On Wednesday, December 15, Tompkins County Mental Health announced they would be limiting intakes from December 23rd through the end of January. See the notice at this link for details on intake specifications:
https://www2.tompkinscountyny.gov/mh/mental-health-limits-intakes-news-2021-12-15
This announcement has been troubling to families with loved ones who may be impacted by the limitations. People who reach out to NAMI FL often cite month's long waiting lists at other providers, such as Family & Children's Service, mentioned in the comments below. Mental Health Association has also registered their concerns about this change with NAMI FL, citing increased calls to their warm line, long wait times for care at local providers, and the challenges to providing peer support during a time of such critical need.
We reached out with our concerns and questions. Public Health Director, Frank Kruppa, responded and his answers are below.
1. Does the NYS Office of Mental Health have to approve changes like this?
Yes, OMH Regional Office is aware of and approved the temporary plan. We have also communicated the plan to Cayuga Medical Center so they are aware that patients discharged from the hospital will not be impacted by this action. We also met with Family and Children’s Service to establish protocols around triaging any increased referrals they receive that require more intensive services that our clinic provides. A member of our clinical leadership team will be reviewing referrals daily and triaging them based on need.
2. What can OMH do to help resolve this crisis in the short term? What will be done in the long term to ensure it doesn't happen again?
OMH has been awarded additional funding as a part of Federal COVID relief efforts to address the healthcare workforce crisis that NY State is facing. These funds are in the process of being dispersed to OMH licensed programs now. The actual amount of funding provided to each program however is limited and will take time to reach employees. The workforce shortage has been a significant problem for some time that has been exacerbated by COVID. The issues we are facing in Tompkins County are not unique to us and have been experienced by other providers in our community and across NY State. OMH is aware of these challenges. Many of these issues however are beyond their control such as low insurance reimbursement rates that impact salary and benefits of those working in the field at the same time higher education costs have significantly increased. Both these factors are barriers to people selecting a career in mental health.
3. What will be done about prescribing medication for someone who needs assessment if they are not already engaged with TCMH? Can they get medication to help them without an intake? Where else will people be prescribed critical medications for their well being if there are less than a handful of Psychiatrists in this county?
People can continue to be referred for treatment but initiating treatment will be delayed. Unless, through our triage process, it is determined that their needs are immediate or can only be addressed by Tompkins County Mental Health. This would include clients receiving injectables and other prescriptions that other local providers are unable to prescribe. Primary care offices are sometimes able to provide psychiatry and families may want to seek care there in the interim. There is a growing trend to expand into psychiatric treatment through primary care offices across NY State, and those services are available locally in some settings.
4. The notice states that if we need immediate assistance, we should call the Crisis Line. Upon calling the Crisis Line, we learned that they were not aware of the referral to them in this notice. Isn't it a better solution for someone who has the insight to seek help on their own to have an intake and be assessed for services, rather than allowing their lack of access upon self-initiated care to escalate to a crisis...for which you would respond with an intake (as mentioned in the notice)?
I believe we were asking people to call the crisis line if they are in a crisis now. This is not a change in practice. We were just reminding the public that crisis services are available. The Crisis hotline currently triages needs during a crisis and refers directly to our Mobile Crisis Team when necessary. They can assist with referral to other community supports when appropriate as well. We agree that it is better to receive services in a timely manner and regret that our workforce shortage is disrupting access at a critical time of the year.
5. Is the number of people coming to the clinic on their own for services so high that this impedes the clinic's ability to meet crisis follow up needs with intakes? If so, how are policymakers going to address our inability to provide care to people prior to escalating to the point of crisis going forward?
Yes, right now we are unable to provide treatment to new clients while also effectively attending to individuals who are in crisis and need immediate access to care. We are re-allocating our intake time to provide treatment to ongoing clients and address the needs of those who may need immediate support.
By limiting intakes to address the needs of individuals in crisis and collaborating with Family and Children’s Service to assist in treating new clients with lower intensity needs, we believe we can effectively support our community. We are already planning beyond this workforce shortage to meet client needs immediately upon re-opening and we are re-evaluating our plan weekly.
6. Should we tell families that this moratorium on intakes will be over when the notice states and is there a plan to ensure that happens? Or is the reality that it will be re-evaluated then and possibly continue?
While no one can predict the future, we have taken many steps to improve our recruitment and retention process including expanding our hiring to other master’s level clinicians (LMHC, LCAT and LMFT), becoming an HRSA approved loan forgiveness employer, establishing a flexible four-day work week as an option, and providing a half time work from home schedule that is approved by OMH and the County. We have also updated therapist schedules to create more flexibility to seek out input from colleagues and to have more breaks from this intense work in their day. We have provided information to staff on other ways to reduce burn out as well.
Unfortunately, we were unable to hire sooner to avert this crisis due to the civil service exam being announced by NY State for the psychiatric social worker position. We had to wait for the exam to be offered and a list of potential candidates created. This occurred at the same time we were beginning to have openings due to retirements and other departures from the clinic. We have already hired one individual and are in the process of interviewing this week for other positions. So, we expect to be fully staffed by the end of January. If possible, we will end limited intakes sooner.
7. If this will remain in place for a month and a half through the end of January, please provide language NAMI Finger Lakes representatives can share that accurately instructs struggling families and individuals what to do in the event they've expressed interest in seeking care to end their suffering prior to spiraling into crisis?
As previously stated, we have talked with Family and Children’s Service about the potential increase in referrals they may experience. We will be in close communication with them to ensure those with serious mental illness and who need immediate care and treatment are referred to the Tompkins County Mental Health Clinic. There are private practice settings in Ithaca as well including MindWell Center, Clinical Associates of the Southern Tier, and local clinicians in private practice who are publicly accessible on two websites:
Psychology Today found at website https://www.psychologytoday.com/us/therapists/new-york?gclid=EAIaIQobChMI2vf1rujo9AIVbjizAB0ztQFZEAAYASAAEgJwsfD_BwE and
CareDash found at www.caredash.com
There are multiple virtual treatment options that are also available that people may want to explore that can also be found online. Finally, the Mental Health Association of Tompkins County can provide paraprofessional and peer support for those interested in receiving assistance in the interim. While none of these are perfect solutions, together these alternative options offer additional access to care
