NEWSDAY – July 21, 2014 by ANDREW MALEKOFF
New York State has launched a three-year plan it says will transform the public mental health system. It intends to shift emphasis from costly long-term inpatient treatment to a community-based network of “regional centers of excellence.” The fact is that only children from families with Medicaid insurance fit into the plan, which hardly suggests excellence.
Here are the facts: 75 percent of serious mental illness occurs before age 24, and 50 percent before age 14. Yet, only 1 out of 5 children with emotional disturbances receives treatment from a mental health specialist.
In the past 25 years, the mental health system has undergone many changes. In New York, it consisted primarily of outpatient clinics, community hospitals, state hospitals and residential treatment facilities. It now includes additional services originally funded with dollars saved from the 1990s reduction in state hospital beds. The largest of these programs are Medicaid-driven.
Middle-class parents find that there are major gaps in our system. For example, at North Shore Child and Family Guidance Center government funding has not increased in more than 30 years. Yet, almost 65 percent of the children it serves do not have Medicaid. Increasing referrals are coming from clinics that no longer accept private insurance due to substandard rates of reimbursement. It is only through fundraising that community-based agencies can meet the demand.
The onset of managed care resulted in hospitals discharging kids earlier, often before they were sufficiently stabilized. Outpatient mental health clinics then have to provide adequate care to these often high-risk children and youths, but with highly inadequate rates of financial support from insurance companies and government.
Despite a growing demand for community-based mental health care, some outpatient clinics in Nassau County have closed, or have been taken over by corporate entities with no community roots, or have been transformed into fee-for-service operations with little or no capacity for dealing with crisis situations.
Further, some insurance companies expected to demonstrate “network adequacy” and “parity” are not delivering. Network adequacy refers to a health plan’s ability to deliver the benefits for health care services. Parity refers to acknowledging and treating mental health conditions and substance-use disorders the same as all physical pathologies. For example, the state has settled cases against Emblem Health and Cigna for wrongly denying behavioral health care coverage.
Nevertheless, more and more families find insurers do not have adequate behavioral health care networks. When it comes to seeking mental health care, finding help is difficult.
We continue to treat illnesses above the neck differently from those below the neck. Children with mental health problems, and their families, often suffer in silence, while those with physical problems evoke the sympathy, support and comfort of others.
Community mental health organizations that provide care for children are diminishing. Long Island Consultation Center in West Hempstead and Roosevelt Counseling and Resource Center, which operated since 1958, closed in 2012. Also, community acute-care hospitals, due to insurance limitations, are often unable to keep kids long enough to stabilize them. If the state is to truly create regional centers of excellence, it must not ignore the need for community-based care for the children of middle-class families on Long Island.
Malekoff is executive director of the nonprofit North Shore Child and Family Guidance Center in Roslyn Heights.
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