As Erie County moves toward a model that diverts those with mental health and substance problems away from jails and prisons, it faces challenges in ensuring the quality of care through multiple agencies.
The sequential intercept model allows people to get access to services throughout the criminal justice process —whether that’s when they’re first arrested, in the holding center or in front of a judge.
"The energy and the focus behind that is to make an effective intervention at any of those intercept points,” said Michael Ranney, the former Erie County Commissioner of Mental Health.
Within that model, more organizations — ranging from the jails to nonprofits to hospitals — are meeting up to create a better line of communication so that a personalized care plan runs smoothly at different parts of the system.
“What I found with the jail is that I was reading things, hearing things, questioning things and then I made an appointment, I went in and I had a conversation,” said Cindi McEachon, executive director of Peaceprint of WNY. "It's amazing when you have open, respectful and objective dialogue, how much can get done."
One of the things that communication fostered was a joint partnership between the Erie County Holding Center and the nonprofit Peaceprints of WNY which is looking to stop re-entry at the local level.
It's called Project Blue,and the goal is to provide transitional services in the jail and then ease the individual into the community through workforce-ready programs, housing, and intensive case management.
Nearly 60 percent of the holding center’s population has a mental health condition, and a lot of these problems Western New York is facing were decades in the making.
"We're dealing with multi-generational incarceration, multi-generational trauma, broken families, severe poverty and [because of] these experiences, we're seeing those numbers go up as a result,” McEachon said.
McEachon advocates that the county government develop a quality standard for treating people who are both in the criminal justice system and the mental health care system.
"Step one is truly taking the politics out of all of it, and developing a quality standard and an understanding and open, I guess, transparent dialogue with all parties," she said.
Another challenge in developing that quality standard for mental health care is holding insurance companies accountable for denying behavioral health care treatments at higher rates than other medical treatments.
Mental health care requests were denied twice as often as medical treatments, according to a 2015 report by the National Alliance of Mental Illness.
In 2008, the U.S. Congress passed the Mental Health Parity and Addiction Equity Act to ensure equal coverage of treatment for mental illness and addiction and released rules to implement this law in 2013.
Ten years later, the New York State Office of the Attorney General released a report documenting how, despite both federal and state laws, mental health disparity still existed.
The investigation came after several complaints of unwarranted denials of mental health treatment, excluding residential treatment for behavioral health conditions and charging consumers higher co-payments for behavioral healthcare than primary medical care.
All of those actions are against the law.
Among the insurance companies that violated the law were Cigna, Anthem, and Beacon Health Options.
To hold insurance companies responsible to both these laws, State Senator Rob Ortt (R) introduced a bill that required insurance companies to report their coverage rates to the Committee on Mental Health and Developmental Disability.
"There's a host of reports this committee is supposed to receive from executive agencies that we don't,” Ortt said. “That's been a big issue that I've had over the years that I've been in the Senate is getting that data that allows us to be able to do our job to provide that oversight."
This August, Governor Cuomo signed Ortt’s bill into law.
Even with improvements to communication at the local level, and laws passed to hold insurance companies accountable, there are still barriers to improving the continuum of care.
Of the eight counties in Western New York, the bulk of resources, from hospitals to mental health professionals, are in Erie County.
Those who can't find care in their community travel to Erie County for mental health treatment, Ortt said.
Three counties have no licensed in-unit psychiatric beds and Chautauqua County will lose 20 of its 60 beds on January 1.
But the closing of that facility is still under review, according to The New York State Office of Mental Health.
Ortt said there needs to be an increase in funding by the state for beds, improvements to transportation, and community-based services in rural counties.
"The reality is that a lot of these community settings are in urban areas, you know, City of Buffalo, New York, Rochester, Syracuse,” Ortt said. “But if you go to Newfane, or if you're in, you know, a rural part of the state, you may not have those community services in your area. So what does that person do?"
Advocate for lawmakers to create a quality-of-care standard for those with mental health and substance use disorders. The U.K.’s National Institute for Health Care and Excellence, or NICE, started developing quality standards to measure the impact of what different efforts had on addressing this population's need.
Improve access to resources in rural counties and work across county lines to improve the continuum of care as many people travel to where mental health services are available.
As mental health and substance abuse treatment shifted from hospitalization to services based in the community, it presented a multitude of problems for the hospitals to provide those services. That’s here on Monday at 6 and 11 p.m.