Behavioral health is an umbrella term that includes mental health care and alcohol and substance abuse treatment. Choices Mental Health Counseling PLLC offers individual psychotherapy, group, couple, and family counseling with adults, adolescents and children for trauma history, mood and anxiety disorders, attentional and communication problems, parent-child issues for risk reduction and prevention, pre-adoption home studies and follow-up, psychoeducational services in mental health and abuse of alcohol and other drugs, evaluations for courts, and for the NYS DMV as an OASAS approved provider of clinical screening and assessment services for impaired driving offenders to consider restoration of driving privileges after a DWI, and other behavioral health needs.

"The Sober Truth" - Seeing a Local and National Need for More Safe Supports for Women in Recovery

OPINION

By Tom Rue, MA, LMHC, CASAC

A journalist friend, Eva McKend, recently commented online (not in a work capacity) concerning a CBS News "48 Hours" report she viewed entitled The Sober Truth regarding a lawsuit reportedly filed by the parents of Karla Brada Mendez against Alcoholics Anonymous World Services, asking a court to hold AA liable for the murder of their adult daughter by her live-in boyfriend because she met him in the rooms of AA. What standing the parents of a grown woman might claim to sue an association of recovering alcoholics who make it abundantly clear that they are not professionals, but is built on the idea of "one drunk helping another", is unclear.

Clearly a victim of domestic violence, if Karla met the man who would later murder her at church, or in a PTA meeting, would they have asserted a similar claim against those organizations? What was CBS News thinking when they produced this documentary?

Ms. McKend commented that she found it disturbing that women "...are being taken advantage of in AA programs across America. While I'm not ready to further stigmatize the formerly incarcerated as I think that they are separated from so much in our society already, I do think it's important that people are aware that AA might not be the safe space that they thought it was."

Local human rights activist Sandra Cuellar Oxford focused her well informed reply on the need for more therapeutic services both for incarcerated inmates and post-release in the community, concluding by calling me out by name, "What think you, Tom Rue?" So here is what I think. I understand the documentary has generated discussion and self-examination in recovery-oriented circles, so the lawsuit and documentary may have served a constructive purpose by telling the story of a family's traumatic loss. However, many if not most members of AA find themselves understandably reluctant to speak publicly out of respect for the 11th Tradition which includes a commitment to refrain from engaging in public discussion of the fellowship which has helped bring about their recovery.

In an FAQ type pamphlet for newcomers, in response to the question "How can this help me with my drinking problem?", the AA General Services Conference explains the non-professional nature of the fellowship: "We in AA know what it is like to be addicted to alcohol, and to be unable to keep promises made to others and ourselves that we will stop drinking. We are not professional therapists. Our only qualification for helping others to recover from alcoholism is that we have stopped drinking ourselves, but problem drinkers coming to us know that recovery is possible because they see people who have done it."

In a general, however, AA and support groups like it are deeply "therapeutic" in that they help to bring about and maintain critical and lasting behavioral changes which help people to save their own lives. I believe the topics raised by 48 Hours are important and deserve public attention, though I do not believe the producer's portrayal of 12-step programs was either fair or accurate. I believe I can safely express my opinions on this subject, making it clear that I am not speaking on behalf of any agency, organization, or employer other than myself as a clinician.

Writing as a professional mental health and substance abuse counselor in private practice, not associated with any organization or agency, I offered the following comments in response, including advocating for more gender-specific addiction treatment and services and sober supports than currently exist in our community. It is important to note that 12-step fellowships and similar programs are not "therapeutic services" in any professional sense.


"I watched the full 48 Hours episode. Thanks for pointing it out. The focus on AA is misdirected. The deeper issue is domestic violence and abuse of power by men in society. If there were a hashtag for this, it would be #YesAllWomen. The defect is endemic to our whole society. It has nothing to do with AA. This acknowledgment is missing from the video report. Not once in the documentary is the word 'patriarchy' used.

"One damning comment by a friend of the murderer who said he heard knew the victim was being abused and he did nothing other than offer moral support was, 'We don't call the police. We take care of things ourselves.' I know of nothing in AA that supports this sort of enabling and permissive behavior.

