Resources
Spring 2012
pring 2012 VOL. 15 O. 4
Morningside Westside Bulletin
ISSUES I METAL HEALTH EST. 1994
T H I S I S SU E:
The Ghettoization of the Mentally Ill by Nancy Walder
What’s in the President’s 2013 Budget Proposal for Mental Illness Research, Services, Housing and Veterans Programs by Andrew Sperling
Reading, Writing, & Recovery Formula for Achievement by David Harris
Lost by Trina McNeil
Recovery & Reintegration Anonymous
My Journey by Annelle S.Finkel
MWCAC Acknowledgements
The Ghettoization of the Mentally Ill
By: Nancy Walder, M.A.
“The unfortunate result is that the mentally ill person does not stand,
nor is he encouraged to stand, outside his comfort zone where the
door to growth is opened and the advantages offered by mainstream
society lie.”
As currently structured, many advocates in the mental health community fight for a self-perpetuating and separated enclave where only the few can succeed. In essence, it is a ghetto. The mentally ill are not only robbed of their rights, but the greater community loses the talents of those with a mental illness as well as insights into their valuable humanity and strengths. Understanding is curtailed and stigma is ultimately reinforced.
As head of a mental health agency and mental health counselor and in my experience as someone who has a mental illness, I have witnessed firsthand certain disturbing patterns. The community professes to work towards success, equality, and the elimination of stigma, but current approaches lead to a largely segregated population with limited rights and contact restricted to their own. There is no integration.
Look at the types of rights advocated by the mentally ill and their supporters such as security of entitlements or homogeneous reatment programs. Housing is typically restricted to living with others who are mentally ill or with family members. Even the social lives of the mentally ill are largely constrained to the people met in their own programs and other groups and functions which the mentally ill attend. These restrictions are largely motivated by fear, lowered expectations, and a lack of wider vision not only on the part of the mentally ill but also their providers of services and family members. Advocacy groups fight for special rights rather than freedom for and inclusion in the broader society. Furthermore, this segregation is promoted and reinforced by the financial under pining of how services are structured and delivered and therefore by their government and private funding sources. For those within these systems, confidence is reduced and personal growth is impeded.
The unfortunate result is that the mentally ill person does not stand, nor is he encouraged to stand, outside his comfort zone where the door to growth is opened and the advantages offered by mainstream society lie. This leads to a limited perspective among the mentally ill––a rigid mindset narrowed both by history and environment.
In my personal experience in the mental health community, it is hard for a person with a mental illness to even comprehend what the true nature of reintegration, mainstreaming, and recovery is. Their answers to what these things are often reference back to groups made up of others with a mental illness, be it an advocacy group, a social organization, a training or day program, or a place of residence. Even their providers of services or their own family typically share these limited views and expectations.
Without question, there needs to be a safety net for some of the mentally ill whose struggle is more difficult. This is true of some segments of the broader society. Incremental steps to recovery are needed for others who have a mental illness. However, if there is no exit door through which the mentally ill can go—aided by such supports as medication and therapy—there can be no real recovery. For a large segment of this population the assumption of the rights of society means taking on contributory work and social responsibilities. In an insular world, we foster our own stigma and the fruits of society remain largely beyond our grasp.
Look at the example of any immigrant group’s integration into society. Eastern Europeans, the Irish, the Jews, and Italians assimilate while retaining their unique qualities and heritage. This is evident, in the melting pot which is New York City–– culture, religion, language, and food often are passed from generation to generation and in time contribute to the broader society. This rich diversity was accomplished through successful integration. Segregation is un-American and when one segment of society is set free and gains equality the whole society benefits. It is a freer, richer and more prosperous whole.
Look at the limited success only available to the few in other marginalized groups. The more homogeneous any group remains the less success there is for the greater number.
Typically success among segregated groups is limited to community leaders and those in fields historically identified with the group. In the fight for civil rights for racial minorities, for example, one thinks of Dr. Martin Luther King Jr. as a community leader, Jay-Z or Michael Jordan in fields where African-Americans have long excelled, and exceptions such as public and community leaders Ralph Bunch or Barack Obama. Examples in groups such as these are along a continuum depending how old their fight for rights is and how much progress the group has made.
