for each of the service 

components within the public 

mental health system. 

Already a valuable resource to 

OMH, the white paper has been 

heralded as one of the most important 

documents of recent years. Its 

full text is included in Appendix 4. 



Planning for Service Needs 

of Special Populations 

takeholders' feedback on the 2004- 

S2008 Comprehensive Plan has 

helped to identify the following set of 

emerging community mental health 

needs that New York will begin facing 

during the next five years. 

Populations with Emerging 

Special Needs 

opulation groups with emerging 

Pspecial needs were identified 

during the planning process to 

include young adults, older adults, 

and adults in adult homes and in 

prisons. Information about adult 

homes is included in Chapter 5. 

Young Adults 

s an OMH special population, 

Ayoung adults are persons ranging 

in age from 18 to 24 years. Each year 

New York's public mental health system 

serves approximately 52,434 

young adults. Of these individuals, 

the greatest number, 36%, is diagnosed 

with bipolar disorder or major 

depression, and a sizeable minority 

(13%) suffer from schizophrenia and 

related disorders. The Diagnostic and 

Statistical Manual of Mental Disorders 

– Fourth Edition (DSM-IV) also indicates 

that the average age of onset 

for anorexia nervosa is 17 years old 

and the onset rarely occurs in 

females over age 40. Among young 

adults, four potential areas of need 

have been identified and initial goals 

to address them include: 

◆ The smooth transition to adult 

services for young adults "aging 

out" of the children's mental health 

system who will require ongoing 

services in the adult system. 

Goal: Assess issues of access, linkage 

and coordination, and new 

service models. 


◆ Effective intervention for young 

adults of college age who present 

with serious diagnoses, such 

as schizophrenia or bipolar disorder, 

who have not been 

served in the children's mental 

health system. 

Goal: Identify the at-risk population 

in preparation for the development 

of prevention and early 

intervention strategies. 

◆ Suicide prevention among young 

persons between 18-24 years, 

recognizing that suicide is the 

third leading cause of deaths 

among this group in our nation. 

Goal: As part of OMH's SPEAK 

public education campaign, 

identify depression and suicidal 

ideation among young persons 

in need of intervention. 

◆ Care for young adults suffering 

from eating disorders. 

Goal: Collaborate with the Department 

of Health in planning and 

implementing Comprehensive 

Care Centers for Eating Disorders, 

which were signed into legislation 

by Governor Pataki in June 2004. 

Older Adults 

uring the public input process to 

Dthe 2004-2008 Comprehensive 

Plan, stakeholders identified the mental 

health needs of older adults as a 

priority area. This subject was the 

most prominent theme addressed in 

the New York City public hearing, 

and the newly formed Geriatric Mental 

Health Alliance of New York 

(GMHANY) presented OMH with the 

report Issues in Geriatric Mental 

Health Policy: A Report of the Observations 

of Advocates, Providers, 

Researchers, Academics, Government 

Officials and Older Adults. As stated 

in the report, the Alliance was 

formed “to advocate for changes in 

mental health policy that will result in 

improvements of current mental 

health services for older adults, and 

for changes that will lay the ground- 



work for the development of an adequate 

response to the mental health 

needs of the elder boom generation.” 

The GMHANY report provides an 

overview of themes that emerged 

from a series of discussion groups 

that included representatives of 

mental health agencies, psychiatric 

hospitals, settlement houses and 

senior centers, nursing homes, 

home health care agencies, governmental 

leaders from both aging and 

mental health, researchers, academics, 

and advocates. The representation 

in these groups illustrates that 

mental health problems of older 

adults are a shared concern across 

the public and private sectors. 

There was widespread agreement 

among discussion group participants 

that the fundamental job of a 

system of services for older adults 

with mental health problems is to 

provide support for them to lead 

satisfying lives in their communities. 

separate analysis of population projections for 

Aolder residents of New York State identifies 

four major trends that will have a significant impact 

on agency policies, programs and services:* 

◆ Increased racial and ethnic diversity: 

Between 2000 and 2015, the number of older 

New Yorkers will increase by approximately 

19%, and will be more diverse than any preceding 

old age group in terms of ethnicity, income 

level, education, family configurations, living 

arrangements and health. Minority elderly populations 

will increase the fastest: Black, non-Hispanic 

by 27%, Hispanic by 76%, and 

Asian/Pacific by over 110%. 

◆ Weakened family support structures: Baby 

boomers moving into the older population will 

be more likely than the preceding cohort to 

enter old age without spouses, and more will 

be childless or parents of only children. More 

grandparents will be involved in raising their 

grandchildren, and the most significant mental 

health problem for this group will be depression, 

with one in four grandparent caregivers 

(nationally) now experiencing a significant level 

of depression. 

There was also widespread confidence 

that effective treatments are 

now available and they can help 

people sustain satisfying lives in 

their communities. At the same 

time, the report acknowledges that 

access to effective treatments is limited, 

and many older adults and 

their families do not seek treatment 

even when it is accessible. 

Since receiving the report, OMH 

has been collaborating with stakeholders, 

including GMHANY, concerning 

these issues. These collaborations 

have resulted in the 

identification of two sub-population 

for consideration: individuals 

with a mental illness who are getting 

older and developing comorbid 

conditions related to aging, and 

older New Yorkers who are at risk 

for developing mental illness. A 

series of roundtable discussions is 

planned for Spring 2005, at which 

experts, stakeholders and providers 

will further discuss the mental 

Figure 3.2 

Expected Increase 

in Ethnic and Racial 

Diversity by 2015 

120% 

100% 

80% 

60% 

40% 

20% 

0% 

110% 

Asian/ 

Pacific 

76% 

27% 

Hispanic Black, 

Non-Hispanic 

◆ Major growth in 

two groups: Rapid 

population growth 

of younger and 

older minority 

populations is 

expected; also 

anticipated is major 

growth in the older 

worker and preretirement 

populations 

as baby 

boomers age out. 

◆ More demand 

for care, fewer 

caregivers: New 

York’s dependency 

ratio is changing, and there are fewer caregivers 

for a larger number of older persons 

needing care. As a result, the family, which currently 

provides 80% of long-term care services, 

will be providing less care and the “systems of 

care” providing more. 

*In Project 2015, OMH and 35 other State agencies were directed by Governor Pataki 

to consider what New York State's demographic makeup will be by 2015, and identify 

strategies for assuring that the State is prepared to recognize the opportunities 

and meet the challenges presented by its changing population. 



health needs of aging New Yorkers. 

The GMHANY report and additional 

information can also be 

found on the Web at http://www. 

mhawestchester.org/advocates/ 

issuesd1004.pdf. 

Adults in Prison 

ndividuals with mental health dis- 

in prisons require mental 

Iorders 

health services to reduce psychiatric 

symptoms and promote functioning. 

As of December 2003, there were 

approximately 65,000 prisoners 

incarcerated in Department of Correctional 

Services' facilities. Of 

those, approximately 11% or 7,500 

inmates were assigned to the OMH 

corrections-based caseload. The 

2005-2006 Executive Budget continues 

$7 million for a multi-year 

effort to expand mental health 

treatment, clinical staffing, and bed 

capacity. More detailed information 

about adults in prison is included in 

Chapter 7. 

Planning for Children’s 

Inpatient Services 

oundtable discussions have also 

Rplayed a prominent role in planning 

the mental health needs of 

children and adolescents. When 

developing the structural design of 

a children’s unit currently under 

construction at the Greater Binghamton 

Health Center, OMH administrators 

and the project’s architect 

sat down with children who have 

been hospitalized and their families, 

facility staff, and other area mental 

health providers. Together, they discussed 

various design elements that 

would enhance the recovery 

process, as well as those that may 

inhibit it. They fine tuned the 

details, and the end result will be 

an inpatient unit truly designed to 

support recovery. It will balance 

individual privacy and appropriate 

supervision, provide a safe and 

therapeutic environment, and will 

be family friendly, especially in the 

visiting areas. 


In November 2004, OMH hosted a 

roundtable discussion among leading 

providers of inpatient care for children 

and adolescents in the metropolitan 

New York City area. The discussion 

also included State and City 

government representatives, family 

advocates, and parents whose children 

have been hospitalized. The 

purpose of the gathering was to 

examine the clinical profiles of the 

youngsters currently receiving inpatient 

care, explore what treatments 

are currently being used, and discuss 

clinical, administrative and structural 

opportunities that might improve the 

quality of care provided. 

Participant discussion led to consensus 

around a number of themes 

including the following examples: 

1. Develop more extensive crisis 

services for children. Many 

children in emergency rooms 

were described as needing immediate 

mental health services, but 

not necessarily inpatient hospitalization. 

In the absence of a more 

systematic, completely reliable 

alternative, many emergency 

room physicians opt for the safety 

and immediacy of inpatient care. 

2. Increase family involvement 

in the course of inpatient hospitalizations. 

Family involvement 

was seen as an important 

yet often missing component, 

especially in acute settings. 

3. Develop core clinical competencies 

where there is strong 

research support for particular 

interventions. 

4. Explore the use of common 

assessment and outcome 

measurement systems. 

Discussions and follow-up are 

continuing. A second follow-up 

roundtable is planned. 



Population-based Planning Efforts 

MH is committed to providing 

Oquality mental health services to 

all New Yorkers in need. Many different 

communities and constituents 

are continually engaged to assist 

the agency in the development and 

evaluation of services that are culturally 

appropriate and linguistically 

suited for New York’s diverse populations. 

Examples include: 

◆ The Multicultural Advisory Committee 

(MAC) is composed of 

diverse consumers, family members 

and providers. During 2004, 

the group met directly with the 

OMH cabinet to address population-based 

planning efforts as 

well as disparities that may be 

present in mental health services. 

There was an opportunity to 

exchange information regarding 

language assistance needs and 

service adaptations based upon 

culture, ethnicity, age and gender. 

Members also made recommendations 

for development of a 

standardized cultural competence 

curriculum for use in training 

community-based licensed programs. 

The first draft of the training 

content has been outlined, 

and its development continues. 

◆ In addition to the statewide 

MAC, several counties have local 

multicultural advisories that are 

working in collaboration with 

OMH to improve service quality: 

The Nassau County MAC has 

developed a series of culturespecific 

training opportunities; 

Suffolk County held an annual 

cultural competence symposium; 

Orange County has expanded its 

training activities to include technical 

assistance for the development 

of cultural competence 

plans for all county human service 

agencies; Broome County 

has continued its language interpreter 

program; and Monroe 

County continues an extensive 

cultural competence evaluation, 

training and plan development 

process for county agencies. 

◆ Throughout the State, grassroots 

networks are also partnering 

with OMH to enhance mental 

health services. Consumer and 

family groups such as National 

Alliance for the Mentally Ill 

(NAMI) Harlem and Harlem 

Hospital have hosted events to 

provide a public education 

forum about mental illness and 

mental health. The training, “Cultural 

Competence: Maintaining 

an Asking Stance,” has been presented 

to provider agencies, 

trade associations, social work 

education programs, and community 

groups throughout the 

State. Agencies have adapted the 

material to directly address specific 

community issues and to 

enhance service planning. 

◆ OMH is also working to increase 

its outreach efforts by partnering 

with groups including the Association 

of Hispanic Mental 

Health Professionals, Black Psychiatrists 

of Greater New York, 

and the Coalition for Asian 

American Mental Health. Recognizing 

that many New Yorkers 

seek assistance outside of formal 

mental health settings, OMH has 

also formed alliances with other 

systems and programs, including 

the Peri-natal Network and the 

Caribbean Cultural Center. 

The 2004 Interim Report of the 

Statewide Comprehensive Plan for 

Mental Health Services contains a 

more complete description of 

increased opportunities for public 

input. It is available on the OMH Web 

site at http://www.omh.state.ny.us. 

Partnerships in the Development 

and Implementation of New 

Service Models 

ersonalized Recovery-Oriented 

PServices (PROS) is a comprehensive 

program for individuals 

with severe and persistent mental 

illness that is designed to facilitate 



individual recovery by integrating 

treatment, support, and rehabilitation 

services. Goals for individuals 

in the program are to improve 

functioning, increase employment, 

attain higher levels of education, 

secure preferred housing, reduce 

contact with the criminal justice 

system, and decrease utilization of 

inpatient and emergency services. 

Throughout the PROS development 

process, OMH actively sought 

input from a broad array of stakeholders, 

and frequently modified 

the program’s design in response 

to their questions and concerns. 

The agency conducted more than 

150 briefings and meetings on 

PROS with other State agencies, 

county government officials, mental 

health service providers, and service 

recipients who are attending 

programs that might convert to the 

new PROS license. 

OMH has made concerted efforts 

to involve county governments as 

partners in the planning, implementation, 

and oversight of PROS programs. 

An extensive county planning 

process was initiated to ensure 

that county mental hygiene directors 

had an opportunity to manage 

the impact of PROS on their Local 

service systems. Since PROS programs 

are funded by Medicaid, 

OMH has worked with county representatives 

to fashion regulatory 

requirements for a county/provider 

agreement that will replace Local 

contracting for State Aid funding as 

the vehicle for supporting the county 

role in program monitoring and 

quality improvement. 

The OMH Web site contains a 

PROS section that includes a program 

description, announcements 

on the status of implementation 

efforts, responses to frequently 

asked questions, and sections of a 

draft handbook for PROS providers 

(http://www.omh.state.ny.us/omhweb/pros/). 

Draft PROS regulations 

have been posted on the site, and 

stakeholders have been invited to 

submit comments in advance of 

the mandatory comment period 

that is initiated once the regulations 

are formally filed as proposed. 

The PROS State/county collaborative 

relationship is continuing as 

program implementation begins. As 

announced in October 2004, an initial 

implementation phase will 

involve seven counties representing 

a mix of urban, suburban, and rural 

settings. The scope of this phase 

takes into consideration OMH’s 

ability to provide the intensive technical 

assistance necessary to support 

successful program transitions 

to the new PROS license. 

Strengthening the Capacity for 

Data-Driven Decision Making 

MH remains committed to pop- 

based planning, fore- 

Oulation 

casting, and management that uses 

relevant data from agency performance 

measures to enable data-driven 

decision-making. Populationbased 

planning in the public 

mental health system requires that 

localities identify the specific services 

needed in their communities 

based on the specific groups that 

need service, taking into account 

age, ethnicity, sex, and growth projections 

within the population. 

Beginning in April 2004, OMH 

launched an initiative to strengthen 

its capacity to use modern geographic 

information systems (GIS) 

technology to support datainformed 

State and Local mental 

health planning. Local planning is 

by definition geographically based, 

and an increasing number of the 

data sources needed for datainformed 

planning include geographic 

information such as county, 

zip code, and street address. In 

recent years, the capabilities of GIS 

technology have expanded rapidly, 

making it feasible to look with 

fine-grained geographic precision 

at important public mental health 




system issues such as prevalence of 

serious mental illness and access to 

evidence-based services. OMH’s 

GIS initiative has two tracks: 

◆ Improving staff skills so that 

increasingly sophisticated and 

useful geomaps of mental health 

phenomena can be produced. 

◆ Incorporating geographic data 

into the OMH enterprise data 

warehouse so that geomaps and 

spatial analysis can be carried 

out more efficiently and with 

greater frequency. 

A major target audience for OMH 

GIS efforts is Local mental health 

directors and their staff. In a May 

2004 regional planning meeting 

with county mental health directors 

and State psychiatric center directors, 

OMH staff presented and discussed 

an initial set of geomaps 

that displayed local variation in the 

prevalence of serious and persistent 

mental illness and access to 

Assertive Community Treatment 

and Intensive Case Management 

services at the zip code level. At 

this and subsequent presentations, 

counties have expressed strong 

interest in the GIS initiative and 

have requested additional 

geomaps, including maps of the 

prevalence of serious emotional 

disturbance and access to specialized 

children’s services. Joint State 

and Local planning discussions 

stimulated by the geomaps have 

begun to produce a common 

understanding of mental illness 

prevalence estimates and the relationships 

between prevalence and 

service access and use. 

Disaster Response 

and Preparedness 

A 

s described in the 2004-2008 

Comprehensive Plan, OMH is 

responsible for coordinating New 

York State’s emergency mental 

health response and ensuring that 

mental health services are available 

for those in need. OMH is continuing 

the emphasis on disaster preparedness 

and response, which 

includes reviewing emergency mental 

health response systems through 

a comprehensive disaster preparedness 

planning process conducted in 

collaboration with other State and 

Local agencies. OMH also continues 

to provide leadership in disaster 

mental health planning with other 

State agencies, Federal agencies, 

CLMHD, and the American Red 

Cross in New York State (ARCNYS). 

Through these processes, OMH recognizes 

the complementary roles, 

shared commitment, and the mutual 

advantage of an integrated 

approach to improving emergency 

mental health services for all New 

Yorkers. 

The 2004-2008 Comprehensive Plan 

reported on two initiatives to strengthen 

State and local disaster response 

and preparedness capabilities. 

◆ OMH, CLMHD, and ARCNYS 

have been collaborating to 

establish procedures and protocols 

to strengthen county and 

State ability to respond to disasters 

by providing critical mental 

health supports to victims. The 

first step in this effort was signing 

a Statement of Understanding 

outlining the roles, responsibilities, 

and expectations of each 

organization when responding to 

a moderate or severe disaster. 

This document also outlined 

steps to provide for a more 

coordinated and cooperative 

effort in the areas of communication, 

training, and mobilization 

of mental health responders, as 

well as a commitment to pursue 

an evidence-based approach. 

◆ An additional collaboration with 

the State Department of Health 

(DOH) was initiated to develop 

public mental health education 

materials that will be included in 

a Bio-Terrorism Toolkit designed 

to facilitate Local disaster plan- 



ning with a focus on preparing 

families and communities for the 

potential effects of a biological 

weapons attack. The kit will 

include fact sheets about smallpox 

and anthrax, vaccination 

information, and how to cope 

during these uncertain times. 

These two initiatives were merged 

into a single, coordinated project 

during 2004 and substantial progress 

was achieved. The next major goal 

of the partners in this collaboration 

is to operationalize these agreements 

at the county level. In Spring 

2004, OMH initiated site visits, with 

its CLMHD and ARCNYS partners, 

to several counties with a reputation 

for having established best practices 

in the area of disaster mental health 

response. The purpose was to 

review current practices, identify 

potential best practices, and create 

models that can be shared with 

other counties. During July visits 

were completed to five county 

mental health departments selected 

to be pilots. 

OMH, CLMHD and ARCNYS are 

also seeking to develop a disaster 

response curriculum for mental 

health responders based on evidence-based 

practice. The goal of 

this effort is to undertake statewide 

training of State and county disaster 

mental health professionals to 

expand their capabilities for providing 

effective disaster mental health 

interventions. The 

development team 

has included staff 

from the University 

of Rochester Medical 

Center (URMC) for 

Disaster Medicine 

and Emergency 

Preparedness. 

URMC was tasked 

to research 

national “best 

practices” and 

develop the appropriate 

curriculum upon which the 

statewide training is to be based. 

The county mental health directors 

invited their Local disaster services 

partners to the full-day training 

development meetings. Information 

gathered at these sessions, together 

with best practices research, was 

used to complete an eight-module 

training curriculum. In August 2004 

the full curriculum was successfully 

pilot tested with two county mental 

health departments. Phase II of this 

project, scheduled to begin soon, 

will advance the training to OMH 

and county mental health offices 

through the use of “train-the trainer” 

(TTT) techniques. This work is to 

be undertaken during the first half 

of the 2005 calendar year. 

It is OMH’s intent to facilitate the 

use of this TTT cadre to undertake 

the training of disaster mental 

health professional responders 

across New York State. These 

resources can than be made available 

for individual counties to customize 

the mix of State, Local, and 

voluntary disaster mental health 

providers together with the application 

of the EBP methodologies in 

which they have been trained. 

Project Liberty 

he September 11 terrorist attacks 

T on the World Trade 

Center have no 

precedent in 

the history of 

the U.S. The 

disaster had a 

dramatic 

impact on 

Americans, 

especially 

those who 

were living and 

working in New 

York City, in terms 

of the devastating 

loss of life, 

enormity of 

physical 

To All Project Liberty 

provider agencies and staff: 

n the behalf of OMH and 

Opersonally, I wish to 

thank all of you who have 

participated in Project Liberty. 

Faced with a humancaused 

disaster of unprecedented 

scope, New York’s 

mental health providers 

responded with alacrity, creativity 

and commitment. 

Through your steadfast 

efforts, hundreds of thousands 

of New Yorkers have 

been reached and their individual 

needs met. You have 

been instrumental in helping 

your community recover and 

become more resilient in the 

aftermath of the tragedy of 

9/11. New York is proud of 

what you have accomplished 

and grateful for the dedication 

each of you brought to 

your work in Project Liberty. 

Sharon E. Carpinello, RN, PhD 

Commissioner 


Office of Mental Health 




Notes 

1 Felton, C.J., Donahue, S., Lanzara, C.B., 

Pease, E.A., & Marshall R. (in press). Project 

Liberty: Responding to mental health needs 

after the World Trade Center terrorist 

attacks. Cambridge: Cambridge University 

Press. 

2 Norris, F.H., Friedman, M.J., Watson, P.J., 

Byrne, C.M., Diaz, E., & Kaniasty, K. (2002). 

60,000 disaster victims speak: An empirical 

review of the empirical literature, 1981-2001. 

Psychiatry, 65, 207-239. 

3 Schuster, M.A., Stein, B.D., Jaycox, L., 

Collins, R.L., Marshall, G.N., Elliott, M.N., 

Zhou, A.J., Kanouse, D.E., Morrison, J.L., & 

Berry, S.H. (2001). A national survey of stress 

reactions after the September 11, 2001, terrorist 

attacks. New England Journal of Medicine, 

345, 1507-1512 

destruction, adverse economic consequences, 

and serious mental distress 

and psychological disorder. 

With support from the Federal government 

and State and Local mental 

health authorities, OMH responded 

rapidly with the development and 

implementation of a large-scale 

Federally funded public health program 

called Project Liberty, which 

was aimed at addressing a range of 

psychological reactions and lessening 

the traumatic consequences 

experienced by individuals in close 

proximity to the disaster site and its 

surrounding areas. 1 

With incidents of intentional mass 

violence that result in a significant 

loss of life and property, as well as 

extensive unemployment, previous 

research shows that the resulting 

trauma may be associated with 

severe, long lasting, and widespread 

psychological effects. 2 In 

the immediate aftermath of the 

World Trade Center disaster, widespread 

mental distress was found 

in the general population. One 

national study found that 44% of 

adults and 35% of children reported 

one or more reactions consistent 

with traumatic stress. For 

adults living in the City and within 

100 miles of the disaster site, 61% 

reported considerable traumatic 

stress symptoms. One year after the 

disaster, New York Academy of 

Medicine uncovered new-onset 

post-traumatic stress disorder 

(PTSD) among World Trade Center 

disaster victims, where 5% of survey 

respondents without PTSD in 

March 2002 met criteria for PTSD 

in September 2002. 3 

The terrorist attacks produced an 

unprecedented and chaotic postdisaster 

environment that required 

the most complex emergency management 

response ever mounted in 

national history. Project Liberty, 

which was officially launched in 

September 2001, was jointly operated 

by the Federal Emergency Management 

Agency (FEMA) and the 

Center for Mental Health Services 

(CMHS) of the Substance Abuse 

and Mental Health Services Administration 

(SAMHSA). It provided 

funding for short-term public education, 

outreach, crisis counseling 

and referral services. The role of 

OMH was to develop an infrastructure 

for Project Liberty that enabled 

the City and county departments of 

mental health to ensure the effective 

delivery of a continuum of supportive 

counseling interventions 

designed to meet disaster-related 

mental health needs in their communities. 

Program services were 

ended December 31, 2004. In all, 

Project Liberty was a successful collaboration 

between the State, local 

governments, and more than 130 

local service providers. It was and 

continues to be the single largest 

public mental health program put 

into operation in the U.S. 

While Project Liberty services have 

ended, Governor Pataki has continued 

to support the ongoing needs of 

New York City firefighters and their 

families. New York State has provided 

$2 million in State funds, which 

will be utilized with New York City 

funds to provide additional mental 

health and crisis counseling services 

to the New York City firefighter community. 

An important Project Liberty innovation 

was its evaluation of various 

components of the crisis counseling 

model. Prior to Project Liberty, Federal 

funds were prohibited from 

being used to evaluate disaster 

response programs. In partnership 

with New York City, the disasterdeclared 

counties and its academic 

partners, Project Liberty, however, 

began to remedy gaps in knowledge 

through its evaluation of programs 

and services. In addition to collecting 

service encounter data, the Project 

gathered feedback from stakeholders 

who provided counseling, shedding 

light on program implementation 

and operational issues and the needs 

of the communities served. Addition- 



ally, service recipients were surveyed 

about their experiences, needs, and 

opinions and their views on the 

helpfulness of and satisfaction with 

counseling services. 4 

The evaluation provided important 

information that proved valuable 

to Project Liberty senior leadership 

in administering and 

monitoring program operations, 

such as reaching populations that 

are difficult to serve, and enhancing 

project decision making. 5 An 

essential by-product of the evaluation 

was the ability of OMH to use 

data to inform disaster preparedness 

efforts, by providing a clear 

picture of the process of implementing 

a large-scale disaster mental 

health program; gaining a fuller 

appreciation of best practices and 

obstacles encountered; and articulating 

lessons learned. 

During 2005, Project Liberty will 

complete final reporting to FEMA 

and CMHS. The final report is 

expected to yield new insights into 

the assessment, organization, 

implementation and evaluation of 

future disaster mental health 

response initiatives. OMH will 

employ reports, presentations, publications, 

and the dissemination of 

tools to aid disaster mental health 

response efforts nationwide. 

Through its public, private, and 

academic partnerships, OMH will 

continue to build on the strengths 

of Project Liberty’s World Trade 

Center disaster mental health 

response efforts and contribute 

new and vital information to the 

growing body of disaster mental 

health knowledge. 

National Collaborations for 

Disaster Preparedness 

ince September 11, OMH has 

Sbeen participating in national 

efforts sponsored by the Federal 

government to advance our country’s 

evidence base concerning the 

mental health impact of terrorism 

and effective response strategies. 

Several Federally sponsored scientific 

meetings have brought together 

disaster mental health researchers, 

trauma experts and mental health 

policymakers over the past three 

years. These efforts have been an 

effective forum for synthesizing 

existing information on the mental 

health impact of terrorism and 

appropriate responses and for initial 

reactions by these experts to new 

data collected post-9/11, including 

Project Liberty evaluation findings. 

Participants at the first of these 

meetings developed consensus 

guidelines for appropriate mental 

health response during the first four 

weeks following an event. These 

guidelines were subsequently published 

by the National Institute of 

Mental Health (NIMH). 

A second forum was held by the 

National Institute of Medicine 

(IOM) for the purpose of soliciting 

expert testimony as a first step in 

the creation of an IOM report on 

the mental health impact of terrorism. 

OMH staff were invited to participate 

and provided testimony 

that reviewed the lessons learned 

from the first year of Project Liberty’s 

operation. The final IOM 

report, titled Preparing for the Psychological 

Impact of Terrorism contains 

a series of recommendations 

aimed at strengthening the nation’s 

disaster mental health preparedness 

and further increasing scientific 

knowledge concerning the mental 

health impact of terrorism and the 

necessity and effectiveness of interventions 

to counter that impact. 

Together, the recommendations 

represent an overall “call to action” 

for the creation of a nationwide 

surveillance and response infrastructure. 

A third national meeting in which 

OMH participated focused on 

screening procedures and interventions. 

Discussion at that meeting 

was informed both by the guide- 

Notes 

4 Felton, C.J. (2004). Lessons learned since 

September 11th 2001 concerning the mental 

health impact of terrorism, appropriate 

response strategies and future preparedness. 

Psychiatry 67(2), 147-152. 

5 Appendix 5 contains the latest Project Liberty 

service delivery data. 




lines produced at the October 2001 

meeting and the IOM report but 

also the intervening two years of 

real-world experience in responding 

to September 11. The meeting 

yielded a high degree of consensus 

amongst participants concerning 

the necessary components of an 

overall mental health response 

model, and workgroups are now 

finalizing these recommendations. 

As part of our efforts to preserve 

the mental health response infrastructure 

created after September 

11 and disseminate lessons learned, 

OMH has developed a toolkit consisting 

of public educational materials, 

training curricula, data collection 

tools and protocols, and 

screening instruments developed 

for Project Liberty. This toolkit, 

which will continue to be revised, 

is available for free on CD-ROM 

from OMH. 6 We are currently 

working with our Federal partners 

at SAMHSA to further refine these 

toolkit materials into national technical 

assistance resources available 

to other jurisdictions in the future. 

Notes 

6 The CD-ROM can be ordered from the 

Project Liberty Web page at: http://www. 

projectliberty.state.ny.us/educational.htm 


Chapter 4: Basic and Clinical Research 35 

Basic and Clinical Research Chapter 4 

umerous reports document 

Nextraordinary gains recently 

made in mental health care, some 

of them based on advances in our 

understanding of the human brain 

and some based on a better understanding 

of how to deliver care to 

those who suffer from mental disorders. 

Since 1999, the U.S. Surgeon 

General has released two 

broad-ranging reports on mental 

health, one general, 1 and one 

focused on ethnic, cultural, and 

Table 4.1. 

Disease Burden by Selected 

Illness Categories in Established 

Market Economies, 

1990 

Illness 

Category 

Percent of Total 

Years Lost 

All cardiovascular 

conditions ..............................18.6 

All mental illness 5 ..................15.4 

All malignant 

diseases (cancer)....................15.0 

All respiratory conditions ........4.8 

All alcohol use ........................4.7 

All infectious 

and parasitic diseases ..............2.8 

All drug use..............................1.5 

Source: DHHS, 1999 

racial issues. 2 In 2001, the World 

Health Organization (WHO) 

released a comprehensive report 

on the state of global mental 

health. 3 In 2003, a White House 

Commission released its final report 

on the U.S. mental health care 

delivery system. 4 

Collectively, these reports 

demonstrate an increasing societal 

awareness of mental illness, and 

reflect the unambiguous emergence 

of mental health research as a key 

priority in the U.S. and internationally. 

However, the reports also 

point to substantial gaps in basic 

and clinical scientific knowledge 

related to the treatment and prevention 

of mental diseases, as well 

as gaps in mental health services 

research to translate state-of-the-art 

treatments and incorporate them 

into mainstream practice. As a 

result, the disease burden of mental 

illness remains very high, perhaps 

higher than that of any other 

single category of disease, and the 

costs for treating mental illness are 

higher than those of other chronic 

diseases. 5 

Disease Burden 

of Mental Illness 

ecent WHO estimates suggest 

Rthat at any one time, 450 million 

persons worldwide suffer from 

neuropsychiatric disorders, including 

depression and/or mania, 

Notes 

1 United States Department of Health and 

Human Services. (1999). Mental health: A 

report of the surgeon general. Rockville, MD: 

U.S. Department of Health and Human Services, 

Substance Abuse and Mental Health 

Services Administration, Center for Mental 

Health Services, National Institutes of 

Health, National Institute of Mental Health. 

2 United States Department of Health and 

Human Services. (2001). Mental health: Culture, 

race and ethnicity. A supplement to 

Mental health: A report of the surgeon general. 

Rockville, MD: U.S. Department of 

Health and Human Services, Substance 

Abuse and Mental Health Services Administration, 

Center for Mental Health Services, 

National Institutes of Health, National Institute 

of Mental Health. 

3 World Health Organization. (2001). The World 

Health Report 2001. Mental health: New 

understanding, new hope. Geneva: WHO. 

4 New Freedom Commission on Mental 

Health, Achieving the Promise: Transforming 

Mental Health Care in America. Final Report. 

DHHS Pub. No. SMA-03-3832. Rockville, MD: 

2003. Retrieved November 1, 2004 from 

http://www.mentalhealthcommission.gov/ 

reports/FinalReport/toc.html 

5 Disease burden associated with “mental 

illness” includes suicide. In these rankings, 

mental illness ranks first if one includes 

the burden of substance abuse in addition 

to suicide. 



36 Chapter 4: Basic and Clinical Research 

Figure 4.1 

Prevalence of major depression in patients with physical illnesses 

Hypertension 

Myocardial Infarction 

Epilepsy 

Stroke 

Diabetes 

Cancer 

HIV/AIDS 

Tuberculosis 

General 

Population 

Up to 10% 

Up to 29% 

Up to 22% 

Up to 30% 

Up to 31% 

Up to 27% 

Up to 33% 

Up to 44% 

Up to 46% 

0 10 20 30 40 50 

Source: WHO, 2003 

Notes 

6 World Health Organization. (2003). Investing 

in mental health. Geneva: WHO. 

7 Mental disorders include unipolar major 

depression, schizophrenia, bipolar disorder, 

obsessive-compulsive disorder, panic disorder, 

post-traumatic stress disorder, and selfinflicted 

injuries (e.g., suicide). Excluded are 

substance-abuse disorders that include alcohol 

addiction. 

8 Murray, C. J., & Lopez, A. D. (1996). Evidence-based 

health policy—lessons from 

the global burden of disease study. Science, 

274(5288), 740-743. 

schizophrenia, dementias, and anxiety 

disorders. 6 In New York State, 

a majority of the more than 600,000 

adults and children who receive 

services in the public mental health 

system each year are diagnosed 

with serious mental illness–a mental 

disorder where symptoms have 

led to serious impairment of dayto-day 

functioning. 

The WHO uses disability-adjusted 

life years (DALYs), a measure that 

combines estimates of disease morbidity 

(relative incidence) and mortality 

to estimate how many productive 

years of life are lost due to 

the impact of disease. Mental disease 

ranks second only to cardiovascular 

disorders in the number of 

years lost (Table 4.1). Specifically, 

1991 data collected by WHO, Harvard 

University, and others indicate 

that 15.4% of the total disease burden 

in industrialized countries can 

be directly attributed to mental disorders. 