"Holding segregated meetings for criminals and non-criminals is simply not workable. AA is not a professional organization. It is a loosely structured network of people who choose to associate with other people who share a desire to stop drinking. This lawsuit seems aimed to restrict that freedom to associate.

"Perhaps bars, which unlike AA are in fact licensed by the State, should be required to segregate patrons who have been convicted of a crime into separate rooms from law-abiding drinkers? More education is needed, all across society, on the subtle nature and impacts of patriarchy, male privilege, and other forms of oppression. Safe places need to exist, without restricting freedom of association, for mutual support and aid of all types.

"Gender-specific meetings and treatment programs are important and should be expanded, but they themselves do not solve the problem of domestic violence and patriarchal attitudes.

"An issue touched on in the video, but inadequately explained, is the abuse of 12-step fellowships as part of criminal sentences. Not only is court-ordering people to attend 12-step meetings inconsistent with the traditions of AA as an autonomous fellowship in which the only requirement for membership is a desire to stop drinking, legal precedents explicitly prohibit 12-step meeting attendance as a compulsory intervention (e.g. DeStefano et al., Appellants, v. Emergency Housing Group, Inc., et al., Respondents [281 AD 2d 449; 722 NYS 2d 35]; Arnold v. Tennessee Board of Paroles [1997], Griffin v. Coughlin [New York, 1996], Warner v. Orange County Department of Probation [2nd Cir. 1997], Rauser v. Horn [3rd Cir. 2001], and Kerr v. Farrey [7th Cir. 1996]).

"Perhaps the fact that the story is set in California is one factor, but the above cited decisions are Federal precedents. Maybe the USSC needs to rule for courts across the country to get the message.

DeStefano is perhaps the most widely cited of the above mentioned decisions. While AA is clearly not a "religion" per se, it promotes a spiritual world-view and calls on individuals to come to some sort of understanding and relationship with a Power higher than themselves, Courts have widely held that compelling criminals to attend 12-step meetings in order to avoid incarceration violates the establishment clause of the First Amendment and is unconstitutional. One unmet need evidenced by the 48 Hours story is the inadequacy of available services and supports, both professional (inpatient and outpatient care) and non-professional (like AA, NA, etc.), designed for women, men, LGBTQ, and other special populations."

The lawsuit by the parents of Karla Brada Mendez was reportedly filed around September of 2012. At this writing, no information is known to have been made public concerning how the case proceeded, whether it was dismissed, settled out of court, or if litigation is ongoing. None of the articles I have been able to find on the web about this lawsuit even contain a docket number. It would be interesting, as an academic matter, to know the outcome. If anyone reading this knows, I would be pleased to update this page. Based on what I have read, however, I doubt the lawsuit will get far, even if a court recognizes the parents' alleged standing to sue.

The vast majority of women and men currently in recovery from alcoholism or addiction to other drugs benefited from co-educational treatment programs and engage in integrated male/female support meetings. In so doing, members of 12-step fellowships suggest that men stick with men, and women with women, for support; choose a sponsor of the same gender; and not start any new intimate relationships during the first year of recovery. This is a system which has worked well for countless thousands of people in recovery who have chosen to work it.

Still, it is important to acknowledge the gender-specific local programs that exist locally, specifically designed to meet the needs women who prefer them, as well as the advocating for the creation of more...

Women-Only 12-Step Meetings in Sullivan County, New York:

  • Women in AA, Mondays, 7:00 PM, Rock Hill ambulance building
  • Women's NA meeting, Wednesdays, 6:00 PM, Clubhouse, 17 Hamilton Avenue, Monticello
  • Words of Wisdom Women's AA Group, Saturdays, 11:00 AM, Clubhouse, 17 Hamilton Avenue, Monticello

Women's Inpatient Programs (not co-ed):

  • New Hope Manor, Inc., Barryville (long-term residential): "New Hope Manor is committed to offering high quality, research-based substance abuse treatment services that are sensitive to the individual needs of each woman. We respect the dignity and uniqueness of every woman who seeks our help, and strive to enhance the personal growth and development of those we serve... Our program works to strengthen families, including the bond between women and their children, and to involve family members in the treatment process whenever possible" (website).
  • Richard C. Ward Addiction Treatment Center, Middletown (21 to 28 days): "The Women's Program is based upon the philosophy that women have unique needs that can be addressed in a discrete setting. The core component of this track is a multi-disciplinary treatment team based on the principle of 'women treating women'. Gender specific programs address the many barriers that traditionally have blocked women from accessing treatment" (website).


