NYS AG Letitia James Public Hearing on Mental Health - Lee Foundation's Submitted Comments

The Patrick P. Lee. Foundation (“Foundation”) is a private foundation based in Buffalo, NY. Established in 2007, the Foundation has key investment areas – education and mental health. While we are incredibly proud of our scholarship programs which support 100 students annually, my comments will focus on the Foundation’s work in mental health.

The Foundation has long prioritized mental health and concentrates the majority of its funding on strengthening the workforce and supporting treatment services. Because of the Lee family’s own experiences caring for a loved with schizophrenia, programs supporting adults living with serious mental illness (SMI) are of particular interest to the Foundation. Individuals with SMI are an often-forgotten group, yet they have the most acuity and vulnerability. When untreated, outcomes for individuals with SMI can be dire leading to homelessness and/or interactions with the criminal justice system.

In addition to grantmaking, an important part of the Foundation’s work is advocacy. We co-fund Think Bigger Do Good, a policy series that identifies behavioral health concerns and provides actionable recommendations and strategies. Authored by national thought leaders in mental health, the papers are often written with a federal lens, but the analysis and recommendations are applicable to WNY, especially those addressing the workforce shortage, housing, and the crisis system/988. 

Philanthropy plays a critical role in our communities. Private foundations have the ability to be nimble and avoid the red tape/delays that often ensnare even the most efficient of public institutions. However, there is a limitation to our work. While we can foster new programs and support our partners’ growth and innovation, our funds are finite and a longer-term investment from the public sector is necessary.

In my time with the Foundation, I have met with families, peers, providers, practitioners, advocates, elected officials, universities, insurance companies, and fellow funders. Many of the concerns raised in these conversations were mentioned at Wednesday’s public hearing.

Like many, I am cautiously optimistic about Governor Hochul’s proposed $1B investment to address the failings of our current system. Although there are many areas requiring our attention, I will focus on two the Foundation believes warrant priority.

#1 Without addressing the critical mental health workforce shortage, Governor Hochul's plan is not feasible. 

Recruitment and Retention

The rising costs of higher education and historically low wages deter people from entering the field. Those who do choose mental health as a career are saddled with student loans, large caseloads, and challenging work schedules. As one social worker shared with me, she could have a higher salary, more consistent hours, and less stress working in retail.

Unfortunately, there are few scholarship opportunities for graduate level studies and the cost of graduate degrees continues to climb. In an effort to remove some of the financial barriers, the Foundation provides scholarships to medical students pursuing psychiatry, psych NPs, and psychology interns and fellows. I expect the Foundation will expand its support to social workers and mental health counselors in the near future. Providing loan repayment and/or loan forgiveness should be a top priority of the State. While there is Public Service Loan Forgiveness (PSLF), many professionals experience burn-out and leave the field or seek higher paid positions in private practice before they are eligible.

It is imperative that the capacity of providers be enhanced and those already dedicating themselves to the field be supported. While the Foundation’s primary goal is to increase the number of practitioners, we know retention is critical. To that end, the Foundation provides free professional development opportunities and also covers the costs of the CEUs. A portion of the State’s funding should be allocated to retention which may include stipends and covering the cost of continuing education and licensure fees to help alleviate the financial burden on current practitioners and demonstrate our shared commitment to their success.

Expanding the traditional view of “workforce”

Our community must redefine “workforce” and think beyond mental health practitioners. As Dr. Davis noted in her comments at the hearing, primary care can play an important role in addressing mental health concerns of patients.

Last year, the Foundation funded three programs aimed at providing mental health training to primary care offices. With appropriate supports, primary care physicians and pediatricians can successfully screen patients and manage patients with mild to moderate mental health conditions. This will allow licensed mental health providers to focus on the more acute patients. Identifying ways to engage primary care will help alleviate the current strain on the system.   

To meet current demand, we should also explore ways to maximize other members of the care team such as peers, care coordinators, and case managers. These individuals are key to a patient’s recovery and provide needed supports – such as system navigation, appointment follow-up, linkage to other services, housing assistance, etc. In many cases, they also support family members, helping them to understand how best to care for their loved one. In the past, the Foundation has funded grants to cover the salaries of family peer advocates and case managers. These valuable services, although not clinical, are essential to a patient’s recovery and should be billable.  

#2 We must leverage new programs by increasing accountability and raising community awareness of existing services. 

New programs on the horizon

Crisis stabilization units/centers are successful at diverting individuals from the emergency department and the criminal justice system. I applaud the Governor’s efforts to establish this level of care across New York. As the Buffalo center is developed, I encourage the State to look to best practices across the United States, including Connections Health System in Tucson, Arizona. Developed in partnership with law enforcement, the center extends its impact by utilizing crisis mobile teams and co-locating hotline staff with 911 dispatchers to intercept crisis calls that are more appropriately handled by mental health professionals than police. The coordination of multiple services has been very effective. Although AZ has different funding mechanisms, there is much that can be gained through shared learning.

Another program that will soon be available in our community is an intensive crisis respite program managed by Recovery Options Made Easy. The Foundation supported this project with a $300,000 grant and we believe it will offer much needed step-down care from inpatient settings as well as step-up care from community outpatient programs.  

Outreach, collaboration and shared accountability

While it is promising to have these programs coming online, they must work collaboratively with our existing programs (Crisis Services Mobile Teams, Behavioral Health Teams, ACT teams, and CPEP) or they will fail to have meaningfully impact. Stronger collaboration, better tracking of outcomes, and shared accountability are critical. An independent oversight position and/or committee should be created to identify and work through challenges encountered by patients as well as providers. This oversight entity should have the power (and enforcement) of the State behind it. It is also important community members be aware of the various levels of care available to them. As part of its 988 marketing efforts, the State should conduct targeted outreach to historically underserved communities to provide information and answer questions. Leveraging trusted partners such as churches, FQHCs, community centers, and schools will enhance the effort.    

Thank you for inviting the community to voice its concerns and share its collective aspirations for a better, more comprehensive system of care. The Foundation welcomes the opportunity to continue the conversation.