Dutchess County’s 2012 budget includes a shift from continuing day treatment (CDT) mental health clinics to those with a personalized recovery emphasis. This change will be felt this year in Millbrook, Dover, Rhinebeck, Poughkeepsie and Beacon. It is a decision that as it stands now will result in the layoff of 22 jobs in April, and the all but certain legal arbitration initiated by their union. The shift from continuing day treatment where participants go daily for continuous care is to a clinic model that is designed to be temporary care. Its goal is to transition people; allowing previously institutionalized persons to integrate back into the community by imparting independent living and employment skills. Among all the statewide changes to the modern mental health system that 2011 ushered in, it will be the least unsettling in fulfilling the State’s role to those in need. 

New York’s role in the mental health field dates to 1894 when the Constitution was amended to create a system of State Hospitals for the insane. It was not however until the Great Depression in 1938 that the State leapt head-first into social welfare by adding two articles to the State Constitution: Housing and Social Welfare. Section I of Article 17 specifies “the needy” while Section III describes “those suffering from mental disorder or defects” as targeted populations. The constitutional change is significant as it created an affirmative social expectation for the needy as well as a requirement for the State to assume a major role in meeting their economic and social needs. 

The same Constitutional Convention enshrined social rights by making social welfare among the exceptions to its own limitations on use of state credit and restrictions upon local debt and taxation in Section 8. This meant that governments still had to exercise fiscal discipline, but that they could go into debt or tax to provide for the needs of the less fortunate. Specifically mentioned in the Constitution were aid and support for the needy, children, the unemployed, the sick, the old, and the physically handicapped. The language went beyond permissive (may) but said that it is “the responsibility of the State for the aid, care and support of persons in need.” A 1977 Court of Appeals case, Tucker v. Toia, reaffirmed the seriousness of the State’s role in determining that it was the judiciary’s role to see that the Legislature does not “shirk its responsibility.”

With hospital closures and sweeping systematic reform amid the trying financial times of today, the State — it could be argued — is departing at least in substance if not in form from the policies of 1894 and 1934. 

The same is not true of Dutchess County. The shift from CDTs to recovery clinics, although accelerated by the decrease in state reimbursement rates, is grounded also in modern concepts of mental health. The elimination of 49 positions including 22 layoffs will save taxpayers money and the new privatized recovery clinics will be infused with a philosophy that emphasizes not mental illness, but mental wellness.