7 By comparison, only cardiovascular 

diseases rank higher, at 

18.6%. Cancer is a close third, at 

15%, while respiratory diseases 

(6.2%) and alcohol-related morbidity 

(4.7%) are fourth and fifth, 

respectively. 1, 8 

Comorbidity, which signifies the 

simultaneous occurrence of two or 

more disorders in a person is also 

important to understanding the disease 

burden of mental illness. 

Comorbid mental disorders are 

often under-recognized and not 

always effectively treated; they 

result in lower adherence to medical 

treatment, an increase in disability 

and mortality, and higher health 

costs. According to WHO (2003), 

research shows that a number of 

mental disorders (e.g., depression, 

anxiety, and substance abuse) occur 

in people suffering from other diseases 

more often than would be 

expected by chance. In addition, 

people suffering from chronic physical 

conditions have a greater probability 

of developing mental disorders 

such as depression (Figure 

4.1), and rates of suicide are higher 

among people with physical disorders 

than among other people. 

These relationships between mental 

and medical illnesses further 

emphasize the need for continued 

mental health research. 



Figure 4.2 

Yearly Cost per Patient of Selected Medical Conditions: 

United States US$/Patient/Year 

Alzheimer 

Schizophrenia 

Cancer 

Stroke 

Coronary Heart Disease 

Diabetes 

Congestive Heart Failure 

Depression 

Osteoporosis 

Arthritis 

Hypertension 

Asthma 

0 5,000 10,000 15,000 20,000 25,000 

High costs of mental 

disorders compared to other 

major chronic conditions 

I 

Source: WHO, 2003 

n addition to the severe disease 

burden of mental disorders, 

research shows that the costs for 

treating these disorders are high 

compared to the costs for treating 

other major chronic conditions. A 

recent study 9 considers different 

diseases in terms of the average 

cost per patient, and as shown in 

Figure 4.2, Alzheimer’s disease and 

schizophrenia are the two most 

costly, their average cost per 

patient being higher than that for 

cancer and stroke. 

Given the high disease burden 

and treatment costs for mental illness, 

the WHO, U.S. Surgeon General, 

and President’s New Freedom 

Commission on Mental Health have 

concluded that we must continue 

to invest in research at all levels to 

gain needed advances in treatment, 

and ultimately to prevent mental 

illness. Just as research offers great 

hope for cancer, heart disease, and 

diabetes, research is essential to 

reducing the burden of mental illness 

by improving access to effective 

care and achieving urgently 

needed knowledge about the 

brain, mind, and behavior. 

OMH Research 

s a national and international 

Aleader in mental health research, 

New York State is committed to 

reducing the burden of mental illness 

and improving access to effective 

care. OMH research is conducted 

by the Research Division and 

also by Evaluation Research (ER) 

staff from the Center for Information 

Technology and Evaluation Research 

(CITER). The Research Division performs 

basic, clinical and services 

research primarily at two locations: 

the Nathan S. Kline Institute for Psychiatric 

Research (NKI) in Orangeburg 

New York, and the New York 

State Psychiatric Institute (NYSPI) in 

New York City. 10 Evaluation research 

focusing on service system improve- 

Notes 

9 Berto, P., D’Ilario, D., Ruffo, P., Di Virgilio, R., 

& Rizzo, F. (2000). Depression: Cost-of-illness 

studies in the international literature: A 

review. The Journal of Mental Health Policy 

and Economics, 3(1), 3-10. 

10 More information about the institutes can 

be found at their respective Web sites: 

http://nyspi.org/Kolb/index.htm 

and http://www.rfmh.org/nki/. 




Table 4.2 

Mission and Goals 

of OMH Research 

Mission 

The mission of OMH 

Research is to develop 

better methods of prevention 

and treatment of 

mental illness. 

Goals 

◆ Learn more about the 

causes of mental disabilities. 

◆ Contribute to the development 

of new treatments. 

◆ Evaluate the effectiveness 

of existing and emerging 

treatment methods. 

◆ Determine new and better 

models of service 

delivery which are 

planned with input from 

consumers and are culturally 

relevant. 

◆ Quickly and effectively 

disseminate the results of 

research findings to State 

and local clinicians, 

providers, recipients, 

families, and other stakeholders. 

◆ Make the expertise of 

research scientists available 

to practitioners in 

the OMH system through 

continuous education 

and consultation. 

◆ Delineate the magnitude 

of social cost and burden 

of mental disorders in 

order to prioritize utilization 

of resources. 

ment is conducted by staff from 

CITER-ER at OMH Central Office in 

Albany, and some research activities 

are also carried out at other OMH 

facilities, including Bronx Psychiatric, 

Bronx Children's, Buffalo, Creedmoor, 

Hutchings, Manhattan, Pilgrim, 

Rochester, Rockland, and Sagamore 

Children's Psychiatric Centers. 

New York State’s investment in 

research is augmented by many 

grants from Federal and other 

sources through the Research Foundation 

for Mental Hygiene (RFMH), 

Inc. This Chapter provides highlights 

of the exemplary basic and clinical 

research that is taking place in the 

Research Division. Chapter 5 provides 

an overview of OMH evaluation 

activities that focus on service 

system improvement. 

OMH’s interdisciplinary teams of 

clinical and services researchers 

include physicians, epidemiologists, 

psychologists, neuroscientists, and 

sociologists who perform a broad 

range of basic, clinical and services 

research (Table 4.3). All institute 

clinical research must first receive 

approval from the facility Institutional 

Review Board (IRB), which is in 

turn overseen by the Director of the 

Research Division with the assistance 

of staff from RFMH. All OMH 

Table 4.3 

OMH Research Areas of Study 

◆ Alzheimer’s Disease and 

Other Memory Disorders 

◆ Personality Disorders 

◆ Assessment and Prevention 

of Violence 

◆ Post-traumatic Stress and 

Other Anxiety Disorders 

◆ Child and Adolescent 

Psychiatry 

◆ Psychiatric Epidemiology 

◆ Genetics 

◆ Psychoanalytic Research 

◆ Geriatrics and Gerontology 

◆ Psychopharmacology and 

Other Therapeutics 

Central Office’s research must first 

receive approval from either the 

Central Office or Forensic IRB 

(depending on the population under 

study), which is in turn overseen by 

the Senior Deputy Commissioner 

and Chief Information Officer of 

CITER, with the assistance of RFMH. 

As they contribute to the science 

knowledge base for mental illness 

prevention, treatment, and service 

delivery, OMH researchers are 

actively involved in national and 

international research communities. 

Each research institute has a strong 

collaboration with an academic 

partner–NKI with New York University, 

and NYSPI with Columbia 

University. Research is also performed 

collaboratively with institutions 

including Alzheimer’s Disease 

International, the Institute of Psychiatry 

in London, the Louis de la 

Parte Florida Mental Health Institute, 

the National Association of 

State Mental Health Program Directors 

Research Institute, and the 

World Health Organization. Additional 

academic collaborations take 

place with universities including 

the State University of New York 

(SUNY) at Albany, SUNY Buffalo, 

SUNY Upstate, SUNY Downstate, 

Brown, Harvard, the University of 

◆ Homelessness and 

Mental Illness 

◆ Schizophrenia and Bipolar 

Disorder Research 

◆ Social and Community 

Psychiatry 

◆ Neurochemistry 

◆ Statistical Sciences and 

Research Methods 

◆ Neuroimaging 

◆ Substance Abuse 

and Mental Illness 

◆ Neurophysiology 



Pennsylvania, the University of 

Rochester, Texas A&M, and Yale. 

Research in public mental health 

is also supported through public 

psychiatry fellowships designed to 

train psychiatrists who plan to 

devote their careers to working 

with high-risk populations in the 

public sector and conducting 

research. Fellows are trained to use 

evaluation strategies, clinical techniques, 

and management skills 

within established institutions serving 

these populations. 

◆ A Public Psychiatry Fellowship at 

NYSPI and the Columbia University 

College of Physicians and 

Surgeons was initiated in 1981 

with funds from OMH to facilitate 

recruitment and retention of 

high-caliber psychiatrists in the 

public sector. Each year, ten 

one-year Fellowships are awarded 

to psychiatrists desiring a 

career in public psychiatry, with 

funding support from OMH and 

placement sites. 

◆ OMH is also affiliated with the 

Albert Einstein College of Medicine 

Forensic Psychiatry Fellowship, 

which is a one-year training 

program in Law and 

Psychiatry offered by the College’s 

Division of Law and Psychiatry. 

Forensic psychiatry is a 

subspecialty of psychiatry in 

which scientific and clinical 

expertise is applied to legal 

issues in legal context embracing 

civil, criminal, and correctional 

or legislative matters. 

◆ The Forensic Psychiatric Residency 

Program of the SUNY Upstate 

Medical University in Syracuse 

was developed in 1986 in collaboration 

with Central New York 

Psychiatric Center and the Syracuse 

University College of Law. 

The program was awarded 

ACGME (Accreditation Council 

for Graduate Medical Education) 

Accreditation in August 2000. 

This one-year program incorporates 

didactic experiences at the 

College of Law and Upstate Medical 

University, clinical experience 

at Central New York Psychiatric 

Center and several local 

correctional institutions, and 

courtroom experiences. 

Improving Care 

through Basic and 

Clinical Research 

MH’s Research Division makes 

Oimportant contributions toward 

improving care through basic and 

clinical research. Described here 

are contributions in two critical 

areas: schizophrenia and dementia. 

Schizophrenia Research 

Burden of Care 

chizophrenia is among the 

Scostliest of diseases. It affects 

about two million people in the 

United States and is more prevalent 

than epilepsy or multiple sclerosis. 

11 Nationwide, individuals with 

schizophrenia account for approximately 

20% of all social security 

disability days and 25% of hospital 

bed days are devoted to individuals 

with schizophrenia. 12 In New York, 

approximately 23% (96,000) of 

adults aged 18-64 who receive care 

in the public mental health system 

have a primary diagnosis of schizophrenia 

or a related disorder. Ten 

percent of individuals with schizophrenia 

take their own lives. 13 

According to 1996 figures, schizophrenia 

costs the U.S. health care 

system $17.3 billion per year with 

an additional $15.2 billion per year 

in indirect costs. 14 Much of the burden 

of caring for individuals with 

schizophrenia is borne at state, 

county and local levels as the first 

Notes 

11 Hafner, H., & an der Heiden, W. (1997). Epidemiology 

of schizophrenia. Canadian Journal 

of Psychiatry, 42, 139-51. 

12 Management Decision and Research Center. 

(October, 2002). Effective treatment for 

schizophrenia. Practice Matters, 7(1): 1-6. 

13 National Institute of Mental Health. (2000, 

May). Schizophrenia research fact sheet. 

Bethesda, MD: NIMH Office of Communications 

and Public Liaison. Retrieved December 

15, 2004, at http://www.nimh.nih.gov/publicat/NIMHschizresfact.pdf 

14 Knapp, M., Mangalore, R., & Simon, J. 

(2004). The global costs of schizophrenia. 

Schizophrenia Bulletin, 30(2):279-293. 




Notes 

15 White, L., Harvey, P.D., Opler, L.A., & Lindenmayer, 

J.P. (1997). Empirical assessment of 

the factorial structure of clinical symptoms 

in schizophrenia. A multisite, multimodel 

evaluation of the factorial structure of the 

Positive and Negative Syndrome Scale. The 

PANSS Study Group. Psychopathology, 

30(5):263-274. 

16 Robinson, D.G., Woerner, M.G., McMeniman, 

M., Mendelowitz, A., & Bilder, M. (2004). 

Symptomatic and functional recovery from a 

first episode of schizophrenia or schizoaffective 

disorder. Am J Psychiatry, 161(3):473-479. 

onset of schizophrenia, which can 

be longstanding, is usually in the 

teens and twenties. 

OMH researchers were the first to 

show that symptoms can be 

grouped into five categories: positive 

symptoms including delusions 

and hallucinations; negative symptoms 

such as loss of interest in the 

environment and emotional withdrawal; 

autistic preoccupation 

symptoms such as preoccupation, 

poor attention and cognitive deficits; 

activation symptoms such as hostility, 

excitement, and poor impulse 

control; and dysphoric mood symptoms, 

such as anxiety, guilt, and 

depression. 15 Prior to the introduction 

of the second generation 

antipsychotics in the 1990s, positive 

symptoms were considered the only 

symptoms of schizophrenia 

amenable to medication treatment. 

Now, thanks to research initiated in 

OMH facilities, new medications are 

becoming available that target not 

only positive but also negative, activation, 

dysphoric mood, and autistic 

preoccupation symptoms. 

The precise causes of schizophrenia, 

at present, are unknown. We 

do, however, know that schizophrenia 

is associated with both 

genetic and environmental factors. 

Children of individuals with schizophrenia 

have about a 15% chance 

of developing the illness, and if 

one member of an identical twin 

pair has schizophrenia, then there 

is a 50% likelihood that the other 

twin will have schizophrenia, too. 

These rates are similar to other 

complex conditions such as diabetes 

or obesity, but much lower 

than those that are single gene. 

Current Treatments 

for Schizophrenia 

ll current medications for schiz- 

including both typical 

Aophrenia, 

and newer atypical antipsychotics, 

function by blocking the actions of 

dopamine, a neurotransmitter that 

carries signals between nerve cells 

in the brain. Because of various 

improvements, the newer atypical 

antipsychotics produce fewer neurological 

side effects, such as motor 

disturbances, than did older medications, 

and are also better tolerated 

by many individuals. Nevertheless, 

many of the newer atypical 

medications have turned out to 

have unexpected side effects, such 

as propensity to cause weight gain 

and precipitate diabetes, complicating 

clinical care. 

Most importantly, only about 20% 

of individuals with schizophrenia 

show full resolution of symptoms 

despite treatment with the best 

available agents. 16 Although persistent 

positive symptoms contribute 

to poor outcomes, many individuals 

can learn to function despite 

hallucinations or even delusions. 

More debilitating are negative 

symptoms such as severe apathy, 

loss of drive, social withdrawal, 

and cognitive deficits, such as 

impaired memory and problem 

solving ability. These core symptoms 

of schizophrenia remain 

largely unaffected by current medications, 

suggesting that new treatment 

approaches are required. 

Research Programs 

OMH conducts schizophrenia 

research with the overarching goal 

of developing new treatment 

approaches for this disease. Over 

the past five years, OMH 

researchers have been awarded 

numerous grants from both the 

Federal government and independent 

research foundations to support 

their research, and have also published 

hundreds of articles and 

chapters on topics relevant to 

schizophrenia. This section highlights 

how OMH is facilitating the 

translation of new research 

approaches into practical new 

treatments for schizophrenia in 

three key areas: basic research, 

studies of neurocognition, and 

medication treatment studies. 



Basic research studies 

o develop better treatments, 

Tinvestigators need to understand 

how schizophrenia arises. Many 

brain regions and systems operate 

abnormally in schizophrenia. 

Although imbalances in the neurotransmitter 

dopamine were once 

thought to be the prime cause of 

schizophrenia, new findings suggest 

that impoverished signaling by 

the more pervasive neurotransmitter 

glutamate–or, more specifically, 

by one of glutamate’s key targets 

on neurons (the NMDA receptor)– 

better explains the wide range of 

symptoms in this disorder. 

These new findings are guided by 

the “phencyclidine model of schizophrenia.” 

The model is based on 

the observation that phencyclidine 

causes symptoms similar to those 

seen in schizophrenia by blocking 

the NMDA receptors, which are 

widely distributed in the brain and 

participate in processes such as 

learning, memory, attention, and 

“signal amplification.” The ability of 

phencyclidine and related drugs to 

induce symptoms of schizophrenia 

by blocking NMDA receptors has 

led to the theory that dysfunction 

of NMDA receptors may cause 

symptoms of schizophrenia. This 

model was first proposed by OMH 

research scientists in a 1991 journal 

article, 17 which has since been cited 

over 700 times, and was the second 

most widely cited schizophrenia 

paper during the 1990s. 

Studies conducted over the past 

several years have investigated 

effects of phencyclidine, with the 

goal of developing new targets for 

treatment. One issue addressed by 

these studies is the relationship 

between NMDA disturbances and 

dopamine functioning in individuals 

with schizophrenia. With a goal 

of better understanding the possible 

causes of schizophrenia and 

developing more effective treatments, 

these studies investigated 

first, the ability of phencyclidine to 

induce abnormalities of the 

dopamine system similar to those 

seen in schizophrenia, and second, 

the ability of amino acids, such as 

glycine, to reverse the effects. 

Study results suggest that glycine 

counteracts the effects of phencyclidine. 

This pattern is similar to 

what has been observed symptomatically 

in individuals with schizophrenia 

receiving glycine. A limitation 

of glycine treatment is that 

high doses must be given to obtain 

significant therapeutic effect. 

This analysis, and others like it that 

have been developed by OMH 

research scientists, permit testing of 

newer medications that may be 

shown to treat schizophrenia more 

effectively. To date, several novel 

medications, including a class of 

drugs termed “glycine transport 

inhibitors,” have been shown to produce 

effects quite similar to those 

produced by glycine. Several such 

compounds are currently under clinical 

development and are expected to 

begin clinical testing within the next 

few years. Other newer approaches 

are currently under development in 

the Research Division, providing a 

multifaceted attack on the problem. 

These studies were funded from 

grants received from both the 

National Institutes of Health (NIH) 

and the Stanley Medical Research 

Institute. Study results have been 

published in several high profile 

journals, including Biological Psychiatry 

and Neuropsychopharmacology. 

Studies of neurocognition 

MH studies of neurocognition are 

Oproviding a better understanding 

of the cognitive deficits associated 

with schizophrenia. Average IQ in 

the normal adult population is set at 

100, and a value of 70 is considered 

the cutoff for “borderline” intellectual 

function. Approximately 80% of 

individuals with schizophrenia are 

below their expected IQ, based on 

Notes 

17 Javitt, D. C., & Zukin, S. R. (1991). Recent 

Advances in the Phencyclidine Model of 

Schizophrenia. American Journal of Psychiatry, 

148(10), 1301-1308. 




Notes 

18 Goldberg, T.E., Torrey, E.F., Gold, J.M., 

Bigelow, L.B., Ragland, R.D., Taylor, E., Weinberger 

DR. (1995). Genetic risk of neuropsychological 

impairment in schizophrenia: a 

study of monozygotic twins discordant and 

concordant for the disorder. Schizophrenia 

Research, 17(1):77-84. 

19 Hollis, C. (2002). Adolescent schizophrenia. 

Advances in Psychiatric Treatment, 6, 83-92. 

those of their parents and siblings. 18 

On average, adolescents with schizophrenia 

have a mean IQ of 85 and 

30% of these adolescents have IQs 

of 70 or below. 19 This is because 

their mean IQ is reduced by about 

five points during childhood, and 

they then experience another ten to 

15 point drop in the six-month to 

two-year period prior to the onset of 

the illness. This drop in IQ is illustrative 

of the “dementia” aspect of 

schizophrenia that robs individuals 

of the coping skills they need to 

deal effectively with their symptoms. 

The pattern of cognitive deficit in 

schizophrenia, however, is different 

from the pattern observed in other 

dementing illnesses such as 

Alzheimer’s disease. Further, the 

degree of brain degeneration is 

much less, suggesting that the 

deficits might be reversible (or at 

least preventable) if underlying 

causes are known. Thus, OMH 

studies of neurocognition have the 

overall goals of providing information 

to allow early identification of 

individuals predisposed to schizophrenia, 

and early intervention to 

prevent cognitive decline, as 

important next steps in the management 

of the disease. 

In recent years, significant strides 

have been made in developing 

tests that distinguish individuals 

with schizophrenia from those 

without the disease. A goal over 

the next several years is application 

of these tests to individuals showing 

what may be early signs of 

schizophrenia to identify those 

who require early intervention. 

OMH researchers use a combination 

of high-density electrophysiology, 

which analyzes the minute 

electrical waves given off by the 

brain during cognitive activity using 

electrodes placed on the scalp, and 

functional brain imaging, which 

analyzes blood flow in key brain 

regions using magnetic resonance 

imaging. Together these techniques 

can trace the flow of information in 

the brain, and determine the locations 

and hopefully, the causes of 

abnormal brain functions. 

One area of particular interest is 

in the early stages of information 

processing. Most schizophrenia 

studies focus on dysfunction of 

complex brain regions, and while 

there are deficits associated with 

those regions in schizophrenia, 

even much simpler processes 

appear to be impaired which 

involve how individuals “decode” 

the world around them. For example, 

it has often been assumed that 

individuals with schizophrenia hear 

and see information normally, but 

just interpret it incorrectly. OMH 

research has shown that this is not 

the case. For example, individuals 

with schizophrenia have much 

more difficulty than others in 

detecting simple changes in musical 

pitch. As a result, they are less sensitive 

than other individuals to 

detecting emotion based upon 

other people’s vocal intonations. 

Individuals with schizophrenia also 

have difficulty in decoding complex 

images, such as partially obscured 

pictures, or even facial expressions. 

This also leads to difficulty in 

understanding other people’s emotions. 

These same deficits also give 

rise to difficulty in reading books or 

magazines, another overlooked 

deficit in schizophrenia. 

These deficits in basic sensory 

processes contribute to the difficulty 

that individuals with schizophrenia 

may have in what for most 

people are simple day-to-day interactions-decoding 

a person’s emotions 

by looking at their face or listening 

to the tone of their voice, 

expressing their own emotions, or 

distinguishing frightening from 

non-frightening objects. These 

basic deficits are not affected by 

the types of medication available to 

date, and whether or not they 

respond to newer medications 

remains to be established. Recent 

OMH studies of cognitive dysfunc- 



tion point up new avenues for cognitive 

remediation. For example, 

when individuals with schizophrenia 

are helped to read, their comprehension 

is often relatively normal. 

These findings provide new 

avenues for designing remediation 

programs to address the core disturbances 

in schizophrenia, and 

hope for ultimate rehabilitation. 

Medication treatment studies 

MH research scientists conduct 

Omedication trials in order to 

hasten the use of behavioral science 

and neuroscience advances in 

clinical care. The research institutes 

have been test sites for several 

promising compounds, including 

glycine and other compounds that 

stimulate NMDA receptors. 

Clinical trials are conducted collaboratively 

across several centers. For 

example, an OMH research institute 

participated recently in the National 

Institute for Mental Health (NIMH) 

CONSIST trial for treatment of cognitive 

and negative symptoms, and 

will be one of only six sites nationwide 

that will be evaluating new 

medications to treat neurocognition 

as part of the newly awarded, 

NIMH-funded TURNS consortium. 

Some of the compounds entering 

clinical trials, such as D-serine, are 

compounds conceived or developed 

within OMH research institute laboratories. 

Others have been developed 

based upon complementary 

theories elsewhere. 

Dementia Research 

Burden of Care 

ementia describes a syndrome 

Dassociated with a range of diseases 

that progressively impair 

brain functions and rob the afflicted 

of their ability to learn, reason, 

make judgments, communicate and 

carry out daily activities. Dementia 

knows no social, economic, ethnic 

or geographical boundaries, and 

the full extent of its impact has only 

begun to be appreciated. 

Alzheimer’s disease, the leading 

cause of dementia, accounts for 50- 

60% of all cases. Other common 

causes of dementia include vascular 

dementia, Parkinson’s disease, and 

Lewy Body disease. 20 Alzheimer’s 

disease or other forms of dementia 

frequently coexist with psychiatric 

conditions. In older psychiatric 

patients with even mild dementia, 

disruptive behaviors are more common 

and persistent, and increase 

the utilization of psychiatric services, 

including hospitalization. Studies 

of psychiatric inpatient populations 

show that the presence of dementia 

is under-recognized by clinicians, 

which may complicate the treatment 

outcomes of these individuals. 

Increasing age is the greatest risk 

factor for Alzheimer’s disease. The 

likelihood of developing 

Alzheimer’s approximately doubles 

every five years after age 65. 21, 22 By 

age 85, the risk reaches nearly 

50%. 23, 24 An estimated 4.5 million 

Americans have Alzheimer’s disease 

25, 26 

and, based on a 1992 Gallup 

survey that indicated 1 in 10 persons 

had a family member with 

Alzheimer’s disease, in 2000 an estimated 

19 million Americans 21 

years of age or older had a family 

member with the disease. 27, 28 These 

numbers have more than doubled 

since 1980 as the percentage of elderly 

in the population has risen. In 

New York State, the number of 

people with dementia, currently 

estimated to be 300,000, will grow 

to approximately 500,000 in just 

five years. 29 Without a preventative 

therapy, the burden of care for this 

growing population will fall to a 

smaller, younger generation. 

The impact of Alzheimer’s and 

related disorders on individuals, 

families, and our health care system 

makes dementia one of soci- 

Notes 

20 Lewy Body disease, the second most frequent 

cause of dementia in elderly adults, is 

a neurodegenerative disorder associated 

with abnormal structures (Lewy bodies) 

found in certain areas of the brain. Because 

these structures and many of the symptoms 

of dementia with Lewy bodies are associated 

with Parkinson’s and Alzheimer’s diseases, 

researchers do not yet understand 

whether dementia with Lewy bodies is a distinct 

clinical entity or perhaps a variant of 

Alzheimer’s or Parkinson’s disease. 

21 Brookmeyer, R., Gray, S., & Kawas, C. (1998). 

Projections of Alzheimer's Disease in the 

United States and the public health impact 

of delaying disease onset. American Journal 

of Public Health, 88(9): 1337-1342. 

22 National Institute of Aging. (2004). 2003 

Progress report on Alzheimer’s disease: 

Research advances at NIH. U.S. Department 

of Health and Human Services, National 

Institutes of Health, Publication No. 04-5570. 

23 Evans, D.A., Funkenstein, H.H., Albert, M.S., 

et al. (1989). Prevalence of Alzheimer’s Disease 

in a community population of older persons: 

higher than previously reported. JAMA, 

262(18): 2551-2556. 


Progress report on Alzheimer’s disease: Taking 

the next steps. U.S. Department of 

Health and Human Services, National Institutes 

of Health, Publication No. 00-4859. 

25 Hebert, L.E., Scherr, P.A., Bienias, J.L., Bennett, 

D.A., & Evans, D.A. (2003). Alzheimer 

disease in the U.S. population: Prevalence 

estimates using the 2000 Census. Archives 

of Neurology, 60(8): 1119-1122. 


Progress report on Alzheimer’s disease: 

Research advances at NIH. U.S. Department 

of Health and Human Services, National 

Institutes of Health, Publication No. 04-5570. 

27 Alzheimer’s Association. (1993). Gallup survey 

commissioned by the Alzheimer’s Association. 

Chicago: Alzheimer’s Association 

Green-Field Library. 

28 U.S. Census Bureau. (2000). QT-01. Profile of 

general demographic characteristics: 2000. 

Data Set: Census 2000 supplementary survey 

summary. Tables. Accessed online December 

15, 2004, at http://factfinder.census.gov/ 

servlet/QTTable?_bm=y&-geo_id=D&- 

qr_name=ACS_C2SS_EST_G00_QT01&- 

ds_name=D&-_lang=en&-redoLog=false. 

29 New York State Department of Health. 

(2004). Chronic disease teaching tools - New 

York State dementia registry: Quick facts 

about the registry and dementia in New York 

State. Albany, NY: Author. Retrieved December 

15, 2004, at http://www.health.state.ny. 

us/nysdoh/chronic/nysdr.htm. 




Notes 

30 The bulk of this care is custodial care/supervision 

(e.g., help with activities of daily living, 

preventing wandering, etc.) and may 

include skilled or unskilled nursing care. 

31 Medicare and Medicaid Costs for People with 

Alzheimer’s Disease. Washington, D.C.; April 

2001: The Lewin Group; p.1. Retrieved 

December 16, 2004 at http://www.alz.org/ 

Media/newsreleases/alzreport.pdf 

32 Koppel, R. (2002). Alzheimer’s disease: The 

costs to U.S. businesses in 2002. Chicago: 

Alzheimer’s Association. Retrieved December 

15, 2004, at: http://www.alz.org/Media/ 

newsreleases/2002/062602ADCosts.pdf 

ety’s greatest medical, social and 

fiscal challenges. Alzheimer’s disease 

advances at widely different 

rates, and consequently, the duration 

of the illness can vary from 

three to 20 years. Because of its 

disabling rather than fatal nature, 

dementia not only deprives individuals 

of many years of healthy life, 

but also consigns family members 

to long years of care giving associated 

with substantial psychological 

and financial strain. 

More than 70% of people with 

Alzheimer’s disease live at home, 

where nearly 75% of their care is 

provided by family and friends. The 

remaining care 30 is provided by professional 

caregivers at an average 

cost of $12,500 per year, which is 

paid mostly out-of-pocket by families. 

Dementia is the greatest single 

contributor to the cost of residential 

aged care, which often exceeds 

$60,000 per year per consumer. 

Nationally, direct and indirect annual 

costs of caring for individuals with 

Alzheimer’s disease alone are at least 

$100 billion a year. 31 These include 

$61 billion in costs to American businesses 

for Alzheimer health care and 

expenses related to caregivers of 

individuals with Alzheimer’s, which 

include lost productivity, absenteeism, 

and worker replacement. 32 

The promise 

of Dementia Prevention 

n the absence of a cure for 

IAlzheimer’s, interventions that produce 

even a modest delay in the 

onset of dementia will have a major 

positive public health impact. It has 

been estimated that a preventative 

treatment in 2005 that delays the 

onset of Alzheimer’s by just five 

months could reduce new cases by 

5% each year. A preventative treatment 

that delayed onset by five 

years could reduce new cases annually 

by 50%, and halve the burden 

of total cases by 2040. The savings 

in terms of human suffering are 

immeasurable. Given the impending 

epidemic of dementia, there is an 

urgent need to maintain the commitment 

to research to reduce the 

human toll of dementia and its 

expanding economic burdens. 

Research Programs 

wealth of accumulating evi- 

indicates that with a sus- 

Adence 

tained research effort, the goal of 

delaying dementia is within reach. 

Over the last 15 years, remarkable 

progress has been made toward 

understanding dementia and 

improving its management as a 

result of advances in neuroscience, 

genetics, medical technology, and 

clinical care. OMH researchers 

have been on the forefront of these 

developments, contributing to both 

the understanding of the causes of 

dementia and the use of this 

knowledge to develop the newest 

generation of therapies aimed at 

preventing or delaying its onset. 

Complementary clinical programs 

have continued to make advances 

in the treatment and management 

of individuals who already have 

dementia and are in the community, 

residential homes, and State 

hospitals. 

For their work in dementia, OMH 

researchers have received the highest 

awards bestowed by the National 

Institute of Health (NIH), the 

national Alzheimer’s Association 

and other organizations. Their 

research has been published in 

highly regarded scientific journals, 

including Nature, Science, and Neuron. 

More importantly, as illustrated 

below, OMH research in dementia 

and affiliated clinical programs has 

made tangible progress toward 

translating research findings into 

practical clinical treatments for the 

prevention, treatment and management 

of dementia, and disseminating 

this knowledge to individuals 

with dementia and their caregivers. 



Progress toward dementia 

prevention is accelerating 

lzheimer’s disease is a devastat- 

disorder of the brain’s nerve 

Aing 

cells and not a normal part of 

aging. By the time symptoms 

emerge, nerve cells that process, 

store and retrieve information have 

already begun to degenerate and 

die. The areas of the brain that 

control memory and thinking skills 

are affected first, but as the disease 

progresses, cells die in other 

regions of the brain. Alzheimer’s 

disease has no known single cause, 

but in less than two decades, scientists 

have learned a great deal 

about factors that play a role. Two 

abnormal microscopic structures 

that appear in the brain, called 

“plaques” and “tangles,” are considered 

Alzheimer hallmarks. Plaques 

contain clumps of amyloid protein 

that accumulate outside the brain’s 

nerve cells. Tangles are twisted 

strands of another protein that 

form inside cells. Although it has 

not been fully resolved whether or 

not plaques or tangles cause 

Alzheimer’s, therapies that lower 

amounts of these abnormal proteins 

have been a key objective of 

many researchers trying to develop 

new therapies to prevent or treat 

the disorder. 

OMH researchers have advanced 

this goal by identifying novel 

processes that can cause nerve 

cells to overproduce amyloid, 

thereby revealing new possibilities 

for blocking amyloid accumulation. 

In international collaborative studies, 

OMH research scientists recently 

discovered that amyloid in the 

blood outside the brain may contribute 

to its accumulation in the 

brain. This research is being 

viewed as a scientific basis for 

novel medications that act outside 

the brain to prevent amyloid accumulation, 

including the Alzheimer’s 

vaccine currently in clinical trials. 

OMH research scientists were also 

instrumental in a milestone study 

that first demonstrated memoryenhancing 

effects of an amyloid 

vaccine, and are well recognized 

for their models of Alzheimer’s 

which are being used worldwide 

by pharmaceutical companies and 

scientists to screen potential therapeutic 

agents for both Alzheimer’s 

and Parkinson’s disease. In addition, 

new models of Alzheimer tangle 

pathology recently patented by 

OMH researchers are already being 

used in drug discovery programs. 

It has become clear that whatever 

triggers Alzheimer’s disease 

begins to damage the brain years 

before symptoms appear. OMH 

research scientists have shown that, 

even before this damage or amyloid 

appears, critical changes in 

nerve cell function are detectable 

up to a decade or more before the 

person develops symptoms of 

Alzheimer’s. These Alzheimer’s-specific 

changes, the earliest known 

sentinels of the disease detected so 

far, involve defects in the way 

brain cells bring in and metabolize 

nutrients, and provide insights into 

why and how brain cells eventually 

die in the disease. These findings, 

which were the principal basis for 

a 1999 $7 million NIH grant award 

for OMH Alzheimer’s research, are 

revealing novel strategies for early 

diagnosis and a rationale for new 

prevention approaches, some of 

which have already reached the 

stage of clinical testing. That disease-specific 

changes precede the 

symptoms of Alzheimer’s by many 

years, or even its earliest nerve cell 

damage, has enormous implications. 

The time that exists between 

the first tell-tale biochemical sign of 

disease and the first memory symptoms 

provides a valuable opportunity 

to intervene before brain cells 

are ever lost. 

