December 15, 2003
Honorable Sheldon Silver
Dear Speaker Silver:
I am pleased to submit to you the 2003 Annual Report of the Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities.
On behalf of myself and the other members of the Committee, I would like to express my sincere appreciation for your support and encouragement throughout the year.
Very truly yours,
NEW YORK STATE ASSEMBLY
2003 ANNUAL REPORT
Peter M. Rivera
RoAnn M. Destito
Luis M. Diaz
William L. Parment
Matthew Mirones, Ranking Minority
Fred W. Thiele, Jr.
Donald A. Robbins, Legislative Coordinator
Carl R. Letson, Jr., Legislative Associate
Elana Marton, Associate Counsel
Antoinette M. Nowak, Executive Secretary
Guillermo Martinez, Legislative Director for Mr. Rivera
Anton Konev, Committee Clerk
|Table Of Contents|
The New York State Assembly Standing Committee on Mental Health, Mental Retardation and Developmental Disabilities serves as the focus of Assembly efforts to ensure quality care, treatment, and services to persons with mental illness, mental retardation and developmental disabilities.
Consistent with that role, the Committee is responsible for reviewing, developing, and recommending mental hygiene legislation; working with the Assembly Ways and Means Committee to consider proposed appropriations and reappropriations for the Office of Mental Health (OMH), the Office of Mental Retardation and Developmental Disabilities (OMRDD), the Commission on Quality of Care for the Mentally Disabled (CQC), and the Developmental Disabilities Planning Council (DDPC); and monitoring the activities of OMH, OMRDD, CQC, DDPC, the Mental Hygiene Legal Service (MHLS) and all programs licensed or operated by these agencies.
During the 2003 Session, the Committee's focus was on improving the services available while supporting consumers, providers, and families in the mental hygiene system as it wrestled with the difficulties imposed by Governor George Pataki's failure to fulfill his constitutional responsibilities. Article IV, Section 3 of the New York State Constitution states that, "The governor...shall expedite all such measures as may be resolved upon by the legislature, and shall take care that the laws are faithfully executed." Since first taking office, Governor Pataki has not complied with the statutory planning and reporting requirements of the Mental Hygiene Law. The result has been a disjointed, top-down planning process that is inefficient, facilitated wasteful use of public resources, and hindered the ability of the Legislature to focus the use of public resources to meet the needs of the mentally disabled.
The Governor allowed the Community Reinvestment Act to expire in 2001 and removed over $60 million in State general funds from the mental health service system during the 2002-2003 fiscal year. Even though in 2003 the Governor did not propose the reinvestment of savings from the reduction of inpatient census, including those related to the possible facility closings and consolidations, the Committee, in conjunction with the Assembly Ways and Means Committee, worked with the Senate to pass legislation ensuring that savings resulting from the downsizing of the State-operated mental health system would be reinvested into community-based programs.
The failure of the Governor to faithfully execute the laws of the State of New York and to expeditiously implement the laws approved by the Legislature created a public health crisis and is a violation of the public trust. The failure of the Governor to comply with the planning and reporting requirements of the Mental Hygiene Law and his removal of significant public resources from the mental health system has severely limited the ability of the State to develop alternative residential and service delivery programs for mentally ill persons in their home communities. As a result, thousands of mentally ill persons suffered indignities and abuse, and hundreds of others have succumbed to untimely deaths due to a dysfunctional mental health system.
The Committee is committed to holding the Governor accountable for complying with the statutory requirements of the Mental Hygiene Law. The Committee also remains committed to capturing all savings from the downsizing of State psychiatric centers and reallocating those resources into communities across the State to facilitate the ability of the mentally disabled to enjoy dignified, stigma-free lives in their home communities.
This commitment led the Committee and the Committee on Alcoholism and Drug Abuse to hold public hearings in Albany, Buffalo and New York City in 2001 and early 2002 to review the Governor's compliance with the statutory planning requirements of Section 5.07 of the Mental Hygiene Law. Section 5.07 was established by the Legislature to help ensure a bottom-up planning process that would enable the Legislature to establish policy and budgetary priorities responsive to the needs of the various regions of the State. After a review of written and verbal testimony, the Committee proposed legislation, which was passed by the Assembly in 2002 and reintroduced in 2003, to strengthen the statutory planning process and ensure the Offices within The Department of Mental Hygiene (DMH) work closely to address the needs of the multiply disabled.