When thought of as a civil rights movement, the fight for the rights of the mentally ill makes sense. Along with populations such as racial and religious minorities, women, and gays there should be equal access to education, jobs, decent housing, health care, legal rights, and social opportunity. Why not fight for inclusion using our unique strengths and abilities— all of which can grow over time and build—as opposed to the mere support for the group’s perceived weaknesses?
The obstacles and difficulties the mentally ill face builds courage, strength and endurance. It is the resilience of survivorship. This group remarkably and unexpectedly did well after the tragedy of 9/11 as compared to other groups. Its members exhibited remarkable strength and courage based on the very difficulties they have encountered because of their illness.
Can we forget the great intelligence and extraordinary leadership abilities shown by individuals in politics and public service who have had a mental illness such as Lincoln and Churchill? Or can we ignore the creativity, imagination and gifted writing exhibited by such authors as Styron and Plath? There are many other stellar examples of the mentally ill who have succeeded throughout the growth of civilization. Think of the gifts which remain untapped.
Mental illness must not be looked upon as a disability which by definition is limiting. Rather we must seek opportunities specifically accorded us by our histories and individual perspectives and abilities.
If the leaders of the mental health movement and their followers seek in certain ways to assimilate while maintaining their uniqueness and special gifts which meaningfully contribute to society, this will certainly lead to acceptance and reduced stigma. True leaders are those who lead by example, who forge a path within the mainstream. True supporters are those with great expectations who raise the bar. Armed with a positive attitude, we are only limited by our vision. And this should be our rallying cry.
Nancy Walder is President of Morningside- Westside Community Action Corporation
What’s in the President’s 2013 Budget Proposal for Mental Illness Research, Services, Housing and Veterans Programs
By: Andrew Sperling, J.D.
“It is important to note that holding the NIMH budget at its current level will likely leave the agency struggling to fund an adequate number of “new and competing” research grants in FY 2013.”
The cuts in the President’s budget are proportionally spread across both mental health and substance abuse programs.”
On February 13, President Obama and his Administration presented their $3.8 billion budget for Fiscal Year 2013. Included in the budget are requests to Congress for funding levels for all discretionary programs including those for NIMH, SAMHSA and HUD. Two important qualifications are needed with respect to the President’s budget. In August, the President and Congress agreed to the Budget Control Act and strict limits on overall discretionary spending levels for the next decade. These limits are now in effect and provide little room for the President or the Congress to go above them – with the exception of spending categorized as “security,” which includes veterans’ medical care. Second, in this current political environment, with a looming presidential campaign, there is little prospect of a major agreement on spending bills before Fiscal Year 2013 begins on October 1st. As a result, the President’s budget is only the first step in a drawn out process that will likely extend through December 2012. Included below are details of the President’s budget as it relates to mental illness research and services, housing and veterans programs, as well as proposed changes to Medicare and Medicaid.
Mental Illness Research at NIMH
The President’s budget for Fiscal Year 2013 proposes to freeze funding for the National Institute for Mental Health (NIMH) at its current Fiscal Year 2012 level of $1.479 billion. This is in line with the President’s request for all other Institutes and Centers at the NIH, which is also proposed for a freeze at $31 billion.
It is important to note that holding the NIMH budget at its current level will likely leave the agency struggling to fund an adequate number of “new and competing” research grants in Fiscal Year 2013. First, a freeze fails to account for “medical research inflation,” the annual escalation in research cost. This would mark the fifth consecutive year that the NIMH budget failed to rise at least to account for medical research inflation. In addition, at least through Fiscal Year 2012, NIMH has nearly $700 million in “out-year” commitments (more than 40 percent of the total NIMH budget) of ongoing multi-year grants for basic research and clinical studies.
While this is expected to improve next year, nonetheless, holding the NIMH budget at a freeze for Fiscal Year 2013 could further erode the Institute’s “pay-line” to 15 percent. In other words, 85 percent of “new and competing” research grants (that get through peer review and are deemed to be meritorious science) will not receive funding. The cumulative effect is that in 2011, NIMH was only able to fund 465 new and competing research grants, the lowest level since 1998. This is expected to improve in 2013 and exceed 500 new and competing grants. Nonetheless, this is far below the tremendous scientific opportunities that exist for new discoveries and better treatments for schizophrenia and bipolar disorder.
