What are we going to be talking about?

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2 What are we going to be talking about? 1. Review 2015 Legislative Activities on the Federal and State Levels Legislative Priorities for New York State: Broad Issues and Specific Legislation 3. Making Your Voice Heard: How to be the Most Impactful Advocates

3 Pain, Progress and Promise Mental Health Initiatives in 2015

4 2015 Developments on the Federal Level

5 A Lot Can Happen in a Four Weeks Ending 2015 and Starting 2016 with a Bang! U.S. Senate Passes Mentally Ill Offender and Treatment Crime Reduction Act (MIOTCRA) Budget agreement contains several positive advancements U.S. Senate passed S Mental Health Awareness and Improvement Act of 2015 President Obama calls on Congress to allocate additional $500m for mental health services

6 U.S. Senate Passes S.993 Mentally Ill Offender and Treatment Crime Reduction Act (MIOTCRA) Sponsored by Senator Al Franken (D. MN) Strong bipartisan support, co-sponsors included Senate Judiciary Committee Chair Chuck Grassley (R. Iowa) and Ranking Member Patrick Leahy (D. Vermont).

7 MIOTCRA Bill Will: Expands the use of MIOTCRA funds to include the following: Veterans treatment courts CIT type training for law enforcement and correctional officers on how to respond to individuals experiencing psychiatric crises Mental Health and substance abuse treatment and services for individuals who are incarcerated Alternatives to solitary confinement Mental health and substance use services for individuals reentering communities following incarceration to reduce recidivism Enhanced data collection and measurement of outcomes.

8 MIOTCRA Bill Still Before House The House version HR 1854 has yet to be voted on. Rep. Maloney is NOT a sponsor of the bill. Call his office at or and tell him to support HR New York State Reps Co-Sponsoring HR 1854 Rep. Hanna, Richard L. [R-NY-22] Rep. Rangel, Charles B. [D-NY-13] Rep. Tonko, Paul [D-NY-20] Rep. Jeffries, Hakeem S. [D-NY-8] Rep. Katko, John [R-NY-24] Rep. Meeks, Gregory W. [D-NY-5]

9 Budget Agreement Contains Several Positive Advancements The budget bill includes a number of important provisions including: An increase of $50 million for the State Mental Health Block Grant program administered by the Substance Abuse and Mental Health Services Administration (SAMHSA. 10% of these funds are designated for funding early intervention programs for people with serious mental illness, an increase from the current 5% set-aside. These programs deriving from the NIMH Recovery After an Initial Schizophrenia Episode (RAISE) initiative include

10 Budget Agreement Contains Several Positive Advancements NIMH Funding Increase An increase of $85.4 million in funding for biomedical and services research at NIMH. Total funding for NIMH in FY 2016 will be increased to $1,548,390,000 RESEARCH=HOPE!

11 Budget Agreement Contains Several Positive Advancements The bill also provides $15 million for a new Assisted Outpatient Treatment (AOT) pilot program through SAMHSA. NAMI will be encouraging SAMHSA to focus on funding projects modeled after San Francisco's new AOT program that include a significant outreach and engagement component prior to AOT or if an AOT order is necessary, to assist and empower people under AOT orders to realize their personal goals and achieve better outcomes. MIOTCRA funding sustained in budget agreement, but as I just detailed, we want to pass the bill to expand funds by passing HR1854

12 Mental Health Awareness and Improvement Act of 2015 Introduced by Senators Lamar Alexander (R-TN) & Patty Murray (D-WA) Provisions limited to Garrett Lee Smith Act Reauthorization and Mental Health Awareness Training

13 President Obama Calls for $500m for Mental Services The Administration is proposing a new $500 million investment to help engage individuals with serious mental illness in care, improve access to care by increasing service capacity and the behavioral health workforce, and ensure that behavioral health care systems work for everyone. This effort would increase access to mental health services to protect the health of children and communities, prevent suicide, and promote mental health as a top priority.

14 President Obama Calls for $500m for Mental Services Statement from Address "We must continue to remove the stigma around mental illness and its treatment and make sure that these individuals and their families know they are not alone. While individuals with mental illness are more likely to be victims of violence than perpetrators, incidents of violence continue to highlight a crisis in America's mental health system. In addition to helping people get the treatment they need, we must make sure we keep guns out of the hands of those who are prohibited by law from having them."