This commitment also led the Committee to hold public hearings on the Governor's proposal to close three psychiatric centers and the Institute for Basic Research absent a 5.07 plan consistent with existing statutory requirements. As a result, all of the proposed closings and consolidations were rejected by the Legislature.
In conjunction with the Committee on Alcoholism and Drug Abuse, the Committee held a public hearing to look into issues and gaps in services related to individuals with dual diagnoses of mental illness and substance abuse. Additionally, in conjunction with the Committee on Corrections, public hearings were held to review conditions and services provided to mentally ill inmates in special housing units within State correctional facilities.
The Committee continued its work, in conjunction with the Committees on Aging, Health and Oversight, to improve conditions for residents of adult homes with diagnosed mental illnesses. While the Governor proposed the creation of housing alternatives for residents of adult homes, his proposals did not reflect the immediacy of the need for such housing since, under the Governor's proposal, alternative housing options would not come on line for at least three to four years.
The Committee determined that, in the absence of a viable planning process and the removal of significant resources from the mental health system by the Governor, the resulting crisis called for a comprehensive response. The Committee formed a Mental Hygiene Task Force, composed of more than fifty stakeholders representing consumers, families, advocates, providers and public employee unions to restructure the mental hygiene delivery system to more effectively and efficiently meet the needs of the mentally disabled. The Task Force will issue its findings and recommendations at the end of 2004 so that applicable budgetary and statutory responses can be implemented beginning in the 2005-2006 fiscal year.
As part of its focus on improving services available to consumers, the Committee held public hearings in 2001 on the use of Electroconvulsive Therapy (ECT) on patients in New York State. As a result of Committee staff research and testimony from the hearings, a series of bills were passed by the Assembly to address issues identified. The Senate also passed one of the Assembly's ECT bills but the Governor vetoed the legislation.
The Committee considered 71 bills during the 2003 Legislative Session. Of that number, 18 were reported for further consideration.
The following is a detailed report of the Committee's activities during the 2003 session and a preview of some particularly important issues to be addressed during 2004.
Governor Pataki released his 2003-2004 State budget proposal in January, 2003. The Governor did not recommend the extension or replacement of the Community Mental Health Reinvestment Act (Chapter 723 of the Laws of 1993) which expired on September 30, 2001. Instead, he proposed the closure of 3 State-operated psychiatric centers, consolidating two psychiatric institutes and closing the Institute for Basic Research, removing $32.6 million in general fund support from the mental hygiene system. The Legislature denied the Governor's proposals and restored, over the Governor's veto, the funds to the mental hygiene system.
In addition, the Community Mental Health Support and Workforce Reinvestment legislation was enacted (Chapter 62 of the Laws of 2003) to re-establish the reinvestment of resources from the downsizing of State operated facilities into community based programs, This legislation also amended the Mental Hygiene Law to include consumers and family members on community service boards.
The Committee will continue to monitor State revenues and ensure that, consistent with the Assembly's commitment to reinvestment and pursuant to the planning requirements of Section 5.07 of the Mental Hygiene Law, a fair share of that money will go to address the needs of those individuals with mental illness, mental retardation and developmental disabilities.
Inter-Office Coordinating Council (A.5946/Rivera)
Chapter 978 of the Laws of 1977 reorganized the Department of Mental Hygiene (DMH) into its component offices and established an Inter-Office Coordinating Council (IOCC). In addition, Section 5.07 was enacted to provide a planning mechanism to establish statewide goals and objectives and statewide plans of services for the mentally disabled.
It was determined by former Governor Hugh Carey and the Legislature that three separate Offices would be better able to focus on the needs of the mentally disabled within their purview than a department that had a bias towards the needs of the mentally ill. The IOCC was created to help ensure that the Offices worked together to meet the needs of the multiply disabled and that certain resources could be shared by the Offices for greater efficiency of operations. At the same time, the Commission on Quality of Care for the Mentally Disabled (CQC) was established to provide an independent review of the offices within DMH. Over time, the IOCC was stripped of its resources and each office essentially went about its own business.
