NY Misses the Target on Mental Health: DC Gets It Right

Quite frankly, the biggest issue with New York’s new gun law is not what’s in it, it’s what’s missing.

New York took bold steps last week and with lightening-speed passed what has been called the “nation’s toughest gun law.” The stuff that makes NRA-types go nuts got all the media attention – bigger restrictions on assault weapons, a new limit on ammunition magazines, a ban on Internet sales, and real-time background checks to name a few.  But also within the Secure Ammunition and Firearms Enforcement Act (SAFE) is a new provision that requires licensed mental health professionals – psychiatrists, psychologists and social workers – to alert local mental health officials if a patient “is likely to engage in conduct that would result in serious harm to self or others.” The local mental health folks will then conduct their own evaluation and if they concur with the potential risk, that patient will be added to a statewide database of folks who can’t get a gun. If they already own a gun, local cops are going to bang on that person’s door, demand to see the gun and take it.

Mental health professionals have always carried an ethical duty to warn, but the state has generally left it to practitioners to decide when and how to report. Practitioners usually listen for an explicit threat, conduct a more thorough assessment, and then weigh a series of options that might include notifying those at risk, arranging hospitalization, and/or calling the police. That flexibility has given clinicians the ability to deal with a potential risk of violence without breaching confidentiality and perhaps keeping that person engaged in a course of treatment that in and of itself, may diminish risk.

The mandate in the new law is broad and in this environment, will likely be applied much more often than the current standard. Several prominent mental health experts have already expressed their concerns.  Dr. Paul Appelbaum, director of law, ethics and psychiatry at Columbia University told the New York Times, “It undercuts the clinical approach to treating these impulses, and instead turns it into a public safety issue.” Dr. Eric Neblung, a psychologist and the president of the New York State Psychological Association told the Wall Street Journal, “You’re turning psychologists into police officers.”

To the average person, keeping guns out of the hands of the mentally ill is a no-brainer. But get this: a large body of research suggests that people with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. One national survey found that those with chronic and severe mental were victimized a whopping eleven times more often than those in the general population.

And if we can’t get that imposing image of the crazed gunman out of heads long enough to consider the numbers, it’s important to recognize that New York’s new law doesn’t target the few mentally ill who could become shooters. It targets those who seek treatment – including cops, corrections officers and other uniformed personnel, who are often most reluctant to seek help. And if we are truly concerned about guns winding up the hands of unstable folks, why not make psychological testing a pre-requisite for getting a gun?

Quite frankly, the biggest issue with New York’s new gun law is not what’s in it, it’s what’s missing. The Secure Ammunition and Firearms Enforcement Act does absolutely nothing to enhance access to mental health services and contains no new funding for such programs. Perhaps that’s because our state is cash-strapped, or maybe it’s because including funds would have prompted some of the more fiscally conservative folks to hold-up the bill. Then New York wouldn’t have been first.

A day later, President Obama rolled out his gun control package. It contained all the high-profile stuff like background checks for gun show shoppers, limits on high-capacity ammunition magazines and the like, but he also called for new federal investments in school safety and mental health counseling. 

In addition to $180 million in school safety spending, the President’s proposal includes: $15 million to help teachers and youth professionals provide “Mental Health First Aid,” to identified students; $40 million to help school districts, law enforcement and local agencies better coordinate services for students in need; $25 million to finance new, state-based strategies to better identify individuals ages 16 to 25 with mental health and substance abuse issues and get them the care they need; $25 million to boost school-based mental health services aimed at treating trauma, anxiety, and enhancing conflict resolution; and $50 million in new funds to train social workers, counselors, psychologists and other mental health professionals.  That money would also provide stipends and tuition reimbursement for more than 5,000 new mental health professionals that want to work with young people in school and community-based settings.

Is it enough? Probably not.  It does, however, restore some of the $235 million the Administration ripped out of the state Safe and Drug Free Schools grants program last year and ensures a more proactive, comprehensive approach to keep our kids and communities safer.

While it’s true that New York, our legislators and Governor Cuomo can now lay claim to passing the first and toughest gun law in the wake of the Sandy Hook shootings, the absence of solid mental health solutions means that it probably won’t prove to be the nation’s best.

Photo: White House Photo

Dead Addicts Don’t Get Better

More than 350 Long Islanders lost their lives to accidental overdose last year – about one per day. Nationwide, someone dies of an overdose every 19 minutes and countless others survive, but suffer irreversible brain damage.