Achieving earlier diagnoses and 

preventative treatments by capitalizing 

on this knowledge is a major 

I 

t has been estimated that 

a preventative treatment 

in 2005 that delays the 

onset of Alzheimer’s by just 

five months could reduce 

new cases by 5% each 

year. A preventative treatment 

that delayed onset by 

five years could reduce 

new cases annually by 

50%, and halve the burden 

of total cases by 2040. 




thrust of current OMH dementia 

research. For example, OMH 

researchers have utilized advanced 

brain imaging to detect abnormal 

brain function, possibly heralding 

the future onset of Alzheimer’s, in 

symptom-free elderly individuals 

who are at higher genetic risk to 

develop the disease. Other new 

imaging techniques are now being 

applied with the goal of widening 

the window of prevention opportunity 

even further. 

Promising recent advances 

in the treatment and 

prevention of Alzheimer’s 

mong the most promising recent 

Aadvances in the treatment and 

prevention of Alzheimer’s are new 

studies revealing factors, beyond 

age and rare genetic causes, that 

increase the risk of dementia. These 

studies have raised hopes that 

dementia onset may be delayed or 

prevented by modifying these factors. 

Of particular importance is the 

discovery that vascular disease 

plays a large role not only in vascular 

dementia, but also in 

Alzheimer’s disease, most likely by 

decreasing blood flow to the brain. 

The benefits from this research in 

terms of Alzheimer’s prevention 

may be coming soon since moderately 

effective measures that can 

prevent stroke and disease of the 

blood vessels in the brain already 

show promise. 

People with heart disease are at 

higher risk of developing dementia 

while those with Alzheimer’s 

disease pathology decline faster if 

they also have vascular-related 

brain damage. Research in this area 

was catalyzed by the findings of an 

OMH research scientist, who identified 

the first gene causing a form of 

dementia that is related to 

Alzheimer’s but affects primarily the 

blood vessels. Subsequently, these 

scientists have developed unique 

laboratory models of the disease for 

drug screening and understanding 

further this important interaction of 

blood vessel disease with 

Alzheimer’s disease. In current clinical 

trials of the amyloid vaccine 

and other amyloid-lowering therapies, 

the impact on blood vessels 

has assumed critical importance 

and research by OMH scientists is 

having a crucial influence on the 

design of these promising therapeutic 

strategies. 

Strengthening the link between 

heart and brain in Alzheimer’s disease 

even further are new observations 

that a host of risk factors for 

vascular disease (including high 

blood pressure, cholesterol and 

homocysteine, diabetes, smoking, 

and obesity) increase risk for 

dementia and hasten memory 

decline. Emerging evidence suggests 

that controlling these risk factors 

and promoting general healthy 

aging reduce Alzheimer risk. 

Observations that dementia may 

develop at different rates in individuals 

from the same ethnic population 

living in different parts of the 

world has suggested that lifestyle 

factors, many of which are modifiable, 

may potentially forestall the 

onset of dementia. Diet is one of 

these lifestyle factors. Foods or 

supplements containing antioxidants 

or omega-3 fatty acids have 

been found to be protective whereas 

foods high in total and saturated 

fat and cholesterol increase risk. 

Seminal work by several OMH 

researchers showing that dietary 

reductions of cholesterol lowered 

amyloid accumulation in the brain 

led to the first demonstration that 

cholesterol-lowering drugs, called 

statins, have similar but even more 

potent effects. These and other 

findings have provided the impetus 

for current clinical trials of statins 

nationwide in people with 

Alzheimer’s disease, the first of 

which has recently reported very 

encouraging results. 

Based on these rapidly emerging 

findings and the precedent that 



population-based strategies to 

reduce heart disease (general 

screening, dietary interventions, 

education, and pharmacotherapy) 

reduce mortality and cardiovascular 

risk, and are cost effective, the 

Alzheimer community and the 

national Alzheimer’s Association 

urge the adoption of healthy 

lifestyles such as regular exercise to 

delay the onset of dementia, which 

would have enormous benefits to 

citizens around the nation and in 

New York State. 33 

Even after neurodegenerative 

processes have begun, the symptoms 

of dementia are treatable. Of 

the four medications available to 

treat Alzheimer’s, three act by raising 

levels of a chemical messenger 

(acetylcholine) that is depleted 

when cells die, while the fourth 

(memantine) belongs to a new 

generation of drugs aimed at preventing 

brain cells from dying. 

In addition to its history of conducting 

trials on acetylcholineenhancing 

drugs as they were 

developed, OMH research institutes 

served as a clinical site in the first 

U.S. study showing the efficacy of 

memantine in moderate 

Alzheimer’s. The study found that 

memantine showed beneficial 

effects on thinking, behavior, and 

overall functioning (as compared to 

a placebo). Moreover, the medication 

was found to be quite safe 

and not significantly different from 

placebo in terms of reported side 

effects. As a result, memantine 

received FDA approval and was 

made available in 2004 for the 

treatment of “moderately to severely 

impaired” individuals with 

Alzheimer’s. Individuals who were 

in the group receiving the study 

medication were able to receive 

this medication when they were in 

the earlier, rather than later stages 

of the disorder, and three or four 

years prior to the time it became 

available to others commercially. 

Managing Dementia: 

Raising Standards of Care 

n important mission of OMH 

AAlzheimer’s research has been 

to optimize the management of 

both memory and behavioral 

symptoms of people with dementia. 

Besides trials of new memoryenhancing 

medications, these 

efforts have included research 

into effective treatments for agitation, 

the most common symptom 

leading to hospitalization and residential 

nursing care of demented 

individuals, as well as investigations 

on the adverse effects of 

commonly used medicines for 

dementia. Such studies are crucial 

to the development of best practice 

standards for dementia care. 

OMH clinicians and scientists are 

also working in concert with residential 

care groups, local clinicians, 

and Alzheimer’s Association chapters 

to inform them about the latest 

advances in dementia therapy and 

management. The need is great. A 

recent OMH public information 

event for Alzheimer’s disease 

attracted an audience of more than 

400. Although there is now greater 

awareness of dementia, there is 

much less understanding of the 

nature of these disorders, their progression, 

and the potential for prevention. 

Increasing public awareness 

and understanding on an 

ongoing basis sends a strong public 

health message that individuals 

may be able to reduce their risk of 

dementia and that support for caregivers, 

evidence-based care interventions, 

and medications can 

reduce the impact of the condition. 

Future Directions for Schizophrenia 

and Dementia Research 

hile OMH research programs 

Wcontinue to be highly effective 

in determining causes and new 

treatment approaches for schizophrenia 

and dementia, much work 

still remains. In schizophrenia 

Notes 

33 Alzheimer’s Association. (2004, July 20). 

Alzheimer’s, cardiovascular disease share 

risk factors: Cholesterol levels, diabetes and 

hypertension - known risk factors for strokes 

and heart attacks - can contribute to risk of 

cognitive decline and dementia later in life 

[news release]. Chicago: Author. Retrieved 

December 15, 2004, at http://www.alz.org/ 

internationalconference/pressreleases/ 

072004_head_heart.asp 




research, new imaging approaches 

have been developed over recent 

years that permit detailed assessment 

of structural brain abnormalities 

in schizophrenia, to complement 

functional neuroimaging 

studies. Highly significant relationships 

have been observed between 

these brain structural deficits and 

both symptoms and neurocognitive 

dysfunction that need further study. 

There is also a clear need to start 

translating current treatment 

approaches into younger populations 

to prevent the deterioration 

that often occurs in the early years 

of the illness, and to determine 

whether schizophrenia can be prevented 

rather than just treated. 

In dementia research, more 

needs to be done to establish safe 

therapies that prevent or delay the 

onset of the many forms of dementia. 

We are beginning to identify 

some of the factors that increase or 

reduce the risk for Alzheimer’s disease, 

but it is also critical to know 

how these factors influence specific 

aspects of the disease process in 

the brain in order to maximize the 

effectiveness and safety of potential 

therapies. The most successful preventative 

and treatment approaches 

will require that interventions begin 

during the period between the first 

brain changes and the appearance 

of the first memory symptoms of 

Alzheimer’s. Such interventions can 

happen only if this crucial window 

of time can be recognized reliably 

in a diverse and aged population. 

No such early diagnostic test currently 

exists but momentum toward 

this goal is building. Biomarkers, 

which are factors measurable in 

blood or other fluids that provide 

information about the presence of 

disease, are being investigated in 

people with Alzheimer’s disease. 

More research in this area is needed 

if caregivers are to begin treatments 

early enough in the disease 

to make the greatest difference. 

OMH Research Benefits 

Many New Yorkers 

s has been also described 

Aabove, research conducted at 

OMH's research institutes benefits 

an increasingly large proportion of 

New York State’s population and 

many millions of people nationally 

and internationally. Table 4.4 presents 

examples of how a broader 

population benefits from OMH 

research. In addition to the examples 

provided below, Chapter 8 

presents an extensive review of 

OMH's suicide prevention initiative, 

which represents a significant 

research effort applicable to a 

broader audience. 

Conclusion 

ew York State has a tradition of 

Ncommitment to engaging in 

basic and clinical mental health 

research that has brought hope to 

many thousands of individuals with 

mental illness and their families. 

Individuals with mental illness 

and their care providers are entitled 

to the same high quality of 

research-based information upon 

which to make treatment and service 

decisions as persons with heart 

disease, cancer, or other general 

medical conditions. Today, 

researchers, mental health care 

providers, general health care personnel, 

service systems administrators, 

policymakers, and most critically, 

individuals with mental 

illnesses and their families recognize 

that research is essential to 

generate information that, properly 

used, will better enable people with 

mental illnesses to receive optimal 

care. Mental health research must 

be sustained to guarantee improving 

the health and quality of life of 

individuals with mental illness, their 

families and our communities 

across New York State. 



Table 4.4. 

Examples of OMH Research Benefiting a Broader Population 

Psychological Risk Factors 

for Heart Disease 

This research explores a psychophysiological 

model of coronary disease that identifies 

the autonomic nervous system as the link 

between psychological factors and atherosclerosis. 

Specifically, the model suggests that by 

enhancing parasympathetic control of the 

heart, already known by cardiologists to promote 

survival following myocardial infarction, 

potentially pathogenic oscillations in blood 

pressure can be buffered. This model is the 

basis of several ongoing investigations funded 

by NIMH and the National Heart, Lung, and 

Blood Institute to explore factors that alter cardiac 

autonomic control: aerobic conditioning, 

cognitive-behavioral reduction of hostility, and 

surgical denervation. Additional research studies 

the relationship of depression to the development 

of cardiac disease and to mortality 

and morbidity in heart attack, unstable angina, 

and coronary artery bypass patients. 

Seasonal Affective Disorder 

Within the past two decades, seasonal affective 

disorder (SAD) has been increasingly diagnosed 

and treated. OMH researchers are comparing 

three distinct treatments for seasonal 

affective disorder: post-awakening bright light 

therapy, dawn simulation, and high-intensity 

negative air ionization (the latter two administered 

during sleep). Interim results demonstrate 

superiority of all three active treatments 

relative to a low-density negative ion placebo 

control. OMH researchers have also published a 

novel on-line instrument (http://www.cet. 

org/AutoMEQ.htm) by which people can estimate 

their circadian rhythm phase and determine 

the optimum time for antidepressant 

light exposure. The instrument is being used in 

a new research study to chart chronotype (e.g., 

the set of circadian factors that determine 

whether someone is a morning or an evening 

person) globally and across the seasons. 





Chapter 5: Services Research 51 

Services Research Chapter 5 

ental health services research 

Mintegrates research, practice, 

and policy directions into mainstream 

practice. It takes place in 

“real-world” settings and examines 

characteristics of individuals, families, 

providers and the service system; 

aspects of social, psychological 

and cultural environments and 

their influence on how people 

seek care; the nature and type of 

care selected or provided; and 

what occurs during service delivery 

and the outcomes of care. The 

overall goal is to improve treatment 

and services for people with mental 

illness by helping them get the 

best possible care. While evaluation 

and services research conducted 

by OMH is the focus of Chapter 

5, information about OMH basic 

and clinical research related to the 

treatment and prevention of mental 

diseases is found in Chapter 4. 

A 1999 National Institute of Mental 

Health (NIMH) report, Bridging 

Science and Service, focuses attention 

on the need for mental health 

services research that is useful and 

practical for people with mental illnesses, 

clinicians, purchasers, and 

policy makers. 1 OMH conducts rigorous 

services research that is 

strongly influenced by the demands 

of the public mental health system 

and, in turn, influences the development 

of policy and practice on a 

wide range of pertinent issues. A 

significant portion of OMH services 

research is conducted in the Evaluation 

Research (ER) branch of the 

OMH Center for Information Technology 

and Evaluation Research 

(CITER), with additional services 

research being conducted at the 

New York State Psychiatric Institute 

and the Nathan S. Kline Institute for 

Psychiatric Research. Evaluation 

research and statistical analysis on 

agency operations provide information 

that improves the effectiveness 

and facilitates the management of 

mental health services in New York 

State. New knowledge gained 

through these activities leads to 

improved public mental health outcomes 

in meaningful and measurable 

ways. This information affects 

the organization, financing, management, 

delivery, and access to services, 

as well as the course, cost, and 

consumer level outcomes of care. 

This chapter reviews 2004 OMH 

services research regarding a number 

of evidence-based practice initiatives 

designed to improve the 

quality of care offered to adults 


children with serious emotional 

disturbance. It also highlights care 

coordination initiatives, which are 

designed to support important 

OMH program initiatives. Together, 

OMH program and care coordination 

initiatives are contributing to 

the base of knowledge in New 

York State and nationally on effective 

clinical strategies that support 

individuals with serious mental illness 

as they strive toward recovery. 

Notes 

1 National Advisory Mental Health Council. 

(1999). Bridging science and service: A 

report by the National Advisory Mental 

Health Council’s Clinical Treatment and Services 

Research Workgroup. NIH Publication 

No. 99-4353. 



52 Chapter 5: Services Research 

Science Informing 

Practice: Evidence- 

Based Initiatives 

ental health services research 

Mhas demonstrated that some 

specific treatment approaches are 

effective in improving outcomes for 

individuals diagnosed with serious 

mental illness. Called evidencebased 

practices (EBPs), these interventions 

are rooted in reliable scientific 

inquiry, and supported by a 

body of evidence; they have demonstrated 

effectiveness in improving 

outcomes in areas relating to wellness 

(e.g., physical health, selfesteem, 

symptom management, and 

behavior management) and community 

integration (e.g., housing, 

employment, and education). Adherence 

to specific population, outcome, 

and implementation standards 

is key to producing outcomes consistent 

with recovery. 

OMH’s Winds of Change campaign 

continues the drive to promote 

recovery from serious mental 

illness through the implementation 

of EBPs in routine mental health settings. 

The implementation of EBPs 

in New York State has been guided 

by a model that builds on strategies 

for change through three phases: 

consensus building, enacting, and 

sustaining. As described in Table 5.1, 

the process is dynamic and involves 

Table 5.1 

OMH Planning Matrix For Evidence-Based Practice Implementation 

Change 

Strategies 

PHASE I: 

Consensus 

Building 

PHASE II: 

Enacting 

PHASE III: 

Sustaining 

AWARENESS: 

Encouragement and 

collaboration with 

stakeholders 

Identify and use a 

network of champions 

from local government, 

stakeholders, 

and advising 

groups 

Using formal consensus-building 

projects to 

create a set of evidence 

based demonstrations 

throughout the state 

(including Drake pilot sites) 

Evaluate for widespread 

replication 

EDUCATION: 

Introduction and 

development of new 

quality initiatives 

Produce introductory 

materials, include 

national EBP toolkits 

and quality outcome 

measures 

Develop several 'Centers 

for Excellence' 

for ongoing research 

and education 

Secure permanent 

funding for 'Centers 

for Excellence' 

statewide 

STRUCTURAL 

& CLINICAL 

IMPROVE- 

MENT: 

Incorporation of quality 

measures into both 

individual practitioner 

and provider performance 

Develop and test 

quality outcome 

measures using network 

of champions 

and demonstration 

sites 

Develop fiscal and 

regulatory changes 

indicated during 

development and 

testing 

Create a local level 

evaluative capacity to 

monitor performance 

against outcomes 

CONTINUAL 

IMPROVEMENT 

& SUPPORT: 

Monitoring of the 

quality measures and 

means for continuous 

upgrading 

Use existing progress 

report structure to 

'test' an initial series 

of performance 

reviews in selected 

EBP areas 

Use performance 

data in selected EBP 

areas to make regulatory 

and funding 

decisions 

Periodically revisit 

consensus building 

stages to identify and 

promote innovations 



careful coordination, monitoring, 

and ongoing evaluation of the 

implementation of EBPs. 

A cornerstone of the Winds of 

Change campaign is involvement 

of stakeholders at all levels of the 

system in continual quality 

improvement efforts. During 2003- 

2004, approximately 6,000 individuals 

who used mental health services 

participated in public forums to 

provide input on the EBP campaign. 

Additionally, ongoing support 

for the seamless integration of 

EBPs into the OMH quality agenda 

occurred when more than 400 people 

from New York State and 

around the nation attended a July 

2001 symposium on EBPs and trauma 

treatment. 

OMH evaluations of specific EBPs 

share common components and 

target areas specific to the practice 

under study. Common elements 

include tracking the number of programs, 

staff trained in the delivery 

of the intervention and individuals 

served; measuring clinician satisfaction 

with training; examining program 

adherence to EBP standards 

(better known as fidelity to implementation); 

and assessing the quality 

of programs being implemented 

and clinical outcomes. 

Adult Services 

he implementation of EBPs 

Tamong the adult population 

with serious mental illnesses is 

being studied across service settings: 

inpatient, outpatient, and in 

jails and prisons. Principal areas of 

study currently under way include 

medication management, Assertive 

Community Treatment, family psychoeducation, 

and consumer 

assessments of service quality. 

Improving the Quality 

of Medication Practices 

edications are a critical compo- 

of the treatment of serious 

Mnent 

mental illness. Two important studies 

of medication management have 

been designed to better understand 

their impact on the quality of medication 

practices in the public mental 

health system. The first study is 

aimed at investigating the effect of 

an innovative software application 

called PSYCKES, which has been 

developed by OMH for use in State 

hospitals to improve the quality and 

safety of medication prescribing 

practices. The second involves collaboration 

with the State Department 

of Health (DOH) to extend 

the reach of the PSYCKES concept 

to physicians throughout the State, 

who prescribe antipsychotic medications 

for Medicaid clients with 

schizophrenia. 

Implementation of PSYCKES, an 

Automated Clinical Decision 

Support Tool. 

MH researchers have developed 

Othe Pharmacy Service and Clinical 

Knowledge Enhancement System 

(PSYCKES), a novel Webbased, 

clinical and management 

decision support system, to support 

evidence-based decision making in 

the State mental health system 

(Sidebar, page 54). PSYCKES is 

designed to increase the quality of 

care and enhance consumer safety 

by improving clinician access to 

medical record information, relevant 

clinical practice guidelines, 

and medical reference information. 

It is contributing toward standardizing 

practice patterns and error 

proofing through automated, 

guideline-driven performance 

measures that profile quality, safety, 

and conformance to EBPs at the 

hospital and physician levels. In 

making data available to the clinician 

at the point of practice, PSY- 

CKES addresses a key barrier to 




Special Recognition Goes to the OMH PSYCKES Team 

he New York State Governor’s Office of Employee Relations pre- 

the 2004 Workforce Champions Award to the OMH PSYCKES 

Tsented 

Team for its extraordinary contribution of a system that provides better 

service to the public and advances the mission of OMH. At the October 

5, 2004, ceremony, the PSYCKES Team was honored for its innovation 

and dedication in creating and implementing the PSYCKES decision 

support system, one of the first of its kind in the nation. The 

Team was praised for improving the quality and safety of medication 

prescribing practices in the New York State mental health system and 

incorporating this EBP into day-to-day patient care. “The excellence of 

New York Government depends on the hard work, creativity and innovation 

of its workforce,” George Madison, Director of the Governor’s 

Office of Employee Relations said in presenting the award. “It gives me 

great pleasure to honor those who exemplify that ideal.” 

Left, GOER Director 

George Madison presents 

the Workforce Champions 

Award to OMH Commissioner 

Carpinello (first row 

center), Senior Deputy 

Commissioner Felton, and 

the PSYCKES Team. 

implementing evidence-based 

guidelines-the lack of knowledge 

of which medications were tried in 

the past. When deciding which 

medication to try next, the clinician 

is able to obtain from PSYCKES 

critical decision making information, 

for example, which medications 

have been previously tried, 

for how long, at what dose, and in 

what sequence. 

PSYCKES is currently available at 

18 OMH inpatient facilities and 

training sessions have been held at 

ten facilities. Full statewide implementation 

at the remaining facilities 

is anticipated by April 2005. Currently, 

more than 400 clinicians 

have access to the system and data 

collected during PSYCKES training 

sessions show that PSYCKES is 

user-friendly and a practical clinical 

tool. Clinicians gave the system 

high average usability scores (6 or 

more on a 7-point scale), rated 

PSYCKES as the single most useful 

source of information about medication 

histories (8.8 on a 10-point 

scale), and gave it high average 

usefulness scores (6 or more on a 

7-point scale). Preliminary findings 

also show that PSYCKES meets 

clinical information needs in a 

time-efficient way. Due to the fact 

that many individuals who have 

serious mental illness have lengthy 

treatment histories spanning multiple 

years and are often served during 

the course of their treatment by 

multiple providers, physicians often 

lack access to full and complete 

information documenting an indi- 



vidual’s complete history of medication 

trials. Physicians without 

access to PSYCKES correctly identified 

only 24.6% of medication trials; 

with PSYCKES, the physicians 

improved to 76.9% and also 

recorded a 59.8% decrease in the 

time needed to assemble a medication 

history. Further analysis will 

explore factors associated with use 

and the impact of PSYCKES on 

clinical prescribing practices. 

Incorporating Quality 

Indicators into Antipsychotic 

Drug Utilization and Review 

Processes. 

O 

MH researchers are also working 

with NYS Department of Health 

(DOH) staff to review the prescribing 

practices of physicians outside of 

the State mental health system who 

prescribe antipsychotic medications 

for clients who have schizophrenia. 

The two agencies are working to 

incorporate quality indicators adapted 

from PSYCKES into the DOH 

Drug Utilization and Review 

processes. The overall goal is to 

educate physicians outside of the 

public mental health system on best 

practice guidelines, with the potential 

over the long term of using a 

PSYCKES-type information system to 

improve the quality of care. 

Assertive Community 

Treatment (ACT): A Measure 

of the Quality of Care 

CT is a model of care that 

Aincludes outpatient treatment, 

rehabilitation, case management, 

and support services. It is aimed at 

adults with serious mental illness 

who have not fared well in traditional 

treatment settings. Research 

has consistently found that ACT, 

when compared to other case management 

approaches, is more effective 

at decreasing psychiatric hospitalizations 

and improving housing 

stability among individuals with 

mental illness. 2 

ACT services are delivered by a 

mobile, multidisciplinary mental 

health treatment team that shares 

caseloads and includes specialists 

from the fields of psychiatry, nursing, 

psychology, social work, substance 

abuse, and vocational rehabilitation. 

Team members 

collaborate, plan and deliver a set 

of integrated services that are 

responsive to clients’ individual 

choices and preferences and tailored 

to meet their specific needs. 

Services are delivered primarily in 

the community and include medication 

management, counseling 

and psychotherapy, housing support, 

job search and retention assistance, 

life skills development, integrated 

mental health and substance 

abuse treatment, and family support 

and education. The staff-toclient 

ratio is small and services are 

provided 24-hours a day, seven 

days a week, for as long as they 

are needed. 

ACT is documented to be effective 

by the National Institute of 

Mental Health’s Schizophrenia 

Patient Outcomes Research Team 

(PORT) study, 3 and is endorsed in 

the Surgeon General’s 1999 report 

on mental health as an essential 

treatment for many individuals who 

have serious mental illness. Additionally, 

families and clients have 

generally indicated high levels of 

satisfaction with ACT. The federal 

Centers for Medicare and Medicaid 

Services has authorized ACT as a 

reimbursable treatment service, and 

the Substance Abuse and Mental 


(SAMHSA) has designated access to 

ACT as a measure of the quality of 

a state’s mental health system. 

OMH has fostered growth of the 

ACT treatment model through the 

development of a new licensed 

Notes 

2 Phillips, S.D., Burns, B.J., Edgar, E.R., 

Mueser, K.T., Linkins, K.W., Rosenheck, R.A., 

et al. (2001). Moving assertive community 

treatment into standard practice. Psychiatric 

Services, 52(6), 771-779. 

3 Lehman, A.F., & Steinwachs D.M. (1998). 

Patterns of usual care for schizophrenia: Initial 

results from the Schizophrenia Patient 

Outcomes Research Team (PORT) client survey. 

Schizophrenia Bulletin, 24(1), 11_20. 




program category in Medicaid 

billing. As of December 2004, 61 

ACT programs were licensed, serving 

3,037 individuals. An additional 

11 ACT teams are in the licensing 

process, bringing the capacity of 

individuals served to 4,656. 

The ACT evaluation is also examining 

the impact of introducing 

ACT model fidelity requirements 

into the licensing and certification 

process. 

Using feedback from the provider 

community, OMH recently enriched 

funding of the ACT model, 

enabling more effective recruitment 

and retention of qualified staff and 

providing additional funding for 

training. These enhancements 

underscore OMH’s commitment to 

this form of care coordination. 

ACT Evaluation 

MH continues to support an 

Oongoing evaluation of ACT in 

the State, with a focus on contributing 

to the base of knowledge 

that will improve care in New York 

State and nationally. The evaluation 

of ACT covers seven specific areas, 

from better understanding of who 

is served by ACT and clinical outcomes 

of ACT in relation to other 

forms of case management, to an 

examination of factors related to 

successful implementation of the 

ACT model. The evaluation is also 

examining the role of licensing in 

ACT implementation and is helping 

to determine how effectively a 

nationally developed toolkit facilitates 

program implementation. 

The OMH Child and Adult Integrated 

Reporting System (CAIRS) is 

an important tool in meeting a 

number of ACT evaluation aims, 

including the capacity to aid clinicians 

in monitoring individual 

client outcomes. Data from CAIRS 

provide a picture of the characteristics 

of individuals from around the 

State who are being served by 

ACT. Based on eligibility criteria for 

admission to ACT, of the 1,039 

clients on new ACT teams, 60% are 

considered high risk, including 17% 

with involvement in the criminal 

justice system/jail in the past six 

months, 32% with two psychiatric 

hospitalizations in the past year, 

24% homeless, and 11% assigned 

to ACT through Assisted Outpatient 

Treatment (AOT) court orders. 

Current data are consistent with 

the results of early evaluations of 

favorable clinical outcomes with 

ACT. Data from CAIRS are being 

used to examine outcomes for ACT 

recipients after their first six 

months of ACT services. As of 

November 2004, the results indicate 

a significant reduction in emergency 

room visits, from an average 

of 0.59 to 0.38 visits; a decrease in 

number of admissions to psychiatric 

hospitals, from an average of 

0.79 to 0.61 admissions; and a dramatic 

decrease in length of hospitalization, 

from an average of 25.89 

to 10.07 days. 

The next phase of OMH’s ACT 

evaluation is focusing on obtaining 

additional feedback on implementation 

processes, including EBP trainings, 

licensing audits, field office 

technical assistance, monthly team 

leader conference calls, billing systems, 

documentation burden, and 

SPOA referrals. It is also assessing 

organizational factors that may be 

related to fidelity (e.g., cohesion, 

commitment, and leadership); examining 

factors that may contribute to 

staff continuity and burnout (e.g., 

job satisfaction, skill variety and role 

ambiguity); and investigating recovery 

practices, an area of focus for 

policy development. 

As part of the ACT evaluation, 

OMH has been collaborating with 

seven other states in the national 

Implementation Toolkit Project, a 

project funded by SAMHSA to 

study the implementation of EBPs. 

The study is examining the implementation 

process, identifying barriers 

and strategies, and assessing 

specific observational criteria to 



better inform implementation initiatives 

and policy development. 

Study findings will be used as a 

basis for revising and refining the 

national toolkits, which have been 

used by New York State providers 

and others in implementing EBPs. 

Family Psychoeducation 

ver the past 25 years, research 

Ohas clearly demonstrated that 

family psychoeducation interventions 

significantly improve the lives 

and independent functioning of 

people with serious mental illness 

by reducing relapse and promoting 

personal goal attainment such as 

employment. Based on the work of 

McFarlane (2002), 4 current initiatives 

aim to support the competent provision 

of evidence-based family psychoeducation 

approaches that combine 

education about mental illness, 

family support, crisis intervention, 

effective communication strategies, 

and problem solving skill training. 

The main goal in working with families 

is to help them develop the 

knowledge and skills to support the 

recovery of their family members. 

OMH is working with mental 

health providers and stakeholders 

to improve the quality of mental 

health services through the provision 

of comprehensive and recovery-oriented 

family psychoeducation 

and support services. The 

agency is currently involved in two 

different family psychoeducation 

implementation initiatives: the 

implementation of family psychoeducation 

in 41 programs statewide, 

in collaboration with the Family 

Institute for Education, Practice and 

Research at the University of 

Rochester Medical Center, and the 

implementation of a federally funded 

family psychoeducation research 

project in three culturally diverse 

communities in New York City. 

Statewide implementation 

MH has established a partner- 

with the Family Institute for 

Oship 

Education, Practice and Research at 

the University of Rochester Medical 

Center to support the implementation 

of family psychoeducation 

statewide. The newly formed Family 

Institute is educating mental 

health providers throughout New 

York State concerning how to effectively 

provide family services to 

individuals with a mental illness 

and their families. An evaluation of 

the implementation process is 

focusing on the identification of 

factors associated with the successful 

incorporation of family psychoeducation 

among 41 participating 

programs. The evaluation will serve 

to inform further dissemination of 

the model statewide. 

Three different models of implementation 

are being compared, 

including on-site, one-to-one consultation, 

and group supervision. 

The preliminary evaluation of 

fidelity to the national model at 

baseline has shown that all three of 

the conditions are equal. The three 

consultation models will have 

assessments of fidelity to the 

national model at 12, 18 and 24 

months post training. The 12- 

month fidelity scale assessments 

began in January 2005 and findings 

are expected to be available in 

September. As of November 2004, 

65% of the one-to-one consultation 

sites and 31% of the group supervision 

sites have had family psychoeducation 

workshops. 

Family psychoeducation 

training evaluation 

and implementation in 

three diverse communities 

AMHSA is funding a three-year 

Sstudy to explore how to best 

implement family psychoeducation 

in the African American, Chinese, 

and Hispanic communities. While 

evidence suggests that the effec- 

Notes 

4 McFarlane, W. R. (2002). Multifamily Groups 

in the Treatment of Severe Psychiatric Disorders. 

New York: Guilford Press. 




tiveness of family psychoeducation 

generalizes to nearly all major cultural 

populations, there is awareness 

that culture and language can 

pose significant barriers to the provision 

of family psychoeducation, 

requiring culturally relevant adaptations 

and further study. OMH 

researchers have designed the 

study to provide insights into culture-specific 

barriers related to 

accessing quality mental health 

services and to develop culturally 

based enrichments for the national 

Family Psychoeducation Implementation 

toolkit. The necessary cultural 

adaptations and “lessons 

learned” can be replicated in other 

settings in the State and incorporated 

into the final refinement of the 

national Family Psychoeducation 

Implementation toolkit. 

Consumer Assessment 

of Community-Operated Outpatient 

Services: Peer-Professional 

Collaboration 

s part of our efforts to improve 

Aquality of care and promote 

recovery from serious mental illness, 

OMH is continuing to seek 

stakeholder input in promoting 

quality care. We are particularly 

interested in levels of satisfaction 

among persons receiving services 

and perceptions of how services 

have impacted their quality of life. 

Every two years, OMH conducts 

a statewide survey of consumer 

assessment of services. During the 

most recent survey in 2004, OMH 

partnered with peer-run and peer 

advocacy programs to sponsor a 

consumer assessment of care in 

non-residential community programs 

in eight counties. The initiative 

examined the value of the 

assessment tool, the Mental Health 

Services Survey (MHSS), and the 

partnership approach with consumers 

in the conduct of the survey. 

The MHSS, which was developed 

by OMH with extensive 

consumer participation, is used to 

evaluate the quality of services in 

four service domains: access, 

appropriateness, global satisfaction, 

and outcomes. The overall goal of 

the assessment in non-residential 

community programs was to develop 

a basis for quality improvement 

in the full spectrum of communityoperated 

public mental health services 

for adults. 

To maximize diversity of the survey 

sample, evaluators divided the 

State into two upstate urban and 

rural regions and two downstate 

urban and suburban regions. Two 

counties were randomly selected in 

each of the four regions, with the 

single condition that a peer organization 

be present and operational 

in each county. Peer programs in 

each selected county chose two 

consumers who received one day 

of training and assisted OMH staff 

in administering the surveys in 

accessible locations. The peer 

advocates also publicized the surveys 

and pre-registered up to a 

maximum of 50 participants per 

site. OMH and peer program partners 

enlisted consumers from a 

stratified mix of different types of 

non-residential community programs, 

such as case management, 

clubhouses, and psychosocial rehabilitation. 

In the eight counties, a 

total of 388 individuals participated 

in the anonymous survey and early 

results indicate that the initiative 

was successful in both the consumer 

partnership and its data collection 

methods. 

Among outcomes, the majority 

(81%) of survey participants rated the 

overall improvement they made as 

good or excellent and 83% indicated 

as good or excellent the likelihood 

that they would continue to use 

services when needed. Eight out of 

ten respondents also rated as good 

or excellent the staff’s belief that they 

could change, grow and recover. A 

number of areas were also identified 

by respondents as opportunities for 

improvement; for example, in the 



area of receiving assistance in obtaining 

housing, vocational or educational 

services, six out of ten survey participants 

gave this item a rating of 

good to excellent. 

As has been documented in other 

evaluation studies, it appears that 

peer program co-sponsorship and 

peer participation in survey administration 

contribute to objective 

assessment and the identification of 

opportunities for improvement by 

consumers of services. 5,6 Moreover, 

the Institute of Medicine Report, 

Crossing the Quality Chasm, 7 indicates 

that consumer participation is 

a key strategy in improving the 

delivery of healthcare in the U.S. 