Section 5.07 was established to ensure that there would be a bottom-up planning process that would reflect the partnership between the State and local government units, emphasize how gaps in services would be filled, and ensure that services are provided to the multiply disabled. Advisory councils were created for each of the Offices to establish measurable statewide goals and objectives, to be reviewed on an annual basis by means of a process that was open, visible and accessible to the public. The Offices were then to formulate comprehensive five-year plans with annual updates. These plans were to be formulated from local comprehensive plans developed by each local government with participation of consumers, consumer groups, providers of services, and Department facilities. Section 5.07 specified what, at a minimum, was to be included in the annual plans. These plans were due on October first of each year with copies to the Legislature. This was done so that the plans could be considered by the Governor and the Legislature in the next ensuing Executive budget.
In addition, an interim report is to be submitted to the Governor and the Legislature no later than February 15th of each year, detailing each Commissioner's actions in fulfilling the requirements of Section 5.07 and modifications being considered.
Section 5.07 also requires each office to prepare a three-year capital plan that corresponds to the statewide five-year plans. The advisory councils are to review these plans and make recommendations. Copies of this plan, as well as the recommendations, are also to be submitted to the Legislature on October first of each year or concurrent with the annual submission of estimates and information required by Section One of Article Seven of the New York State Constitution in order that such plans could be considered with the estimates of the Offices for the preparation of the Executive budget for the next succeeding State fiscal year.
The needs of the multiply disabled, which were originally intended to be addressed by the IOCC, are not being given appropriate attention in the annual planning process since the planning process being implemented does not conform with the requirements of law. The end result is the Legislature has insufficient information to establish policy and budgetary priorities.
The Committee, in conjunction with the Committee on Alcohol and Drug Abuse, held joint public hearings in Albany and Buffalo in 2001, and a public hearing in January, 2002 in New York City to receive information on how the statutory planning process has been implemented by the Executive and how Section 5.07 and related sections of the Mental Hygiene Law could be strengthened. Members of the advisory councils, local governments, consumers, consumer groups, service providers and agency representatives were invited to testify.
Legislation was introduced by the Committee (A.5946) to establish the IOCC as a viable entity within the Department of Mental Hygiene, with an independent Chairperson and give it responsibility for planning and delivery of services to the multiply disabled. It also establishes a Council for Mental Hygiene Planning with members to be appointed by the Governor and the Legislature. The Council is responsible for goal setting and planning for the needs of the multiply disabled. In addition, this legislation strengthened the planning process by:
The Assembly deferred action on this bill until the Mental Hygiene Task Force has had the opportunity to review issues related to inter-agency cooperation and strategic planning. Pressures on the mental hygiene service delivery system will increase as people experience such problems as post-traumatic stress syndrome; alcohol and substance abuse; gambling; and the inability of fragile, mentally disabled persons to cope. The Committee is committed to ensuring that there is a viable, bottom-up planning process to meet the needs of the mentally disabled. The Committee is further committed to ensure that the needs of the multiply disabled are being addressed effectively and efficiently by the Offices within DMH.
Electroconvulsive Therapy (ECT) is a procedure used to treat certain mental illnesses by directing electrical current through the brain to produce an epileptic seizure. In February, 2001, the Assembly became aware of concerns regarding the forced treatment of mental illnesses with ECT. Since the Legislature last looked at ECT over 30 years ago, the Committee decided to revisit the issue. A public hearing was held in New York City on May 18, 2001, where both proponents and opponents of the use of ECT provided testimony. Information provided to the Committee included issues related to the long-term efficacy of ECT treatments, cognitive side effects, use of antiquated equipment, inconsistent procedures for implementing ECT, informed consent protocols, court-ordered ECT, and education and training of ECT practitioners.
A second hearing was held on July 18, 2001 to receive testimony regarding proposed legislation. The Committee also requested the CQC to conduct a review of ECT practices at State-operated psychiatric centers. The CQC raised issues of concern regarding the informed consent procedures, lack of standard practices to be uniformly followed by all facilities, and different protocols for certifying ECT practitioners. The CQC recommended the Commissioner convene a blue ribbon panel to address these issues. The Committee considered the CQC recommendations and many of the suggestions presented at the July 18th hearing and made appropriate amendments to the legislation.
The Committee introduced one resolution and four bills designed to address some of the issues identified. The resolution was adopted and one bill, requiring reports on the utilization of ECT in New York State, was passed by both Houses. Unfortunately, Governor Pataki vetoed this legislation.