Last Friday was International Overdose Prevention Day, but if today is like every other day in recent memory, at least one Long Island family will begin making funeral plans for a loved one whose untreated addiction to prescription painkillers, heroin, methadone, cocaine, Xanax or some combination of drugs and alcohol claimed their life. More than 350 Long Islanders lost their lives to accidental overdose last year – about one per day. Nationwide, someone dies of an overdose every 19 minutes and countless others survive, but suffer irreversible brain damage.

Overdose fatalities involving prescription painkillers like OxyContin, Vicodin, Percocet and Fentanyl are three times what they were a decade ago. The misuse of these and a few other medications were responsible for 15,000 US deaths in 2008 and 475,000 emergency department visits in 2009. A whopping 12 million Americans reported using prescription painkillers non-medically in 2010 and an estimated two million more people will join their ranks in 2012.

The National Health Center for Health Statistics recently found that drug overdose has edged out car crashes to become the leading cause of accidental death in the US. If only there were something like say, seatbelts, or airbags or anti-lock brakes that could save someone who is careening through the pitch black tunnel of an overdose death. There is.

It’s a drug called called Naloxone, which is distributed under the brand name “Narcan.” Developed in the late 1960’s, Narcan immediately reverses opiate overdoses by blocking key brain receptors and counteracting life-threatening central nervous system and respiratory depression. The generic drug, which can be administered via a nasal spray or injection is not prone to abuse because it doesn’t get you high (in fact, it does just the opposite) and has no major side effects if administered in error. Addicts in the throes of overdose who get the drug will likely suffer significant withdrawal symptoms and they’re frequently pissed rather than thankful, but they’ll live to see another day.

Emergency departments and emergency medical technicians (EMTs) have dispensed Narcan for decades, but too many folks are dying waiting for an ambulance to arrive and in many cases, the 911 call happens long after the person has expired. Few non-medical people know about Narcan and it’s only available via prescription, though the federal Food and Drug Administration (FDA) held a hearing earlier this year to explore over-the-counter availability.  It costs less than $20 per dose.

Community access to Narcan happens now through a limited number of overdose prevention programs that train drug users and their families to recognize the signs of overdose, underscore the importance of immediately calling for medical help and equip them with life-saving Narcan kits. In February, the federal Centers for Disease Control and Prevention (CDC) released results from a survey of 48 such programs nationwide that detailed 10,000 overdose revivals since 1996. The New York State Department of Health has approved about 75 Opioid Overdose Prevention Programs to date, including one run by the Long Island Council on Alcoholism and Drug Dependence (LICADD), which so far has trained in excess of 300 community members, including two dozen residents of the Shinnecock Indian Reservation.

Those efforts got a boost in recent weeks as the Suffolk County Police Department kicked off a pilot program that put Narcan nasal sprays in the hands of 300 cops in the 4th, 6th and 7th Precincts. Sector cars often arrive on the scene well before ambulances and during a medical emergency, every second counts. The early results are mind-blowing: cops have revived three people in as many weeks. Those three people likely got the wake-up call of their lives and their families can arrange drug treatment, rather than a funeral.

Suffolk lawmakers led by Kara Hahn (D-Setauket), who voted unanimously to create the pilot program, should immediately expand it to include every sector car in the county. Nassau should do the same. School nurses across Long Island – particularly those working in high schools where prescription drug abuse is rampant – should be trained and given Narcan kits. Parents of addicted kids need access more than anyone else and drug users should be trained and equipped to help their friends.

Seventy percent of people who abuse prescription painkillers say they get them from family, friends or straight out of the medicine cabinet. Shouldn’t an overdose antidote like Narcan, which is safe, cheap and proven to save lives, be as easy to obtain? Why isn’t Narcan included in every first aid kit distributed across America?

New York has been pretty progressive on this issue. State lawmakers approved a bill in 2006 that allows non-medical folks to administer Narcan and extends good samaritan protections to those who use the drug in good faith. The Legislature also approved a measure last year that provides for limited immunity from prosecution for certain drug offenses when someone calls for help during an overdose.

We’re also beginning see an awakening at a national level. Even Obama’s drug czar, Gil Kerlikowske, who as a former police chief is a law-and-order kind of guy, recently spoke out in favor of increased access to Narcan. “The Administration supports the use of naloxone by public health and law enforcement professionals because we have seen how effective the drug can be,” he told a group in North Carolina last week.

