May 21, 2014 was declared a Day of Special Recognition through the Town of North Hempstead for North Shore Child & Family Guidance Center.
Regina Barros, Victoria Domingo, Nellie Taylor-Walthrust, Bruce Kaufstein, Town of North Hempstead Councilman Peter Zuckerman, Andrew Malekoff
For three decades New York State has been systematically marginalizing middle class and working poor families who have children with serious mental health problems. This is a truth that the public is unaware of unless you have a child who is refusing to go to school, cutting herself, paralyzed by anxiety, deeply depressed or suicidal. Because mental illness is stigmatized, the reality of the State’s neglect has been obscured from view.
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Anton News, Long Island; Opinion – Andrew Malekoff
March 26 – April 1, 2014
The American reality today is 1 out of 10 children has a serious emotional disturbance and more children suffer from psychiatric illness than from autism, leukemia, diabetes and AIDS combined. Yet, we continue to treat illnesses above the neck differently than those below the neck. People with mental health problems, and their families, often feel a sense of shame and suffer in silence; while people with physical health problems evoke the sympathy, support and comfort of others.
In the past 25 years, the mental health system has seen many changes. From a system in New York State that consisted primarily of outpatient clinics, community hospitals, state hospitals, and residential treatment facilities, a continuum has evolved which now also includes a variety of additional services, originally funded with the reinvestment dollars saved from the 1990’s reduction in state hospital beds. The largest of these programs are Medicaid-driven.
Nevertheless, parents still find that there are major gaps in our service system. Even with the available community support services, children with mental illness and their families continue to need good, often intensive, outpatient clinical services. The onset of managed care resulted in hospitals discharging children earlier, often before they are sufficiently stabilized to return home. Mental health outpatient clinics are then left with the task of trying to provide adequate clinical care to these needy and often high-risk youths, but with highly inadequate rates of financial support from insurance companies and government.
Despite a growing demand for community-based children’s mental health care, right here in Nassau County there are outpatient mental health clinics that have closed their doors, have been taken over by larger corporate entities with no community roots, have transformed their operations into fee-for-service factories with little or no capacity for dealing with inevitable crisis situations, or have decided to turn away anyone who does not have Medicaid.
Commercial insurance companies are expected to demonstrate what is called “network adequacy.” Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. Nevertheless, many insurers do not have adequate mental health care networks despite the many names on their rosters. When it comes to seeking mental health care, for many families, the process of finding help is a shell game.
Only quality community-based children’s mental health organizations are capable of providing the labor-intensive quality of care necessary to address the mental health needs of children with serious emotional disturbances. Yet, these vital organizations are being squeezed out of Nassau County because of substandard insurance reimbursement and government neglect. Furthermore, community-acute care hospitals, because of insurance limitations, are not able to keep kids long enough to stabilize them in many cases. And, so, kids are being discharged to a community with inadequate supports.
The NYS Office of Mental Health has established a multi-year vision for the future of New York State’s mental health care system that they refer to as Regional Centers of Excellence. The vision does not include community-based care for middle class and working poor families with commercial health insurance.
Sounds more like Regional Centers of Mediocrity to me.
Andrew Malekoff, North Shore Child and Family Guidance Center, 480 Old Westbury Road, Roslyn Heights, New York, 11577; E-mail:amalekoff@northshorechildguidance.org
Since the 2012 massacre at Sandy Hook Elementary School, society has been discussing mental health, specifically eradicating stigma and ensuring ready access to quality community-based care [“Newtown’s mental health needs,” News, March 17].
Seventy-five percent of serious mental illness occurs before the age of 24, and half before the age of 14. Yet, only one out of five children who has an emotional disturbance receives treatment from a mental-health specialist.
In New York, continued access to care is assured only to children and families with Medicaid coverage, because reimbursement from commercial insurance is far lower and many providers will simply not accept it. The state Office of Mental Health has established a multi-year vision for the mental health system called Regional Centers of Excellence, which does not change the reimbursement formula. This will continue to marginalize community-based care for middle-class or working-poor families that have commercial health insurance.
Community clinics are the last bastion in addressing the needs of children and adolescents with serious emotional disturbances. Private psychotherapists and child psychiatrists, with some exceptions, will not accept commercial health insurance or will not provide the costly, labor-intensive work necessary to properly serve children and families struggling with serious emotional disturbances.
Andrew Malekoff, Long Beach
Editor’s note: The writer is the executive director of the North Shore Child and Family Guidance Center in Roslyn Heights.
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Gov. Andrew M. Cuomo made a grave error by vetoing Assembly Bill 7667-B, which would have directed state officials to develop a maternal-depression screening and referral plan, and to provide maternal-depression education.
The Centers for Disease Control and Prevention reports that postpartum depression affects up to 20 percent of mothers within the first year after giving birth. The rate of depression for mothers living in poverty is close to a staggering 50 percent.
Mental health experts agree that constancy of relationship from early childhood is the single best predictor of positive outcomes in later life. Promoting safe and warm relationships with parents and other caregivers is critical to young children’s healthy development and later success in school and beyond.
Leaving screening, education and referral to the discretion of practitioners, as a result of Cuomo’s veto, is a roll of the dice and a step toward destabilizing families, compromising the well-being of newborns, marginalizing mothers with maternal depression and putting their lives at risk. The bill would have widened the safety net.
Andrew Malekoff
Long Beach
Editor’s note: The writer is the director of North Shore Child and Family Guidance Center in Roslyn Heights, which operates the Diane Goldberg Maternal Depression Program in Manhasset.