The safety of the devices used to administer ECT has been an issue of longstanding contention among professionals and advocacy bodies. In 1976, Congress enacted legislation granting the federal Food and Drug Administration (FDA) authority to regulate medical devices, including machines used to administer ECT. However, the FDA was given only limited jurisdiction regarding ECT equipment due to a grandfather clause that allowed continued use absent FDA testing. Subsequently, in 1979, the FDA designated and classified ECT devices as Class III medical devices. A Class III designation is used for pre-market approval for devices that show an unreasonable risk of illness or injury. Yet, no formal tests were conducted by the FDA to determine the safety of such devices. This resolution calls on the United States Congress to require the FDA to determine the safety of ECT equipment and to pass legislation establishing proper protocols and administration of use.
The issue of informed consent is critical in enabling a patient to make a decision regarding the use of any medical intervention. The courts in New York State have consistently recognized and upheld the right of every individual to make his or her own treatment decisions. The Committee found that there is a significant degree of variability among facilities regarding information provided during the informed consent process. The ability of a patient to obtain appropriate information regarding ECT and the timeframe in which he or she must evaluate the efficacy of the information, as it relates to the patient, is crucial for the patient to make a reasoned and informed decision.
At the request of the Committee, the CQC conducted a survey of the provision of ECT at State psychiatric centers. The CQC found that, "protocols varied in detail regarding the procedure itself, as well as in issues such as physician privileging and determining capacity to consent." The impact of bias on the determination of capacity to consent necessitates extensive review as part of the informed consent process. Misdiagnosis, either as the result of bias or human error, can lead to faulty judgments regarding capacity to consent and validity of information provided during the informed consent process. This legislation addresses these concerns by involving mental health professionals, such as clinical psychologists, who have no involvement in ECT to help ensure that patients are diagnosed correctly and that bias in capacity determinations is minimized. In addition, this legislation:
This legislation establishes a temporary advisory council to assist the Commissioner of OMH in developing procedures and practices to be followed by all ECT facilities; recommend licensing requirements for those that administer ECT; recommend prohibition of certain ECT equipment; and to identify acceptable equipment to be used for the administration of ECT. The Committee found that ECT protocols vary widely among facilities and, absent federal stipulations regarding ECT protocols, determined the need for a temporary advisory council to address such issues within New York State. In January, 2001, the Commissioner of OMH stated that an internal blue ribbon panel was addressing ECT protocols and that a report would be forthcoming with recommendations. As of the date of this report, neither the promised report nor a list of OMH panel members has been provided to the Committee.
The Committee found that there was little cumulative data regarding the usage of ECT statewide. This bill requires OMH to report the incidence of ECT use in public and private hospitals or other facilities where ECT is administered. After completing negotiations with the Senate, S. 2691 was passed by both Houses, however Governor Pataki vetoed it.
The American Psychiatric Association's (APA) 2001 ECT Task Force Report states that, to some extent, adverse medical adverse events can be anticipated with ECT. The APA recommends that ECT facilities be appropriately equipped and staffed with personnel to manage potential clinical emergencies. This bill prohibits the use of ECT in doctors' offices or other locations that do not have emergency medical facilities.
The State Office of Mental Health currently limits the provision of licenses, the transfer of licenses, and the expansion of services under existing licenses based on the availability of State Medicaid funds. This "cap" of State Medicaid funds as a determining factor for licensing is not a criteria used by the Department of Health, OMRDD, or the Office of Alcoholism and Substance Abuse Services. The effect of this practice has been a restriction in the expansion of outpatient mental health services with a net result of a severe shortage of available outpatient mental health services. It also discriminates unfairly against programs that provide services to Medicaid recipients. This bill would bring parity to mental health in this regard. It was passed by the Assembly and transmitted to the Senate.
The Office of Mental Health currently has the authority to bill patients for services provided in its facilities. Unfortunately OMH has in the past billed patients for services when the patients have suffered from mistreatment, including one case where a person was killed while a patient at a psychiatric center. This legislation would prevent OMH from billing a person for his/her care and treatment when the source of the funds for making such payments comes from the proceeds of a suit against the State from negligence or improper treatment. This bill passed the Assembly and was reported to the Senate Rules Committee.
There is a great need for the establishment of a waiting list that would truly reflect the need for housing and related services for people in New York with mental disabilities. This bill would facilitate development of appropriate housing options and help bring the State in line with federal legislative and judicial mandates to better enable the mentally disabled to live productive lives in their home communities. This bill passed the Assembly and was reported to the Senate Rules Committee.
