Michael Weiner is currently the Commissioner of Mental Health for Erie County. He began his new position in February 2000 after being appointed Commissioner by the newly elected Erie County Executive Joel Giambra. His long career in the behavioral health system has included positions as the director of the Buffalo field office of the New York State Office of Mental Health, the Director of Inpatient Services at Erie County Medical Center and work at the field office of the State Office of Alcoholism and Substance Abuse Services (OASAS) as well as several positions in not-for-profit community-based agencies serving youth. In an interview, Weiner discussed his background, his new position and some of his plans for shaping the mental health policy in Erie County over the next few years.

"At Erie County Medical Center, I was able to work with seriously ill individuals who were in great need. Certain needs couldn’t always be accommodated in the inpatient setting. I had the opportunity to work out some decent arrangements with community providers to improve the linkage between outpatient and inpatient services. In that era, 1978-84, there was a very high demand for inpatient beds. A lot of what we had to do, unfortunately, was transferring people to the state psychiatric center. We would transfer folks from the acute care sector to the long-term care sector late at night or on weekends because that was the only way you could keep up with the demand for beds. This was neither fair nor therapeutic to consumers or their families. Yet, it was the only option that we had at that time.

"We have since improved this system in a number of ways. Managed care has lessened the length of stay. We are providing more available housing for people who are ready to leave inpatient settings. This has also helped reduced lengths of stay. We have gotten better at managing discharge planning. There has been a significant expansion in the availability of community support programs. I think medication has reduced the need for more extended stays in inpatient settings. Consumers are able to be stabilized more quickly with fewer side effects. I never thought it was a good idea to keep a person in an inpatient setting longer than necessary.

Benefitting by prior experience

"I have a vision and a framework that will take me into the first twelve months of this job. This is partly established by my prior experience in the community. I have been living here for thirty years. I know the mental health community very well. I know the strengths, the weaknesses, the opportunities and threads in the system, and where there are hot spots and places that need corrective action. I know these things because consumers and providers have told me. I also have this familiarity from my own state mental health experience.

"Stakeholders have also told me that there are certain things that they would like to see happen. This has helped me to shape the directions in which I would like to see this community move.

"With that, I have developed a list of about twelve areas where I will be concentrating my efforts. I thought it was important to come into a new job for me, my staff, and the community and be able to say these are the areas to work on in partnership.

"I think my vision is very straightforward. This vision includes collaboration, partnership, creativity, innovation and customer service. When I think about going to work each day, when I get involved in meetings, when I have to make difficult decisions and when I am working with others around program development and planning, I think about my vision to be certain that I am embracing these important values. Meeting with stakeholders

"One of the most important activities in my initial framework was getting out and meeting with all the stakeholders. I know a lot of the players, particularly many of the mental health providers because of my work on the state side but I do not know many in the developmental disabilities or in the alcoholism and substance abuse communities. I have been increasing my learning curve in these areas. This has been not only the agencies that we contract with but other groups that we do business with such as consumer and family organizations, other branches of county government, politicians and the like. I need to get some reactions from them and determine if I am on target. This is one of the things in which I have invested a lot of my time. I average about four to five meetings a day and I spend only about two hours a day in my office.

"Another element of my plan is to work closely with the county legislature, particularly the health/mental health subcommittee. I believe that the commissioner should have a working relationship with the committee so that when we propose legislation they can talk to us if they have questions or concerns. It is important that they know we will be responsive. At the same time, as the commissioner, I can work with my staff to see that the committee is educated on issues about the way we operate and the way that the community is organized. I meet with the committee chair Legislator Judy Fisher on a monthly basis and I am committed to regular attendance at committee meetings as well as responding to invitations to address the committee.

"I also thought that it was very important to reconstitute the Erie County Mental Health Community Services Board (CSB). When I came in, I noticed there were a lot of vacancies, little diversity and an absence of clinical leadership. I called on old friends and people that I used to work with and asked them if they could help round out and complement the board. We now have two psychiatrists, our first Native American person and our first adolescent on the board.. We also have an intensive case manager who has a lot of mental health experience. We are also in the process of filling four vacancies on the alcohol and substance abuse subcommittee as well as changing the focus of this group to be more active in planning efforts. This board can be a very important group for my office. In order to bring advocacy and advice to this department, we need to make sure that we have a diverse group that represents the community as well as people who are skilled and knowledgeable and willing to put energy into their participation on the board. This is not to take anything away from those who have been active participants over the years. If anything, these people will benefit from the infusion of new members with new ideas. I am excited about this effort.

"The siting (where to locate and place programs) of behavioral health programs in the county is going to be a major issue. I knew this before I started my new role and I even participated in several meetings even before I began as commissioner. This is a very challenging issue. Siting represents issues associated with community concerns, stigma, discrimination, politics, economic development and consumer access and choice. One of the real weaknesses about siting right now is that no one knows what the rules are and no one knows what the process is for determining whether a program gets support for siting in a particular area. I think that mental health consumers and providers, criminal justice services and alcohol and substance abuse organizations have been unfairly burdened by siting issues. There has been notoriety in particular around certain populations.

"I am working with Judy Fisher, who chairs the siting committee come up with an administrative protocol for siting. By describing what the administrative process is, we would like to gain the full confidence of the community that allows my department to make decisions about siting based on common agreed upon criteria. We are working with a group of providers and consumers. We have a long way to go with this issue. It is important enough that we sit down with the city law department, the city community economic development department, the county law department, Judy, and interested providers and consumers so they know what to expect. There needs to be some commitment and integrity to the process. I do not think there is a lot of trust right now that the siting issue is being handled fairly. There is the potential for violations of the Americans with Disabilities Act. There have been related court cases. As the administrator responsible for review of siting of certain programs, I want to have some ability to influence the process and to do it fairly. My goal is to have the committee feel confident that the mental health department manages the siting review process effectively so that they can step back and look at larger issues of siting. For example, there are issues about siting programs beyond behavioral health. There are issues about siting human services in general.