Mental Health Services at SAMHSA
The overall constraints on discretionary spending have a significant impact on the President’s request for Substance Abuse and Mental Health Services Administration (SAMHSA) in Fiscal Year 2013, with proposals to enact deep cuts to existing grant programs for primary care integration and systems of care for children. Overall, the President is requesting $3.152 billion for SAMHSA, as compared to its current Fiscal Year 2012 level of $3.347 billion, a $195 million cut. The cuts in the President’s budget are proportionally spread across both mental health and substance abuse programs.
The Mental Health Block Grant program is proposed for a freeze at $439 million. A positive development in that the Obama Administration is supporting the $41 million increase enacted by Congress for Fiscal Year 2012. The PATH formula grant program for the states (outreach and engagement for homeless individuals living with mental illness) is also proposed for a freeze at $65 million.
The President’s budget proposes a $40 million reduction in discretionary funding for grants to the states for Primary and Behavioral Health Integration, cutting funding from its current $65.7 million level, down to $26 million. NAMI has vigorously supported this program as part of an overall strategy for integrating primary care services into specialty mental health settings such as CMHCs to address early mortality among people living with serious mental illness. Numerous studies have demonstrated both the high incidence of medical co-morbidities (diabetes, heart disease, COPD, etc.) and dramatic gaps in access to basic primary care in this population. These grants support a range of innovative activities including integrating basic primary care services into CMHCs. While this appears in the budget as a deep cut to the program, in fact, SAMHSA should be able to account for a full 4-years of funding for the current set of grants awarded in 2011 and 22 new grantees in 2012. This would ensure that all current grantees are able to complete their grant cycle. This was done by allocating existing dollars from the Prevention Fund authorized under the Affordable Care Act (see below). In addition, the $26 million in new discretionary funds requested for Fiscal Year 2013 will allow for 12 new grantees in 2013.
NAMI is concerned about SAMHSA’s move to fund the Primary Behavioral Health Integration program solely with ACA Prevention Fund monies. This shift jeopardizes the ability of people living with serious mental illness to access critical health care services by moving the program toward reliance on a vulnerable funding stream. Opponents of the Affordable Care Act have repeatedly tried to repeal the Prevention and Public Health Fund, efforts that are expected to continue in 2013. In fact, $5 billion from the Prevention Fund (a third of its total funding) is being transferred to help pay for the Medicare physician payment fix included in the payroll tax extension bill moving through Congress. Instead, NAMI will be urging Congress to restore the PBHCI program to SAMHSA budget authority so as to preserve the critical prevention and treatment services that it supports.
There are further reductions at SAMHSA proposed for the Programs of Regional and National Significance (PRNS) within the Center for Mental Health Services (CMHS), a broad range of service demonstration and capacity building programs that includes mental health transformation, suicide prevention, seclusion and restraint, cooccurring disorders and homelessness. Overall, PRNS funding would be reduced from its Fiscal Year 2012 level of $286 million, down to $248 million. Included in this reduction is a $16 million cut to suicide prevention activities under the Garrett Lee Smith Act (including grants to states and colleges). Under the President’s budget, GLS funding would slip from $58 million down to below $42 million.
Supportive Housing Programs at HUD
The President’s budget proposes a $15 million reduction for the HUD Section 811 program, reducing the program from its current Fiscal Year 2012 level of $165 million, down to $150 million. Section 811 funds grants to states and non-profit agencies to develop and maintain permanent supportive housing targeted to non-elderly people living with severe disabilities including serious mental illnesses. For Fiscal Year 2013, HUD projects that $96 million will be needed to renew expiring projectbased operating subsidies (known as PRACs) and fund contract amendments for existing units. These funds cover the operating costs for the more than 30,000 existing 811 units across the country, paying the difference between actual costs (utilities, insurance, maintenance, reserves) and tenant rent contributions.