So, with questions about potential liability, safety and costs handily addressed, what’s the hold-up? It’s apathy more than opposition, though a few naysayers have suggested that educating drug users about overdose and giving them Narcan will leave them a false sense of security and encourage them to use more drugs. That’s the same mindset that allowed HIV/AIDS to kill hundreds of thousands of Americans as we bickered about whether a piece of latex would encourage people to become promiscuous. Think about it. We don’t all drive faster because our cars are equipped with airbags, nor do we eat more Ring Dings because there’s an automated external defibrillator (AED) bolted to the wall in our corporate cafeteria.

Potentially avoiding death doesn’t encourage drug use any more than the fear of death stops it.  Addiction is an inherently irrational brain disease, but it’s also treatable and needn’t prove fatal. Too many families are losing the race against time as they beg, plead, and try to cajole their loved one into treatment for a disease whose calling card is massive denial. Too many young people never make it through the doors of a treatment center, never come face-to-face with a counselor and never get a shot at experiencing the miracle of recovery.

Given the enormity of the opiate crisis and recent advances in substance abuse prevention and addiction treatment, it’s easy to wonder whether getting an addict breathing again is the best we can do. Nope, but it’s certainly the least we can do.

No Short Cuts on Straight Path

Suffolk County Executive Steve Levy has asked a NYS Supreme Court judge to bar 37 known gang members from hanging out together within a carefully drawn two-square-mile “safety zone” in Wyandanch. “Gangs have the propensity to take over schoolyards, street corners, playgrounds and many areas within a downtown district,” he said at an August 16th press conference flanked by SCPD brass, community activists, and frustrated residents.

Predictably, the Suffolk County chapter of the New York Civil Liberties Union has raised concerns about profiling, due process and the legality of banning people from public places. But Suffolk’s legal maneuver isn’t entirely new or novel. Los Angeles starting getting gang injunctions in the late 1980’s and today, the city has reportedly won 37 injunctions covering 57 gangs and a total of 11,000 gang members. Court decisions nationwide have been mixed, but carefully worded and limited injunctions have survived constitutional muster and a study published earlier this year in the Journal of Criminal Justice Research suggests that injunctions in California’s urban areas with significant gang penetration have effectively reduced serious crime by 12-17%.

Whether Suffolk’s injunction would produce similar results remains an open question, but it’s safe to say that forcing these 37 bad guys to find new friends won’t solve the myriad problems in Wyandanch, nor will it prevent gang organizing and its resultant violence, drug dealing and other criminal activity. Banish them from Straight Path and there will be another 37 young men and women ready to take their place. And 37 more after that. 

Why? It’s not that the bad guys are brilliant. Gang recruiting is easy given the right environment and an absence of other options. Kids join gangs because they want a sense of belonging and because they have nothing else to do.  Beyond the obvious benefits of protection, potential financial gain and a daily adrenaline rush, gangs serve as a surrogate family for young people, creating a sense of identity, social support, solidarity and kinship.

Want to run gangs out of Wyandanch? Go beyond the traditional suppression efforts that play well at press conferences and with community members at their wits’ end. Try funding – or maybe even just stop cutting – youth services. Clean-up and expand playgrounds, teen centers and public parks. Foster a renewed sense of community through outreach efforts, neighborhood activities and educational programs. Strengthen and support families.  Give schools the resources they need to do their jobs. Reward the kids doing great things and encourage leadership. Support meaningful job opportunities, economic development, small business creation and success. Do that and we won’t need to worry about keeping 37 bad guys out of a safety zone; we’ll be inviting tens of thousands of young people in.

Charitable Choices

Dr. Jeffrey Reynolds gives tough love to colleagues in the nonprofit sector telling them, “Times are going to get tougher and there’s less money to go around. Some nonprofits will not survive the recession and perhaps they shouldn’t. We need to stop playing the victim and get into the game.”

Jeffrey Reynolds Jed Morey
AP Photo courtesy of the Long Island Press

The sky is falling. Again. The state budget deal approved last month contained significant budget cuts disproportionately aimed at education, health and human services, as did the recent federal budget deal that helped avert yet another government shutdown.  At the county level, youth organizations are fighting for their lives in Nassau where continued funding is being tied to red light camera revenues.  Suffolk County is facing a $127 million deficit that will only deepen as we head into the fall budget season.  And if you think this is bad, just know that by all accounts, 2012 is going to be even uglier.

