“We are at a crisis point”: New York Attorney General hears spotlight on children’s mental health failures

This article was created for the local reporting network of ProPublica in partnership with THE CITY. Sign up for shipments to receive stories like this as soon as they are published.

By reducing inpatient psychiatric care, New York has left people with too few places to seek treatment for serious mental illness, Attorney General Leticia James said at a hearing held by her office on Wednesday.

James convened the hearing after reports from THE CITY and ProPublica about the failure of the state of New York to provide care for the mental health of children and adolescents. Our investigation found that government officials have closed nearly a third of children’s beds in state psychiatric hospitals since 2014 under a “transformation plan” introduced by former Gov. Andrew Cuomo. During the same period, nonprofits closed more than half of the beds in residential children’s homes in New York, largely because government payments were too low to keep the programs running.

“We are in a crisis situation and we definitely need action,” James said during the hearing. “Emergency departments are overwhelmed with people who need more intensive psychiatric services but do not have access to the necessary psychiatric inpatient beds or community services.

“When a child is in crisis,” James continued, “parents or guardians have only two options: to go to the emergency room or to call 911. And all too often, as we saw in our office, they have had clashes with the police, who only worsens the situation. These children have been waiting for months and months for treatment. ”

The lack of care is largely a direct result of cost-saving measures and the deliberate closure of hospital beds made during the Cuomo administration, said James, who quoted our report during the hearing.

In return for closing the beds, government officials have promised to expand access to outpatient and community-based mental health services aimed at keeping children safe at home. But these programs have never been adequately funded, and providers say they cannot afford to hire or retain enough staff. According to a lawsuit filed in March, New York does not provide community mental health services to the majority of children who are entitled to them under federal law. (The civil servants mentioned in the lawsuit have not yet responded to the complaint.)

“Things are desperate there,” said Alice Buffin, associate executive director of policy and advocacy at the New York City Civic Committee for Children. “Children present themselves at a younger age with a serious mental illness. Families are blocked at every stage of finding care. Young people come in and out of emergencies and hospitals because they can’t get the care they need early. ”

The problems are “caused by chronically underinvestment in children’s behavioral health care systems,” both by New York State and by private insurance plans that underpay mental health providers and fail to provide access to preventative mental health care, he said. Buffin.

In March, Rich Azopardi, a spokesman for Cuomo, told THE CITY and ProPublica that the closure was part of a larger effort to shift funds from hospital beds to outpatient care. The Kuomo administration has significantly increased investment in community mental health services, Azzopardi writes.

During this year’s session, the New York legislature approved funding increases for many mental health programs. However, several suppliers and advocates testified at the hearing that very little of the new money had been distributed and that the increases, while valuable, would not be enough to turn decades of underfunding.

Access to hospital care for children in mental health emergencies may be nearly impossible, said Ronald Richter, a former commissioner for child welfare in New York and current CEO of the JCCA, which manages foster care programs. care in Westchester County. Children in crisis have been rejected by Westchester Medical Center, Richter said. “These emergency departments cannot evaluate young people because they are overcrowded. They are afraid to admit young people to their emergency rooms because they have nowhere to discharge these young people. There just aren’t enough psychiatric beds for children who are suffering. “

From 2014 to 2021, New York closed 32% of public hospital beds for children, reducing the total number from 460 to 314. The largest reduction occurred at the Children’s Center in New York, where the total number of beds was reduced by almost half – to 92 in 2021. Meanwhile, in the first five years after the launch of the Transformation Plan, the number of visits to emergency departments for mental health by young people under the Medicaid program in New York – the public health insurance plan, which covers more than 7 million more low-income residents of the country – increased by nearly 25%.

JCCA staff sometimes resort to taking children to Bellevue, a state hospital in New York, for a greater chance of being evaluated or admitted, Richter said.

In response to Richter’s testimony, James noted that hospitals have a legal obligation to assess and stabilize anyone who comes to the emergency department with a medical crisis, and she asked New Yorkers who were rejected for emergency mental health care to contact her. office “so we can review these complaints to determine if individuals are complying with the law.”

“This hearing is to explore potential areas for reform and inform my office of future investigations into allegations of inadequate mental health treatment or lack of parity,” James said.

In all, more than two dozen people testified at the hearing, including elected officials, health care providers and New Yorkers who said they did not have access to mental health when they or their children needed it.

Among them was a Long Island mother named Tamara Begel, whom we identified in our report as her middle name, Ray. Begel’s son began entering and leaving emergency psychiatric wards after attempting suicide at the age of nine. Most times he was not admitted to a stationary bed. When he was, he had to wait a few days in the emergency room because all the beds in the children’s psychiatric hospitals were full. “The problems started long before COVID,” Begel said at the hearing.

During his last hospitalization, doctors said Begel’s son needed care in a long-term state psychiatric facility, but the beds were full there as well. He waited for two months in a hospital ward for a short stay, where he was attacked by other patients and repeatedly detained, both physically and with injected drugs, his mother testified.

“Long Island’s care system as a whole has completely collapsed,” Begel told James. “Parents are at a turning point because we can’t get health care for our children. We need people to step in. “

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