Links to Meeting Locators and Treatment Programs

Any errors, omissions, and additions to the above list of local programs may be addressed to tom@choicesmhc.com. This posting is not approved by and does not reflect the views of AA or any other organization or agency. Opinions expressed are solely those of the writer.

Recent mental health features in The River Reporter newspaper

The following articles have appeared recently in The River Reporter of Narrowsburg, New York:

Sleep hygiene The River Reporter, December 4, 2014.

There Is No Health Without Mental Health : The vision to see and to make wise choices The River Reporter, October 2, 2014.

Past Traumas, Present Pain: Traumatic Stress and Chronic Pain The River Reporter, August 7, 2014.


Older articles on human development and related and services by Tom Rue, contributing editor, The River Reporter, 1985 to 2000.

Stop "Carving Out" Insurance Benefits For Mental Health From Those Most In Need... Reform Managed Care Medicaid And Medicare In Albany And Washington

By TOM RUE, LMHC, CASAC
Choices Mental Health Counseling, PLLC

At a time when much is said in the media about a need for increased access to behavioral health care, legislative reforms that will actually work receive little attention. I applaud the efforts of reformers like Congressman Chris Gibson at a Federal level, and our local Assemblywoman Aileen Gunther (who chairs the Assembly Mental Health Committee) in Albany and others, for ongoing efforts to reform Medicaid and Medicare.

A major inequity in the current health insurance system is the fact if a person is on Social Security, mental health and substance abuse counseling are most likely designated as "carved out benefits" of managed care. This means they are not covered by, for example, Hudson Health Plan, Fidelis Care NY, or any of the other good quality plans that provide managed care Medicaid to the public (i.e. those who are not classified as disabled or otherwise covered by Medicare).

If a person has SSI or SSD (i.e. those in the community who suffer from the most severe physical or psychiatric disabilities), or is a senior citizen collecting a pension, they are most likely limited to seeking mental health or addiction counseling from a Medicare provider, which can be especially hard to find in a rural county like Sullivan. Under the present system, the majority of outpatient treatment providers are not eligible to participate in Medicare.

This longstanding inequity is neither a result of, nor is it resolved by, the controversial Affordable Care Act. (As of December 15, 2013, uninsured and under-insured New York residents became eligible to apply for health insurance through the NYS Department of Health's Insurance Exchange website, which has not been reported to have had the type of technical problems that have beset the Federal government's website for those states that have elected not to maintain their own health insurance exchange.) But like "Obamacare" or hate it, this problem is not new and has not gone away.

For a real-life example, not long ago a patient was referred to me by her gynecologist for mental health counseling due to depression and anxiety after undergoing a total hysterectomy for cervical cancer. She responded well over the months that I saw her, both to her cancer treatment and to psychotherapy. She was making progress with managing her moods and panic attacks, but suddenly had to stop her attending counseling when her application for Social Security Disability application was approved, and outpatient behavioral health became a "carved out" benefit. Even though I was a participating provider in her managed care network, only a Medicare provider was eligible for reimbursement under her policy once her SSD benefits for the cancer began. Due to her income, she was not able to afford even a reduced self-payment she was offered. She continued antidepressant medication prescribed by her doctor (which was still covered by her insurance), but told me she was not interested in switching therapists to a county or state operated clinic that could bill her "straight" Medicaid.

This gap in coverage is something I see too often. It has the unfortunate discriminatory effect of making life harder for many when they are most in need of treatment.

I get many calls many calls each month from people with managed care Medicaid asking for appointments for mental health treatment. If they have a Medicaid plan that I participate with (such as Hudson Health or Fidelis), the next question I have to ask is whether they receive Social Security benefits. Most say no, and they are offered appointments. If the answer is yes, regardless of the condition for which they are seeking treatment, they are advised to call the number on the back of their insurance card and request a referral to someone who can bill NYS Medicaid or Medicare, which are few and far between due to antiquated Federal and State laws. (See the list at the upper left column of this website for a list of health insurance and EAP plans in which I am currently in-network).