Thus, in addition to planning quality 

initiatives around the findings 

from this survey, OMH plans to 

continue to expand peer participation 

to the annual evaluation of 

community programs statewide, 

and, where possible, utilize Webbased 

protocols in facilitating the 

evaluation process. 

Forensic Mental Health 

Services: Supporting 

Recovery 

n the forensic mental health sys- 

OMH services research is 

Item, 

directed toward minimizing the disabling 

effects of serious mental illness. 

Evaluations are lending support 

in modifications to the 

forensics system, including evaluation-informed 

changes for inmatepatients 

with serious mental illness 

in special housing units, and for 

inmate-patients re-entering communities 

from maximum security prisons. 

Additionally, a study is under 

way to investigate interventions to 

improve the discharge planning 

process for all inmate-patients 

returning to the community. 

Evaluation of Mental Health 

Services for Inmates in 

Special Housing Units 

he New York State Department 

Tof Correctional Services (DOCS) 

has more than 5,000 disciplinary 

Special Housing Unit (SHU) cells. 

Inmates who are transferred into 

these cells for the most serious 

infractions of prison rules receive 

mental health services. To better 

meet the mental health needs of 

SHU inmates, an evaluation study 

was initiated in 2002 in the SHU 

cells of 11 maximum security prisons. 

The study examined the characteristics 

of inmates, their mental 

health needs and diagnoses, their 

disciplinary records, and the 

amount of mental health services 

they were receiving. 

Based on the 2002 results, a comprehensive 

plan was implemented 

to improve mental health services 

to patients in SHU cells. Important 

elements of the plan were the creation 

of private mental health treatment 

space to which patients 

would be escorted out of their SHU 

cells; a joint DOCS/OMH committee 

to review mental health needs of 

inmates for possible transfer; a designated 

OMH SHU clinician; an 

increase in private mental health 

treatment to a minimum of two 

non-physician and one physician 

sessions per month; an increase in 

OMH cell-side visits to all inmates 

in SHUs to every work day to 

screen for mental health needs; and 

measurement of psychiatric functioning 

every 90 days. The study 

was repeated in 2004 to determine 

the extent to which the SHU plan 

of improvement was being implemented. 

Key results from the 2004 

study show the following: 

◆ A dramatic increase in private 

mental health treatment hours. 

Between 2002 and 2004, average 

patient private contact hours per 

SHU increased from .4 to 1.73 

Notes 

5 Polowczyk, D., Brutus, M., Orvieto, A., Vidal, 

J., & Cipriani, D. (1993). Comparison of 

patient and staff surveys of consumer satisfaction. 

Hospital and Community Psychiatry, 

44(6). 

6 Campbell, J. (1997). Towards collaborative 

mental health outcomes systems. New 

Directions for Mental Health Services, 71. 

7 Committee on Quality of Health Care in 

America, Institute of Medicine. (2001). 

Crossing the Quality Chasm: A New Health 

System for the 21st Century. Washington, 

DC: National Academies Press. 




hours per month (a rise of 

333%) for inmates classified as 

requiring the highest level of 

mental health care, Level 1. The 

average private contact hours 

increased from .2 to 1.31 per 

month (a 555% increase) for 

inmates at the next level of mental 

health care, Level 2. 

◆ A significant increase in cell-side 

contact hours. The average cellside 

contact hours per inmate 

increased to 2.01 hours per 

month in 2004 from .81 in 2002. 

Inmates requiring Level 1 mental 

health care had an average of 

2.57 cell-side contact hours per 

month in 2004 as compared to 

1.2 in 2002. Inmates receiving 

Level 2 mental health care had 

an average of 2.23 cell-side average 

contact hours in 2004 compared 

to 1.0 hour in 2002. 

◆ An improvement in compliance 

with psychiatric medication use. 

In 2002, 13% percent of inmates 

in SHUs refused psychiatric medications. 

By 2004, noncompliance 

had significantly decreased to 4%. 

◆ A major reduction in the percentage 

of inmates diagnosed 

with a serious mental illness. 

From 2002 - 2004, there was a 

47% decrease in the percentage 

of inmates with a serious mental 

illness diagnosis of schizophrenia, 

bipolar disorder, or major 

depression in SHU cells. 

The results indicate that the SHU 

plan of improvement was successfully 

implemented. Mental health 

contact hours increased dramatically 

both in the private treatment and 

cell side. Moreover, the reduction 

in number of inmates with major 

mental illness strongly suggests that 

the joint DOCS/OMH committee 

has been effective in moving or 

diverting persons with serious 

mental illness from SHU cells. The 

study will be repeated again in 

March 2005 and ongoing monitoring 

by OMH will continue with 

reviews of the DOCS/OMH committee 

minutes, functional assessment 

results, and charts of inmates 

in SHUs by OMH Unit Chiefs. Further 

study will also explore the 

outcome of additional contact 

hours in relation to reductions in 

mental health disability and disciplinary 

infractions. 

Evaluation of the Community 

Oriented Re-entry Program (CORP) 

oving from prison to the com- 

is difficult and pro- 

Mmunity 

vokes anxiety in inmates. It is even 

more difficult for inmates with serious 

mental illness. In 2003, a 30- 

bed Community Oriented Re-entry 

Program (CORP) was opened at 

Sing Sing Correctional Facility to 

assist inmates with serious mental 

illness in their transition to the 

community. Sing Sing was chosen 

because it is the maximum security 

prison closest to New York City 

where the majority of inmates will 

return after incarceration. 

CORP goals are to improve community 

living skills; increase the 

length of stay in the community for 

former inmates with serious mental 

illness; and increase access to and 

use of mental health services in the 

community. CORP provides a variety 

of supportive services including 

community preparation, vocational 

assessment, peer support, community 

linkage, discharge planning, 

orientation to parole supervision, 

and a psychiatric medications program. 

Community providers come 

on-site to participate in pre-release 

preparation and provide direct linkage 

to their programs on release of 

inmates. An evaluation of the 

CORP program shows promising 

results: 

◆ A return of 77.4% of CORP participants 

to the community. Of 

those CORP participants not 

returning to the community, 

9.4% were transferred to a civil 

psychiatric hospital, 9.4% to 

inpatient services at the Central 



New York Psychiatric Center, 

and 3.8% to prison. 

◆ A significant improvement in 

psychiatric functioning. CORP 

participants’ scores on the Global 

Assessment of Functioning 

Scale and the Carlson Psychological 

Survey subscales indicated 

significant improvement. 

◆ A significant improvement in all 

areas of resources and skills for 

community survival. At CORP 

intake, more than 2/3 of participants 

had a severe lack of financial, 

housing, and employment 

resources. Upon CORP termination, 

92% of participants had 

access to free medications in the 

community, and 87% were eligible 

for Social Security and 85% 

for Medicaid. 

Based on the evaluation of the 

Sing Sing CORP program, this program 

shows continuing potential 

for enabling former inmates with 

serious mental illness to remain in 

the community with improved community 

survival skills, psychiatric 

functioning, and access to entitlements 

and supportive community 

programs. Future research will also 

focus on following former CORP 

participants for longer periods. 

Discharge Planning for Individuals 

who are Leaving Prison and 

Returning to the Community 

ore than 3,000 persons who 

Mactively receive mental health 

services leave New York State prisons 

each year and return to the 

community. Many of these individuals 

have major mental illness diagnoses 

and require daily doses of 

psychotropic medications to manage 

their illness. OMH staff develops 

discharge plans for all inmates 

with serious mental illness before 

they return to the community, with 

the goals of establishing community 

treatment services for the 

inmates that will help them function 

and cope with their mental illness, 

and thereby not return to 

prison. Discharge coordinators 

secure services in the community, 

including housing, financial entitlements, 

and access to psychiatric 

medication. 

In 2004, discharge services data 

collection was greatly improved 

and an evaluation study is currently 

in progress to determine the effectiveness 

of these services. The goal 

is to use the data from the evaluation 

to develop more effective 

strategies to engage inmates 

preparing for discharge. 

Children’s Services 

hree parallel State initiatives 

Thave been undertaken in the 

past few years to support expansion 

of EBPs for youth. First, “manualized” 

or standardized parent 

empowerment programs are being 

tested and linked to family support 

services in New York City. Second, 

manualized clinician engagement 

protocols are being linked to the 

implementation of EBPs in specialty 

mental health clinics. Third, the 

School Mental Health Support Programs 

are also being expanded to 

include a wider range of school 

mental health services, with 

statewide expansion planned over 

the next few years. As described in 

this section, the substantial OMH 

investment in these three programs 

for children and adolescents and 

their families has yielded success. 

NYC Parent Empowerment 

Program (PEP) 

he Youth Services Evaluation 

TBureau in OMH is studying the 

effectiveness of the New York City 

Parent Empowerment Program. An 

important component of PEP is its 

manualized training program, 

which is designed to increase the 

self-efficacy 8 of minority families 

Notes 

8 Self-efficacy is defined as people’s beliefs 

about their capabilities to produce designated 

levels of performance that exercise influence 

over events that affect their lives. 

(See:Bandura, A. (1994). Self-efficacy. In V. S. 

Ramachaudran (Ed.), Encyclopedia of human 

behavior (Vol. 4, pp. 71_81). New York: Academic 

Press). 




and their children, thereby facilitating 

improved access and quality of 

mental health services through 

increased consumer demand and 

knowledge. Research shows that 

among children with an identified 

mental health problem who receive 

no treatment or services, unmet 

need is highest among minority 

children. 9 

PEP was developed following a 

systematic review of the literature 

and all available evidence concerning 

documented and manualized 

parent empowerment programs 

(Table 5.2). Its development has 

included input from all of the 

major mental health advocacy 

organizations, including the Federation 

of Families for Children’s Mental 

Health, the National Alliance for 

the Mentally Ill, the National Mental 

Health Association, and Children 

and Adults with Attention- 

Deficit/Hyperactivity Disorder. 

PEP uses a “train-the-trainer 

model,” and it is through parent 

advocates that the content of the 

training manual is delivered. Parent 

advocates are “professional” parents, 

oftentimes themselves parents 

of children with mental illness 

drawn from the communities in 

which they work. Advocates are 

knowledgeable about mental illness 

and how to advocate for and 

gain access to mental health treatment 

and other community 

resources. 

PEP has an Advisory Board where 

decision-making authority is shared 

equally among all partners, including 

parents and State/City policy 

representatives. The Board has 

sought and obtained broader stakeholder 

input on how the PEP manual 

might be most effectively adapted 

to the needs of New York City families, 

and it has identified several 

new content areas to be added to 

the manual. New content areas 

include self-efficacy exercises, roleplays, 

and general training on how 

to access New York City’s mental 

health, primary care and school 

services. Additionally, the Advisory 

Board has requested that specific 

information on common service 

issues related to depression, conduct 

problems, trauma/post-traumatic 

stress disorder (PTSD), attentiondeficit/hyperactivity 

disorder 

(ADHD), co-morbidity, and medication 

management be added. Thus, 

the manual is now conceptualized 

as containing a flexible set of content 

areas, to which modules can be 

added as needed to address the 

interests of specific parent groups. 

Table 5.2 

Parent Empowerment Program Goals 

Notes 

9 National Institute of Mental Health. (2001). 

Blueprint for change: Research on child and 

adolescent mental health. Washington, DC: 

National Advisory Mental Health Council 

Workgroup on Child and Adolescent Mental 

Health Intervention Development and 

Deployment. 

◆ Enhance parent advocates’ ability to engage parents who are seeking 

help; provide support and advocacy and help them to understand 

their children’s mental health problems; and provide information 

about specific child mental health problems and evidence-based 

treatments. 

◆ Improve the mental health of children by promoting parent partnerships 

with mental health providers and teachers. 

◆ Teach parents treatment management skills. 

◆ Increase parents’ knowledge about their children’s mental health 

needs and evidence-based service delivery options. 

◆ Strengthen parents’ self-efficacy in their interactions with mental 

health service providers. 

◆ Improve the communication and assertiveness skills of parents 



Results from a small pilot test 

conducted in 2003 with 30 parent 

advocates suggested that participation 

in the PEP training program 

led to changes in knowledge about 

EBPs, improvements in collaborative 

skills, and increased self-efficacy. 

The National Institute of Mental 

Health recently funded a two-year 

study to examine the impact of the 

PEP initiative on both parent advocates’ 

knowledge, skills, attitudes, 

self-efficacy, and behavior, as well 

as the skills, attitudes and behaviors 

of the caregivers with whom the 

advocates work. The study, which 

began in the fall of 2004, will test 

PEP’s effectiveness with a group of 

40 advocates and 180 caregivers of 

children with mental health problems 

in New York City. Preliminary 

results will be available in one year, 

and final results in two years. 

Child and Adolescent Trauma 

Treatment Services (CATS): 

Engagement of families in services 

esearch has identified a lack of 

Rclinician engagement with families 

as a key issue contributing to 

the high attrition rates of families 

from mental health services, especially 

among low-income populations. 

10, 11, 12 In New York City, similar 

to other urban populations, 

rates of attrition from mental health 

services range from 30-50%. 13 

In addition to the parent empowerment 

programs, OMH has been 

working to extend engagement 

strategies to a range of evidencebased 

implementation initiatives for 

youth. The Child and Adolescent 

Trauma Treatment Services program 

(CATS) is the largest evidence-based 

youth initiative in 

New York State in which engagement 

strategies to decrease attrition 

rates have been delivered and are 

being evaluated. The CATS program 

was implemented in response 

to the World Trade Center disaster 

of September 11, 2001, through a 

$3 million grant to OMH. Awarded 

by SAMHSA, the grant is focused 

on implementing evidence-based 

trauma treatments for school-age 

children affected by the disaster. A 

needs assessment commissioned by 

the New York City Board of Education 

determined that, six months 

after the terrorist attacks, as many 

as 75,000 children (10.5%) in the 

New York City school system had 

symptoms consistent with PTSD. 13 

Because the issue of family retention 

in services was considered critical 

to the success of the CATS program, 

OMH provided engagement 

training to the consortium of nine 

participating sites. 

Launched in 2002, the CATS program 

is a cooperative agreement 

study with OMH oversight. The 

CATS Consortium developed a 

common protocol, selected a core 

set of evidence-based screening 

and assessment instruments, and 

agreed to train, supervise and 

deliver cognitive behavioral therapy 

(CBT) trauma treatments to all eligible 

youth and families. Two 

empirically validated trauma treatments 

were selected for implementation 

in this project: Cognitive 

Behavioral Therapy for Traumatic 

Bereavement in Children, manualized 

by Cohen and colleagues from 

the Center for Traumatic Stress in 

Children and Adolescents in Pittsburgh; 

14 and Trauma/Grief-Focused 

Group Psychotherapy, developed 

for adolescents and manualized by 

Layne, Saltzman and Pynoos. 15 To 

date, 615 children and adolescents, 

ages 5-21 have been enrolled in 

the treatment study, which compares 

youth receiving the evidencebased 

trauma treatments to those 

receiving trauma treatments as usually 

delivered in standard care. 

The formal protocol for the CATS 

engagement intervention, developed 

by Dr. Mary McKay of Mount Sinai 

School of Medicine, was used to 

improve initial contact with the fami- 

Notes 

10 New York City Department of Health and 

Mental Hygiene and the Mailman School of 

Public Health at Columbia University. (August 

2003). Children’s needs assessment in the 

Bronx. New York: New York City Department 

of Health and Mental Hygiene. Retrieved 

November 30, 2004 from 

http://www.nyc.gov/ 

html/doh/pdf/pub/na-cmh0803-bx.pdf. 

11 Armbruster, P., Gerstein, S. H., & Fallon, T. 

(1997). Bridging the gap between service 

need and service utilization: A school-based 

mental health program. Community Mental 

Health Journal, 33, 199-211. 

12 McKay, M. M., Pennington, J., Lynn, C. J., & 

McCadam, K. (2001). Understanding urban 

child mental health l service use: two studies 

of child, family, and environmental correlates. 

Journal of Behavioral Health Services 

& Research, 28(4),475-83. 

13 Applied Research and Consulting, Columbia 

University Mailman School of Public Health, 

& New York State Psychiatric Institute. 

(March 2002). Effects of the World Trade 

Center attack on NYC public school students. 

Retrieved November 30, 2004, from 

http://www.nycenet.edu/offices/spss/wtc%5 

Fneeds/firstrep.pdf 

14 Cohen J.A., Mannarino, A.P., & Deblinger E. 

(2002). Child and parent trauma-focused cognitive 

behavioral therapy: treatment manual. 

Unpublished manuscript. 

15 Layne, C.M., Saltzman, W.R., & Pynoos, R.S. 

(2002). Trauma/grief-focused group psychotherapy 

program. Unpublished manuscript. 




Figure 5.1 

Engagement Rates at CATS Sites 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

89 86 89 

Assessment Treatment TOTAL 

Figure 5.2 

Engagement Rates by CATS 

Service Setting 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

89 

98 

90 

School Community Hospital/School 

Notes 

16 McKay, M. M., Stoewe, J., McCadam, K., & 

Gonzales, J. (1998). Increasing access to 

child mental health services for urban children 

and their caregivers. Health and Social 

Work, 23(1), 9_15. 

17 McKay, M. M., McCadam, K., & Gonzales, J. 

(1996). Addressing the barriers to mental 

health services for inner city children and 

their caretakers. Community Mental Health 

Journal, 32(4), 353_61. 

ly and youth and improve retention 

over time. This engagement intervention 

was modified to reflect 

recent research findings with innercity 

families on salient factors associated 

with keeping child mental 

health appointments. Specifically, 

the engagement intervention in 

CATS targets empirically defined attitudes 

toward mental health care, 

while simultaneously helping parents 

gain confidence in their ability 

to bring their child to a mental 

health appointment. In addition, the 

intervention encourages discussions 

with members of each family’s social 

support network about help seeking 

before the first appointment. 

Thus far at each of the sites, four 

to eight staff members, including 

clinical and administrative staff, 

have received a two-day training 

focused on engaging youth with 

mental health needs and their families 

in clinic services. In addition, at 

each of the sites an “engagement 

team” has been organized, consisting 

of the site’s intake workers, 

representatives from the clinical 

and administrative staff, and supervisors. 

This team oversees the 

implementation of the intervention 

at each site. Further, monthly meetings 

are held with each site team 

to fine tune interventions and to 

collect child mental health outcome 

data. Preliminary data from the 

CATS study on retention rates for 

296 caregivers at eight weeks, as 

shown in Figure 5.1, demonstrate 

that this approach to enhancing clinicians’ 

skills in engaging families 

was highly effective, with overall 

engagement rates of 89% across the 

nine sites. 

These rates are particularly 

impressive for treatment, considering 

that prior research indicates that 

rates for initial appointments can 

range from the rate of 72% to 85% 

at the high end with some type of 

engagement interventions 16 and as 

low as 40% to 50% in standard care 

conditions. 10, 17 These data also indicate 

that engagement rates are high 

regardless of service settings, but 

are highest in community-based 

programs (Figure 5.2). 

School Support Projects (SSP): 

Strengthening School-Based 


he largest school initiative in 

TNew York State involves a joint 

partnership between OMH and the 

State Education Department (SED). 

The School-Based Mental Health 

Demonstration Project, called the 

School Support Projects (SSP), was 

launched in 2001. Originally in 

seven schools, it was expanded in 

2003 to 60 schools. The purpose of 

SSP is to support inclusion of mental 

health services, including EBPs, 

in schools. SSP mandates that at 

least one parent advocate and at 



least one school mental health professional 

be employed to deliver 

mental health services. 

After a series of consultations, the 

Steering Committee selected a common 

core assessment battery for 

use across all of the sites. Pilot testing 

was undertaken to determine 

its acceptability and usefulness to 

clinicians and families. Providers at 

all sites were trained in the use of 

measures included in the battery 

and routine monitoring procedures 

were put into place to ensure that 

complete data were collected. The 

Steering Committee then selected a 

set of EBPs targeted at the identified 

problems. These included CBT 

for anxiety (the Coping Cat program) 

18 and interpersonal therapy 

for adolescents (IPT-A) for depression, 

19 as well as classroom consultation 

methods and algorithms for 

the optimal use of medications for 

children with ADHD and other disruptive 

behavior disorders. 

To illustrate how these methods 

have been used to increase the 

application of EBPs, specific clinical 

decision points were built into 

assessment and treatment algorithms 

and then used as quality 

indicators to track decision making 

and treatment implementation. Indicators, 

for example, were developed 

to encourage school-based 

mental health specialists to implement 

classroom-based behavioral 

therapy methods and to consider 

medication referrals earlier in the 

course of treatment, with the goal 

of improving outcomes. A database 

registry developed by SED to track 

all participants allows all cases and 

records to be flagged when they 

meet specific symptom-level thresholds 

on teacher or parent behavior 

checklists. The tracking system 

combined with the quality indicators 

allows school mental health 

staff and supervisors to receive 

case-level feedback. Group supervision 

of school mental health staff is 

provided by expert clinicians. 

An evaluation is being completed 

to assess the feasibility of implementing 

these procedures. Preliminary 

data indicate that, after one 

year of intensive technical assistance 

and consultation, five of the 

original seven SSP schools are fully 

operational and have routinely 

incorporated EBPs. Examination of 

the two other clinics reveals that 

organizational factors at the school 

such as staff turnover have hampered 

efforts to implement the program. 

Among the five schools that 

are implementing EBPs, administration 

rates of the assessment battery 

to eligible students range from 70% 

to 95%, with a mean rate of 89%. 

An analysis of data from a school 

clinician survey showed that 

between two-thirds and four-fifths 

of the clinicians who had been 

trained to deliver a set of evidencebased 

interventions in the schools 

agreed or strongly agreed that the 

training they received in EBPs had 

been valuable and helped them in 

their work with students. 

Innovative Care 

Coordination Initiatives 

ew York State is committed to 

Nidentifying and evaluating innovative 

supportive clinical practices, 

thereby increasing the pace of new 

treatment development and applying 

knowledge drawn from basic 

behavioral sciences. Consistent 

with recommendations in the President’s 

New Freedom Commission 

on Mental Health, enhanced care 

coordination places a heavy 

emphasis on the development of 

individualized plans of care for 

adults with serious mental illness 

and children with serious emotional 

disturbance and the involvement 

of individuals and families in working 

toward recovery. 

Notes 

18 Kendall, P.C., Flannery-Schroeder, E., 

Panichelli-Mindel, S.M., Southam-Gerow, 

M., Henin, A., & Warman, M. (1997). Therapy 

for youths with anxiety disorders: a second 

randomized clinical trial. Journal of Consulting 

and Clinical Psychology, 65(3):366-80. 

19 Mufson, L., Weissman, M.M., & Moreau, D. 

(1993). Interpersonal Psychotherapy for 

Depressed Adolescents. Roslyn Heights, NY: 

Libra Publishers. 




Decision Support 

for Care Coordination: 

Single Point of Access (SPOA) 

he SPOA process is the mecha- 

by which Local depart- 

Tnism 

ments of mental health statewide 

have centralized their intake and 

referral systems to prioritize access 

to services based on need. The 

SPOA infrastructure is designed to 

improve access to services for individuals 

with the greatest need, 

thereby enabling county mental 

health departments to manage 

resources with a greater recognition 

of who is being referred to 

and receiving services. Counties 

have considerable flexibility in 

structuring their SPOA systems as 

long as the general purposes of 

SPOA are addressed. 

All SPOAs are required to establish 

the following major components: 

a system for identifying and 

prioritizing individuals with the 

highest needs; a screening process 

to identify the specific service 

needs of each individual; and 

mechanisms for coordinating and 

making available an array of service 

options to meet the needs that 

are identified. In addition, the children’s 

SPOAs are expected to 

develop the capacity to conduct 

comprehensive functional assessments 

that support the tailoring of 

service plans to the strengths and 

needs of individual children and 

their families. 

Counties are beginning to use the 

OMH Child and Adult Integrated 

Reporting System (CAIRS), a critical 

decision support system used by 

State and local providers, to coordinate 

and manage care to high-risk 

mental health clients in the community. 

To date, 10 counties have 

become active in using CAIRS and 

submitting data. Other counties are 

currently reviewing their Local 

referral processes to determine 

how best to utilize CAIRS. OMH 

continues to work intensively with 

all counties to detail Local referral 

practices and determine the best 

technical solution to their needs. 

All counties in Upstate New York 

and Long Island have SPOAs for 

children. In New York City, a 

SPOA initiative in the Bronx has 

developed algorithms based on 

John Lyons’ Child and Adolescent 

Needs and Strengths Survey 

(CANS). These algorithms are guiding 

the objective assignment of a 

service level based upon the completion 

of a valid and reliable functional 

assessment instrument. Plans 

are also progressing to expand the 

SPOA system for children to the 

remaining boroughs. 

Throughout the State, approximately 

20,000 children and families 

have had service plans coordinated 

through SPOAs, with county mental 

health authorities reporting a variety 

of positive outcomes. In Livingston 

County, for example, 30 different 

agencies are participating in its 

SPOA initiative, the Youth Assessment 

Committee. At intake the 

average score for a child on the 

Child and Adolescent Functional 

Assessment Scale had been 109, 

demonstrating a level of functioning 

that would require intensive services 

from multiple sources. After 

three months, however, the average 

score fell to 83, indicating a significant 

increase in the level of functioning 

and a reduction in the risk 

for out-of-home placement and 

intensive service provision. Similarly, 

in Genesee County, the Family 

Court Diversion Project, which is an 

organized effort between the Coordinated 

Children’s Services Initiative 

(CCSI), SPOA, Family Court, probation 

and law enforcement agencies, 

has resulted in a cost savings of 

approximately $35,000 annually due 

to a reduction in court-ordered psychiatric 

admissions. The reduction 

was made possible largely by 

improved assessment of clinical 

functioning by the county SPOA, 

and a close working relationship 

with Family Court judges who 



relied on the determinations and 

used them in lieu of court-ordered 

psychiatric evaluations. 

Assisted Outpatient 

Treatment: Kendra’s Law 

n August 9, 1999, Governor 

OGeorge Pataki signed Kendra’s 

Law (Chapter 408 of the Laws of 

1999), creating a statutory framework 

for court-ordered Assisted 

Outpatient Treatment (AOT) to 

ensure that individuals with mental 

illness and a history of hospitalizations 

or violence participate in community-based 

services appropriate 

to their needs. Kendra’s Law was 

named in memory of Kendra Webdale, 

a young woman who died in 

January, 1999 after being pushed in 

front of a New York City subway 

train by Andrew Goldstein, a man 

with a history of mental illness and 

hospitalizations. The law became 

effective in November of 1999. 

Since that time, OMH has been 

evaluating the impact of Kendra’s 

Law on individuals receiving courtordered 

services. In January, 2003 

OMH issued an Interim Report 

required by Kendra’s Law, which 

reviewed the implementation and 

status of AOT and presented findings 

from OMH’s evaluation of the 

program. 20 A Final Report on the 

status of AOT in New York State is 

available on the web at http:// 


Kendra_web/finalreport/. 

Implementation of Assisted 

Outpatient Treatment 

Kendra’s Law established new 

mechanisms for identifying individuals 

who, in view of their treatment 

history and circumstances, 

are likely to have difficulty living 

safely in the community without 

close monitoring and mandatory 

participation in treatment. It also 

established mechanisms for ensuring 

that local mental health systems 

give these individuals priority 

access to case management and 

other services necessary to ensure 

their safety and successful community 

living. 

The statute created a petition 

process, found in Mental Hygiene 

Law section 9.60, designed to identify 

at-risk individuals using specific 

eligibility criteria, assess whether 

court-ordered outpatient treatment 

is required, and if so, develop and 

implement mandatory treatment 

plans consisting of case management 

and other necessary services. 

Kendra’s Law requires that each 

county in New York State and New 

York City establish a local AOT 

program to implement the statute’s 

requirements, and charges OMH 

with the responsibility for monitoring 

and overseeing the implementation 

of AOT statewide. Implementation 

of Kendra’s Law and 

AOT has been a joint responsibility 

and collaboration between OMH 

and local mental health authorities. 

Eligibility Criteria for AOT 

Kendra’s Law contains the following 

summary description of the 

AOT target population: 

“...mentally ill people who 

are capable of living in the 

community with the help of 

family, friends and mental 

health professionals, but who, 

without routine care and 

treatment, may relapse and 

become violent or suicidal, or 

require hospitalization.” 

The statute further defines specific 

eligibility criteria, which are listed 

below. 

An individual may be placed in 

AOT only if, after a hearing, the 

court finds that all of the following 

have been met. The individual 

must: 

1. be eighteen years of age or 

older; and 

Notes 

20 OMH’s Interim Report on Kendra’s Law is available 

on the OMH Web site at http://www.omh.state. 

ny.us/ omhweb/Kendra_web/interimreport/ 




2. suffer from a mental illness; and 

3. be unlikely to survive safely in 

the community without supervision, 

based on a clinical determination; 

and 

4. have a history of non-adherence 

with treatment that has: 

a. been a significant factor in his 

or her being in a hospital, 

prison or jail at least twice 

within the last 36 months; or 

b. resulted in one or more acts, 

attempts or threats of serious 

violent behavior toward self 

or others within the last 48 

months; and 

5. be unlikely to voluntarily participate 

in treatment; and 

6. be, in view of his or her treatment 

history and current behavior, 

in need of AOT in order to 

prevent a relapse or deterioration 

which would be likely to 

result in: 

a. a substantial risk of physical 

harm to the individual as 

manifested by threats of or 

attempts at suicide or serious 

bodily harm or conduct 

demonstrating that the individual 

is dangerous to himself 

or herself; or 

b. a substantial risk of physical 

harm to other persons as 

manifested by homicidal or 

other violent behavior by 

which others are placed in 

reasonable fear of serious 

physical harm; and 

7. be likely to benefit from AOT; 

and 

8. if the consumer has a health 

care proxy, any directions in it 

will be taken into account by 

the court in determining the 

written treatment plan. However, 

nothing precludes a person with 

a health care proxy from being 

eligible for AOT. 

Program Evaluation Findings 

MH’s ongoing evaluation of 

OAOT examines the outcomes of 

AOT judicial proceedings; how 

many individuals have received 

court-ordered AOT; how long individuals 

typically remain under 

court-ordered treatment; the characteristics 

of AOT recipients and 

outcomes for AOT recipients. 

These findings derive from several 

sources: 

◆ OMH Central and Field Office 

staff record basic information on 

each court order and the status 

of each order in an electronic 

tracking system. This system is 

used to generate regular aggregate 

reports on the volume of 

court orders throughout the state 

and the number of individuals 

receiving AOT. 

◆ OMH collects additional information 

concerning AOT recipients 

from their case managers via a 

paper-based survey data collection 

process. Case managers 

complete a standardized assessment 

for each AOT recipient at 

the onset of the court order 

(baseline), at the end of the initial 

court order (six month follow-up), 

and, if the court order 

is renewed, every six months for 

the duration of the order. The 

assessments capture: demographic 

characteristics of AOT 

recipients; their status in areas 

such as living situation, services 

received, engagement in services, 

and adherence to prescribed 

medication; incidence of significant 

events such as hospitalization, 

homelessness, arrest, and 

incarceration; functional impairment 

in the areas of self-care, 

social skills, and task performance; 

and any incidence of 

harmful behaviors. These assessments 

are sent to OMH and the 

results entered into an evaluation 

database. OMH uses the 

resulting data to assess outcomes 

for all AOT recipients as a 



group. Due to time lags inherent 

in paper-based survey data collection 

and processing, and the 

limited scope of the data collected 

on the standardized assessments, 

OMH does not use the 

evaluation database to monitor 

the clinical status of individual 

recipients. 

Summary of AOT Proceedings 

Referrals/Investigations, Petitions, 

Court Orders and Service 

Enhancements 

Between November 1999 and 

December 31, 2004, 10,078 individuals 

were referred to local AOT 

coordinators for investigation to 

determine potential eligibility for 

an AOT court order. Referrals 

resulted in petitions filed for the 

issuance of an AOT court order for 

4,041 individuals (40% of all individuals 

referred); of these, petitions 

were granted and court orders 

issued for 3,766 individuals (93% of 

all individuals with petitions filed). 

Investigations led to service 

enhancements rather than court 

orders for 2,863 individuals (28% of 

all investigations). 

Court orders and service 

enhancements have been issued in 

all regions of New York State, with 

58% of all court orders and service 

enhancements occurring in New 

York City. Table 5.3 summarizes 

data on outcomes of the judicial 

procedures associated with AOT. 

Table 5.3 

Summary of AOT Judicial Proceedings 

Through December 31, 2004 

Referrals/Investigations..................10,078 individuals 

Petitions Filed ....................................4,041 individuals 

Petitions Granted.............................. 3,766 individuals 

Percent of Individuals for whom Petitions 

were Filed and Granted ........................................93% 

Length of Time in AOT 

As noted in Table 5.3, as of 

December 31, 2004, 3,766 individuals 

had received court ordered 

treatment through AOT. Initial 

court orders for AOT recipients are 

generally six months in duration. 

Court orders, however, can be 

renewed and recipients may 

receive additional court orders after 

previous orders expire. About one 

third of AOT recipients spend six 

months under court order. Court 

orders for most AOT recipients 

(64%) are renewed and so the 

majority of individuals remain 

under court order for more than six 

months (Table 5.4). 

Table 5.4 

AOT Court Order Renewal Rates 

Through December 31, 2004 

Court Orders Eligible 

for Renewal ....................................3,493 individuals* 

Court Orders Renewed......................2,236 individuals 

% with Court Orders 

Renewed ................................................................64% 

* This number excludes all initial court orders that, as of 

December 31, 2004, were still in effect (and thus not yet eligible 

for renewal). 




Figure 5.3 Table 5.5 

Time Recipients Spend in AOT 

November 1999 - December 2004 

Incidence of Hospitalization, Homelessness, 

Arrest and Incarceration Three Years Prior 

to Issuance of Court-Order 

Over 30 

months 

(7%) 

Over 18 months 

to 30 months 

(17%) 

Over 12 months 

to 18 months 

(21%) 

O to 6 Months 

(36%)* 

Over 6 months 

to 12 months 

(19%) 

* Persons for whom an initial court order was not renewed. 