For most of Long Island’s nonprofits, this is just the latest series of body blows. Foundations with declining major gifts and lower investment returns are naturally making fewer grants. Companies don’t make corporate contributions when their revenues are in the toilet and they’re laying-off staff; only LIPA does that. For the average Long Islander struggling to pay their bills, well, charity begins at home.  And at the same time, record numbers of volunteers and contributors are becoming clients looking for a helping hand from local charities instead of giving one. Requests for assistance have skyrocketed, creating the proverbial “perfect storm.”

Some charities are weathering the storm better than others, but it’s tough for even the best managed, well-established, resourceful and leanest organizations to meet the growing demand for services in this environment. That’s in part because there are more than 3,000 non-profits on Long Island. While some are quickly-incorporated non-functioning entities that never quite got up and running, at least half are going concerns whose biggest challenge these days is staying in business.

There are lots of nonprofit executive directors laying awake at night these days trying to figure out how to reduce client waiting lists, keep the lights on and make payroll. Business owners do that all the time; it goes with the territory. But there’s got to be a better way.

Nancy Lublin who runs DoSomething.org, argued in the December 2010 issue of  Fast Company that charities – especially those that have achieved their missions – should have an expiration date.  “For-profits go out of business all the time, for reasons good and bad, from fierce competition to poor management to an inability to adapt. Lehman Brothers. Circuit City. Linens ‘n Things. All dead!” she writes, before issuing this challenge: “Now try to name a closed nonprofit.”

Of course, the work of many organizations isn’t done. We haven’t yet conquered poverty, homelessness, hunger, addiction, youth violence, sexual assault, AIDS, or cancer and the likelihood that we’ll eradicate these plagues anytime soon is pretty nil. Maybe that says something , too.

As an alternative to just closing up shop, the non-profit world and its funders have talked about “consolidation” and “mergers” for years, especially as times have gotten tougher. We all agree it needs to happen, but it hasn’t.  Merger discussions between regional nonprofits haven’t panned out for one reason or another – boards or management teams were incompatible, the programs weren’t a good mix or it “just didn’t feel right.”

Here’s the problem, though: Each of Long Island’s roughly 1,500 operational nonprofits has its own board of directors, an executive director or CEO, office rental costs and overhead expenses. Each one receives tax breaks, collects community contributions, enjoys the goodwill of volunteers and a fair amount get government grants.  Each one competes with the other for charitable dollars and at the end of the day we all have less money to spend on services. Our dream of actually achieving our agency mission, solving some problems and moving on becomes ever more elusive.

But faced with yet another round of budget cuts, we hold press conferences and rallies, wave placards, give fiery speeches, launch Facebook campaigns, and encourage our clients to call, write and hound our elected officials. We use words like “draconian” and “irresponsible” to characterize proposed reductions. We threaten to close programs, turn folks away and promise to send them en masse into the offices of elected officials. Nobody particularly wants a waiting room full of homeless, hungry, disabled or sick folks, so we often get our way and win at least partial funding restorations. Until now, this well-rehearsed strategy has worked pretty well, but all of us hate doing it and it’s simply not sustainable. It’s exhausting and the need to ratchet-up the rhetoric with each proposed round of cuts undermines our credibility.

Times are going to get tougher and there’s less money to go around. Some nonprofits will not survive the recession and perhaps they shouldn’t. Digging our heels in and desperately repeating our “no cuts” mantra leaves us out of some important conversations where our intelligence and experience could help reshape the non-profit sector in a way that preserves decades worth of investments. We need to stop playing the victim and get into the game. We know which nonprofits are high performers and which ones aren’t. We know which programs work and which ones don’t. So do our clients. Government – as the largest purchaser of health and services – is beginning to figure it out, too. 

The general public, though, doesn’t care. They want government to spend less so that they in turn, will pay fewer taxes and be able to support their families. They want it to happen now and they don’t care if the cuts are across-the-board, rather than strategic, surgical and well-considered. So far, most of the public pressure for change has been focused on school districts and the messages have been clear: Consolidate. Eliminate waste. Stop spending money we don’t have. Become more transparent, efficient and stop clinging to the outdated, implausible notion that any funding reductions will result in the end of civilization as we know it.  The message to nonprofits, though not yet as explicit, is exactly the same.