"Even if I am able to work out the administrative review process for the county, the City of Buffalo has its own administrative review process. We don’t know how much we will be able to influence the city process when it controls access to the special use permit process which can sometimes be quite politicized.

"I have heard mental health service providers say that they could be at risk of losing funding if they choose to site programs in certain areas. This is a process that should be handled administratively and I am going to wrestle with that. I also have heard consumers concerns that they want access to services and that they want to live in certain areas. I also have heard that there are areas that are lacking services. I do need to respect the concerns of certain communities who say there is saturation. I need to look at this to see if saturation does exist if I can steer programs into other areas.

"It is important that this department give full consideration to serving the needs of the high needs/high risk population that exists across all disability groups. This assessment has been made to a great extent by my exposure to initiatives previously developed and the new resources coming into the community as a result of the assisted outpatient commitment law. We hope this year to expand our service network, supports, recovery and rehabilitation efforts for those individuals who are in the high need, high risk category. I think that this is a good start. However, I think we are at a point where we have an opportunity to improve our supports for people in the community, to improve our accountability and monitoring, and to reduce problems with access to services. I think to a great extent the availability of a full spectrum of services is better than in previous years when resources were more limited. I am excited about it.

"The alcohol and substance abuse budget is not as exciting as the mental health budget. There has not been a lot of growth in that budget at all over the past four years. It is basically a status quo budget. It is hard to say what has contributed to this lack of funding.

"The developmental disability budget has had a more supportive budget over the last few years. They have the New York Cares initiative which calls for the creation of 5,000 new beds for persons with developmental disabilities over the next five years. We are struggling in this community to develop expanded housing resources like this on the mental health side. Creating Task Forces - Housing, Restructuring Contracting, and Anti-stigma

"My plan includes creating task forces to deal with certain issues. The first task force that will be created deals with housing. This task force is designed to specifically address the needs of mentally ill adults. I knew that this was a big issue before I became commissioner. I knew that Erie County was an under-bedded community. I also knew that the housing providers had been working on a needs assessment. Therefore, when I became commissioner, there was already a report prepared on the housing needs for mentally ill adults. It was a helpful report in that it gave a snapshot of the housing needs from the perspective of consumers, family members and provider agencies. This work group provided a lot of valuable information.

"I am putting together a group of stakeholders who have a common interest and want to see us improve access to housing. With the governor’s new budget, this year we will be see approximately 100 new beds. In addition, before I left the State Office of Mental Health, we had issued a letter of approval for Erie County to establish a SRO (single room occupancy) facility which would accommodate as many as 85 individuals who had serious and persistent mental illnesses and who were in need of supervised housing.

"I also had some concerns with two programs providing housing for mental health consumers. These programs do not receive funding from the mental health department yet they serve a higher percentage of mental heath consumers. These are Bridgewell and the YWCA. Bridgewell has 140 beds and 93% of the consumers that live there have a serious mental health diagnosis. This facility has been cited by Commission on the Quality of Care and the Department of Health with major deficiencies. I cannot walk in and ignore Bridgewell. The YWCA has 85 consumers most of whom come from the Psychiatric Center. This is also a large program that has some needs as well. My department is looking at ways to support the service needs of consumers in both of these programs.

"We are looking at general housing issues and examining whether a single entry point model for housing would work in Erie County. This model, utilized in some other communities, has a single authority administering admission to the housing continuum. It is able to watch the turnover to see how we can improve on the waiting list, and where we might have to do new development. This can all be part of an administrative process that is coordinated and integrated among the housing providers. In order to do this, all of the housing providers would have to work in partnership. I think there is a willingness for this although I do not know what the outcome is going to be. We want to research ways to improve housing by reducing barriers and improving access. The task group will meet and make certain recommendations for change over the next six months.

"Another task force that we are developing is on "performance based"contracting. The Department of Mental Health started outcome based contracting a few years ago with developmental disabilities agencies as well as one mental health provider. We are looking to move from a structured cost-based contract to a performance-based, outcome focused contract. We would like to focus on what outcomes are associated with resource allocation and service delivery getting and how we are improving the quality of life for consumers and families through the contract process.

"All of the stakeholders that I have met who currently have contracts with us have said that we should change the way we contract. We want this group to formulate recommendations on how to modify the department’s contract and its process. When stakeholders say that the contract process is not working, I need to respond to that. This is a contract process that has not changed in 20 years. I am glad that I have come in a time when the department had already begun to experiment with some developmental disability agencies. These agencies told me that they are all much happier with the alternative way of contracting.

"A third task force that I am creating is the anti-stigma task force. I would like the department to have a plan that demonstrates a commitment to an anti-stigma platform. This platform will attempt on a regular basis throughout the year to present positive perspectives of consumers across disability groups who have benefitted from rehabilitation and are recovering throughout the community. This approach is necessary so we are not primarily hearing about the horrific events and tragedies which often create prejudice and negative attitudes like NIMBY(not in my backyard.) I would like to bring together a group who have interest in this issue and in six months time have them make recommendations on a plan. I am willing to commit resources to make this anti-stigma approach a reality.

"This anti-stigma campaign is consistent with David Sacher’s (the U.S. Secretary General) report on mental illness. Communities need to work on dispelling the myths about mental illness and dealing with stigma and discrimination. I think that it is the right thing to do."