Figure 5.3 shows 

the total amount of 

time spent by recipients 

in AOT. The 

average length of 

time recipients 

remain under court 

order is 16 months. 

Psychiatric Hospitalizations 

Mean number in last 36 months ..........................3.08 

Percent hospitalized (at least one episode) ........97% 

Number of admissions (range) ............................0-13 

Homeless Episodes 


Percent homeless (at least one episode) ............19% 

Number of episodes (range) ..................................0-6 

Arrests 


Percent arrested (at least one episode) ..............30% 

Number of arrests (range) ....................................0-10 

Incarcerations 


Percent incarcerated (at least one episode) ........23% 

Number of incarcerations (range) ........................0-10 

Notes 

21OMH derives its estimates of the number of people 

served annually by the public mental health system 

from its Patient Characteristics Survey (PCS). The PCS, 

which is administered every other year, gathers information 

about the demographic and clinical characteristics 

of persons receiving mental health services in 

programs operated, funded, or certified by OMH during 

a one-week period. The data presented in this 

section are derived from the 2003 PCS, which is the 

most recent available.21 OMH derives its estimates 

of the number of people served annually by the public 

mental health system from its Patient Characteristics 

Survey (PCS). The PCS, which is administered every 

other year, gathers information about the demographic 

and clinical characteristics of persons receiving 

mental health services in programs operated, funded, 

or certified by OMH during a one-week period. The 

data presented in this section are derived from the 

2003 PCS, which is the most recent available. 

Incidence of Hospitalization, 

Homelessness, Arrest 

and Incarceration. 

Table 5.5 summarizes the incidence 

of hospitalizations, homelessness, 

arrest and incarceration 

for persons in AOT prior to courtordered 

treatment. In the three 

years prior to the court order, 97% 

of individuals had at least one psychiatric 

hospitalization. On average, 

these individuals had been hospitalized 

approximately three times 

during that period with some individuals 

having had as many as 13 

hospitalizations. Nineteen percent 

of individuals had experienced at 

least one episode of homelessness 

in the three years preceding their 

court order. Thirty percent were 

arrested at least one time in the 

three years prior to AOT. These 

individuals had as many as ten 

arrests during that time. Twentythree 

percent were incarcerated at 

least once in the three years prior 

to their court order. Some individuals 

had as many as ten incarcerations 

in those three years. 

When compared with a similar 

population of mental health service 

recipients, 21 AOT recipients were 

twice as likely to have had a previous 

episode of homelessness and 

50% more likely to have had contact 

with the criminal justice system 

prior to their court order. In addition, 

AOT recipients were 58% 



more likely to have a co-occurring 

substance abuse problem. 

Outcomes for Recipients during 

the First Six Months of AOT 

nitial court orders for AOT recipi- 

are usually six months long. 

Ients 

The six month milestone is critical 

because it is at this juncture that 

decisions are made regarding 

renewal of the court order. Outcome 

findings presented in the next 

section focus on change between 

the onset of the court order and the 

status of recipients after six months. 

The results presented below are for 

AOT recipients for whom both 

baseline (onset of court order) and 

six-month follow-up assessments 

were available in the OMH evaluation 

database at the time of this 

report’s preparation. 

AOT was designed to ensure 

supervision and treatment for individuals 

who, without such supervision 

and treatment, would likely be 

unable to take responsibility for 

their own care and would be 

unable to live successfully in the 

community. For persons in AOT, 

Table 5.6 

Services Received by AOT Recipients 

Participation Rates Prior to AOT and During AOT 

the goals are to increase access to 

the highest intensity services and to 

better engage them in those services. 

An additional goal is to reduce 

the incidence of behaviors harmful 

to themselves or others. Participation 

in AOT should result in 

improved adherence to prescribed 

medication and decreased hospitalization, 

homelessness, arrests, and 

incarceration. In addition, AOT 

recipients should benefit through 

improved functioning in important 

community and personal activities. 

Increased Participation in Case 

Management and Other Services 

Table 5.6 compares participation 

in services by AOT recipients prior 

to and subsequent to the initial 

court order. For all categories of 

service, a greater percentage of 

individuals are participating in the 

service while under court order 

than were receiving it prior to thecourt 

order. A dramatic example is 

in the area of case management. As 

prescribed by the legislation, all 

individuals receiving a court order 

are enrolled in case management. 

Percentage of AOT Recipients 

Percent 

Service Prior to AOT At Six Months Increase 

Case Management 53% 100% 89% 

Medication Management 60% 88% 47% 

Individual or Group Therapy 51% 75% 47% 

Day Programs 15% 22% 47% 

Substance Abuse Services 24% 40% 67% 

Housing or Housing Support Services 19% 31% 63% 

Urine or Blood Toxicology 

(adherence to medication) 18% 37% 106% 

Urine or Blood Toxicology (substance abuse) 17% 35% 106% 




Figure 5.4 

However, prior to AOT, only 53% 

of these individuals were receiving 

this service. 

In addition, the percentage of 

AOT recipients who are receiving 

substance abuse services increased 

by 67% as a result of their courtordered 

treatment plan, increasing 

from 24% to 40%. Similarly, the 

percentage of persons in AOT who 

receive housing services as a result 

of their court-ordered treatment 

plan also increased from 19% to 

31%. Substantial increases are also 

seen for urine or blood testing 

used to assess adherence to medication 

or substance abuse. 

Increased Engagement 

in Services and Adherence 

to Prescribed Medication 

Two important goals of AOT are 

increased engagement, i.e., active and 

regular participation in services; and 

increased adherence to prescribed 

medication, i.e., taking medications 

Changes in Service Engagement 

and Adherence to Medication 

At Onset of Court Order vs. Six Months 

75% 

60% 

45% 

30% 

15% 

0% 

41% 

62% 

Individuals 

Exhibiting Good 

Service Engagement 

34% 

Individuals 

Exhibiting Good 

Adherence 

to Medication 

At Onset of Court Order 

At Six Months 

69% 

necessary to manage psychiatric 

symptoms as directed by the treating 

physician. To assess engagement, 

case managers were asked to rate the 

engagement of persons in AOT using 

a scale ranging from “not at all 

engaged in services” to “independently 

and appropriately uses services.” 

Recipients were considered to have 

“good engagement” if they received a 

rating of either “good - able to partner 

and can use resources independently” 

or “excellent - independently and 

appropriately uses services.” Data collected 

since the onset of AOT show 

the percent of individuals who exhibit 

good engagement in services 

increased significantly from 41% to 

62% at six months. 

To assess medication adherence, 

case managers were asked to rate 

adherence of persons in AOT using 

a scale ranging from “taking medication 

exactly as prescribed” to 

“rarely or never taking medication 

as prescribed.” Recipients were considered 

to have “good adherence to 

medication” if they were rated as 

either “takes medication as prescribed 

most of the time” or “takes 

medication as prescribed.” The 

resulting data show that the percent 

of individuals with good medication 

adherence increased significantly 

from 34% to 69% after six months. 

Figure 5.4 displays the improvement 

in engagement in services and 

adherence to medications after six 

months of AOT participation. 

Improved Community 

and Social Functioning 

The evaluation database also 

documents changes in AOT recipients’ 

day-to-day functioning. Measures 

that are used for this assessment 

are the Global Assessment of 

Functioning (GAF) and three sets 

of items that assess individuals’ 

abilities in specific functional areas: 

self-care, social and community living 

skills, and task performance. 

The GAF is a commonly used 

measure of overall functioning. It 



includes social, occupational, academic, 

and other areas of personal 

performance and results in an 

overall numerical rating score 

which can range from 0 to 100. A 

score of 50 or below denotes serious 

impairment in social, occupational 

or school functioning. At the 

onset of an AOT court order, 39% 

of individuals had a GAF score 

below 50. After receiving services 

under an AOT court order for six 

months, the percentage of persons 

with a GAF score below 50 

dropped to 33%. 

AOT recipients’ functioning in 

the area of self-care and community 

living also improved after six 

months of program participation. 

Table 5.7 displays the change in 

these measures. The table compares 

the percentage of persons in 

AOT who were reported as having 

difficulty at the onset of their court 

ordered treatment with the percentage 

reported as having difficulty six 

months later. For all items, there 

were fewer individuals rated as 

having difficulty, and in all measures 

the change was statistically 

significant. Although changes are 

relatively small in magnitude for 

any single measure, a consistent 

pattern of overall improvement 

(reduction in difficulties) is seen 

across all areas of self-care and 

community functioning. 

Among the items included on 

Table 5.7, some measures can be 

linked to the AOT program’s goals 

Table 5.7 

Improvements in Self Care and Community Living 

Percent of AOT Recipients with Difficulties 

Percent 

At Onset of 

Reduction 

AOT Court Order At Six Months in Difficulties 

Access community services 23% 16% 30% 

Prepare meals 17% 12% 29% 

Take care of own possessions 14% 10% 29% 

Maintain adequate personal hygiene 7% 5% 29% 

Follow through on health care advice 26% 19% 27% 

Make and keep appointments 27% 20% 26% 

Manage medication 36% 27% 25% 

Take care of own living space 16% 12% 25% 

Maintain adequate diet 9% 7% 22% 

Handle finances 29% 25% 14% 

Avoid dangers 7% 6% 14% 

Shop for food, etc. 16% 14% 13% 

Access transportation 9% 8% 11% 

Average Percent Reduction 23% 




Table 5.8 

Improvements in Social, Interpersonal, and Family Functioning 


Percent 


Reduction 


Ask for help when needed 28% 20% 29% 

Effectively handle conflict 50% 36% 28% 

Manage assertiveness 44% 33% 25% 

Engage in social/family activities 34% 26% 24% 

Communicate clearly 13% 10% 23% 

Respond to social contact 20% 16% 20% 

Maintain support network 40% 33% 18% 

Manage leisure time 28% 24% 14% 


Table 5.9 

Improvements in Task Performance 


Percent 


Reduction 


Understand and remember instructions 19% 14% 26% 

Perform in coordination with or in proximity 

to others without being distracted by them 28% 21% 25% 

Sustain an ordinary routine 

without special supervision 33% 25% 24% 

Perform activities within a schedule, 

maintain regular attendance and be on time 33% 25% 24% 

Maintain attention and concentration spans 25% 19% 24% 

Complete tasks without assistance 28% 22% 21% 

Perform at a consistent pace 

without unreasonable rest periods 27% 22% 19% 

Complete tasks without errors 27% 22% 19% 




of increasing adherence to medication 

and increasing engagement in 

services. In particular, the percent 

of AOT recipients who had difficulty 

managing medication decreased 

from 36% to 27% between the 

onset of the court order and six 

months. Similarly, the percent of 

recipients who had difficulty following 

through on health care 

advice and making and keeping 

appointments declined from 26% to 

19% and 27% to 20% respectively. 

Tables 5.8 and 5.9 display the 

changes during the initial six 

months of AOT in the areas of 

social, interpersonal and family 

functioning and task performance. 

On 15 of the 16 measures for these 

areas, the reduction in difficulties 

experienced by AOT recipients 

between the onset of the court 

order and at six months was statistically 

significant. For instance, the 

percent of recipients who had difficulty 

effectively handling conflict 

and managing assertiveness 

dropped from 50% to 36% and 44% 

to 33% respectively. Similar to the 

findings noted above for self care 

and community living, an overall 

pattern of reduced difficulties and 

therefore improved functioning 

characterizes the findings concerning 

social, interpersonal and family 

functioning, and task performance. 

Reduced Incidence 

of Harmful Behaviors 

Case managers also reported 

reductions in the incidence of 

harmful behaviors for AOT recipients 

at six months in AOT when 

compared with a comparable period 

of time prior to AOT. Table 5.10 

shows significant declines in the 

incidence of behaviors harmful to 

self, behaviors harmful to others, 

Table 5.10 

Reduced Incidence of Harmful Behaviors 

(Percent of Persons with One or More Events Reported in the Past 90 Days) 

Percent of AOT Recipients 

with Harmful Behaviors 

Percent 

Reduction 


in Harmful 

AOT Court Order At Six Months Behaviors 

Physically Harm Self/Made Suicide Attempt 9% 4% 55% 

Abuse Alcohol 45% 23% 49% 

Abuse Drugs 44% 23% 48% 

Threaten Suicide 15% 8% 47% 

Physically Harm Others 15% 8% 47% 

Damage or Destroy Property 13% 7% 46% 

Threaten Physical Harm 28% 16% 43% 

Create Public Disturbances 24% 15% 38% 

Verbally Assault Others 33% 21% 36% 

Theft 7% 5% 29% 





and harmful behaviors directed at 

property. Similarly, substantial 

declines are also seen in alcohol 

and substance abuse. In summary, 

during the first six months of courtordered 

treatment, individuals in 

AOT showed a significant decline 

in the incidence of harmful behaviors. 

The average percent decrease 

in harmful behaviors was 44%. 

Adult Homes: A New Care 

Coordination Model of Support, 

Empowerment and Collaboration 

dult homes are residences in 

Athe community licensed by the 

New York State Department of 

Health (DOH), and ranging in size 

from less than 20 beds to more 

than 300. The majority of individuals 

served by OMH live in a cluster 

of homes often referred to as 

“impacted adult homes,” meaning 

that either 25 residents or 25% of 

the total resident population 

received mental health services. 

In Spring 2002, Governor Pataki 

appointed an Adult Home Workgroup 

comprised of key stakeholders, 

including advocates, home 

operators, DOH, OMH, the State 

Commission on Quality of Care for 

the Mentally Disabled, and the 

State Office for the Aging. This 

Workgroup was charged with making 

recommendations to improve 

conditions for residents living in 

DOH-licensed adult care facilities. 

Consistent with the Workgroup’s 

recommendations for change, 

OMH and its sister agencies developed 

a comprehensive service 

package to support adult home residents, 

improve their access to 

mental health services, and help 

them meet their recovery goals. 

The package includes provisions 

and activities that focus on health 

and safety, appropriateness of care, 

quality of care, quality of life, housing, 

and public awareness. 

To promote resident recovery 

and independence, a new model 

of on-site case management and 

peer support services was proposed 

for adult home residents. 

The model is a unique combination 

of coordinated and integrated 

services that focuses on resident 

strengths and needs and the provision 

of supports to ensure independence 

and personal choice. 

Rehabilitation principles and values 

that emphasize support, empowerment, 

and collaboration are expected 

to result in a merger of consumer 

and professional 

perspectives. OMH’s commitment 

to this initiative has been strengthened 

by a recent increase in the 

rate for blended case management, 

as well as the issuance of two 

Request for Proposals aimed at the 

development of supportive case 

management, utilizing supportive 

case managers and peer services. 

The first was issued in 2003 with 

services beginning in 2004, and the 

second was issued in November 

2004 with services to begin in 

2005. When fully implemented, the 

case management/peer support initiative 

will be providing services to 

approximately 3,500 individuals 

residing in adult homes in New 

York City, Long Island, and various 

Upstate counties. 

Under this initiative, existing 

adult home treatment services are 

being restructured to provide an 

evidenced-based set of services 

focusing on wellness and self management 

techniques. The case 

management/peer support program 

engages service recipients and 

involves family and friends by providing 

educational information 

regarding the range of multiple 

community resources available. 

On-site social and recreational 

opportunities enhance the quality 

of life for residents of adult homes 

and opportunities are created for 

participation in a variety of home 

and community activities. The case 

management/peer support initiative 

has resulted in the facilitation of 

numerous groups and activities not 



Table 5.11 

Case Management/Peer 

Support Program 

Enhanced Group Activity Areas 

◆ Stress management 

◆ Developing coping skills 

◆ Self-esteem 

◆ Family support 

◆ Time management 

◆ Computer classes 

◆ Anger management 

◆ Arts and crafts 

◆ All-male interpersonal skills 

◆ Life skills development 

◆ Wellness for residents whose 

psychiatric conditions restrict 

their ability to care for cooccurring 

medical conditions 

previously available to residents of 

adult homes (see Table 5.11). 

Many community-based and onsite 

enrichment activities are attended 

by residents on a regular basis. 

Attendance at on-site activities at 

four adult homes averages 300 residents 

per month. Some events are 

coordinated and supported by case 

managers and peers, while others 

are coordinated through the OMH 

Office of Consumer Affairs. 

The OMH Office of Consumer 

Affairs also plays a key role in 

offering support to a number of 

self-governing, resident-run Resident 

Councils. The councils meet 

regularly to discuss issues and concerns, 

which are communicated to 

staff designated to serve as liaisons. 

The Office of Consumer Affairs 

provides training and technical 

assistance to the Resident Councils 

and other adult home staff and has 

also worked to identify community 

partners for the Councils. 20 As 

requested by Resident Council 

leaders, the Office of Consumer 

Affairs is coordinating training on 

hope. This training will be provided 

by the Mental Health Empowerment 

Project as a pilot project to 

five adult homes in New York City 

over the next year. 

The OMH Office of Consumer 

Affairs is supporting an initiative in 

Queens, where residents are being 

offered information about community 

resources and assistance in 

linking to groups in their neighborhoods. 

Adult home operators, case 

managers and peer specialists provide 

support for a range of guests 

and activities, including faith-based 

groups, computer literacy groups, 

volunteer opportunities, and voter 

registration activities. Approximately 

150 residents per month attend 

these programs. Additionally, traditional 

mental health services such 

as supportive employment agencies 

have been introduced, but with a 

focus on securing jobs outside of 

the mental health system, for 

example, a volunteer opportunity 

available at a local museum. Based 

on the success of the Queens initiative, 

this pilot project will be 

replicated in three homes in New 

York City and one in each region 

of the State. 

The provision of rehabilitation 

and recovery training to the case 

managers and peer specialists was 

a primary focus of 2004 and will 

continue into 2005 and beyond. 

Training has been aimed at effectively 

assisting residents of adult 

homes to successfully attain and 

maintain their personal recovery 

goals and to develop and or 

strengthen natural community and 

social supports. Building on these 

efforts, the Adult Home Monitoring 

and Training Team, which is 

responsible for facilitating the mental 

health component of the 

statewide interagency team, will 

provide training programs to case 

managers and peer specialists on 

strategies for effective education of 

adult home residents who have 

mental illness. The training will 

focus on engaging participants in 

skills development that will enable 

Notes 

22 In New York City, there is an Adult Home 

Caucus of all the resident councils that is 

supported by the Coalition of Institutionalized 

Aged and Disabled. 




them to work toward their recovery 

goals. Importantly, residents 

who identify educational and vocational 

goals now have the opportunity 

to attain these goals under a 

vocation and education initiative, 

which is organizing job fairs and 

providing GED opportunities. 

Translating Evaluation 

and Services Research 

Findings into Practical 

Clinical Treatments 

and System Supports 

O 

MH research is also improving 

the quality of care by translating 

research findings into practical clinical 

tools, treatments and services in 

our communities and State psychiatric 

hospitals. Below, we highlight 

several initiatives conducted by 

OMH’s two research institutes that 

illustrate the immediate, real-world 

translational benefits of research. 

We include some examples that 

have been widely disseminated in 

New York State, as well as demonstration 

projects that serve specific 

target populations in small geographic 

areas. OMH is examining 

the possibility of expanding successful 

demonstration projects to 

broader populations. 

Child and Adolescent Psychiatric 

Evaluation Service 

he Child and Adolescent Psychi- 

Evaluation Service (CAPES) 

Tatric 

fills a noticeable gap in evaluating 

children for psychiatric illness. The 

service provides expert consultation 

to primary care physicians and 

families with children ages 3 to 17 

years who may suffer from behavioral, 

emotional and developmental 

problems. CAPES is partnering with 

pediatricians throughout New York 

City, and has evaluated over 600 

individuals to date. In addition to 

psychiatric consultation, children 

referred to CAPES are guaranteed a 

free and thorough evaluation comprising 

a psychological interview, 

structured diagnostic assessment, 

child cognitive screening, a multifaceted 

symptom assessment, and 

expert consensus on diagnosis and 

treatment recommendations. 

Cultural Competence 

he President’s New Freedom 

TCommission on Mental Health 

cited the lack of culturally competent 

mental health services as a key 

factor in creating disparities in 

access to care for various racial and 

ethnic groups. OMH researchers 

have developed an 11-item scale 

for behavioral healthcare agencies 

to assess their cultural competency. 

Use of the scale is intended to 

motivate agencies to develop culturally 

competent behaviors and to 

guide the development of culturally 

competent adaptations of EBPs. 

NIMH has awarded funds to study 

the psychometric properties of this 

scale. Future plans include the 

development of an instrument 

applicable to mental health authorities 

or umbrella agencies and a 

version of the scale for agencies 

that serve a single culture. 

Memory Education 

and Research Initiative 

he Memory Education and 

TResearch Initiative (MERI) is a 

State and Local collaborative project 

that offers at no cost a memory 

and cognitive evaluation to individuals 

with memory complaints who 

live in Rockland County. Since its 

inception, the program has 

screened more than 300 individuals. 

Many of these individuals had 

concerns about memory loss or 

were worried because they had 

close relatives with Alzheimer’s disease. 

Most of those screened did 

not, in fact, have the disorder but 

were reassured by the positive 

results of the evaluation. These 

individuals will be followed annually 

in an effort to look for some of 

the earliest predictors of decline. In 



cases where the evaluation determined 

that individuals were at the 

early stages of the disorder, the 

individuals were able to benefit 

from early diagnosis and treatment. 

Movement Disorders 

ome individuals who take 

Santipsychotic medications over 

extended periods are at risk for the 

development of tardive dyskinesia, 

a medication side effect characterized 

by repetitive and abnormal 

involuntary movements and may 

occur in the face, mouth, tongue, 

hands and or feet. The efforts of an 

OMH researcher have produced an 

amino acid food product (classified 

by the FDA as a medical food) that 

is reported to offer a safe and 

effective treatment for the disorder 

among men, reducing symptoms 

by as much as 86%. The rights for 

this novel treatment have been 

assigned to OMH, the Research 

Foundation for Mental Hygiene 

(RFMH), the organization responsible 

for administering and directing 

the conduct of all sponsored 

research programs carried out by 

scientists at OMH research institutes 

and facilities, and the National 

Institutes of Health. 

RFMH has entered into a licensing 

agreement with an international 

company to manufacture and market 

the food that is now available 

commercially under the trade 

name, Tarvil. Patents have been 

obtained and work has begun to 

extend the same formulation to a 

second disabling dyskinetic disorder, 

L-dopa induced dyskinesia, 

seen in individuals who suffer from 

Parkinson’s disease. Work has also 

begun to study the same product 

as a treatment for schizophrenia 

and bipolar disorder. 

T 


Post-Traumatic Stress Disorder 

(PTSD) 

he aftermath of the 9/11 attacks 

made it clear that more clinicians 

needed training in evidencebased 

treatments for post-traumatic 

stress disorder (PTSD). The Trauma 

Studies Program led the effort to 

train mental health professionals in 

treating trauma-related problems in 

New York City after 9/11. Between 

2002 and 2004, the team of experts 

trained roughly 400 clinicians in 

the latest in cognitive behavioral 

therapy (CBT) techniques for 

PTSD. The Trauma Studies Program 

has also launched the first largescale, 

nationwide, Web-based survey 

of individuals bereaved as a 

result of the 9/11 attacks. In addition, 

researchers partnered with 

primary care physicians in Manhattan’s 

Washington Heights community 

after 9/11 and the subsequent 

crash of American Airlines flight 

587 to help them meet the 

demands of individuals dealing 

with these traumas. 

Prime-MD 

rimary care physicians often see 

Pindividuals with psychiatric 

problems in their practice, but 

often lack the base of special 

knowledge and skills for proper 

psychiatric assessment and diagnosis. 

OMH researchers knew that by 

simply asking a few pointed questions, 

primary care physicians 

could flush out underlying problems, 

like depression, which would 

otherwise go untreated. This led to 

the development in 1993 of Prime- 

MD, the first standardized questionnaire 

designed by both psychiatrists 

and primary care physicians 

to help screen, evaluate and diagnose 

mental health disorders most 

commonly seen in primary care 

settings. A self-administered version 

of the test was introduced in 1999 

and is still widely used today. 

Telepsychiatry 

n New York State, as in other 

Iparts of the country, psychiatrists 

practice almost exclusively in urban 



and suburban areas, and mental 

health care providers in small 

towns generally have no or little 

access to expert consultation. The 

Telepsychiatry Consulting Program 

allows nationally recognized clinicians 

to examine consumers in virtual 

face-to-face interviews via 

videoconferencing. It provides realtime, 

psychiatric consultations to 

rural practitioners (non-psychiatric 

physicians, non-medical mental 

health clinicians, and adult psychiatrists 

working at community health 

programs, correctional facilities, or 

OMH facilities). These clinicians are 

located in 25 sites throughout New 

York State, including 12 mental 

health units in correctional facilities 

and 12 in community mental health 

programs. 

This method of delivery to outlying 

areas is gradually gaining 

acceptance in other areas of medicine, 

as well as in psychiatry. After 

over 180 consultations with individuals 

between the ages of 5 and 65, 

with common to fairly unusual disorders, 

and with varied behavioral 

interventions, the program has 

amassed an impressive videotape 

library that could function as an 

excellent teaching tool. An in-depth 

assessment of consumers’ reactions 

to this form of service delivery is 

under way. 

Conclusion 

E 

valuation and services research 

are critical to determining the 

degree to which mental health 

services support individuals served 

in the public mental health system. 

Through these activities, OMH continues 

to employ shared goals and 

objectives for measuring performance 

and relying on the results to 

improve the quality of care. Evaluation 

and services research are 

instrumental to the creation of a 

culture at all levels of the public 

mental health system where continuous 

quality improvement and 

data-driven, decision making are 

the principal standards of practice. 


Chapter 6: Children and Depression 81 

Children and Depression Chapter 6 

Background 

hild and adolescent depression 

Cand bipolar disorder, also 

known as mood disorders, are serious 

medical illnesses that affect 

more than 20 million Americans of 

every race and ethnic group. 1 Mood 

disorders are considered to be 

brain disorders because they are 

mediated through the brain. These 

illnesses affect individuals at all 

stages of life, including childhood. 

If left untreated, mood disorders 

can be fatal: nearly one in six persons 

with severe untreated depression 

will die by suicide. 2, 3 According 

to the WHO and the World 

Bank, major depression is the leading 

cause of disability in the U.S. 

and other countries with developed 

economies. 4 Because of the profound 

public health consequences 

associated with these disorders, 

OMH is committed to improving 

the recognition, early intervention, 

and treatment of mood disorders in 

children and youth. 

Among the most significant scientific 

advances in the last three 

decades has been the discovery 

that depression and bipolar disorder 

not only exist in children but 

are as debilitating for them as they 

are for adults. Major depression 

affects an estimated 6% of children 

ages 9-17. 5 As children become 

adolescents, it becomes more common 

in girls than in boys. 6 Epidemiological 

data are lacking on 

the extent to which bipolar disorder 

affects children, but early indications 

suggest that some proportion 

of children and adolescents 

who have major depression will be 

found to have bipolar disorder later 

in life. The likelihood increases if 

the depressed child has a family 

member with bipolar disorder. 7 

Recent scientific advances from 

neuroscience, genetics and clinical 

trials have demonstrated that the 

brain is the primary organ affected 

in depression and bipolar disorder. 

Modern brain imaging technologies 

have revealed neural circuits 

responsible for the regulation of 

moods, thought, sleep, appetite and 

behavior. When these circuits fail to 

function properly, critical neurotransmitters–chemicals 

used by 

nerve cells to communicate–are 

often out of balance. Recent work 

has delineated several neurotransmitter 

and other neurochemical systems 

that are involved in mood disorders, 

including systems that 

modulate gene transcription. These 

discoveries provide clues to potential 

neurochemical targets for effective 

treatments. In addition, genetics 

research indicates that vulnerabilities 

to depression and bipolar disorder 

often result from the interaction 

of multiple genes and environmental 

factors. Numerous treatment 

studies are currently under way to 

examine brain chemistry and the 

mechanisms of action of both psychosocial 

and pharmacologic treatments 

to improve the efficiency and 

effectiveness of these interventions. 

Notes 

1 Kessler RC, McGonagle KA, Zhao S, Nelson 

CB, Hughes M, Eshleman S et al. (1994). 

Lifetime and 12-month prevalence of DSM- 

III-R psychiatric disorders in the United 

States. Results from the National Comorbidity 

Survey. Archives of General Psychiatry, 

51:8-19 

2 Goodwin FK, & Jamison KR. (1990). Manicdepressive 

illness. New York: Oxford University 

Press. 

3 Guze, S. B., & Robins, E. (1970). Suicide and 

affective disorders. British Journal of Psychiatry, 

117, 437-438. 

4 Murray CJL, Lopez AD, eds. (1996). The global 

burden of disease and injury series, volume 

1: A comprehensive assessment of mortality 

and disability from diseases, injuries, 

and risk factors in 1990 and projected to 

2020. Cambridge, MA: Published by the Harvard 

School of Public Health on behalf of the 

World Health Organization and the World 

Bank, Harvard University Press. 

5 Shaffer D, Fisher P, Dulcan MK, Davies M, 

Piacentini J, Schwab-Stone ME, Lahey BB, 

Bourdon K, Jensen PS, Bird HR, Canino G, & 

Regier DA. (1996). The NIMH Diagnostic 

Interview Schedule for Children Version 2.3 

(DISC-2.3): Description, acceptability, prevalence 

rates, and performance in the MECA 

study. Journal of the American Academy of 

Child and Adolescent Psychiatry, 35(7), 865- 

877. 

6 Angold A, Costello EJ, Farmer EMZ, et al. 

(1999) Impaired but undiagnosed. Journal of 

the American Academy of Child and Adolescent 

Psychiatry, 38, 129-137. 

7 National Institute of Mental Health. 

(2000).Depression in children and adolescents: 

A fact sheet for physicians. Bethesda, 

MD: Department of Health and Human Services. 



82 Chapter 6: Children and Depression 

Notes 

8 National Center for Injury and Prevention 

Control. Suicide: Fact sheet. Accessed online 

January 12, 2004, at http://www.cdc.gov/ 

ncipc/factsheets/suifacts.htm 

9 Office of the Surgeon General. (1999). The 

Surgeon General’s call to action to prevent 

suicide. Washington, DC: Department of 

Health and Human Services. 

What are the Symptoms 

of Depression and Bipolar 

Disorder in Children 

and Adolescents? 

nlike normal changes in mood 

Uthat are common among most 

individuals at different times of life, 

the symptoms of depression are 

extreme and often incapacitating. 

The symptoms include a persistent 

sad mood; loss of interest in activities; 

significant change in appetite 

or body weight; difficulty sleeping 

or oversleeping; physical slowing 

or agitation; loss of energy; feelings 

of worthlessness; difficulty thinking 

or concentrating; and recurrent 

thoughts of death or suicide. A 

diagnosis of depression occurs if 

an individual has five or more of 

these symptoms every day during a 

two-week period. In bipolar disorder, 

an extremely debilitating illness, 

episodes of depression alternate 

with periods of persistently 

elevated mood or irritability, sometimes 

accompanied by a decreased 

need for sleep, increased talkativeness, 

racing thoughts, distractibility 

or extreme physical agitation. 

The consequences of untreated 

depression can be devastating. A 

2004 report from the American 

Academy of Child and Adolescent 

Psychiatry documented that suicide 

is the third leading cause of death 

for 15 to 24 year olds, and the sixth 

leading cause of death for five to 

14 year olds. In fact, in 2001 nearly 

4,000 teenagers between the ages 

of 15 and 24 killed themselves. 8 

Depression is responsible for over 

500,000 suicide attempts by children 

and adolescents a year. 9 

How and When Does 

Depression Develop 

in Children? 

uberty appears to be the time at 

Pwhich children, and in particular 

girls, are at increased risk for 

developing depression. The changing 

levels of hormones that occur 

during puberty may affect brain 

function. There is some evidence 

that exposure to increased levels of 

hormones at puberty, particularly 

under conditions of social stress, 

can predict heightened risk for 

depression. 

Depression among children or 

adolescents is often preceded by 

other mental disorders, most 

notably anxiety. Anxiety disorders 

are eight times more common in 

depressed than non-depressed children 

and adolescents, while behavioral 

problems (e.g., conduct disorders 

and oppositional disorders) 

are six times more common. Attention 

Deficit Hyperactivity Disorder 

(ADHD) is five times more common 

among youth with depression 

than youth unaffected by it. In fact, 

the onset of depression usually follows 

the onset of other disorders. 

Consequently, prevention of 

depression is directly linked to the 

prevention or treatment of these 

other psychiatric disorders. 

Depression is also significantly 

associated with abuse, maltreatment 

and trauma. Stress exposure, 

as has been well documented in 

both animal and human studies, 

can produce persistent effects on 

brain structure and function. For 

example, in animal studies, exposure 

to extreme adversity during 

critical periods of development 

leads to changes in perceptions of 

and responsiveness to environmental 

events. The interactions among 

stress exposure, genetic vulnerabilities, 

and development are complex 

and these interactions are still 

being examined. However, effective 

treatments for stress-related 



disorders in young persons, particularly 

trauma, exist and have been 

studied for more than a decade. It 

is likely that providing early and 

effective interventions to children 

who have been exposed to abuse, 

maltreatment or trauma may 

improve their long-term outcomes 

by providing them with necessary 

coping strategies for handling subsequent 

stressors and decrease the 

likelihood that they will develop 

severe depression later in life. 

Other risk factors for early-onset 

depression include family history. 

Children of parents with depression 

are three times more likely to have 

an episode of depression during 

their lifetime than children of parents 

without depression. Recent 

findings from a three-generation 

study of familial depression documented 

significantly increased risk 

of mental disorders among grandchildren 

in families where individuals 

in two generations have experienced 

depression, with almost 60% 

of these grandchildren having mental 

disorders. 10 Furthermore, this 

intergenerational study documented 

that anxiety was a clear precursor of 

depression and that grandchildren 

of depressed parents and grandparents 

were at a significantly elevated 

risk for anxiety disorders. The findings 

from this study strongly suggest 

that early interventions for children 

with a family history of depression 

are especially warranted. 