15 Other Federal Developments in st Century Cures & Medical Innovation Act HR 6 passed the House on July 10, Major provisions: $9.3 billion NIH Innovation Fund, $1.75 billion in mandatory funding each year through 2020, Promoting patient-focused drug development, Streamlining clinical trials and accelerate development of new treatments, Codifying a structured framework at FDA for submission, review, and qualification of biomarkers and other drug development tools, Utilizing evidence from real world clinical settings, and Facilitating responsible communication of scientific developments related to off-label prescribing Senate discussion draft expected soon. Will be much narrower than HR 6

16 Other Federal Developments in 2015 Comprehensive Mental Health Reform Bills HR.2646 & S.1945 HR 2646 Helping Families in Mental Health Crisis Act Introduced on June 4 by Representatives Tim Murphy (R-PA) & Eddie Bernice Johnson (D- TX), >155 bipartisan cosponsors Reported by the House Energy & Commerce Health Subcommittee on November 4 S 1945 Mental Health Reform Act Introduced on August 4 by Senators Bill Cassidy (R-LA) & Chris Murphy (D-CT), 13 bipartisan cosponsors including Sen. Schumer

17 Other Federal Developments in 2015 Comprehensive Mental Health Reform Bills HR.2646 & S.1945 Common Provisions in Both HR.2646 & S.1945 New Office of Assistant Secretary for Mental Health & Substance Abuse Same day billing in Medicaid for mental and physical healthcare services Mental Health Policy Laboratory within HHS to fund innovation grants that identify new and effective models of care and demonstration grants to bring effective models to scale for adults and children State grants to facilitate more effective integration of physical & MH services Interagency Coordinating Committee on SMI Reform of Medicaid Institutions for Mental Disease (IMD) Exclusion MHPAEA (Parity) compliance

18 Other Federal Developments in 2015 Comprehensive Mental Health Reform Bills HR.2646 & S.1945 Differences Between S 1945 & HR 2646 Reforms to the SAMHSA Mental Health Block Grant program 2% bonus allocation for Assisted Outpatient Treatment (AOT) implementation in HR 2646, new requirements for outreach & engagement to special populations in S 1945 HIPAA & FERPA reforms Statutory exceptions allowing disclosure in HR 2646, clarification of existing disclosure to family members and provider education in S 1945 Language from HR 2690 was added to Managers Amendment codifying OCR guidance and establishing a model training program for providers. Provisions only in HR 2646: Reforms at SAMHSA advisory councils and peer review Reforms to the PAIMI Protection & Advocacy program

19 Other Federal Developments in 2015 Comprehensive Mental Health Reform Bills HR.2646 & S.1945 What Fell Out of HR 2646 in Subcommittee? Elimination of 190-day lifetime limit on inpatient care in Medicare Part A (CBO - $3 billion over 10 years) Curbs on the ability of Part D plans to limit access to psychotropic medication (CBO - $700 million over 10 years) Expansion of the Excellence in Mental Health Act Section 223 State Demonstration ($1.8 billion over 10 years) Behavioral Health IT improvements Reforms to the Medicaid IMD Exclusion However, Pallone Amendment was accepted codifying the Medicaid Managed Care Proposed Rule from June 2015 allowing federal financial participation as part of capitated managed care arrangements up to 15 days

20 NYS Co-Sponsors of HR.2646 Demonstrates MH Not a Partisan Issue Collins Hanna Israel Jeffries Katko King Meeks Rangel Reed Stefanik

21 Call Rep. Maloney s office at or and tell him to support HR 1854 and HR 2646!!! Call Sen. Kirsten Gillibrand s office at (202) or (845) and tell her to support S.1945!!!

22 2015 Developments in New York State

23 2015 Developments in New York State Strong Leadership in the Executive and Legislative Branch Passionate Advocacy Voices End of the Year Bill Signings Combine to Make NYS a National Leader in Mental Health MORE WORK TO BE DONE: 2016 COULD BE HISTORIC!

24 2015 Developments in New York State Strong Leadership in the Executive Branch Gov. Cuomo Signs two MH bills, best budget in years and calls for Raising the Age and Family Leave Insurance AG Schneiderman sues insurance companies for failing to honor parity and uses settlement funds to invest in community services.

25 2015 Developments in New York State Strongest Mental Health Budget in Years Highlights of the 2015 budget included: More than $100m invested to Medicaid redesign $30 Million in Housing Investments $15 Million to Expand Community Services $22 Million to Expand Services to People Living With A Mental Illness in the Criminal Justice System $1.5 Million to Expand Crisis Intervention Teams $3.2 Million Investment for Veteran's Mental Health Services $1 million for a Children's Prevention and Awareness Initiative Sustained support levels for NYS's Research Institutions Restoration of Prescriber Prevails

26 2015 Developments in New York State Strong Leadership in the Legislature Assw Aileen Gunther, Chair, MH&DD Committee Sen. David Carlucci, Chair, Social Services Committee Sen. Robert Ortt, Chair, MH&DD Committee

27 2015 Developments in New York State Two Major Bills Signed by Gov. Cuomo: 1-Mandate Mental Health Training for Correction Officers

28 2015 Developments in New York State Two Major Bills Signed by Gov. Cuomo: 2-Check-Off on Tax Refunds to Establish a Public Awareness Campaign on Mental Health Issues Local grants will be made through OMH for awareness initiatives.