Adult home residents, particularly those with mental health diagnoses, have been subjected to abuse and neglect. The Governor has been slow to respond to this crisis. This bill, which amends the Social Services Law, gives residents of adult homes, enriched housing programs and assisted living programs the power to petition the courts to seek temporary or permanent receivers when their health, safety and welfare are at risk. The bill passed the Assembly and was sent to the Senate.
Thousands of mentally disabled youth are presently residing in out-of-state facilities that may or may not be licensed by that state. This bill seeks to ensure that all such facilities are licensed and inspected. This bill was referred to the Ways and Means Committee.
This bill would establish a right of treatment for children who are certified and waiting to be placed in a residential treatment facility (RTF). Currently, many seriously emotionally disturbed children who are certified for and awaiting RTF placement in the interim are not receiving the services they need. This bill would ensure that these children receive equivalent services in the community until they are placed in an RTF.
As more and more people are discharged to the community and mental hygiene services are community-based, the need for oversight and advocacy to protect persons with mental disabilities is greatly increased. This legislation clarifies the CQC's jurisdiction to ensure that people served in the community are able to have the conditions of their care and treatment reviewed when they are being provided by a program or facility funded by OMH or OMRDD. This bill passed the Assembly, and is now pending in the Senate.
Since the deinstitutionalization of large numbers of mentally ill, mentally retarded and developmentally disabled individuals has taken place, the services that they need or desire have not been available in sufficient quantity. Many such persons are capable of living in our community, independent of their families or other full-time care, if some alternate level of services were available. Without clearly delineated lists to demonstrate which services are needed most by this population, and in which areas of the State they are needed, neither the agencies nor the Legislature can properly plan for them. The lists being mandated by this legislation would provide vital information that will assist in the planning by the State and voluntary agencies wishing to establish, direct, or enlarge services for this population.
There has been growing concern that abuse of the mentally disabled by direct care workers is increasing. This bill requires criminal background checks of prospective employees. The bill was signed into law (Chapter 643 of the Laws of 2003).
The Community Mental Health Reinvestment Act (CMHRA) expired on September 30, 2001. Originally enacted in 1993 with a sunset provision and subsequently renewed with revisions, the Community Reinvestment Act established, as State policy, the principle that all savings within the State-operated mental health service delivery system would be reallocated to localities across the State to meet the mental health needs of individuals and facilitate their ability to live independently in their home communities. In 2002, the Governor did not propose a new CMHRA. Both the Assembly and the Senate determined it necessary to maintain the promise to reinvest resources realized from the downsizing of State-operated facilities into community- based programs. In June, 2002, community reinvestment legislation passed both Houses. However, The Governor vetoed it. This legislation was reintroduced as part of the 2003-04 Article VII Budget legislation and was enacted into law.
The Committee worked closely with the Insurance Committee on this legislation, also called Timothy's Law, which would require insurance providers to provide coverage for persons with mental illness on the same terms and conditions as they do for persons with other illnesses. Current law allows insurers to limit the coverage they provide to persons with mental illness. The bill passed the Assembly and died in the Senate.
Section 5.07 of the Mental Hygiene Law lays out the statutory requirements for the planning and implementation of a comprehensive system of service delivery based on the development of local plans and the involvement of consumers, advocates and providers of services. The Governor has not complied with the requirements of this law since he began his tenure.
The failure of the Governor to faithfully execute the laws of the State of New York and to expeditiously implement the laws approved by the Legislature created a public health crisis and is a violation of the public trust. Promises made by the people of this State in the Constitution and through their elected representatives in the Legislature to help the mentally disabled have been broken. The failure of the Governor to comply with the planning and reporting requirements of the Mental Hygiene Law and the removal of significant public resources from the mental health system by the Governor has severely limited the ability of the State to develop alternative residential and service delivery programs for mentally ill persons in their home communities. As a result, thousands of mentally ill persons suffered indignities and abuse, and hundreds of others have succumbed to untimely deaths due to a dysfunctional mental health system.
The Committee is committed to holding the Governor accountable for complying with the requirements of the Mental Hygiene Law. In addition, the Committee is committed to strengthening the planning and reporting requirements of the law and ensuring that services to the multiply disabled are planned for, and coordinated between the Offices within the Department of Mental Hygiene.