Clinical practice guidelines to 

improve identification of adolescents 

with depression for primary 

care providers have recently been 

developed through a consensus 

process. 11 The resulting Guidelines 

for Treatment of Adolescent 

Depression are intended for use by 

primary care professionals for the 

management of adolescents with or 

at risk for depression who are 

between the ages of ten and 21. 

Using a combination of evidenceand 

consensus-based methodologies, 

the guidelines were developed 

in six phases to assist in primary 

care management. The phases 

include: 1) identification/ 

surveillance of youth at risk for 

depression, 2) assessment and 

diagnosis, 3) initial management, 

including family psychoeducation, 

4) treatment, 5) ongoing management, 

and 6) follow-up. 

Treatment 

and Prevention 

T 

here is no longer any doubt that 

children and adolescents can 

experience severe depression. The 

questions that drive current 

research studies are how best to 

intervene early to prevent the later 

onset of depression. Estimates from 

national epidemiological studies of 

adults with psychiatric disorders 

indicate that many adult mental 

disorders begin in childhood. The 

implications of these findings are 

that early recognition and treatment 

of childhood psychiatric problems 

may prevent later illnesses and 

their unfortunate consequences. 

Recognizing and treating psychiatric 

illnesses early in life–particularly 

the devastating disorders of 

depression and anxiety–may have a 

profound and long lasting effect on 

later development, as recognition 

and treatment can help to avert the 

potentially debilitating consequences 

of adult disorders. 

Treatments 

onsiderable progress has been 

Cmade in the past ten years documenting 

effective treatments for 

young persons with depression. 

Most of the efforts to date have 

focused on adolescents. More than 

a dozen clinical trials have demonstrated 

that both cognitive-behav- 

Notes 

10 Weissman MM, Wickramaratne P, Nomura Y, 

Warner V, Verdeli H, Pilowsky DJ, Grillon C, 

& Bruder G. (2005). Families at high and low 

Risk for depression: A 3-generation study. 

Archives of General Psychiatry, 62, 29-36. 

11 Cheung A, Zuckerbrot R, Jensen P, Levitt A. 

(2004, October). North American guidelines 

for the management of adolescent depression 

in primary care. Presented at the annual 

meeting of the Canadian Academy of Child 

and Adolescent Psychiatry, Montreal. 




Notes 

12 Zito JM, Safer DJ, dosReis S, Gardner JF, 

Soeken K, Boles M, & Lynch F.(2002). Rising 

prevalence of antidepressants among U.S. 

youths. Pediatrics, 109(5), 721-727. 

13 Olfson M, Shaffer D, Marcus SC, & Greenberg 

T. (2003). Relationship between antidepressant 

medication treatment and suicide 

in adolescents. Archives of General Psychiatry, 

60, 978-982. 

14 March J, Silva S, Petrycki S, Curry J, et al. 

(2004). Fluoxetine, cognitive-behavioral therapy, 

and their combination for adolescents 

with depression: Treatment for Adolescents 

with Depression Study (TADS) randomized 

controlled trial. Journal of the American 

Medical Association, 292, 807-820. 

ioral therapies (CBT) and interpersonal 

therapies (IPT) are effective 

therapies for adolescents with 

depression. These treatments are 

being delivered and examined in 

New York State. Studies have also 

documented that nonspecific supportive 

psychotherapy, on the 

other hand, is not effective in 

reducing depression. Delivered by 

trained professionals, CBT and IPT 

are structured clinical interventions, 

that target specific factors associated 

with depressive thinking or 

behaviors. For example, active 

problem solving, social skills development, 

activity scheduling, and 

self-monitoring are often targeted 

and taught in these structured treatments. 

Nonspecific supportive psychotherapies, 

on the other hand, 

are unstructured “talking” therapies, 

often characterized by supportive 

listening, play or other nondirective 

activities primarily designed to provide 

emotional “support” to the 

individual. 

For pre-pubertal children with 

depression, no long-term studies 

have been conducted to identify 

the most effective therapy. Similarly, 

there are no controlled trials of 

treatments for preschool depression, 

even though it has been 

found to exist in this population of 

children. Studies are needed to 

address these questions. 

The use of pharmacologic treatments 

for children and adolescents 

has been studied with increasing 

rigor in recent years. It is clear that, 

unlike adults with acute depression, 

the older antidepressants 

(e.g., tricyclic antidepressants) do 

not work well for childhood 

depression. Newer antidepressant 

medications (e.g., SSRIs [selective 

serotonin re-uptake inhibitors]) 

have been examined over the past 

ten to 15 years and increases in 

their use have also been documented. 

12 In addition to psychiatrists, 

many nonpsychiatric physicians 

(primary care physicians) 

have been prescribing these medications 

for depressed adolescents. 

A national study examining rates of 

antidepressant use and suicide by 

geographic regions documented 

that as use of antidepressants for 

depression increased, there was a 

concomitant decrease in the number 

of teen suicide deaths. 13 

Recently the results of a major 

clinical trial on treatment of adolescent 

depression were released. 14 In 

this ten-site clinical trial of adolescents 

with moderate to severe 

depression, which compared SSRIs, 

psychosocial treatments, their combination 

and placebo, short-term 

outcomes (at 12 weeks) demonstrated 

reductions in depressive 

symptoms associated with the use 

of SSRIs. Longer-term outcomes 

have not yet been published. 

Concerns have recently emerged 

about both the safety and effectiveness 

of antidepressant medications 

with children and adolescents. On 

October 15, 2004, the Food and 

Drug Administration (FDA) 

announced that it was requiring a 

“black box” warning to the health 

professional labeling of all antidepressant 

medications regarding their 

use with children and adolescents. 

After considering the large 

amount of information and controversy 

generated by this issue, OMH 

summarized the data in a clinical 

advisory as follows: 

◆ Currently, fluoxetine (Prozac) is 

the only antidepressant 

“labeled,” that is approved by 

the FDA for use in pediatric 

depression (i.e., children and 

adolescents). The prescribing of 

all other antidepressants in children 

and adolescents for any use 

is categorized as “off-label” use. 

◆ To date, only fluoxetine (Prozac) 

has been shown to be clinically 

effective with adolescents who 

are depressed. 

◆ An FDA review of 24 SSRI antidepressant 

studies involving 4,400 

children and adolescents con- 



cluded that all the SSRIs (including 

fluoxetine) and other newer 

antidepressants could increase 

the risk of suicide-related 

thoughts and/or self-harming 

behavior in some children and 

adolescents. The FDA analysis 

identified the average medicationinduced 

risk to be 4% compared 

to 2% for a placebo. This means 

that statistically, four children and 

adolescents out of 100 treated 

might show increased suicidality 

due to the antidepressant medication. 

The medication-induced risk 

is greater when starting or adjusting 

the dose of these antidepressant 

medications. 

◆ In the 24 studies reviewed involving 

children and adolescents taking 

SSRI antidepressant medications, 

there were no deaths. Also, 

none of those with increased suicidal 

ideation or behavior went 

on to commit suicide. 

◆ New research in the treatment of 

adolescent depression (i.e., the 

Treatment of Adolescents with 

Depression Study) demonstrates 

that the combination of CBT 

therapy and antidepressant medication 

(fluoxetine) results in 

successful treatment (71% of 

adolescents who were depressed 

responded positively to the combination 

treatment compared to 

35% taking a placebo). 

◆ In spite of the “black box” warning, 

the FDA has not taken a 

position that SSRIs and other 

new antidepressants are contraindicated 

in children and adolescents. 

Therefore, six medications 

(citalopram [Celexa], 

escitalopram [Lexapro], fluoxetine 

[Prozac], fluvoxamine 

[Luvox], paroxetine [Paxil], and 

sertraline [Zoloft]; three others, 

including bupropion (Wellbutrin), 

mirtazapine (Remeron), 

and venlafaxine (Effexor); and 

MAO inhibitors and tricyclic antidepressants 

can continue to be 

prescribed for children and adolescents 

if rational prescribing 

principles are followed. 

The full text of this advisory can 

be found in Appendix 6 and on the 

OMH Web site (http://www.omh. 

state.ny.us/omhweb/advisories/ 

programltr.htm). It includes a series 

of recommendations to assist practitioners, 

clinicians, and ultimately 

parents or guardians in making 

sound decisions. These recommendations 

are consistent with OMH’s 

continued support for the use of 

evidence based treatments for children 

and adolescents with serious 

emotional disturbance. 

Prevention 

esearch on the prevention of 

Rchild and adolescent depression 

has focused on treatment of maternal 

depression as a major risk factor 

for childhood depression and 

on the development of schoolbased 

programs specifically aimed 

at reducing the risk for depression. 

Interventions that target maternal 

depression have found changes in 

cognitive development and behavioral 

problems among children; 

longer-term studies are still needed 

to determine the direct effects on 

children, although early results are 

promising. 15 School-based prevention 

programs for youth at risk of 

developing depression have 

demonstrated successful outcomes 

in preventing the onset of fullblown 

depression. 16 

Because anxiety often precedes 

depression, especially among girls, 

and because effective CBT and 

pharmacological treatments for 

anxiety disorders exist, there is a 

strong possibility that treatment of 

anxiety problems in children or 

adolescents, including trauma-relat- 

Notes 

15 Miranda J, Duan N, Sherbourne C, Schoenbaum 

M, Lagomasino I, Jackson-Triche M, & 

Wells KB. (2003). Improving care for minorities: 

Can quality improvement interventions 

improve care and outcomes for depressed 

minorities? Results of a randomized, controlled 

trial. Health Services Research, 38(2), 

613-630. 

16 Clarke GN, Hornbrook M, Lynch F, Polen M, 

Gale J, Beardslee W, et al. (2001). A randomized 

trial of a group cognitive intervention 

for preventing depression in adolescent 

offspring of depressed parents. Archives of 

General Psychiatry, 58, 1127-1134. 




ed symptoms, may prevent the 

development of depression. 

Finally, there is emerging support 

for the value of psychoeducational 

family programs for families of children 

with a range of psychiatric 

problems, including depression. 

These educational programs–often 

co-taught by parents and professionals–are 

designed to increase awareness 

and knowledge about effective 

identification, early intervention, and 

treatment for children and adolescents 

with or at risk of depression. 

Family members are taught to identify 

the symptoms and to recognize 

early warning signs that may suggest 

a predisposition to anxiety or depression. 

They are also taught how to 

access information about mood disorders, 

and are provided with information 

about stress reduction, medication, 

and medication side effects. 

The effects of various stressors in a 

child’s life are also examined in the 

context of the child’s major environments 

such as school, home, and 

community. Participants are able to 

network with other parents to discuss 

common issues such as early 

identification, parenting strategies, 

and working with the school system. 

Lack of Treatment 

and Its Consequences 

Untreated, the consequences of major 

depression in children and adolescents 

can be devastating for both the child 

and for his/her family. While the most 

serious consequence of untreated 

depression may be suicide, there are 

other serious developmental, personal, 

and social consequences that may 

result. These consequences can affect 

relationships with family members, 

peers, school success, work productivity, 

and adult development. Clearly 

recognition, identification, and treatment 

of depression in children and adolescents 

can have profound effects on the 

life course. 

Approximately 90% of teenagers 

who die by suicide suffer from a 

treatable mental illness. For more 

than a decade, Columbia University 

has worked to perfect a reliable 

and easy screening program for 

suicide risk and other mental disorders. 

The resulting program, Teen- 

Screen ® , has been implemented in 

41 states nationwide. The Teen- 

Screen ® Program offers evidencebased 

adolescent suicide and mental 

health screening programs to 

government and mental health 

agencies, non-profit organizations, 

schools, physicians, and drop-in 

clinics. At this time, consultation, 

training and implementation assistance 

are offered free of charge. 

More information about the Teen- 

Screen ® Program is available on the 

Web at http://www.teenscreen.org/. 

Future Directions 

MH is committed to providing a 

Ocomprehensive range of services 

for children and adolescents 

experiencing mood disorders, as 

well as support for their families 

and caretakers. To launch an effective 

strategy to prevent the onset, 

recurrence, or sequelae of mood 

disorders, we will implement a set 

of strategies with targeted dissemination 

objectives, which will 

improve the identification, treatment, 

and prevention of child and 

adolescent depression. 

OMH will focus its efforts on 

promoting a statewide response by 

targeting the following activities: 

◆ A public awareness campaign to 

improve recognition of the early 

indicators for mental disorders in 

children 

◆ Promotion of suicide awareness, 

screening, and referral/treatment 

services in schools and communities 

to identify children and 

adolescents at risk 



Figure 6.1 

Announcement of Upcoming Children’s Research to Practice Symposium 

Children’s 

Research to Practice 

Symposium 

Featuring nationally-renowned experts 

in children’s mental health research and best practices 

Save The Date! 

NYS Office of Mental Health 

Office of Children and Family Services, and 

Office of Alcoholism & Substance 

Abuse Services proudly presents 

June 9 & 10, 2005 

New York City 

◆ Tools and training for front-line 

clinical staff in hospital and outpatient 

clinic systems to improve 

recognition of trauma, anxiety, and 

depression among children and 

adolescents and to improve delivery 

of effective, evidence-based 

psychosocial and pharmacologic 

treatments for affected youth 

◆ Dissemination of the Guidelines 

for Treatment of Adolescent 

Depression (referenced earlier in 

this chapter) to primary care 

providers statewide 

◆ Promotion of family psychoeducation 

and support services to 

assist families in recognizing 

early indicators of psychiatric 

problems, to encourage seeking 

evidence-based services, and to 

promote supportive services 

family to family 

◆ Implementation of tracking and 

monitoring systems including 

specific measurable and timely 

outcomes; use of Standardized 

assessment tools for diagnosing 

and tracking outcomes 

◆ Encouragement to programs and 

clinics implementing the monitoring 

of these programs to work 

as collaborative learning partners 

In June 2005 OMH and the State 

Offices of Alcoholism and Substance 

Abuse Services (OASAS), 

and Children and Family Services 

(OCFS), will be co-sponsoring the 

Children’s Research to Practice 

Symposium. The symposium will 

include interdisciplinary sharing of 

the latest findings in neuropsychiatry, 

major treatment trials and services 

research in children’s mental 

health. Additional information 

about the symposium is available 

on the OMH Web site at:http:// 


child_symposium/. 

Additional information about children 

and depression research is 

included in Appendix 7. 





Chapter 7: Forensic Services 89 

Forensic Services Chapter 7 

Introduction 

n New York State, a small yet sig- 

group of individuals suffer- 

Inificant 

ing from mental illness become 

involved with the criminal justice 

system. These individuals receive 

care in the forensic mental health 

system, where OMH provides care 

to New Yorkers pursuant to Mental 

Hygiene, Criminal Procedure or Correction 

Laws. OMH ensures that 

mental health services are available 

to members of this population at 

multiple points throughout the 

forensic system by providing statutorily 

mandated inpatient and corrections-based 

mental health services. 

The forensic population was 

identified during the public planning 

process of 2004 as appropriate 

for special attention in this 

year’s Plan. This chapter describes 

two important components of the 

forensic mental health system: programs 

to avoid incarceration for 

certain individuals with serious 

mental illness, and services to more 

than 7,500 individuals with mental 

illness served in State correctional 

facilities (State Prison). 

Goals for this population 

For adults with mental illness, 

OMH’s overall goals are to: 

◆ Foster the diversion from incarceration 

of adults with mental illness 

who come in contact with the 

criminal justice system into appropriate 

community-based services. 

◆ Provide appropriate prison-based 

mental health services, and 

when necessary, provide inpatient 

services at the Central New 

York Psychiatric Center. 

◆ Assist individuals with mental illness 

released from prison by 

facilitating access to aftercare 

services deemed essential for the 

safe and functional adjustment to 

community-based living. 

New Trends in 

Diverting Offenders 

with Mental Illness 

from Incarceration 

Mental Health Courts: 

An Emerging Evidenced- 

Based Practice 

n 1997, the nation’s first mental 

Ihealth court was created in 

Broward County, Florida to meet 

the needs of defendants with mental 

disorders charged with relatively 

minor offenses and who may have 

a history of frequent contact with 

the legal system. Criteria for admission 

to mental health court programs 

vary by jurisdiction. However, 

most require that the offender 

suffer from a serious mental illness, 



90 Chapter 7: Forensic Services 

Notes 

1 http://www.mentalhealthcourtsurvey.com/default.asp 

such as bipolar disorder, major 

depression or schizoaffective disorder, 

and that the crime committed 

is a misdemeanor or low-level 

felony. Sex offenders and other 

violent offenders are excluded 

from participation. According to the 

Survey of Mental Health Courts 

there are currently 110 mental 

health courts across the U.S. 1 

Research has suggested that mental 

health courts are an emerging 

best practice. A study of the Akron, 

Ohio mental health court showed 

their services helped keep participants 

out of jail. The study tracked 

40 program participants and found 

that their average number of incarcerations 

dropped from about 20 

per person in 2000 to 0.54 per person 

in 2003. Evaluation of the 

Broward County mental health 

court revealed that, at least in comparison 

to a traditional misdemeanor 

court, the mental health 

court enhanced treatment access 

and involvement for a substantial 

number of defendants appearing 

before it. Statistically significant 

results from two mental health 

courts in Seattle suggest that participation 

in the court program had a 

positive impact on relevant criminal 

justice and mental health indicators, 

such as linkage to mental 

health services and increased communication 

between systems. 

Brooklyn Mental Health Court 

he Brooklyn Mental Health 

TCourt was one of the first courts 

in New York State dedicated to 

handling criminal cases of defendants 

with a major mental illness, 

and is designed to provide a more 

clinically appropriate response to 

these defendants in the criminal 

justice system. The Brooklyn Mental 

Health Court has been developed 

as a joint project of the New 

York State Unified Court System, 

OMH and the Center for Court 

Criteria for Participation 

in the Brooklyn Mental 

Health Court 

he offender must have a 

Tmajor mental illness such as 

schizophrenia, bipolar disorder, 

major depression or schizoaffective 

disorder. 

The mental health evaluation 

must indicate that the offender's 

mental illness contributed to 

criminal activity, and that the 

offender is willing to enter into 

treatment and that the treatment 

may help the offender lead a 

crime-free life in the community. 

Innovation (CCI). Other government 

and nonprofit partners 

involved in planning the Mental 

Health Court include the New York 

City Department of Health and 

Mental Hygiene, the Kings County 

District Attorney’s Office, the Legal 

Aid Society, the Brooklyn Defenders 

Service and numerous representatives 

of the mental health 

treatment community. The program 

uses the authority of the Court to 

link offenders with mental illness 

to treatment, stabilize their illness, 

and prevent their return to the 

criminal justice system. 

The goals of the Brooklyn Mental 

Health Court are to: 

◆ Improve the court system’s ability 

to identify, assess, evaluate 

and monitor offenders with 


◆ Use the authority of the Court to 

link offenders with mental illness 

to appropriate mental health 

treatment and supports. 

◆ Ensure that participants receive 

high quality community-based 

services. 

◆ Engage participants in treatment 

and hold them accountable for 

their actions. 

◆ Create better understanding and 

effective linkages between the 



criminal justice and the mental 

health systems. 

◆ Improve public safety by reducing 

recidivism of offenders with 


The Brooklyn Mental Health 

Court process emphasizes the use 

of good information, judicial monitoring, 

clear accountability and the 

coordination of services. 

◆ An on-site clinical team performs 

detailed psycho-social assessments 

of each defendant 

referred to the Mental Health 

Court. This information allows 

the judge to make more 

informed decisions about defendants, 

enabling him to gauge the 

nature of defendants’ illnesses - 

and the risks they pose to public 

safety – in a much more 

nuanced way. Secondly, the 

information is used to craft individualized 

treatment plans for 

each defendant, matching them 

to appropriate counseling and 

service programs. 

◆ Every defendant in the Mental 

Health Court is required to 

return to Court regularly to meet 

with case managers and appear 

before the judge to report on 

progress in treatment. This keeps 

the judge engaged with the 

defendant for the life of the case 

and underlines for the defendant 

the seriousness of the process. 

◆ The Court has a range of graduated 

sanctions and rewards to 

respond to progress (and failure) 

in treatment. Regular monitoring 

of progress in treatment also 

holds service providers accountable 

to the judge. Where appropriate, 

changes in treatment plans 

are implemented to help defendants 

achieve stability. Defendants 

who complete all program 

requirements have their criminal 

charges dismissed or reduced. 

◆ In addition to mental health 

issues, many defendants also 

confront homelessness, unemployment, 

substance abuse and 

serious health problems. Therefore, 

the Mental Health Court 

works with a broad network of 

government and not-for-profit 

service providers to address 

these inter-related issues. 

Outcomes 

ince its inception in 2002, 318 

Sdefendants have been referred 

to the Brooklyn Mental Health 

Court. One hundred and fourteen 

defendants met criteria for program 

participation (based on offense, 

mental illness, etc.) and were 

accepted. Thirty-six participants 

have graduated from the Brooklyn 

Mental Health Court after successful 

program compliance. Only 10 

participants were terminated from 

the program and sentenced due to 

noncompliance. There are currently 

91 active participants in the Mental 

Health Court program. 

There are four other mental 

health courts in New York State. 

They are the Bronx TASC Mental 

Health Diversion Court, Buffalo City 

Mental Health Court, Niagara Falls 

Mental Health Court and the Monroe 

County Mental Health Court. 

The Bronx TASC Mental 

Health Diversion Court 

he Bronx TASC Mental Health 

TDiversion Court is a collaborative 

project of the Bronx Supreme 

Court, The Bronx District Attorney’s 

Office and the Education Assistance 

Corporation’s (EAC) New 

York City TASC (Treatment Alternative 

to Street Crime). 

The development of the Bronx 

TASC Mental Health Diversion 

Court was accomplished through a 

year long consensus building and 

planning process, supported by a 

Substance Abuse and Mental 





(SAMHSA) Community Action 

Grant. Utilizing a best practices 

approach, exemplary practices 

were reviewed for specialized court 

models (including TASC models) 

and provided to the consensus 

building participants developing 

the Court. 

The Bronx TASC Mental Health 

Diversion Court program works out 

of offices close to the Bronx 

Supreme Court and aims to divert 

felony-offenders with mental illness 

from the criminal justice system 

into treatment settings. The program 

staff conduct comprehensive 

psychiatric assessments, including 

risk assessments, and make treatment 

recommendations (including 

recommendations for risk management), 

placement into either outpatient 

or inpatient residential facilities, 

and continue to monitor the 

defendant with active engagement 

of the treatment provider on behalf 

of the court and the district attorney. 

This monitoring continues for 

18 to 24 months until the defendant 

transitions to a permanent 

housing and treatment plan and is 

given a final legal disposition. 

The Bronx TASC Mental Health 

Court continues to receive funding 

from SAMHSA, The Center for Substance 

Abuse Prevention, and The 

Center for Substance Abuse Treatment 

as well as the New York State 

Division of Probation and Correctional 

Alternatives (DPCA). In-kind 

contributions are provided through 

the Bronx Psychiatric Center. The 

program model and in-program 

client outcomes continue to be 

studied as appropriate for 

evidence-based approaches. 

Based on a SAMHSA study of the 

Court reported in March 2004, it 

was found that the findings were 

consistent with program goals: 

decreased substance use, psychiatric 

symptoms and criminal justice 

involvement (e.g. arrests and nights 

incarcerated) and involvement in 

an array of treatment services. 

The positive results of the Brooklyn 

Mental Health Court and the 

four other mental health courts in 

New York State have encouraged 

A Personal Story: 

im was first hospitalized for mental illness in 

J1997 at age 17. In 2001, after two more hospitalizations, 

he moved back in with his mother, 

stepfather and five younger siblings. His mother, 

not appreciating the importance of psychotropic 

medications in stabilizing the symptoms of his 

schizophrenia, encouraged him to stop taking his 

medications and to break his smoking habit with 

acupuncture and herbal treatments. Early in 2002, 

Jim left home, collected soda cans to make some 

money, slept on park benches, and broke into a 

government office to steal some supplies. He was 

arrested for the first time in his life and taken to a 

County Hospital for psychiatric treatment, where 

he was determined incompetent to stand trial and 

transferred to a secure forensic state hospital. 

After several months of treatment, he was deemed 

fit to proceed for trial, and his case was scheduled 

to be heard in the Brooklyn Mental Health 

Court, where he was evaluated by a social worker 

and a psychiatrist. In 2003, he pled guilty to burglary 

and agreed to participate in a court-supervised 

treatment program for 12 to 18 months. He 

began living at home again and attended an 

intensive psychiatric rehabilitation treatment program 

(IPRT) with a focus on completing his GED 

and getting a job. He also began seeing a therapist 

once a week and worked with an intensive 

case manager from a Civil State Psychiatric Center 

who helped to coordinate services for him. He 

reported to the Brooklyn Mental Health Court 

every two weeks for several months and once a 

month after demonstrating engagement in treatment 

and services. At his court appearances, he 

and the Judge talked about the books he liked to 

read and he brought the Judge some short stories 

that he had written. His mother promised the 

Judge that she would never again suggest that he 

stop taking his medication. In February 2004, Jim 

graduated from the Brooklyn Mental Health 

Court. His guilty plea was withdrawn and the 

Kings County District Attorney dropped all the 

charges against him. 



further collaboration between the 

Office of Court Administration 

(OCA) and the OMH. Judith S. 

Kaye, Chief Judge of the State of 

New York selected Judy Harris 

Kluger, Deputy Chief Administrative 

Judge for Court Operations 

and Planning of the New York 

State Office of Court Administration, 

to oversee court-based mental 

health diversion, including the 

development of additional mental 

health courts. Commissioner 

Carpinello and Judge Kluger have 

established a collaborative relationship 

between organizations. One 

collaboration between OMH, OCA 

and CCI is the identification of key 

elements of successful mental 

health courts and the development 

of a technical assistance program to 

assist communities in their development 

of court-based mental 

health diversion. 

Individuals with 

Mental Illness 

in the State 

Correctional System 

Background 

MH and the Department of Cor- 

Services (DOCS) joint- 

Orectional 

ly provide mental health services 

and treatment to individuals incarcerated 

in DOCS facilities. Over the 

past three decades, this service 

delivery system has grown to 

become a nationally respected 

model. It is the only comprehensive 

system in the U.S. to be fully 

accredited by both the American 

Correctional Association and the 

Joint Commission on Accreditation 

of Healthcare Organizations 

(JCAHO). 2 Representatives from all 

over the U.S. and the world have 

come to New York to observe how 

our system is operated. The 

specifics on how these services are 

provided and how the interagency 

collaboration is designed is set 

forth in a formal Memorandum 

of Understanding (MOU) between 

the two agencies. 

Prior to 1976, mental health services 

to persons confined to New 

York State correctional facilities 

were provided by DOCS at Matteawan 

and Dannemora State Hospitals. 

In 1976 legislation was 

enacted which transferred the 

responsibility for mental health 

services to OMH. To fulfill the 

requirements of the legislative 

mandate, OMH opened Central 

New York Psychiatric Center 

(CNYPC), an inpatient facility along 

with a network of correctionsbased 

satellite and mental health 

units which provide triage, crisis 

services referral and clinic services. 

In addition to the beds at CNYPC, 

OMH has 11 satellite and 11 mental 

health units in prisons throughout 

the State. With clinical staffing from 

OMH and security staffing from 

DOCS, satellite units provide a 

broad range of services to inmates. 

The 2005-2006 Executive Budget 

continues to support collaboration 

between OMH and DOCS, and 

builds upon the range of treatment 

services jointly provided for prisoners 

with serious mental illness. A 

total of $7 million in new OMH 

appropriations were provided to 

significantly expand mental health 

treatment capacity and clinical 

staffing for this population. These 

funds will support a range of new 

and expanded treatment services 

based upon a statewide review of 

the forensic program, including 

two new Behavioral Health Units 

established in DOCS facilities; 

almost triple the number of beds 

for the Special Treatment Program; 

expanded bed capacity for the 

Intermediate Care Program; and 

Notes 

2 The American Correctional Association develops and 

promulgates new national standards, revises existing 

standards, and coordinates the accreditation process 

for all correctional components of the criminal justice 

system in the U.S. The Joint Commission evaluates 

and accredits more than 15,000 health care organizations 

and programs in the U.S., including medical 

centers and teaching hospitals, nursing homes, etc. 




improved access to clinical staff for 

mental health services that includes 

hiring additional psychiatrists and 

nurse practitioners. 

The 2005-2006 Executive Budget 

appropriation to enhance corrections-based 

mental health services is 

the third such enhancement since 

1995. In fiscal year 1997-1998 40 

additional full time equivalent positions 

(FTEs) were added to OMH’s 

corrections-based mental health program 

to establish two new Satellite 

Units at Mid-State and Albion Correctional 

Facilities. In addition, in fiscal 

year 1999-2000, 82 additional 

FTEs were added to OMH’s corrections-based 

program to enhance 

aftercare planning services, mental 

health services to inmates confined 

to disciplinary housing units, and 

program oversight and administration. 

With full implementation of the 

2004-2005 Executive Budget Initiatives, 

OMH will have expanded its 

corrections-based services by more 

than 80% (from 231 to 420 FTEs 

since 1997-1998). 

System Overview 

MH provides appropriate cor- 

mental health 

Orections-based 

services to individuals with mental 

illness in State correctional facilities 

who require mental health services 

on either an ambulatory or inpatient 

basis. When inpatient services 

are provided to these inmates by 

law, all admissions are involuntary 

and received at CNYPC. 

Figure 7.1 depicts the typical 

paths individuals experience when 

accessing mental health services 

during their incarceration in DOCS. 

Inmates entering DOCS are 

processed into the system and classified 

at reception centers located 

at the Downstate, Elmira, Ulster, 

and Bedford Hills Correctional 

Facilities. Frequently, mental health 

providers who work in local correctional 

facilities refer individuals 

entering the State correctional system. 

At a minimum, each newly 

admitted inmate is accompanied by 

a discharge summary that describes 

his/her course of care in the local 

correctional facility. Newly admitted 

inmates receive a battery of 

assessments and evaluations including 

a mental health screening. The 

classification process enables DOCS 

to appropriately place inmates in 

the correctional system taking into 

account individual security, medical, 

and mental health needs. 

At each of the reception centers, 

OMH staff is available to evaluate 

the mental health needs of inmates. 

Inmates can be referred by DOCS 

staff as possibly requiring mental 

health treatment or referred for 

additional assessment during the 

classification process. Once placed 

in a correctional facility, inmates 

receive mental health services 

through the inmate orientation 

plan, self-referral, or referral by 

corrections or medical staff. Should 

an inmate require more intensive 

services than are provided in 

prison, she/he can be transferred 

to a correctional facility where the 

needed level of mental health services 

is available, and if needed, 

committed to CNYPC for inpatient 

services. Discharge planning is provided 

to inmates with mental illness 

returning to the community, 

who may be offered services such 

as those provided through the 

Community Orientation and Reentry 

Program (CORP). In addition, 

should inmates require continued 

inpatient mental health services 

after completing their sentence, 

they may be committed to a civil 

psychiatric center. 



Figure 7.1 

Services Delivered in State Correctional Facilities (Corrections-based Services) 

Jail 

Inmate 

Referral 

Typical Path to Access Mental Health Services 

for Prisoners with Mental Health Needs 

ìThe system doesn’t leave you ” 

Services within Corrections 

No Mental Illness Evident 

OMH Inpatient Services 

Mental Illness Evident 

Prison Intake and 

Reception Center 

• Every inmate receives a 

mental health screening 

at intake including state 

mental history review, 

interview with DOCS 

counselors and/or OMH 

clinical staff and record 

review from sending jail 

• Those with identified 

needs receive complete 

assessments and are 

referred to appropriate 

service 

Prison 

with services 

available 

by referral* 

Prison with 

Satellite Unit 

Triage inmate’s 

need for 

inpatient care 

Community Services 

CNYPC 

Inpatient 

Need for Inpatient Psychiatric Care 

Discharge Planning 

Prison 

with mental 

health unit 

Civil PC 

CORP 

Community 

Orientation & 

Re-entry Program 

*While in the general prison population, inmates receive mental 

health services through the inmate orientation plan, self-referral, 

or referral of corrections/medical staff 

Release 

and 

integration 

into the 

community 

Services Delivered in State 

Correctional Facilities 

(Corrections-based Services) 

C 

NYPC’s corrections-based services 

component is responsible for 

planning and providing mental 

health services to sentenced 

inmates with mental illness within 

DOCS facilities, and for coordinating 

their reintegration into the 

community upon release from 

incarceration. As described earlier, 

since 1995, corrections-based mental 

health services provided to State 

prison inmates have improved due 

to a substantial increase in the 

number of mental health staff from 

231 in 1997-1998 to 420 in 2004- 

2005. Today, OMH serves an 

inmate-patient caseload of approximately 

7,500. 

Satellite and Mental Health Units 

ervices are provided at DOCS 

Sfacilities throughout New York 

State through a system of 11 Satellite 

Units and 11 Mental Health 

Units (Figure 7.2). Each Satellite 

Unit has a corresponding catchment 

area of correctional facilities. 




Services are aimed at providing 

continuity of care, enhancing safety 

within the prisons for staff and 

inmates, supporting inmates to better 

function within DOCS programs, 

and assisting them in 

accessing mental health services 

prior to their release back to the 

community. 

Satellite Units are designed for 

inmates with serious mental illness. 

Their program components include 

Residential Crisis Treatment Programs, 

Clinic Services, Intermediate 

Care Programs, disciplinary Special 

Housing Unit Services, Consultative 

Services, and Pre-Release Planning. 

Special programs are also offered 

at select Satellite Units and include: 

Special Treatment Programs, Community 

Orientation and Reentry 

Programs and Creating Options to 

Manage Painful Emotions. Satellite 

Unit staff provide consultative mental 

health services on an as-needed 

basis to correctional facilities in the 

Satellite Unit’s catchment area that 

have no full or part time mental 

health staff. Approximately 35 of 

the 71 DOCS facilities offer on-site 

OMH services. 