29 2015 Developments in New York State Progress on Other Key Pieces of Legislation: S03004/A03870-Paid Family Leave Act PASSED ASSEMBLY A01275/S04722-Amend the mental hygiene law and the correction law to improve care for people with serious mental illness and improving New York's Assisted Outpatient Treatment (AOT) program (Kendra's Law). PASSED NYS SENATE A1346A/S To adopt recommendations made by the United Nations Committee Against Torture regarding the use of solitary confinement in New York prisons and jails. PASSED ASSEMBLY

30 NAMI Names NYS a National Leader in Mental Health

31 NAMI Names NYS a National Leader in Mental Health

32 NAMI Names NYS a National Leader in Mental Health Along with increasing our mental health budget for two years in a row, New York was specifically recognized for being leaders in: Insurance Parity: "Along with California, New York is leading the nation in parity enforcement through legislation and litigation." New York was one of the first states to pass parity laws and Attorney General Eric Schneiderman has shown tremendous dedication to holding insurance companies accountable for lack of parity practices. Criminal Justice: "For a number of years, New Jersey, New York, and California have led the nation in alternative sentencing, driving down prison populations by about 25% while simultaneously reducing crime rates." Reducing Stigma: The report gave a legislative gold star to the Tax Check-Off/Mental Health Awareness Campaign.

33 NAMI-NYS s Response We re proud of the strong advocacy voice and grateful to have leaders committed to creating a more mentally healthy NYS which led to these achievements. However, now is not the time to pat ourselves on the back. Because

34 Good Advocates are Like Mick Jagger We Can t Get No Satisfaction and We Must Keep Rolling

35 The Time for Action is Now! Your Voice is Needed More Than Ever! Past success and strong budgets do not guarantee further progress. We need to show that we are not satisfied. Gov. Cuomo to release Executive Budget on Wednesday. In the second year of the we need to keep the momentum going forward. History can be made, but

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38 Top Issues NAMI-NYS is focusing on 1-The Need for Safe and Affordable Housing for People With Mental Illness 2-Continued Reinvestment in Community Services 3- Ensuring Access to Proper Medication 4- Mental Health Education in Schools 5- Improving the Criminal Justice Mental Illness Interface 6-Support the New York State Office of Mental Health s Research Institutes: NYSPI and NKl 7-Expand Veteran s Mental Health Services

39 Safe and Affordable Housing Because the funding has not kept up with increase in cost of living since 1990, programs are operating at 43% below where they should be today. To restore these crucial housing resources, 92.9 million dollars is needed to replace the funds lost to flat funding as the cost of living has increased. Add approximately $40 million to the Supported Housing rate statewide in 2016 to make up for increases to Fair Market Rents and to ensure that Supported Housing is sustained. Add $23.2 million for Community Residencies-Single Room Occupancies (CR-SROs) to make up for losses from inflation and so that they can better serve those with challenging needs. These provide a high level of service and can be very long-term stay or permanent. Add $17 million for the CR program (includes both CRs and Treatment Apartments) to make-up for losses from inflation and to incentivize providers to admit the most challenging clients safely. Add $12.7 million to Supported- Single Room Occupancies (SP-SROs), permanent housing with supports, to make up for losses from inflation and to better equip them to serve clients with more challenging service needs.

40 Safe and Affordable Housing Governor needs to honor NY/NY4 Agreement and create more supportive housing to address homelessness We need to advocate for continuity of care inside supported housing by giving staff a real living wage. Governor Cuomo wants to give fast food workers $15 an hour, how about those who care for our loved ones?

41 Criminal Justice 1-Expansion of Crisis Intervention Teams 2-Expanded Mental Health Courts 3-Abolish Long Term Solitary Confinement 4-Raise the Age 5- Presumptive Eligibility 6-Improve Mental Health Treatment and Family Engagement in the Correctional and Forensic System

42 Top Five NYS Legislative Bills NAMI-NYS is Supporting in 2016: 1-S-3419A/A-2834A-Regulate Step Therapy: This bill would increase a doctor's ability to override an insurance company's decision not to approve prescribed medication 2-A3887/S2585 -Mental Health Education in Schools: This bill calls on school districts to ensure that their health education programs include mental health 3- S-3004-Paid Family Leave Act: This bill would allow an employee to take a paid leave after the birth of a child or to care for a loved one who is experiencing a physical or psychiatric emergency or has a chronic illness. 4-A01275-Make Kendra s Law Permanent: This bill would streamline and improve New York's Assisted Outpatient Treatment (AOT) program "Kendra's Law." 5-S.5900-Regulate the use of Solitary Confinement: This bill would prohibit the use of solitary confinement for juveniles under the age of twenty-one; and any person with a mental illness or a developmental disability.

