Proving What Works Is Challenge For N.Y.C.’s New MH Director

Lloyd Sederer, M.D., had already set a daunting challenge for himself and his new staff when he became New York City’s executive deputy commissioner for mental hygiene last July.

He is the first occupant of the position, which was created because New York City residents had voted the previous November to merge the city’s Department of Mental Health, Mental Retardation/Developmental Disabilities, and Alcohol and Substance Abuse Services (DMH) with its Department of Health and to mandate that an executive deputy commissioner have responsibility for those three areas. Previously he was director of APA’s Division of Clinical Services for two years.

“When I talked to city officials about taking the job,” Sederer told Psychiatric News, “I proposed that the agency take the next step in its development. It should establish methods and procedures to identify and report on who is being served and the treatments and services they are receiving.”

The agency needed to accomplish those basic tasks to advance to a more sophisticated set of evaluation and planning activities, he explained.

“Ultimately,” Sederer said, “we want to know which services are evidence based or otherwise represent good practices and what outcomes are being achieved, in order to improve rehabilitation and recovery opportunities for New Yorkers.”

The effort is complicated by the fact that the DMH does not provide direct services, but instead “plans, purchases, and monitors” services provided by other entities.

DMH has an annual budget of approximately $750 million, with which it supports 900 programs in the five boroughs of the city. Each year approximately 365 contracts with service providers are in place. A separate entity, the Health and Hospitals Corporation, has jurisdiction over inpatient psychiatric hospital care in the city’s public hospitals.

Sederer said, “We are working with our service providers to foster a climate that encourages the use of meaningful measures to collect data on results. Our goal is to make the process and information understandable to key constituencies such as consumers and their families.”

The effort is particularly important now because of budgetary pressures, he argued. If budgets are cut or remain constant, it will be critical for those concerned about mental health and other related services to have the capability of identifying programs and other funded activities that provide value.

Sederer has had a long-standing interest in the development of outcome measures that reflect patient experience with care and also permit practitioners to understand the impact of what they do and recognize opportunities to improve.

While medical director of McLean Hospital in Belmont, Mass., he and his colleagues developed a clinical quality measurement system for hospital services, and it has been adopted by institutions throughout the country and abroad.

Sederer and his current staff also undertook an epidemiological study that produced preliminary estimates of the need for various services among different population groups in New York City.

In addition to providing data essential to planning efforts, the study will help Sederer educate key constituencies about the economic cost of psychiatric and substance abuse disorders.

“The effort has been well received,” he said, “but we all recognize that we must do more work to produce data that effectively capture the unique need for services in our city. For example, we are developing ways of incorporating the impact of 9/11 on service needs of New York City residents. I knew the job would be tough,” but he also believes his past experiences have helped him meet the challenge.

He said, “I take an old-fashioned approach to the question of preparation and training for a job like mine. Learning how to be a good doctor should be anyone’s first and most important goal, then try to understand what’s involved in giving quality care in a complicated institutional setting that is affected by reimbursement rates and other external issues.”

Knowledge of epidemiology, biostatistics, health services research, and health economics also helps, but he said, such knowledge does not have to be gained in a classroom and encouraged potential administrators to learn from experts around them.

Sederer said, “My years at APA offered a kind of graduate school education in health policy, quality standards, and reimbursement issues.” ▪