Mental Health Units provide similar 

services to those provided at 

Satellite Units with the exception of 

Residential Crisis Treatment and 

Intermediate Care Programs as well 

as special programs. Unit components 

are described below. 

Figure 7.2 

Satellite and Mental Health Units 



Residential Crisis 

Treatment Program 

Residential Crisis Treatment Pro- 

(RCTP) consists of two 

Agram 

services: observation cells (56 beds 

statewide) and a dormitory area 

(93 beds statewide) where inmates 

experiencing a psychiatric crisis 

can be housed, observed, and 

treated. Patients housed in RCTP 

beds receive services from psychiatrists, 

other clinical staff and psychiatric 

nurses. Security is provided 

by DOCS correction officers. Once 

stabilized, RCTP patients are 

returned to their respective prison 

milieu or, if needed, committed to 

the inpatient unit of CNYPC. 

Intermediate Care Program 

n Intermediate Care Program 

A(ICP) is similar to day treatment 

and community residence programs, 

and is jointly staffed by 

DOCS and OMH personnel. A distinguishing 

feature of the ICP is that 

services are provided in a housing 

area that is separate from the general 

prison population. There are 11 

ICP units with 565 beds statewide 

serving inmates who are unable to 

function in the general prison population 

due to the effects of mental 

illness and its resulting functional 

impairment. The ICP’s goal is to 

provide each inmate with the support, 

treatment, and skill training 

necessary to return to the general 

prison population. 

Increased funding has been 

secured through the 2004-2005 

Budget to add a total of 87 new 

ICP beds at the Great Meadow, 

Sing Sing, and Fishkill Correctional 

Facilities. In 2003, nearly 500,000 

hours of therapeutic programming 

were provided to ICP inmates. 

Evaluation of the program has 

revealed significant reductions in 

serious rule infractions, suicide 

attempts, correctional disciplinary 

sanctions, and admissions to inpatient 

and RCTP beds. 

Clinic Treatment Services 

orensic clinic treatment services 

Fare similar to those provided by 

mental health clinics in the community. 

OMH staff provide screening 

and assessment of inmates in 

response to self-referrals and mental 

health referrals from DOCS staff 

and other sources. Patients are provided 

individual and group therapy 

and psychiatric services. In 2003, 

there were a total of 147,141 clinic 

treatment contacts with inmates. It 

is estimated there are 500,000 clinical 

contacts each year for all program 

types. In January 2004, 

CNYPC provided 12,460 treatment 

contacts in their walk-in corrections-based 

mental health clinics, 

an increase of 9% from the 11,454 

receiving treatment in January 

2002. 

Screening and Evaluation 

utpatient services also include 

Othe evaluation of inmates for 

DOCS programs such as Work 

Release, Program Committee and 

Family Reunion Program, and the 

evaluation of inmates referred by 

the Division of Parole. There are 

1,000 screenings per month, not 

including regular screenings of 

those conducted on inmates in disciplinary 

Special Housing Units. 

Forensic Telepsychiatry 

Consultation 

NYPC provides case consulta- 

to remote correctional facili- 

Ction 

ties. Participating correctional facilities 

include Attica, Clinton, Elmira, 

Five Points and Sing Sing. To date, 

Satellite Units have participated in 

more than 40 consultations with 

clinicians at the NYS Psychiatric 

Institute. For the past 21/2 years, 

Great Meadow Correctional Facility 

has been providing telepsychiatry 

services to the Upstate Correctional 

Facility. Beginning in August 2004, 

OMH piloted a telepsychiatry program 

to provide direct services 




between CNYPC psychiatric staff 

and inmate-patients at Elmira Correctional 

Facility. Initial feedback 

has been positive. More information 

regarding telepsychiatry is 


Special Housing Unit Services 

eginning in May 2004, a joint 

BCNYPC and DOCS Case Management 

Committee was implemented 

in all maximum security 

prisons for the purpose of reviewing, 

monitoring, and coordinating 

treatment and behavior plans for 

inmates assigned to a disciplinary 

Special Housing Unit (SHU). 

Inmates are transferred into SHU 

disciplinary cells for only the most 

serious infractions of prison rules 

such as fighting or assault. Every 

inmate in SHU in New York State 

receives mental health screening, 

and if referred, receives evaluation 

and/or screening by CNYPC. 

Each Case Management Committee 

has co-chairs-one from DOCS 

and the other from OMH. The purpose 

of the Committee is to review 

and monitor SHU inmates on the 

OMH caseload and any other SHU 

inmates who are referred to the 

committee. The Committee will 

also review the status of all inmates 

newly assigned to SHU following a 

disciplinary hearing in which the 

inmate’s mental health or intellectual 

capacity is at issue. The Case 

Management Committee meets 

every two weeks. After reviewing 

an inmate’s status, the Committee 

may do one of the following: (1) 

recommend restoration of privileges, 

suspension or reduction of 

SHU sentences, or a housing reassignment; 

or (2) recommend to the 

OMH Satellite Unit Chief that the 

inmate’s medication be reevaluated 

or that the inmate be examined by 

two physicians for possible commitment 

to CNYPC. 

Recent data suggests that there 

has been statistically significant 

improvement in the number of 

mental health contact hours and 

cell-side contact hours among SHU 

inmates. There has also been a significant 

reduction in the percentage 

of SHU inmates who are classified 

as having a serious mental illness. 

Services to SHU inmate-patients 

include: 

Behavioral Health Unit 

MH will be expanding its servic- 

in 2005-2006 to inmates diag- 

Oes 

nosed with serious mental illness, 

who, due to their disciplinary status, 

are serving time in SHU, and 

require mental health treatment 

beyond which has been previously 

available in a SHU environment. 

This new program model, Behavioral 

Health Units (BHU) will be 

located at Great Meadow and Sullivan 

Correctional Facilities and will 

include the addition of 102 beds 

offering evaluation, intervention, 

and supportive mental health services. 

BHUs provide psychiatric and 

behavioral interventions that enable 

inmate to adjust to environmental 

demands, and, if successful, ultimately 

allow for reintegration into a 

prison placement. The inmate population 

targeted for this program 

includes individuals who have not 

benefited from traditional corrections 

based mental health services 

and have demonstrated a marked 

inability to conform their behaviors 

to societal or institutional expectations. 

The BHU program is 

designed to meet the mental health 

needs of these individuals while 

taking into consideration safety and 

security needs of the prison system. 

Bedford Therapeutic 

Behavioral Unit 

he number of female inmate- 

on OMH rolls who 

Tpatients 

demonstrate disruptive, aggressive, 

and self-injurious behaviors resulting 

in extended SHU or Keep Lock 

placement has prompted OMH to 

reconfigure its existing services to 

address the needs of these individ- 



uals to avoid placement in disciplinary 

housing. For this reason, 

OMH, within existing resources, 

will expand the Bedford Therapeutic 

Behavioral Unit (TBU) from 16 

to 32 beds. The program will continue 

to offer psychotherapeutic 

and behavioral treatment interventions 

that will enable inmatepatients 

to adjust to and function 

effectively in a specialized, alternative 

program. The ultimate goal for 

inmate-patients is the achievement 

of behavioral adjustment that will 

allow for reintegration into the 

general population. 

Special Treatment Program 

he Special Treatment Program 

T(STP) is designed for seriously 

mentally ill patients in SHU who 

require extended services. STP 

group and individual interventions 

are provided in the SHU for two 

hours per day, five days a week for 

those patients who meet admission 

criteria. STPs have been in operation 

at Attica since 2000 and Five 

Points since 2001. Program evaluation 

studies report positive outcomes 

including reductions in disciplinary 

consequences for 

participants, reduction in use of crisis 

mental health services, and 

greater treatment adherence including 

medication compliance and 

improved mental health functioning. 

The 2004-2005 Budget includes 

appropriations to expand STP 

capacity (currently 43 slots) by 75 

additional slots. 

Inpatient Services 

hen services provided within a 

Wprison do not meet the needs 

of an inmate-patient, hospital services 

are made available. OMH provides 

inpatient services for persons 

serving sentences within the DOCS 

and local correctional facilities at 

CNYPC, a 189 bed maximum security 

forensic hospital serving an 

inmate population of over 65,000. 

CNYPC is the only State facility 

where inmate-patients who are 

serving sentences (either in prison 

or in jail) may be involuntarily hospitalized 

as psychiatric inpatients. 

Continuity of Care between 

Inpatient and Correctionsbased 

Services 

o ensure continuity of care 

Tbetween inpatient and corrections-based 

services, a new mechanism 

is being piloted at CNYPC. 

Pursuant to a court order, an 

inmate-patient may be treated with 

psychiatric medication over his 

objection at CNYPC’s inpatient unit, 

and that order may follow the 

patient after discharge to one of its 

corrections-based Satellite Units. As 

of November 2004, orders have 

been obtained for 32 individuals. 

Pre-Release Planning 

and Transitional Services 

and Programs 

re-Release planning services are 

Pprovided to inmate-patients, 

who have serious mental illness 

and require follow-up treatment in 

the community. Eligible patients 

are enrolled in the Medication 

Grant Program and have Social 

Security applications submitted. 

Pre-Release Coordinators may refer 

patients approaching release date 

to CNYPC for consideration for 

inpatient treatment and coordination 

to the inpatient Discharge 

Ward, or to Assisted Outpatient 

Treatment (AOT) for determination 

if court-ordered treatment should 

be in place prior to release from 

prison. An AOT Committee reviews 

all referrals and coordinates information 

with county court systems 

to assure public safety. 

The number of inmate-patients on 

the OMH caseload for whom aftercare 

linkages were made upon 

release has quadrupled since 1995. 




This increase is due in part to OMH 

hiring seven new pre-release coordinators, 

and is also a result of 

improved reporting and case finding. 

It is projected that in 2004, 

1,800 individuals will have received 

aftercare linkages. 

Community Orientation 

and Re-entry Program 

MH, DOCS and the Division of 

OParole (DOP) have collaborated 

with community-based service 

providers to develop and implement 

a program designed to meet 

the needs of inmates returning to 

the community whose mental 

health issues go beyond that which 

the pre-release coordinators can 

effectively manage. This innovative 

Community Orientation and Reentry 

Program (CORP) is housed in 

a 30-bed unit within the ICP at 

Sing Sing Correctional Facility. The 

mission of this program is the safe 

and successful return of these 

inmate-patients to the community. 

Inmate-patients identified as seriously 

mentally ill and returning to 

the greater New York Metropolitan 

Area may be transferred to the 

CORP unit approximately four 

months before their scheduled 

release to the community. 

In designing the program, planning 

staff sought to utilize a Best 

Practices approach and incorporate 

the following elements into the 

final program components: Peer 

Support, Peer Bridging, Cognitive 

Behavioral Programming, Reach-In 

Services, On-Site Interviews, Risk 

Assessment and Risk Management 

Plans, Dedicated Mental Health 

Parole Officers, Benefit Applications 

and Coordinated Programming 

through DOCS, DOP and OMH. 

CORP inmate-patients are housed 

in a segregated gallery where corrections 

officers who are specially 

trained in working with inmates 

with mental illness supervise their 

activities. Five days a week, CORP 

patients participate in a variety of 

modules comprising a specialized 

psychiatric rehabilitation day treatment 

program. Modules focus on 

areas such as symptom and medication 

management, substance 

abuse and relapse prevention, 

anger management and alternatives 

to violence, working with DOP and 

community providers, community 

resource awareness and community 

survival skills. 

Major goals of the program are to 

improve community living skills, 

minimize criminal recidivism and 

psychiatric deterioration, and 

increase the successful length of 

stay in the community. Each year 

the program is expected to serve 

100-125 male inmates with serious 

mental illness who are released to 

New York City. 

Community Integration 

Case Management 

he New York State LINK pro- 

has been the anchor of 

Tgram 

New York City-based release programs. 

It is a transition case management 

program which services 

individuals with serious mental illness 

being released from state 

prison. The program has grown to 

include seven case managers who 

use best practice approaches in 

engaging participants, including: 

pre-release telephone interview 

and day-of-entry contact and coordination 

with the Division of 

Parole. The focus of this program 

is to buffer re-entry for individuals 

and transition individuals to longterm 

care providers. 

Most releases to the community 

from CORP are coordinated with 

the State LINK team. Service plans 

may include day treatment programs, 

MICA programs, referral to 

self-help programs or clinic services. 

When individuals do not have a 

residence, referrals are made to 

housing providers. LINK expanded 



its services to provide “reach-in 

engagement,” during which staff 

visit the CORP unit on a regular 

basis to meet with patients and 

participate in community preparation 

groups. 

Parole Supported 


n 2000, New York State devel- 

a housing program for indi- 

Ioped 

viduals with serious mental illness 

being released from prison. OMH 

and the Division of Parole jointly 

funded a parole supported treatment 

program (PSTP) which provides 

50 supported housing beds 

coordinated with an Assertive Community 

Treatment team for individuals 


substance abuse, who will be 

under parole supervision. 

The PSTP provides “reach-in” 

services for CORP patients. Professional 

staff provide on-site interviews 

and community preparation 

groups while peer staff provide 

self-help groups. Referrals are also 

made to other housing providers 

and CORP staff actively cultivate 

housing resources. Since the program 

opened, there have been 

over 50 housing agencies which 

have visited the CORP unit and 

have been impressed with the thoroughness 

of the clinical documentation, 

comprehensiveness of the 

program and engagement of the 

patients. Providers who previously 

had not accepted referrals of prison 

releasees have since agreed to 

accept referrals from CORP. 

Outcomes 

ince opening in January 2003, 

SCORP has averaged 15 new 

enrollments per month. Early evaluation 

results indicate that the program 

is performing well by 

improving mental health functioning 

and community skills. Seventyseven 

percent of enrollees have 

been released to the community 

and another 10% to a community 

psychiatric hospital. After 90 days, 

66% of patients released to the 

community were still living there. 

Most were participating in programs 

and learning new community 

survival skills. Participant comments 

from the program include: 

“This is my third bid (prison sentence). 

When I was released before 

I had nothing like this. When they 

came to me and told me they were 

transferring me to Sing Sing 

because they had a program for 

me, I’m thinking, yeah right, a program 

for me, like last time. They 

gave me lawn mower repair. Lawn 

mower repair? What are you going 

to do with lawn mower repair in 

New York City? So I wasn’t expecting 

much. But I’ll tell you what. 

This program is great. I have a 

chance this time. I have people 

that will help. I have hope.” 

Osborne Association Safe Landing 

unded by the Robert Woods 

FJohnson Foundation, the 

Osborne Association operates a reentry 

program for persons with 

mental illness who are being 

released from Sing Sing and 

Bayview Correctional Facilities. 

Safe Landing staff provide reach-in 

assessment and re-entry preparation 

for individuals returning to 

New York City. Upon release, the 

Osborne Association also provides 

case management and linkage services. 

Program participants are identified 

by a CNYPC pre-release coordinator 

who arranges mental health 

follow-up, while Safe Landing staff 

provide linkage to other services 

including employment, education 

and entitlements. 

Project Caring Community 

roject Caring Community is a re- 

initiative for women with 

Pentry 

serious mental illness being 

released from the Bedford Hills 

and Taconic Correctional Facilities. 




The program’s target population 

includes women who will be 

regaining custody of their children 

upon release. In this program, 

OMH, DOCS, and the Division of 

Parole, have partnered with Goodwill 

Industries and the Bridge Inc. 

for planning, coordination and 

sharing of resources to develop an 

integrated pre-release, transition 

and aftercare program. 

The Medication 

Grant Program 

s part of New York State’s 

AKendra’s Law, the Medication 

Grant Program (MGP) provides the 

ability to file Medicaid applications 

for inmates with mental illness 

prior to their release from prison to 

the community. To qualify for 

MGP, an individual must have 

received mental health services in a 

correctional facility, have a mental 

illness, be prescribed psychiatric 

medications, and apply for Medicaid 

prior to or within one week of 

release from a correctional facility. 

The program covers screening visits 

with a mental health professional, 

medication evaluation and diagnostic 

visits with a physician, 

provision of injectable medications, 

follow-up visits to monitor for 

medication side effects and/or to 

adjust dosages and laboratory tests. 

Enrollees are given a MGP card 

which is valid for use at over 3,700 

pharmacies statewide. 

A Personal Story: 

n 2003, Ben entered CORP. While the program 

Iwas in operation less than a year, it took him 

three and a half decades to get the opportunity 

CORP offered him. Ben is 45 years old and diagnosed 

with schizoaffective disorder. He had 

resigned himself to a life of crime and “doing 

time.” Ben had been designated a juvenile delinquent 

and remanded to a detention center at age 

ten and was first adjudicated as a youthful offender 

in 1975 at age 16 for attempted sexual abuse in 

the first degree. As a result of four additional violent 

felony convictions and two parole violations, 

Ben spent the next 28 years incarcerated with only 

six months time in the community. The violence 

did not stop while incarcerated. He received multiple 

disciplinary tickets. 

Ben’s mental health history is as lengthy and 

serious. He was first treated in 1968 for array of 

psychotic symptoms including paranoid delusions 

and command auditory hallucinations telling him 

to harm himself and others. Like so many patients, 

his clinical picture is complicated by a history of 

polysubstance dependence that included heroin 

crack and marihuana, when available, and sniffing 

glue and gasoline when not. 

In the 116 days that preceded his release, it was 

CORP’s task to change the trajectory of Ben’s life. 

He quickly responded to the milieu and began 

active participation in the program, took solace 

from the prayer circle, and despite isolative and 

paranoid trends, became increasingly involved 

with other CORP patients. At his last meeting he 

thanked everyone with the words “You saved my 

life.” 

He was released from Sing Sing early in 2004. 

He was approved for SSI before release. However, 

he was assigned both an Intensive Case Manager 

from the NYS LINK team and a “peer bridger” 

from Hands Across Long Island. Both maintained 

close contact with the patient, the “peer bridger” 

went beyond his job description to support his 

success. 

Now, almost one year since his release, a man 

who denied his substance dependence and mental 

illness, attends daily AA/NA meetings and receives 

outpatient mental health services. Ben has been 

reunited with his estranged family and is now living 

with them. After a 35 year history of crime, 

Ben remains reformed and free. Ben had no previous 

work history, but is now actively pursuing a 

career as a “peer specialist.” 



OMH-LINK Case Management 

T 

hrough a staff-sharing agreement 

with the Federation Employment 

and Guidance Service, Inc. (FEGS), 

OMH’s LINK Case Management 

Program in New York City provides 

short-term intensive case management 

to individuals with serious 

mental illness who are returning to 

the City from State correctional 

facilities. The LINK program provides 

intensive case management 

services for approximately five 

months until the client is stable and 

placed with other case management 

providers. LINK also attempts 

to find housing and treatment programs 

for these hard-to-place individuals. 

Typical program participants 

have serious mental illness, 

extremely violent criminal justice 

histories, and are homeless. When 

a LINK participant is released from 

prison, the assigned intensive case 

manager meets the inmate at the 

Port Authority Bus Station in New 

York City and assists in all aspects 

of contacting Parole, housing and 

other community supports. This 

program was recognized in 2000 

by the Governor’s Office of 

Employee Relations and an 

Achievement Award was given to 

State work teams for substantially 

contributing to the public good. 

Since 1996, OMH LINK has served 

909 clients. 

Conclusion 

T 

he delivery of effective mental 

health care, treatment and services 

to inmates with serious mental 

illness requires a careful balancing 

of overall safety and security issues 

with the individual treatment 

needs. 

OMH recognizes that collaborative 

planning, program overview 

and use of evaluation information 

are crucial for the continued overall 

effectiveness and success of our 

forensic mental health programs 

and services. OMH is committed to 

providing a comprehensive array of 

mental health services to persons 

across the criminal justice spectrum 

in settings consistent with the public 

safety, as well as supporting 

access to services deemed essential 

to successful adjustment to both 

institutional and community living. 

More information about OMH 

forensic facilities and the populations 

they serve is available on the 

OMH Web page at http://www. 

omh.state.ny.us/omhweb/forensic/ 

index.htm. 





Chapter 8: Preventing Suicide 105 

Preventing Suicide Chapter 8 

Overview 

of OMH’s Statewide 

Suicide Prevention 

Campaign 

I 

n May 2004, OMH launched 

SPEAK, a statewide public education 

and awareness campaign that 

uses a public mental health model 

to help people become more familiar 

with the risks and warning signs 

of suicide. 1 Research has shown 

that suicide prevention and early 

intervention efforts are successful 

in saving lives, and by encouraging 

and assisting people to learn when, 

where, and how to speak up, suicides 

may be prevented. 

With a team of nationally recognized 

experts, clinicians and individuals 

whose lives have been 

touched by suicide, OMH gathered 

the most current scientific knowledge 

available about suicide risks 

and prevention, and produced Suicide 

Prevention Education and 

Awareness Kits (SPEAK) for 

statewide distribution. SPEAK is 

designed to provide people with 

information to help them better 

understand suicide and give them 

ways to help prevent it. The kits 

include information about suicide, 

suicide prevention, risk factors, 

warning signs, and resources about 

how to seek help through crisis 

information and treatment sources 

that are accessible on a 24/7 basis 

in every New York State county. 

There is also information about 

specific populations and age 

groups (i.e. men, women, older 

adults and teens). Ongoing 

research findings are informing further 

development of SPEAK. For 

example, a booklet written specifically 

for parents of college students 

was added in response to a recent 

research finding that the percentages 

of students treated for depression 

and feeling suicidal doubled 

during 1989-2001. 2 

While the main goal of the 

SPEAK campaign is education and 

awareness to prevent suicide, it is 

hoped that SPEAK’s broad-based 

Notes 

1 The OMH press release announcing the 

Statewide Suicide Prevention Campaign is 

included in Appendix 8 

2 Benson, S.A., Robertson, J.M., Tseng, W-C., 

Newton, F.B., & Benton, S.L. (2003). Changes 

in counseling center client problems across 

13 years. Professional Psychology: Research 

& Practice, 34(1) 66-72. 

SPEAK, OMH’s Suicide Prevention Education Awareness Kit 



106 Chapter 8: Preventing Suicide 

Suicide 

Prevention 

Education 

Awareness 

Kit 

overnor Pataki opened 

Gthe Executive Mansion for 

the kickoff of the SPEAK 

campaign on May 19, 2004. 

More than 150 invited guests 

attended, including Members 

of the Assembly and Senate, 

executive chamber staff, 

agency commissioners, local 

mental health directors, 

OMH staff and advisory 

board members, advocates, 

suicide survivors, service 

recipients, family representatives, 

educators, social workers, 

psychologists, psychiatrists, 

suicidologists, primary 

care physicians, and public 

health officials. 

Notes 

3 Conte, Christopher, Dealing with Demons. 

Governing, August 2004, pp. 28-31. 

4 New York spearheads its own suicide prevention, 

education initiative. Mental Health 

Weekly, July 26, 2004, vol.14, no.28, pp. 1-3. 

5 Carpinello, S.E. (December 2004). Going 

proactive: Embracing outreach and prevention 

in the public mental health arena. 

Behavioral Healthcare Tomorrow, 13 (6): 8-9. 

public mental health approach will 

help to mitigate the stigma associated 

with seeking help for psychological 

distress. An important message 

of the SPEAK campaign is to 

ask for help when you or someone 

you care for needs it. 

Extensive use of both print and 

electronic media is an important 

element of the SPEAK campaign. 

In 2004, OMH launched multiple 

initiatives to raise the public’s 

awareness and understanding of 

the need for suicide prevention and 

to combat stigma. More than 10,000 

SPEAK kits have been distributed, 

with an additional 20,000 requests 

for specific booklets, posters, and 

resource guides in the process of 

being fulfilled. These booklets are 

written for specific populations at 

risk: those who are depressed, 

teenagers, older adults, women, 

men, and college students. 

Requests for kits have come from a 

cross section of community organizations 

and individuals: primary 

care physicians and nurses (89); 

not-for-profit agencies (12,155), 

State psychiatric hospitals’ outpatient 

programs (1,122); voluntary 

and private hospitals and health 

maintenance organizations (1,921); 

school districts (all 1,692 schools in 

the State will receive kits via the 

State Education Department); local 

government agencies (1,273); State 

agencies with local programs 

(1,435); colleges and universities 

(375); professional associations 

(1,498); advocacy organizations and 

individuals (1,290); pastoral and 

faith community (196); out-of-state 

(130); individual requests (273); and 

corrections and law enforcement 

(3). These numbers do not reflect 

the potential of other State and 

Local agencies printing and distributing 

SPEAK kits on their own. 

Beyond the printed word, more 

than 2,000 individuals have been 

instructed in person about SPEAK 

by OMH’s Commissioner, Director 

of Project Management, and Health 

Promotion and Education staff. 

Audiences have included: NASMH- 

PD, National Council on Suicide 

Prevention, medical staff at Jamaica 

Hospital Medical Center, NAMI- 

NYS, United Way of New York 

State and New York City, NYSUT 

Health Educators, MHA-NYC, New 

York Psychological Association, a 

statewide Trauma Symposium held 

in Brooklyn, visitors to the 2004 

New York State Fair in Syracuse. In 

all, more than 37 SPEAK presentations 

were held in 2004 and more 

are planned during 2005. In June 

2004, SPEAK was the featured subject 

of a Benita Zahn televised 

health program broadcast on Channel 

13 (Albany), and additional suicide 

prevention public service 

announcements are planned for television 

and radio which target college 

students, adolescents, and the 

elderly. 

SPEAK is also available on the 

OMH Web site in English and 

Spanish at http://www.omh.state. 

ny.us/omhweb/speak/. Feature articles 

on SPEAK have appeared in 

Governing magazine, 3 Mental 

Health Weekly 4 and Behavioral 

Healthcare Tomorrow. 5 

Suicide in New York 

uicide is the leading cause of 

Sviolent death in New York State, 

the U.S., and the world. The number 

of New York State residents 

whose lives are lost to suicide 

(1,292 in 2002) exceeds the number 

of homicide victims by 32%. 

One in ten New York teenagers 

made plans to commit suicide in 

2003, and one in seven seriously 

considered it. The economic 

impact of suicide in our State is 

estimated to be between $1.1 and 

$5.0 billion annually. The suicide 

rate in New York State peaked in 

1994, declined steadily until 1999, 

and has remained constant since 



that time at 6.6 suicides per 

100,000 population. 6 

In 2002, one in 25 suicides in the 

U.S. occurred in New York State, 

and the State had the sixth highest 

number of suicides in the nation 

after California, Florida, Texas, 

Pennsylvania, and Ohio. For each 

completed suicide in New York, 

there are 8-25 attempts, resulting in 

millions of dollars in health care 

expenditures, lost wages, disability 

payments, and lost productivity. 

From 2000-2002, 3,830 New York 

residents completed suicide, and 

more than 24,000 individuals were 

treated and discharged from New 

York hospitals as a result of selfinflicted 

injuries. Most of those 

treated were female. Most of those 

who died were male. 

Geography, Race, Ethnicity, 

Sex and Age Factors 

he incidence of suicide in New 

TYork mirrors a national trend of 

elevated attempts in rural areas, 

compared to urban or suburban 

areas. Besides geography, incidence 

is affected by race, ethnicity, 

sex and age factors. Among suicide 

deaths in New York State in 2000, 

80% were male, 85% were White, 

10% were Black, and 8% were Hispanic. 

Males comprised 68% of suicides 

among Whites and 78% 

among both Blacks and Hispanics. 

Overall, White males aged 25-54 

accounted for nearly 40% of all 

New York suicides in 2000. 

During this time period, there 

were no recorded suicides for 

Black females aged 65 and older or 

for Hispanic females between 25-34 

years of age or older than 75. Finally, 

suicide among the very young 

(


Notes 

8 More information about the United States 

Air Force Initiative to Prevent Suicide is 

available on the Web at 

http://phs.os.dhhs.gov/ophs/BestPractice/us 

af.htm 

9 More information about the TeenScreen ® 

program is available on the Web at 

http://www.teenscreen.org/. 

the burden of suicide prevention 

lies with everyone, not just the 

medical community. It calls for the 

development and enhancement of 

community-based suicide prevention 

programs that involve a crosssection 

of community members 

who can recognize the signs of suicidal 

intent and intervene. Methodology 

compels us to advance the 

science of suicide prevention. 

The National Strategy for Suicide 

Prevention (NSSP), a collaborative 

effort of SAMHSA, CDC, and other 

federal agencies, represents the 

combined work of advocates, clinicians, 

researchers and suicide survivors 

around the nation. Its Summary 

of National Strategy for 

Suicide Prevention: Goals and 

Objectives for Action (2001) lays 

out a framework for action to prevent 

suicide and guides development 

of an array of services and 

programs. The NSSP has established 

twelve goals and encourages 

states to meet them through wellintegrated 

plans and programs. 

More information about this national 

suicide prevention project is 

available on its Web site at http:// 

www.mentalhealth.samhsa.gov/ 

suicideprevention/strategy.asp. 

In 2002 the Institute of Medicine 

of the National Academy of Sciences 

published their report, 

Reducing Suicide. Its panel of 

experts recommended a broad 

range of actions based on the best 

scientific evidence to date. The 

Final Report of the President’s New 

Freedom Commission, Achieving 

the Promise (2003) concluded that 

“suicide is a serious public health 

challenge that has not received the 

attention and degree of a national 

priority it deserves. Many Americans 

are unaware of suicide’s toll 

and its global impact.” Accordingly, 

the Commission’s first goal is to 

save lives throughout the nation by 

preventing suicides across the life 

span. The Commission has identified 

two model mental health programs 

whose goals include suicide 

prevention: the “United States Air 

Force Initiative to Prevent Suicide” 8 

and the “Columbia University Teen- 

Screen ® Program.” 9 

In the early 1990s one-quarter of 

U.S. Air Force deaths resulted from 

suicide. In response, the U.S. Air 

Force Initiative to Prevent Suicide 

was implemented and it has since 

reduced suicides in the Air Force 

by 33%. Key to the program’s success 

is the strong message of support 

from the top of the command 

structure and efforts to reduce the 

stigma of acknowledging mental 

health problems. By changing the 

dynamics of how Air Force personnel 

addressed sensitive personal 

issues and rewarding self-admission 

and penalizing problem-avoidance, 

factors leading to suicide were 

effectively treated. Moreover, the 

intervention also reduced risk for 

other violent behaviors (e.g., accidental 

deaths, violent offenses, and 

severe family violence). 

Columbia University’s TeenScreen ® 

program is designed as an easy and 

reliable screening program for 

depression, suicide risk, and other 

mental disorders that pose a serious 

threat to the health, well-being, and 

academic success of our youth. The 

program’s goal is to ensure that all 

youth are offered a mental health 

checkup before graduating, or otherwise 

leaving high school. At no 

charge, the Columbia University 

TeenScreen ® Program provides consultation, 

mental health screening 

materials, software, training, and 

technical assistance to schools and 

communities. TeenScreen ® identifies 

and refers for treatment those who 

are suffering from an untreated 

mental illness and are at risk for suicide, 

finding them before suicide 

becomes the tragic outcome. 



Beyond Awareness: Suicide 

Prevention in New York State 

uicides are a complication of 

Spsychiatric disorders. More than 

90% of those attempting suicide 

have a diagnosable psychiatric illness, 

10 and the most common diagnoses 

are mood disorders including 

major depression, bipolar disorder, 

and dysthymia. Treatment of 

depression with psychotropic medications 

is usually effective, as are 

certain cognitive therapies. To 

effectively reduce the suicide rate, 

an integrated strategy involving 

multiple interventions is required. 

Access to evidence-based care and 

treatment for those who are 

depressed or suicidal across the life 

cycle is essential. Early identification 

of those who bear suicidal risk 

from depression, coupled with 

referral for treatment, will improve 

the prospects for saving lives. 

A multi-layered strategy that combines 

focused attention on those 

who are imminently suicidal and 

many others who harbor risk factors 

predisposing them to selfharm, 

but are not yet in a suicidal 

state, offers the best hope of saving 

lives in New York. Given the close 

connection between mental disorders 

and suicidality, prevention 

must give special attention to diagnosing 

and treating persons with a 

psychiatric disorder. 

From a statewide perspective, 

mental wellness and suicide prevention 

are “local.” To be meaningful, 

behavioral change must originate in 

our communities in peoples’ homes 

and workplaces; in the courts and 

criminal justice system; in jails and 

prisons; in non-governmental organizations, 

community and faith-based 

agencies; and in government agencies. 

11 The essential goal of such 

grass roots efforts is to de-stigmatize 

help-seeking around suicidal 

thoughts and feelings. 

Saving Lives in New York 

A 

statewide, population-based 

effort at suicide prevention 

needs to be flexible enough to 

impact citizens living in rural settings 

as well as densely populated 

metropolitan areas and suburbs. 

For the past two years, OMH 

researchers have collaborated with 

members of the New York State 

Suicide Prevention Council to 

assess the current state of suicide 

in New York and to offer real 

world solutions to saving lives at 

risk. 12 The result is a 450 page 

study containing recommendations 

based on the ‘best science’ of suicide 

prevention. The study identified 

several approaches to suicide 

prevention including promoting 

personal resilience, adopting guidelines 

for media coverage of suicidal 

events, broader mental health 

screening, availability of warm lines 

and hot lines statewide, and restrictions 

on access to lethal means by 

suicidal persons. The burden of 

suicide throughout the life course 

is explained by specialists in each 

of the following populations: adolescents, 

college students, families, 

suicide survivors, new mothers, 

men in the middle years, cultural, 

ethnic and racial groups, recipients 

of mental health services, the dually 

diagnosed, and older adults. 

The study’s findings and recommendations 

will be available in the 

near future. 

OMH Suicide Research 

and Intervention 

he enigma that is suicide is the 

Tresearch problem that a group 

of neuroscientists and child psychiatrists 

in OMH have made their 

life’s work. The goal is to elucidate 

the triggers for suicide and then 

develop interventions to prevent it. 

OMH researchers are on their way 

to satisfying that goal. 