43 S-3419A/A-2834A- Regulate Step Therapy This bill is important to NAMI-NYS because: People who have psychiatric disorders need to have access to the medications their doctor believe are the most appropriate for them. Anti-psychotic and anti-depressants are not interchangeable and prescribing someone with severe mental illness the wrong medication can be very dangerous. Improper use of medication can lead to negative and expensive outcomes such as emergency room visits, hospitalizations and possible entry into the criminal justice system. The most tragic results can include suicide. Prescribing the correct medication is the safest and most cost-effective option.

44 A3887/S2585 Mental Health Education in Schools This bill is important to NAMI-NYS because: Education, early recognition and intervention as well as working on prevention are keys to minimizing mental health issues that are common in adolescents and hopefully, eradicating the long-term disabilities caused by mental illness. It is vital that New York s education system does a better job of creating a true comprehension of mental illness and mental health issues. You cannot have physical health without mental health which is why it is necessary that mental health is incorporated into existing health education curricula. Including mental health education will save lives; early recognition can prevent our children from suffering the most debilitating longterm effects of serious and persistent mental illnesses. Integrating the proper supports can also lead to a better awareness of body image issues and a reduction in harassment and bullying both of which can contribute to suicide rates in adolescents.

45 S-3004-Paid Family Leave Act This bill is important to NAMI-NYS because: Caregivers play a vital role in a loved one s recovery from psychiatric disorders. We strongly believe that there should not be any barriers to family involvement in the recovery process or after a psychiatric emergency. If enacted, this bill would provide protection for family members to help a loved one during a psychiatric emergency or in the recovery from their chronic illness without having to worry about losing their job or their salary.

46 A01275 Make Kendra s Law Permanent This bill is important to NAMI-NYS because: People with the most serious and persistent forms of mental illness are often overlooked by the mental hygiene system. This bill would improve services and coordinate care for those with the most debilitating psychiatric disorders. Assisting the most at risk people with mental illness adhere to treatment will help reduce the use of emergency rooms and entry into the criminal justice system. Both of these options are more expensive to tax payers and can worsen a person s mental illness. This bill would require the NYS Office of Mental Health to provide education materials to families about the AOT process. Most importantly, it would not only improve these service reforms but would also make them permanent.

47 S.5900-Regulate the use of Solitary Confinement Solitary confinement has been shown to have a negative long-term impact on someone s mental health. The United Nations has deemed the practice an example of torture. New York State has already made strides in regulating the practice. We must ensure that people with a mental illness and juveniles are not subjected to solitary confinement.

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49 Along With Attending the NAMI-NYS Advocacy Day How Can You Make Your Voice Heard?

50 Advocacy Tool Kit Detailed Info on all issues and bills. Tips on how to have the most effective legislative meetings and talking points. List of all bill sponsors. Letter to the editor templates. How to use social media as an advocacy tool.

51 Social Media as an Advocacy Tool Why is it so important to be on social media? There are many reasons for this: It s how a majority of people now communicate and get their news and information. It lets you spread the word at no cost. It allows you to communicate and learn from NAMI affiliates from throughout the state and the country. It allows you to project your advocacy voice.

52 Examples of Social Media Advocacy NAMI New York Jan -We need a NY/NY4 Agreement NOW: 35,000 new supportive housing units statewide! #NY4SupportiveHousing NAMI New York Jan 5 We for including a $500m investment in #mentalhealth services in gun control initiative NAMI New York Jan 5 @HouseGOP & the Senate to support the $500m investment in #mentalhealth gun Ex Order NAMI New York Yes! Insurance companies must be accountable to cover #mentalhealth treatment and medication. NYS must pass S-3419A The Kennedy We agree Let's make 2016 the year Americans get the access they need.

53 Examples of Social Media Advocacy NAMI New York 23 Dec support campaign at NAMI New York State Retweeted David Carlucci we deeply appreciate your leadership to protect the most vulnerable people with mental illness. NAMI New York State added, David Great job Matthew, proud to and I to sign this bill NAMI New York State Retweeted David 7 Dec at Sing Sing, we to expand MH training in NY prisons.

54 NAMI-NYS RIBBON CAMPAIGN

55 You Can Create a More Mentally Healthy NYS!

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57 QUESTIONS? MATTHEW SHAPIRO Facebook: NAMI NEW YORK STATE Make sure you are on the NAMI-NYS list