To help address this widespread problem, Congressman Chris Gibson has introduced HR 3662, the Mental Health Access Improvement Act of 2013. Anyone wishing to advocate for the rights of mentally ill and recovering people, regardless of where you may live in the U.S., are invited to click this link, or otherwise contact Congress and voice your views.

For more information, see “Seniors Mental Health Access Improvement Act of 2013,” Bipartisan Counselor Coverage Bill, on the website of the North Carolina Counseling Association.

In the present environment in Washington, getting any bill out of committee and passed through both houses of Congress is a long shot, but our own Congressman Gibson and the other co-sponsors of this bill, on both sides of the isle, deserve support for this bipartisan import effort to reform Medicare by allowing expansion of the pool of treatment providers. This approach is good for the free market system, and good for consumers. They have my thanks for their efforts.

One effect of the ACA, however, will be to increase the number of people with health insurance who are seeking treatment, making licensed, qualified mental health care providers that much harder to access. This problem is described in a recent article in The Wall Street Journal, For the Mentally Ill, Finding Treatment Grows Harder: New health-care law may add to crunch for enough treatment [PDF].

In New York State, the Medicaid Institute at United Hospital issued a report in 2012 on Implementing Behavioral Health Care Reform in New York's Medicaid Program. The authors explain, "This report examines the implementation of Medicaid policy changes in New York, which will require participation in care management for beneficiaries receiving behavioral health services. Until now beneficiaries have typically received these services under a fee-for-service [i.e. "straight Medicaid"] payment model."

The Western New York Law Center reported in late August 2013 that New York State had received Federal approval to begin a trial program that would allow some SSI/SSD/Medicare recipients greater access to behavioral health, in CMS Approves Launch of Demonstration to Manage Care for All Dual Eligibles.

When these changes will be implemented locally is not clear. Provider Relations departments at managed care insurers that I have spoken with tell me they have no information about these "carve-outs" being eliminated any time soon.

However, the above described Federal and State legislation and regulatory changes offer hope that mental health and substance abuse treatment will become more accessible to those who need it most, and work toward abolishing with the existing system of "carving out" these benefits from managed care and leaving the most impaired patients to seek an appointment at a publicly funded clinic or search for a private therapist who bills Medicare.


The foregoing opinion article is posted as a form of non-partisan patient advocacy.
Linked articles and documents are provided in the public interest, for educational purposes.

Giving Public Thanks To Public Sector Workers, While Increasing Accessibility To Private Outpatient Mental Health And Substance Abuse Counseling In Sullivan County

This a public thank you to co-workers at the State of New York and County of Sullivan I have worked with over the years, many of whom for whom I have the greatest respect. Having spent 13 ½ years at Richard C. Ward Addiction Treatment Center in Middletown – plus more than half that with the Sullivan County Department of Community Services as a Staff Social Worker, in mental health day-treatment and at the outpatient addiction clinic; with adult men and women; six years as a child and family therapist for a private agency under a public contract with Sullivan County Division of Health and Family Services children’s Preventive Services; and previously as a Sullivan County Probation Officer; a houseparent in publicly-operated adolescent group home; and clinical coordinator for a not-for-profit after-school program for teens, since 1985 I have done counseling work with adults and adolescents who suffer from mental illness and addiction, and runaway and ungovernable and delinquent youth, as well as family and couples therapy, with goals of family preservation, reunification, and adoption.

Choices Mental Health Counseling opens new office at 433 Broadway in Monticello

Tom and Carmen Rue on the porch at 433 Broadway The offices of Choices Mental Health Counseling, PLLC are now located at 433 Broadway, across from Landfield Avenue, a half block west of Rotary Corner at the intersection of Saint John Street.

Please use private parking in the rear, or park on Broadway. The public is invited to use the side entrance. The front entry is wheelchair accessible. Free wireless connectivity is available in the waiting room for the convenience of guests. The move took place in late February and was completed by the end of March 2013.

The new site includes a larger rooms than the former location for group and individual counseling sessions, and a comfortable waiting room. (See interior photos.)