Notes 

10 Mann, J.J. (2002). A current perspective of 

suicide and attempted suicide. Annals of 

Internal Medicine, 136: 302-311 

11 Knox, K.L., Conwell, Y., & Caine, E.D. (2004). 

If suicide is a public health problem, what 

are we doing to prevent it? American Journal 

of Public Health, 94(1): 37-45. 

12 See Appendix 9 for a New York State Suicide 

Prevention Council membership list. 




Neuroscientists in OMH have 

embraced modern technologies 

and applied them successfully in 

deciphering the brain. Child psychiatrists 

found that rigorous 

research techniques coupled with 

sensitivity when approaching teens 

at risk is the best approach to getting 

results. 

Suicide and the Brain 

number of years ago, 

Aresearchers began investigating 

the causes of suicide and found 

that while there are biological 

abnormalities in the brain involving 

neurotransmitters, such as serotonin, 

that underlie major depression 

and related mood disorders, 

there was a separate set of abnormalities 

in the brain related to the 

predisposition or vulnerability to 

commit suicide. By careful mapping 

of these abnormalities in the brain 

of individuals who have committed 

suicide, the researchers have been 

able to identify an area of the brain 

that is involved in impulse control. 

The input of the neurotransmitter 

serotonin to this area of the brain is 

clearly impaired in individuals who 

commit suicide. This impairment 

contributes to the clinical observation 

that these individuals tend to 

be more likely to act on powerful 

feelings and, in general, remain 

more impulsive throughout their 

lives. Unfortunately, when this 

impulsivity is coupled with depression 

and suicidal feelings, the individual 

is more likely to act on those 

feelings and commit suicide. OMH 

researchers have observed that the 

serotonin system that supplies that 

part of the brain seems to show a 

deficit and, by extension, have 

determined that there is a similar 

deficit in individuals who are 

impulsively aggressive. Thus, a 

breakdown or an impairment of 

this behavioral restraint system in 

the brain may predispose certain 

individuals to commit suicide when 

they feel very depressed and other 

individuals to commit aggressive 

acts when they feel angry. 

With the availability of brain 

scanning techniques in very recent 

time, we have extended our 

research to try to determine 

whether individuals who are at risk 

for suicidal behavior manifest the 

same deficits in the serotonin system 

in the brain prior to suicide. 

Can these findings in postmortem 

brain studies be observed in living 

individuals before they commit suicide? 

To find out, researchers have 

employed a combination of PET 

(positron emission tomography) or 

PET scanning and MR imaging 

(magnetic resonance imaging) to 

study the brain of individuals who 

are suffering from depressions and 

to compare those who have a history 

of suicidal behavior to those 

who have never manifested any 

suicidal behavior. Preliminarily, 

these findings are beginning to 

demonstrate serotonin abnormalities 

that may be responsible for 

suicidal behavior and opening, for 

the first time, the possibility that 

these individuals can be intensively 

treated in order to prevent suicide. 

The introduction of such scanning 

techniques into clinical practice 

represents a very real possibility in 

terms of enhancing our ability to 

detect such high-risk individuals. At 

present, general clinical evaluation 

has proven an insufficient method 

to detect high-risk individuals, and 

may explain why suicides occur in 

individuals who have seen their 

doctor within the last month. 

Adding brain imaging approaches 

involving brain scans to detect 

these vulnerable individuals may 

increase the likelihood that more 

high-risk individuals will be detected 

before they die and permit the 

implementation of appropriate 

medication and psychotherapies. 

The increasing knowledge gained 

by such innovative research is a 



boon to those in the field as well 

as people whose lives have been 

personally touched by suicide. 

Adolescent Suicide 

MH child researchers have 

Ohelped to launch programs in 

schools nationwide, including New 

York, to address the absence of a 

mental health component to general 

health evaluations. Schools provide 

the ideal setting to introduce 

interventions to identify children 

potentially at risk for suicide and in 

need of treatment. The researchers 

developed the DISC (Diagnostic 

Interview Schedule for Children), 

the most widely tested and 

researched child psychiatric assessment 

tool available. The computerized 

and self-administered version 

of this instrument allows children, 

including those who are unable to 

read, a private interview that provides 

complete reporting and 

instant diagnosis based on DSM-IV, 

the manual of psychiatric disorders. 

While these intervention measures 

are critical, a discussion of suicide 

must also include an examination of 

the contagion phenomenon. Known 

as the “copycat effect,” teens are particularly 

vulnerable to suicide by 

notables or fellow students and are 

influenced by reports and portrayals 

of suicide in their schools or in the 

mass media. To reduce the contagion 

or copycat effect, the OMH 

researchers were recruited for a 

national panel to develop specific 

research-based recommendations for 

the media and for school personnel. 

The report includes facts about suicide 

and mental illness, recommendations 

for interviewing surviving relatives 

and friends as well as 

recommendations for language. This 

was a necessary step towards increasing 

awareness in the media and 

encouraging responsible reporting 

that may serve to educate the public. 

Conclusion 

T 

hrough public mental health 

promotion, research, and collaborative 

work with members of the 

New York State Suicide Prevention 

Council, New York State is talking 

important steps to lessen the burden 

of suicide for our citizens. Giving 

people the information they 

need to help themselves can lead 

to an overall reduction of risk factors 

that can lead to self-harm, and 

an increased quality of life for all. 

In addition, accurate information 

will go far in challenging the myths 

and unveiling the mysteries that so 

often surround mental illness and 

suicide. 

Outreach efforts that are multidimensional 

and address the needs 

of the entire person have the greatest 

potential for positive impact. 

OMH will continue to successfully 

address meeting the needs of 

“every single one” by approaching 

public mental health efforts such as 

SPEAK in partnership with colleagues 

and counterparts in other 

governmental and communitybased 

health, social or family service 

agencies. For example, the 

agency is developing a disaster 

preparedness and “resiliency” campaign 

for the entire State and a 

separate campaign, in partnership 

with the State Department of 

Health, is aimed at combating eating 

disorders in young women. By 

broadening its focus beyond treating 

mental illness only, and reaching 

into communities through public 

mental health promotion efforts, 

OMH has enhanced the potential 

to promote the mental health of all 

New Yorkers. 

Additional Sources 

of Information 

“A Landmark Program Beyond Compare,” Preventing 

Suicide: The National Journal, 3(2) 

February 2004, p. 3. 

American Academy of Child & Adolescent Psychiatry, 

Children and Firearms, 1999. 

Chaudron, L.H., & Caine, E.D. (2004). Suicide 

among women: a critical review. J Am Med 

Womens Assoc., 59(2):125-34. 

Goldsmith, S.K., Pellmar, T.C., Kleinman, A.M., & 

Bunney, W.E. (eds.) Reducing Suicide: A 

National Imperative. (Washington, DC: The 

National Academies Press, 2002). 

Moscicki, E.K., & Caine, E.D. (2004). Opportunities 

of life: preventing suicide in elderly 

patients. Arch Intern Med.,164(11):1171-2. 

National Heart, Lung, and Blood Institute 

(NHLBI), The Framingham Study: Design, 

Rationale, and Objectives. Online at 

www.framingham.com/heart/ Retrieved on 

10/21/04. 

National Strategy for Suicide Prevention: Goals 

and Objectives for Action. (Washington, DC: 

DHHS, 2001). 

President’s New Freedom Commission on Mental 

Health Final Report. (2003). Achieving the 

Promise: Transforming Mental Health Care in 

America. (Washington, DC: DHHS). 

The Surgeon General’s Call to Action to Prevent 

Suicide (Washington, DC: DHHS, 1999). 

National Suicide Prevention Hotline and Web 

Site The U.S. Department of Health and 

Human Services’ Substance Abuse and Mental 

Health Services Administration (SAMH- 

SA) has launched the National Suicide Prevention 

Lifeline 1-800-273-TALK. The 

national hotline is part of the National Suicide 

Prevention Initiative (NSPI)-a collaborative 

effort led by SAMHSA that incorporates 

the best practices and research findings in 

suicide prevention and intervention with the 

goal of reducing the incidence of suicide 

nationwide. In addition to the national hotline, 

a new Web site has been launched at 

http://www.suicidepreventionlifeline.org. 





Chapter 9: Implementing OMH’s Strategic Plan 113 

Implementing OMH’s 

Strategic Plan 

Chapter 9 

Introduction 

ociety places high value on per- 

information because of 

Sformance 

universal interest in learning how 

much return taxpayers receive on 

their social investments. In the 

health care field, including mental 

health, societal concerns are creating 

an increasing demand for information 

on the quality and value of 

services delivered. OMH shares this 

concern and is committed to performance 

improvement in the delivery 

of mental health services. The 

formal “vehicle” for using performance 

information is found in an 

organization’s strategic plan, which 

translates its mission and values into 

desired goals and sets forth measurable 

objectives for performance 

improvement. This chapter focuses 

on the OMH Strategic Plan. Its goals 

and related objectives will form the 

framework for agency quality 

improvement activities during this 

Plan’s life cycle. On a regular basis, 

OMH will publish progress reports 

on its achievement of the objectives 

related to these goals. 

The 2004-2008 Statewide Comprehensive 

Plan described OMH’s conceptual 

framework for performance 

measurement, which focuses on the 

outcome domains of accessibility, 

quality and appropriateness, service 

system outcomes and cost. Last 

year’s Plan also highlighted our 

ongoing efforts to produce performance 

indicators from analysis 

of mental health service delivery 

and outcomes data available to the 

agency. These efforts will continue 

throughout the planning horizon 

covered by this year’s Plan, yielding 

a year-by-year increase in the number 

of performance indicators available 

for use by OMH and in the 

agency’s capacities for using performance 

indicator data to guide 

management decision-making and 

quantitatively assess progress. 



114 Chapter 9: Implementing OMH’s Strategic Plan 

OMH Performance 

Management Model 

he OMH performance manage- 

model, first conceptualized 

Tment 

in the late 1990s, describes performance 

management as a continuous 

process enabling data-driven 

quality improvement. The processes 

include gathering input from 

stakeholders on relevant areas of 

performance, collecting and analyzing 

data related to the area of performance, 

reporting performance 

results, and subsequently refining 

programs and services based on 

user feedback. Together, these 

processes form a continuous quality 

improvement cycle (Figure 9.1). 

This model continues to guide 

agency efforts to produce performance 

measures and it will be used 

to implement the long-term quality 

improvement processes needed to 

realize the goals and objectives in 

our Strategic Plan. 

Figure 9.1 is also intended to 

describe the mental health planning 

process itself in which progress 

toward implementing the goals and 

objectives in the Strategic Plan is 

regularly reviewed, prioritized, and 

refined by interactions with the 

public. The goal of “welding” this 

performance management and 

measurement approach to strategic 

planning is two-fold: improved likelihood 

that the goals and objectives 

Figure 9.1 

Performance Measurement Model 

Start here 

Process: 

Informed health 

care decision making 

Goal: 

Program and resource 

allocation supported by 

data driven consumer 

choice 

Process: 

Interview stakeholders 

Goal: 

Measure outcomes 

deemed vital to 

consumers, family 

and providers 

Accessible, individualized 

recovery-oriented services 

Process: 

Measure performance 

Goal: 

Collect data on 

relevant aspects 

of performance 

Process: 

Analyze and report 

performance 

Goal: 

Performance data 

becomes actionable 

information 

Adapted from: Carpinello, S., Felton, C.J., Pease, E.A., DeMasi, M., and Donahue, S. (1998). Designing a system for managing the performance of mental 

health managed care: An example from New York State's prepaid mental health plan. Journal of Behavioral Health Services & Research, 25: 270-279. 



of the Strategic Plan will be 

achieved, yielding over time quantifiable 

improvements in the quality 

of the public mental health system 

through accessible, individualized 

recovery-oriented services. 

Through this performance management 

model, OMH will continuously 

solicit stakeholder input on 

the Strategic Plan and through this 

interactive process prioritize its 

content into sets of short- and 

long-term agency objectives. The 

process for setting goals and measuring 

performance against them is 

an ongoing management activity 

consistent with the values and 

operating principles contained in 

our Strategic Planning Framework, 

as described in Chapter 1. While it 

is the State’s role as the public 

mental health authority to determine 

goals and objectives, this 

process will be conducted in partnership 

with Local governments 

and the stakeholder community. 

The result will be an open and 

inclusive planning process that provides 

the public with a “road map” 

of agency initiatives, priorities, 

management strategies, and measures 

of success. 

OMH 

Strategic Plan 

T 

he OMH Strategic Plan guides 

agency executives in the development 

and oversight of a targeted 

set of management activities and in 

the initiation of new planning 

activities. This Strategic Plan reflects 

OMH’s response to the significant 

public input received on the 2004- 

2008 Statewide Comprehensive 

Plan. During the series of 2004 

public events and the numerous 

planning advisory meetings 

described in Chapter 3, OMH made 

a concerted effort to understand 

the nature and magnitude of 

response to the agency’s current 

set of initiatives. Of specific note is 

the input received from people 

who use mental health services 

and the resulting publication of a 

White Paper (Appendix 4) with 

recommendations for improving 

mental health care. 

Major Goals and Objectives 

Included in the Strategic Plan 

MH has crafted, with assistance 

Ofrom the expanded stakeholder 

input efforts of 2004, a Strategic 

Plan consisting of: overarching 

goals, objectives related to each 

goal, specific management strategies 

to advance each objective, and 

specific performance indicators to 

gauge success. Figure 9.2 (page 

110), defines the seven goals and 

related objectives included in the 

Strategic Plan; together, these form 

a high-level view of what OMH 

intends to achieve during the 2005- 

2009 planning period. 

We believe these seven goals and 

related objectives capture the 

hopes and expectations regarding 

continuous quality improvement in 

the public mental health system 

expressed by stakeholders during 

2004. We intend to validate the 

degree to which this Plan is 

responsive to public feedback by 

implementing it through our 

renewed emphasis on Local-level 

planning and public participation, 

and through use of OMH’s performance 

management system. 




Figure 9.2 

OMH Strategic Plan 

Goal 1 

Improve the mental 

wellness and 

resiliency of all New 

Yorkers through an 

effective public 

education function. 

1.1. Increase public awareness 

of the prevalence of 

suicide and of risk and 

preventive factors 

1.2. Maintain agency capacity 

to rapidly and effectively 

provide mental health 

support in response to 

natural and man-made 

disasters. 

1.3. Improve public understanding 

of the causes and 

treatment for mental 

illness in adults and 

emotional disturbance 

in children. 

1.4. Promote rapid response to 

the detection and treatment 

of the psychological 

aspects of eating disorders. 

1.5. Promote early intervention 

and prevention strategies, 

particularly with primary 

care physicians and other 

health care providers. 

Goal 2 

Improve the quality of 

mental health services 

currently available 

to all adults with 

serious mental illness 

and all children with 

serious emotional 

disturbance. 

2.1. Increase the availability of 

evidence-based practices in 

routine care. 

2.2. Decrease the risk of experiencing 

adverse consequences 

resulting from 

harm, neglect or suboptimal 

care or treatment. 

2.3. Increase the State’s capacity 

to measure and monitor 

the quality of care. 

2.4. Increase the State’s and 

counties’ capacity to 

improve performance 

based on outcomes measurement. 

2.5. Maintain adequate 

resources to ensure that 

high quality services are 

able to be provided. 

Goal 3 

Increase State and 

Local accountability 

for improvements in 

access to services, 

quality and appropriateness 

of services, 

and cost of services. 

3.1. Improve the State/Local 

mental health planning 

process to promote 

accountability. 

3.2. Improve care coordination 

for people with multiple 

inpatient admissions and 

little connection to appropriate 

outpatient services. 

3.3. Improve oversight of 

medication practices for 

both adults and children. 

3.4. Improve the service 

provider certification and 

licensing process. 



Goal 4 

Goal 5 

Goal 6 

Goal 7 

Reduce the burden 

of illness through 

strengthened ties with 

the scientific community 

engaged in both basic 

and applied research. 

Improve outcomes 

for adults with serious 

mental illness and 

children with serious 

emotional disturbance 

through use of proven, 

effective treatments. 

Increase access 

to appropriate and 

effective services for 

special populations. 

Improve the capacity 

of State and Local 

governments to 

achieve agency goals. 

4.1. Improve knowledge about 

the causes of mental illness. 

4.2. Promote the development of 

new treatments. 

4.3. Improve culturally competent 

models of service 

delivery using consumer 

input. 

4.4. Improve the length of time it 

takes to disseminate research 

findings to relevant audiences. 

4.5. Improve the degree to which 

research scientists provide 

technical assistance (both 

continuing education and 

consultation) to service 

practitioners. 

4.6. Improve the degree to which 

the agency can assess the 

magnitude of social cost and 

burden in order to prioritize 

resource utilization. 

5.1. Increase planning efforts 

concerning inpatient admissions 

and readmissions. 

5.2. Decrease use of treatments 

shown to be ineffective. 

5.3. Increase consumer and 

family input and participation 

in the treatment planning 

process. 

5.4. Increase use of underutilized 

services known to be effective. 

5.5. Improve access to services 

with the potential to help 

individuals achieve success 

and satisfaction in living, 

learning, work, and social 

environments. 

6.1. Improve services for children 

with depression. 

6.2. Improve services for people 

with mental illness who use 

forensic systems of care. 

6.3. Improve services for young 

adults. 

6.4. Improve services for older 

adults. 


with mental illness who 

reside in adult homes 


who require intensive levels 

of care coordination, 

including people served by 

the SPOA system, ACT teams, 

and people served through 

the Assisted Outpatient Treatment 

program 

7.1. Maintain sufficient resources 

for State and Local service 

delivery at levels necessary to 

ensure appropriate access to 

services. 

7.2. Improve retention and 

recruitment to ensure a 

qualified workforce. 

7.3. Improve system capacity for 

delivery of culturally competent 

services. 


delivery of consumerrequested 

services. 


employee skills development 

and competency. 

7.6. Maintain system capacity to 

articulate cost-effectiveness. 




Figure 9.3 

Subset of Goals and 

Objectives from the 


Management Strategies 

and Performance Indicators 

chieving progress on any of the 

Agoals and objectives contained 

in the OMH Strategic Plan requires 

specific and sustained management 

activities, and measuring success 

requires the definition of relevant 

indicators of performance against 

which progress can be measured. 

OMH already has in place many of 

the required management activities 

and performance indicators. The 

agency is currently in the process 

of identifying areas in which existing 

management strategies need to 

be altered or augmented to better 

advance Plan goals and objectives, 

and specific targets for change that 

can be measured using existing 

performance indicators to document 

progress. Figure 9.3 illustrates, 

for a subset of the goals and 

objectives included in the Strategic 

Goal Objective Management Strategy Performance Indicator 

Improve the Mental 

Health and Resiliency 

of all New Yorkers 

Increase public awareness of 

the prevalence of suicide and 

risk and preventive factors 

Continue implementation of 

SPEAK campaign 

Stakeholder ratings of the value 

of public educational materials 

(assessed via online questionnaires) 

Improve public understanding of 

the causes and treatment for 

mental illness in adults and 

serious emotional disturbance 

in children 

Continue to expand production 

of public education materials 

and outreach activities 

Stakeholder ratings of the value 

of public educational materials 

(assessed via online questionnaires) 

Improve the Quality of 


Currently Available to 

Adults with Serious 

Mental Illness and 

Children with Serious 

Emotional Disturbance 

Increase the availability 

of evidence-based practices 

in routine care. 

Increase the State’s capacity to 

measure and monitor the quality 

of care. 

Continue ACT implementation. 

Expand implementation of the 

Child and Adult Integrated 

Reporting System (CAIRS) to 

additional service sectors. 

Number of ACT enrollees per 

1000 Adults with SPMI. 

Number of agencies and county 

mental health authorities using 

the CAIRS system. 

Increase State 

& Local Accountability 

for Improvements in 

Access to Services, 

Quality & Appropriateness 

of Services & 

Cost of Services 

Improve the State/Local 

planning process 

to promote accountability 

Continue 2004 dialogues and implement 

plans for common set of data 

elements and performance measures; 

conduct dialogue meetings in 

all regions of the State; increase the 

number of counties with access to 

the DWH and CAIRS; 

Develop new county planning 

data set in conjunction with 

CLMHD. 

Frequency of use by county staff 

of OMH data warehouse, including 

new county planning data 

set (via web-based portal). 

Improve oversight of medication 

practices for both adults and 

children 

Full implementation of PSYCKES 

and TRAAY (medication guidelines 

and associated decisionsupport 

tools) 

Proportion of OMH physicians 

using PSYCKES to review prescribing 

histories of OMH inpatient 

service recipients under 

their care. 



Plan, some of the management 

strategies already in place and 

related performance indicators. 

O 

OMH Monitoring 

of Strategic Plan Progress 

MH will expand its current performance 

improvement structures 

to further foster cross divisional 

review of performance data 

related to our Strategic Plan. A new 

agency Performance Improvement 

Committee will be established to 

integrate across the agency’s operational 

Divisions the performance 

management and planning process- 

Figure 9.3, Continued 

Subset of Goals and 

Objectives from the 


Goal Objective Management Strategy Performance Indicator 

Reduce the Burden 

of Illness through 

Strengthened Ties 

with the Scientific 

Community Engaged 

in both Basic & 

Applied Research 

Improve culturally competent 

models of service delivery using 

consumer input 

Improve the degree to which 

research scientists provide technical 

assistance (both continuing 

education and consultation) to 

service practitioners 

Continue implementation of 

research demonstration funded 

by SAMHSA on cultural adaptation 

of family psychoeducation. 

Expand OMH’s telemedicine 

service to additional localities 

throughout the State. 

Ratings by culturally-diverse 

family members of the quality 

and appropriateness of OMH 

family psychoeducation services. 

Number of telemedicine sessions 

conducted; Number of 

locations participating in 

telemedicine sessions. 

Improve Outcomes for 

Adults with Serious 

Mental Illness & 

Children with Serious 

Emotional Disturbance 

through Use of Proven, 

Effective Treatments 

Increase family input and participation 

in the treatment planning 

process 

Continue statewide implementation 

of family psychoeducation 

services. 

Family ratings of their level of 

involvement in treatment and 

treatment plan participation (via 

Parent Assessment of Care survey). 

Increase Access to 

Appropriate & Effective 

Services for Special 

Populations 

Improve access to services with 

the potential to help individuals 

achieve success and satisfaction 

in living, learning, work and 

social environments 

Improve services for older adults 

Continue ACT implementation. 

Begin first phase of Personalized 

Recovery-Oriented Services for 

adults (PROS) implementation. 

Continue development of internal 

work plan; vet plan with 

stakeholders. 

Ratings by service recipients of 

their quality of life (Mental 

Health Services Survey) 

To be determined based upon 

finalized workplan. 

Improve services for people who 

require intensive levels of care 

coordination, including people 

served by the SPOA system, ACT 

teams, and people served 

through the Assisted Outpatient 


ACT team implementation and 

evaluation to continue; SPOA’s 

are all operational and many are 

starting to report using CAIRS; 

finalize evaluation report summarizing 

findings from first five 

years of AOT . 

Ratings by case managers of 

recipients’ engagement in community-based 

services. 

Improve the Capacity 

of State and Local 

Governments to 

Achieve Agency 

Goals 

Improve system capacity for 

employee skills development 

and competency. 

Continue educational forums to 

educate workforce in evidencebased 

practice approaches. 

Employee ratings of usefulness 

and quality of EBP practice trainings. 




W 

e urge all readers of 

this report to comment 

on any aspect of 

this year’s Statewide Plan, 

including the OMH 

Strategic Plan outlined in 

this Chapter. One easy 

way to do this is to submit 

feedback electronically 

via the OMH Web site 

at: http://www.omh.state.ny.us 

(you will find instructions 

in the Statewide Plan section 

of the Web site). 

es necessary to achieve goals in 

the Strategic Plan. This Committee 

will consist of high level managers 

with representation from all parts 

of the agency. Specific activities of 

this Committee will include: 

1. Using input from stakeholders, 

develop a “short list” of nearterm 

goals within the Strategic 

Plan. Prioritize plan goals based 

on this list so that there are core 

goals for immediate attention 

and developmental goals. 

2. Review and validate the appropriateness 

of specific performance 

measures in relation to the 

selected goals and reach consensus 

on which measures are to be 

used to monitor progress toward 

goal achievement. 

3. Select relevant management 

strategies that are most likely to 

prove beneficial in achieving 

each goal. Develop specific indicators 

for each strategy. Incorporate 

indicators into existing work 

plans or develop new work 

plans as needed. 

4. Review performance indicators 

and assess whether desired 

changes are occurring and if 

established targets are being met. 

Much of this review process 

already occurs in OMH for ongoing 

initiatives; however, those 

subsumed within the Strategic 

Plan will have progress monitored 

as part of Performance Improvement 

Committee activities. 

5. Identify management strategies 

and interventions that could be 

expected to improve performance. 

6. These “improvement” ideas 

would then be developed into 

specific action steps and work 

plans amended by the appropriate 

organizational unit(s). 

7. The role of the Committee 

would then be to monitor implementation 

of these plans and 

review subsequent impact on 

outcomes. 

Examples of OMH progress 

monitoring reports are included in 

Figure 9.4, located at the end of 

this Chapter. 

Conclusion 

s OMH begins the implementa- 

of its 2005 Strategic Plan, 

Ation 

county governments and stakeholders 

will have the opportunity to provide 

significant input on our Strategic 

Plan and its associated 

management strategies, performance 

indicators, and appropriate performance 

targets through the planning 

process. Progress reporting components 

associated with this process 

will have utility both within OMH 

for internal performance improvements, 

but will also have public 

benefit in that progress toward the 

achievement of goals will be regularly 

transmitted to the public 

through OMH’s Web site and other 

means of dissemination. Using 

OMH’s performance management 

model, the Strategic Plan will 

remain a living plan, one that 

adapts to stakeholder feedback and 

as objectives are achieved. Through 

a reinvigorated, more inclusive planning 

process, it will continually 

change to reflect the needs of New 

Yorkers whose lives are touched by 

mental illness. Our commitment to 

quality is paramount. 



Figure 9.4 

Progress Monitoring Report Example 

Goal: 

Management 

Strategy / Program 

Initiative: 

Improve oversight of medication practices for both adults and children 

Extend availability of PSYCKES to all OMH operated inpatient facilities serving adults 

Performance 

Measures 

Selected for 

Monitoring 

Progress 

Current 

Performance 

Short-term 

target (one year 

interim goal 

unless otherwise 

specified) 

Actions 

to be taken 

to achieve 

target 

Responsible 

Party 

Next 

Committee 

Review Date 

1. Access to 

PSYCKES: 

a. Number and % 

of OMH operated 

adult facilities 

trained to 

use PSYCKES 

1.a. 11 out of 20 

(55%) adult 

facilities have 

been trained 

1.a. 100% of adult 

facilities will be 

trained in PSY- 

CKES 

1.a. Complete implementations 

in 

progress (7 

sites) by scheduling 

and conducting 

trainings 

OMH Center 

for Information 

Technology 

and Evaluation 

Research (CITER) 

OMH Division of 


3 Months 

b. % of attending 

physicians 

with access 

to PSYCKES 

b. 140 out of 275 

(50%) attending 

physicians have 

access to PSY- 

CKES 

b. 100% of attending 

physicians 

have access to 

PSYCKES 

b. Initiate implementations 

at 

remaining sites 

(6 facilities), 

including meeting 

with leadership, 

coordinating 

access 

requests, and 

scheduling/conducting 

trainings 

2. Use of PSYCKES 

Number and % 

of attending 

physicians with 

PSYCKES access 

who access 

PSYCKES at 

least 1/month 

2. 52 out of 140 

(37%) of attending 

physicians 

with access to 

PSYCKES 

accessed the 

program 

(11/2004) 

2. 75% of attending 

physicians 

will access PSY- 

CKES monthly 

2. Investigate and 

share facilitylevel 

best practices 

for supporting 

PSYCKES 

use by attending 

psychiatrists 

Continue to provide 

e-mail and 

telephone technical 

support 






Goal: 

Management 

Strategy / 

Program 

Initiative: 

Increase public awareness of the prevalence of suicide and risk and preventive factors 

Continue implementation of SPEAK awareness campaign using multi-media and trained 

personnel (OMH staff and community “gatekeepers”) 

Performance 

Measures 

Selected 

for Monitoring 

Progress 

Current 

Performance 

Short-term 

target (one 

year interim 

goal unless 

otherwise 

specified) 

Actions 

to be taken 

to achieve 

target 

Responsible 

Party 

Next 

Committee 

Review Date 

1. Self-inflicted 

injury rates for 

general population 

and adolescents, 

ages 

15-19 

2. Suicide rates for 

general population 

and adolescents, 

ages 

15-19 

3. Number of 

SPEAK Kits and 

booklets produced 

and 

available 

1. 2000-2002 

self-inflicted 

injuries and 

rates available 

as “baseline 

performance” for 

all 62 counties 

(DOH website) 

2. 1993-2002 trend 

data for completed 

suicides 

available (DOH) 

3. 30,000 (English) 

3,500 (Spanish) 

1. Monitor self 

inflicted injury 

rates in counties 

adopting SPEAK. 

2. Monitor suicide 

rates for all age 

groups in counties 

adopting 

SPEAK. 

3. Increase supply 

of SPEAK Kits 

and booklets by 

10% within one 

year. 

Overall activity pursuant 

to the foregoing 

targets will 

be pursuant to a 

marketing plan 

developed in consultation 

with the 



Council, the OMH 


Working Group, 

and the Office of 

Public Affairs and 

Planning. 

OMH Office of 

Public Affairs 

and Planning 

3 Months 

4. Number of 

SPEAK Kits 

distributed 

4. Direct mail audience 

for SPEAK 

news release 

and sample kit - 

125 persons 

4. Increase distribution 

of SPEAK 

Kits and booklets 

by 10% 

within one year. 

5. Percent of 

respondents rating 

the kit components 

favorably 

(4 or 5 on 

evaluation scale) 

5. Reviewing evaluation 

5. Increase return 

of evaluation 

forms by 10% 

this calendar 

year. 





Goal: 

Management 

Strategy / 

Program 

Initiative: 




Performance 

Measures 

Selected 


Progress 

Current 

Performance 

Short-term 

target (one 

year interim 

goal unless 

otherwise 

specified) 

Actions 

to be taken 

to achieve 

target 

Responsible 

Party 

Next 

Committee 

Review Date 

6. Attendance 

at SPEAK 

presentations 

7. Number of presenters 

trained 

(OMH workforce, 

community 

“gatekeepers”) 

8. Electronic media 

outlets utilized 

6. Total numbers 

who have 

received an inperson 

presentation 

on SPEAK 

exceeds 2,000 

7. Training to begin 

January 2005. 

8. Taping of PSA’s 

for both television 

and radio by 

Commissioner for 

later broadcast 

planned. 

6. Increase attendance 

at SPEAK 

presentations by 

10% this year. 

7. Increase number 

of SPEAK - 

trained personnel 

by 20% this 

year. 

8 Provide media 

coverage of 

SPEAK in five 

media markets 

within one year 

(print and electronic) 



targets will 




with the 








Planning. 



and Planning 

3 Months 






Goal: 

Management 

Strategy / 

Program 

Initiative: 




Performance 

Measures 

Selected 


Progress 

Current 

Performance 

Short-term 

target (one 

year interim 

goal unless 

otherwise 

specified) 

Actions 

to be taken 

to achieve 

target 

Responsible 

Party 

Next 

Committee 

Review Date 

9. Number of cooperating 

organizations 

(e.g. United 

Way, Samaritans) 

9. Organizations and 

entities who have 

engaged with OMH 

over SPEAK 

include, individual 

physicians (15); not 

for profit agencies 

(157), psychiatric 

centers (48), voluntary 

hospitals (57), 

school districts 

(121), local governments 

(57), state 

agencies (40), university/colleges 

(17), associations 

(31), advocacy 

groups and consultants 

(27), court/ 

judicial (1), pastoral 

(3), organizations 

(28), other (individuals, 

professional 

disciplines, companies, 

etc. (110), and 

local police and law 

enforcement (2). 

9. Grow the number 

of cooperating 

organizations by 

8% this year in 5 

metropolitan 

areas throughout 

the State. 



targets will 




with the 








Planning. 



and Planning 

3 Months 





Goal: 

Management 

Strategy / 

Program 

Initiative: 

Improve fidelity and outcomes of Assertive Community Treatment (ACT) programs. 

Management Strategy: Combine data sources (e.g., CAIRS, Medicaid, Licensing, AOT, and 

State inpatient data) to produce performance indicators measuring fidelity to the ACT model 

and individual outcomes for consumers. 

Performance 

Measures 

Selected 


Progress 

Current 

Performance 

Short-term 

target (one 

year interim 

goal unless 

otherwise 

specified) 

Actions 

to be taken 

to achieve 

target 

Responsible 

Party 

Next 

Committee 

Review Date 

1. Use of CAIRS by 

ACT Teams 

# and % of total 

ACT consumers who 

have CAIRS baselines 

submitted 

Baselines on 2,305 

ACT consumers have 

been submitted (represents 

50% of total 

when all teams have 

full caseloads) 

Baselines submitted 

on all 4,700 ACT 

consumers 

1. Produce and disseminate 

benchmarking 

reports 

on # and % of 

baselines submitted 

by each team 

2. Follow up with 

teams on a regularly 

scheduled 

basis to review 

submission statistics 

1. OMH Center 


Technology 





3 months 

2. Fidelity Measures 

% increase in 

DACTS score for 

ACT teams 

Current mean 

DACTS score is 4.04 

(0.33 SD) 

0.5 SD increase in 

mean DACTS score 

to 4.2 

1. Produce data 

analysis on 

DACTS scores 

2. Provide training 

and consultation as 

needed to improve 

scores on individual 

fidelity items 



Technology 





3 months 

3. Outcome Indicators 

% reduction in inpatient 

days for ACT 

clients 

Average 45% reduction 

for new admissions 

(6 months post 

vs. 6 month pre) 

Increase average 

reduction by 5%, to 

50% 

1. Produce indicator 

reports on hospitalization 

for teams 

2. Discuss performance 

with teams 

and identify and 

assist in resolving 

any barriers to 

goal achievement 



Technology 





3 months

OMH - Office of Mental Health - New York State

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