Our
Kids’ Mental Issues Are Shortchanged
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