Tom and Carmen Rue in front of 433 Broadway

The practice continues to provide private and confidential outpatient counseling treatment for mental health for substance abuse recovery, for individuals, groups, couples, and families. Referrals are accepted from healthcare providers, the legal system, schools, human service agencies, and managed care organizations, or by interested individuals. Reimbursement by most insurances, and several employee assistance programs, is accepted (see list at left).

Office hours are presently limited to evenings and Mondays during the day, but the plan is to expand to full-time in the fall of 2013. The practice has been in operation since August 2010, most recently on Pelton Street and originally in an office in the historic rectory of St. John's Church. Presently, the only site address for Choices Mental Health Counseling PLLC is 433 Broadway, though mail should still be addressed to PO Box 706, Monticello, NY 12701.

Bilingual Support Services

Office manager Carmen Rue, who is fluent in English and Spanish and can assist with translation when needed, graduated in nursing from Federico Villarreal National University in Lima, Peru. A woman of many talents, in her spare moments away from serving the Village of Monticello as an elected Trustee (an office she continues to hold), Carmen was behind the office's decoration and selection of comfortable new furnishings.

Experience and Specialties

Licensed as a mental health counselor (LMHC) by the NYS Department of Education and credentialed by the NYS Office of Alcoholism and Substance Abuse Services as a credentialed alcoholism and substance abuse counselor (CASAC), Mr. Rue is state-approved to provide courts with assessments and evaluations of people charged with impaired driving; as well as being qualified under rules of the US Department of Transportation as Substance Abuse Professional (SAP), as well as experience giving input to Family Court on adoptions, custody, visitation, and parenting concerns.

He has worked as a mental health and addiction counselor since earning his Masters degree at Rider University in New Jersey in 1985, including working 13 years for New York State and 6 years for the Sullivan County Department of Community Services, 7 years as a family therapist for Berkshire Farm Center & Services for Youth, and a few years in the 1980s as a probation officer in Sullivan County. He has been certified as a clinical mental health counselor (CCMHC) and National Certified Counselor (NCC) by the National Board for Certified Counselors (NBCC) since 1990.

Building History

The building at 433 Broadway was erected in 1910, a year after Broadway was decimated by a massive fire. It was built by John F. Tyson, who opened a hardware store across Broadway in 1870. Mr. Tymeson left his property to his son-in-law, the Rev. Emmet Sloat, who served as a local minister from 1923 to 1925.

Rev. Sloat continued to serve community causes, including as treasurer of the American Red Cross of Sullivan County until as late as 1929. More recently, the building housed the healthcare offices of chiropractors Paul Sinew, DC; and from 1967 to 1984 of Jack Bosches, DC.

For more information, call 845-513-5002 or visit www.choicesmhc.com.

View Larger Map

The building at 433 Broadway as photographed by Tom Rue on August 3, 2008 prior to road renovation by the NYS Department of Transportation.

Licensed Mental Health Counselors are Exempt from Reporting Mandates of NY SAFE Act

Don't want to add to the risk of the government taking your guns, but you or a family member need(s) confidential services from a mental health professional? Licensed Mental Health Counselors (LMHCs) are exempt from reporting requirements in the NY SAFE Act, allowing broader privacy protection for persons receiving such services than when provided by other licensed healthcare providers [see NY Mental Hygiene Law § 9.46]. Most insurances are accepted. Call 845-513-5002 to schedule an appointment.

Related external link:
The New York SAFE Act of 2013 and its profound effect on mental health care providers and their patients

March 22, 2013
Health Law Alert
Author(s): Daniel C. Gibbons, Michelle Yuen

Changes In New York State Law Protect Victims Of Domestic Violence

DOMESTIC VIOLENCE PROTECTIONS – Part of the new domestic violence reform law, designed to protect victims’ health care and insurance information, (Chapter 491, S7638), takes effect on January 1, 2012. The landmark law, sponsored by Senator Steve Saland (R-I-C, Poughkeepsie), Chairman of the Senate Codes Committee includes several important provisions to protect victims of domestic violence and establish stronger criminal penalties to punish individuals who commit acts of domestic violence.

As of the first of the year, victims of domestic violence who seek medical and/or mental health services and use their health insurance to pay for that care, can designate alternative contact information so they may receive health insurance correspondence in a safe location of their own choosing, such as the home of a friend or family member, a post office box, or a shelter.