By ignoring the statutory planning requirements of the law, the Governor has created a planning vacuum. The Committee has taken steps to fill this vacuum be establishing a Mental Hygiene Task Force. The task force, composed of over fifty stakeholders, formed four committees to restructure the mental hygiene delivery system to creatively and efficiently respond to the needs of the mentally disabled so they can live productive lives in their own communities. The committees include:
The Committee is committed to addressing issues of concern raised by its review of the adult home industry. The Committee will work with the Assembly Committees on Aging, Health, and Oversight, Analysis and Investigation, as well as the Senate and the Governor during the upcoming session to ensure that the mentally ill have an array of stable, affordable residential options to better enable them to live independent lives in the community consistent with their needs.
The implementation of Assisted Outpatient Treatment (Kendra's Law) will continue to be closely monitored to determine how the process is working and where the gaps in services present themselves. Of particular interest will be the impact of this law on the overall mental health system. The Committee will closely examine amendments likely to be proposed by the Governor's Office, OMH, the Attorney General's Office and community providers.
The Committee will continue to work with the Senate to enact legislation to provide parity for insurance coverage of mental illness with that of other physical illnesses.
When a New Yorker with a mental illness is released from jail, prison, or a State psychiatric facility, he or she is ineligible for Medicaid for at least the 30 to 90 days it takes to process the application. The critical period of transition back to the community is a time not to be without health care coverage. For years this barrier has prevented people from accessing the care they need, resulting in costly relapses. Efforts will continue to include this item in next year's budget.
The Medicaid neutrality cap was put in place in the mid-1990s to hold down Medicaid costs, but currently is a standard only applied to mental health. Expansion of outpatient mental health services has been limited and restricted since the applicant for approved licensure must indicate how both the State and local shares of Medicaid for the proposed outpatient programming will be paid. The Committee is working to change this policy, which has contributed to a severe shortage of available mental health services.
The diversion of the mentally ill from incarceration is a focus the Committee has taken in 2001-2002 and will continue to pursue next legislative session. The Committee has been active in exploring what diverse program options might be the best fit for New York State. It is anticipated that visits to prisons and jails, as well as continuous dialogue with experts in the field, will help yield a package of bills in the areas of treatment and diversion for the next legislative session.
The lack of treatment options for mentally ill prisoners in the State correctional system has resulted in the over use of special housing units (SHUs) in State prisons. Segregation of mentally ill inmates in these restrictive environments with no mental health supports results in deterioration of the mental health of such inmates and does little to improve the safety of these institutions or society when they are released. The Committee is committed to working with the Committee on Correction to pass legislation that will enhance the safety of our prison system while, at the same time, respond to the mental health needs of inmates so that they can better cope with their prison environment and their home communities upon release.
2003 Summary of Action on Bills
|Bills Reported With or Without Amendment|
|Bills Having Committee Reference Changed||0||0||0|
|Senate Bills Substituted or Recalled||0||2||2|
|Bills Never Reported, Held in Committee||46||4||50|
|Bills Never Reported, Died in Committee||0||0||0|
|Bills Having Enacting Clauses Stricken||1||0||1|
|TOTAL BILLS IN COMMITTEE||65||6||71|
|Total Number of Committee Meetings Held||7|
2003 PUBLIC HEARINGS
The Assembly Mental Health Committee periodically holds public hearings on topics of importance. In addition to receiving testimony from many individuals, such public forums allow for the discussion and development of new directions and legislation on vital topics.
Public hearings were held across the State to receive testimony regarding the Governor's proposal to close four psychiatric centers, one children's psychiatric center and the Institute for Basic Research on Staten Island. The hearing regarding the proposed closing of the Institute for Basic Research was held in Staten Island on March 7, 2003. A public hearing was held in Syracuse on March 20, 2003 regarding the proposed closings of Hutchings, Elmira and Middletown Psychiatric Centers. A public hearing was held in the Bronx on May 9, 2003 regarding the proposed closings of the Bronx Psychiatric and Bronx Children's Psychiatric Centers.
The Committee and the Committee on Correction held public hearings on October 7, 2003 in Rochester and November 18, 2003 in Manhattan regarding the disciplinary confinement and treatment of prison inmates with mental illness. In addition, the Committee and the Committee on Alcoholism and Drug Abuse held a public hearing in Manhattan on October 10, 2003 regarding co-occurring disorders (mentally ill individuals with substance abuse diagnoses).