The remaining $54 million in the President’s request would go toward a second year for competition among states for new supportive housing units funded by additional PRACs. This new program option was authorized by Congress in 2010 as part of the Frank Melville Supportive Housing Investment Act. HUD projects that this $54 million will fund as many as 1,900 new supportive housing units integrated into new affordable rental housing projects and leveraged from programs such as the Low-Income Housing Tax Credit program.
For programs under the McKinney-Vento homeless Assistance Act, the President is asking for $330 million increase for Fiscal Year 2013, boosting funding to $2.231 billion. McKinney-Vento funds a range of permanent supportive housing programs such as Shelter Plus Care and SHP that are targeted to chronically homeless individuals living with serious mental illnesses and other disabilities. At the same time, the budget request is targeting most of the increased funds for McKinney-Vento to the Emergency Solutions Grant (ESG) program for activities such as rapid re-housing and other short-term homelessness prevention activities.
Finally, for the VASH (veterans supportive housing) program the President is requesting an additional $75 million in Fiscal Year 2013 for new supportive housing units— specifically, new rent subsidies to secure housing for homeless veterans, with separate support services funded by the VA.
Andrew Sperling is the Director of Federal Legislative Advocacy for AMI, the National Alliance on Mental Illness. He leads AMI’s legislative advocacy initiatives in Congress and before federal agencies.
Reading, Writing, & Recovery
Formula for Achievement
By David Harris
Once a TASK you’ve first begun,
Never finish until it’s done.
Be the LABOR great or small,
Do it well, or not at all.
Lost
By Trina McNeil
Your mind is lost. Can it ever be found?
It’s gone. No sound.
You feel as if your mind doesn’t exist. But it does, it’s just lost.
But it will find its way back and you will heal. That’s the deal.
You don’t let your mind leave. It won’t be lost forever,
But you are the one that has to find faith and get it together.
Recovery & Reintegration
Anonymous
Recovery is a long and tedious process. Despite what one has heard, no one actually recovers completely from a mental collapse or breakdown. This statement may be hard to agree with but ask your psychotherapist if one could regain what was lost in a mental emotional collapse. I felt at one time that if I understood my illness, I could regain and fortify my personality and self esteem. I tried esperately, constantly, endlessly reaching for answers where questions did not exist.
After fifteen years of struggling and looking for encouragement after each try, after each hospitalization, medication and emotional reassurance I received nothing at all.
Group therapy, rap sessions, and art therapy did not help. I thought by extending myself I could shake my extroverted personality and maintain a calm and stable human recovery. How long does it take for a person suffering from a mental illness to say “I’ve recovered”? I’ve been trying for over twenty-five years.
Reintegration begins in a hospital or in any outside facility called a club house. I am all for club houses, where you can learn how another person recovered and reintegrated into the mainstream of society. A club house is designed to meet the needs of the mentally challenged. Fitting into society and finding a place that fits should be your main goal. With proper counseling and encouragement, we can make this life a better place in which to live together as a whole unit, not by separating the mentally challenged on one side and the normal on the other.
My Journey
By Annelle S.Finkel
I was walking down a winding road to my journey and did not know where I was going to wind up.
I was unafraid because I am well prepared for my future.
My journey is not my destination. It is an ongoing road and winding, because life is not a linear focus.
My road is my future; with twists and turns; highs and lows; and controlled by me.
Published by the
Morningside-Westside Community Action Corporation
345 West 85 th Street #31
New York, NY 10024
Nancy Walder, M.A.,
President
Ralph Aquila, M.D.,
Executive Vice President/Treasurer
Robert Ross, J.D.,
Vice President
Rosemary Aquila Sanders,
Secretary
Founded in 1994
Phone 212 799 3550
E-mail mwcac@mail.com
Editorial Board Members:
Frank Aquila, Richard Baerger, Kenneth Clemmons, Margaret Kendall, Constantine Kehaya, Aricelis Rivera, June Thurmon
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Nancy Walder, M.A., Bulletin Director
Steve Schimmele, M.B.A., Editor
Andrew Sperling, J.D. (Dir. of Federal Legislative Advocacy)/ NAMI, National
Editor
Harris T. Schrank, Ph.D., J.D., Contributing Editor
George Aquila, Assistant Editor
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Morningside-Westside Bulletin Spring 2012
Morningside-Westside would like to acknowledge grants from:
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