“Current law already bars disclosure of an address and phone number when an order of protection is in place,” Senator Saland said. “This law greatly expands the information to be protected by ensuring that a victims’ health insurance information is not sent to the same address as the alleged abuser, thus affording more protection domestic violence victims.”

Expanding Options and Coordination of Care

Value Options logoI am presently able to directly bill insurance companies for the networks linked in the left column of this website, which include: Aetna Behavioral, Beacon Health Strategies, CIGNA Behavioral, Capital District Physician's Health Plan (CDPHP), EBS-RMSCO, Fidelis Care New York, Hudson Health Plan, MultiPlan, PHCS Savility, TRICARE (military healthcare), and ValuePoint.

A recent piece of mail announced that CHOICES MENTAL HEALTH COUNSELING, PLLC has "been approved for the following ValueOptions networks: NY-HMO (CHCS), VALUEOPTIONS AND VALUOPTIONS EAP, GHI/EMBLEM HEALTH NETWORK, EMBLEM HEALTH NON HMO, EMBLEM HEALTH HMO, EMBLEM HEALTH MEDICAID, EMBLEM HEALTH MEDICAID, MVP COMMERCIAL, NON HMO NETWORK-IPA, MVP COMMERCIAL, HMO NETWORK."

Here is a useful patient education flyer entitled "When you are in therapy, what your doctor needs to know..." which explains mental health as closely related, sometimes inexorably so, to physical health.

US DOT Qualified Substance Abuse Professional

SAP Evaluations

A transportation worker who has violated DOT regulations must follow specific procedures before being considered by an employer for return to safety-sensitive function. A SAP credentials packet is available for those wishing to confirm my qualifications under DOT rules.

This process, conducted by a qualified Substance Abuse Professional (SAP), includes:

  • Conducting an initial face-to-face clinical evaluation, including standardized testing.
  • Developing recommendations for treatment and/or education.
  • Sending an initial evaluation report to the employer or, if employee has been released from employment, maintaining information for future employer.
  • Assisting the employee in contacting the treatment provider and arranging for services.
  • Maintaining regular contact with the treatment provider, to monitor the employee's treatment progress.
  • Conducting a face-to-face, follow-up clinical evaluation to determine if the employee has complied with recommendations, and to measure success of treatment.
  • Sending a follow-up report and follow-up testing plan to the employer.
  • It is up to the employer to determine whether or not the employee returns to work, not the SAP.
  • If the employee has been released from employment, this information is held for the future employer.

Tom Rue, MA, LMHC, CASAC, a mental health counselor since 1985 and a credentialed alcohol and substance abuse counselor since 1996 (certified through the International Certification and Reciprocity Consortium [IC&RC]), completed fourteen (14) contact hours of training in October 2012, successfully completing the exam requirement later the same month, both sponsored by the Employee Assistance Professionals Association. This training and exam meet the requirements of 40 CFR Part 40.281(c), Qualification Training for Federal DOT Regulations and Assessment Requirements for the Substance Abuse Professional (SAP).

If you are seeking to schedule an appointment for an assessment, call 845-513-5002. Please be prepared to provide the following information during the initial call or fax it in advance to 866-428-0282:

  • Your name, title, company name, address, phone number
  • DOT Mode, i.e., FMCSA, FRA, FTA, FAA, RSPA or USCG
  • Employee name, address, phone number
  • Social security number
  • Date of birth
  • Violation and date of violation
  • Current employment status
  • Name of Designated Employer Representative (DER)
  • Who is responsible for payment? If employer is, provide name and phone number of DER for verification and arrangements.

For an additional fee, the SAP can conduct ongoing monitoring following the employee's return to work, including monthly in-person interviews and revision of the employee's follow-up testing program, when appropriate.

SAP Service Payments

If fees are paid by the employer, full payment can be forwarded to the SAP at the time of the referral or SAP will provide an invoice when initial report is sent.

If fees are paid by the client, full-payment is required prior to the evaluation. Payment must be in exact amount by cash or money order.

SAP Service Payments

For more information, visit dot.gov/odapc/sap and DOT/FMCSA Drug & Alcohol Testing Program: Substance Abuse Professionals

See my listing on SAP List listing.

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