$94 Million in Overtime or Universal Access to Mental Health Care?  You Choose

Andrew Malekoff

New York Nonprofit Press - May, 2014

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.

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 1991, New York State implemented a plan to use Medicaid dollars to fund outpatient community-based mental health services. That approach, also known as Medicaiding-the-system, is gone.

Medicaiding-the-system was a combination of a base Medicaid rate applied for each outpatient community-based mental health clinic visit for Medicaid recipients only and supplemental dollars paid on top of each base payment to subsidize non-Medicaid consumers (known as Comprehensive Outpatient Funding or COPS). This approach to support community-based agencies was developed to replace local assistance or deficit-financing.

Local assistance was a simple and sensible public-private financing partnership. The partners were the State and County governments (through government funding), mental health consumers (through third party and fee-for-service revenue) and the local community (through fund-raising that was a part of the local assistance government contract). Local assistance funding insured that all stakeholders chipped in their fair share to support an essential community-based service.

In 2009, New York State announced that the Medicaid-bankrolled COPS approach of financing community-based clinics had the inadvertent affect of propping up commercial insurers who were paying substandard rates. Having uncovered that festering wound, OMH got to work on creating a new financing plan that they referred to as clinic restructuring or clinic reform.

The clinic reform plan raised the Medicaid-base rate, added new rates for previously unfunded or underfunded services (known as Ambulatory Patient Groups or APGs), and phased out the supplemental COPS Medicaid rate over a four-year-period that recently came to an end. The Medicaid base-rate and APGs now apply only to those families who have straight Medicaid and Medicaid managed care insurance.

In my discussions with New York State officials about the devastating consequences of the clinic reform plan for middle class and working poor families who do not have Medicaid insurance, I was advised that community-based mental health centers must re-negotiate rates with commercial insurers. That is nothing new. It is common practice. The state officials advised me that if the commercial insurers do not raise their rates to sufficient levels that will help to cover the cost of the services provided, then we should terminate our contracts with them.

Community-based providers routinely re-negotiate rates with the managed-care companies which represent private health insurers. However, they rarely agree to rates that come close to covering the cost of service. As one managed-care representative told me, “C’mon, we’re hurting too.” And, he said it with a straight face, despite record profits. State officials told me that community-based agencies like North Shore Child and Family Guidance Center, a specialty children’s outpatient clinic where I have worked for 37 years, should change their payor-mix. Payor-mix is a euphemism for terminating contracts with private health insurers and, consequently, denying service to thousands of children who need us.

When I pressed him on this, his response was that “the marketplace will take care of it,” referring to private practitioners. But mental health providers know that private child psychiatrists and other private behavioral health practitioners will not accept substandard rates or take on the labor-intensive work required to address the needs of children with serious mental illness (e.g. collateral contacts, crisis intervention, etc.) Nevertheless, commercial health insurers must by license demonstrate “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. The truth is that many health insurers do not have adequate mental health care networks despite the voluminous number of names on their rosters. But tell me, really, what private citizen or community-based nonprofit can be successful in advocating for the revocation of licenses of private health insurers with the millions of lobbying dollars backing them up? Good luck!

The truth is that for many families, when it comes to seeking mental health care for their children, the process of finding help is a shell game aided and abetted by New York State. New York State claims that they cannot provide additional local assistance funding to help to subsidize universal mental health care in community-based clinics, which must also raise funds by contract, to support these vital services. Consequently many clinics are turning away all but Medicaid applicants for their services. But, is it true that New York State cannot offer local assistance support?

In a recent report issued by NYS Comptroller Thomas DiNapoli, it was revealed that the New York State Office of Mental Health runs up annual overtime expenses of $94 million a year. And, this is happening at the same time that the state is footing the bill for nonprofit community-based mental health clinics to enroll in state-sponsored efficiency classes that are a part of the State Office of Mental Health’s Clinical Technical Assistance Center (CTAC) initiative.

The goal of the efficiency classes is to improve the bottom-line by implementing centralized scheduling, open access and collaborative documentation. Fair enough. However, CTAC trainers have joined the state officials’ chorus about marginalizing the middle class and working poor. One CTAC trainer told me, during a recent webinar when I raised the question about the discrepancy in reimbursement rates, “You must change your payor-mix.”

Can you imagine how much savings there would be if OMH took the efficiency classes and were just a little bit more efficient with their use of overtime; and, how much of that savings could go towards supporting universal community-based outpatient mental health care for children?

And, keep in mind that that OMH’s excessive annual overtime expenditures presents New York taxpayers with a pay now and pay later scenario. We pay today for overtime and we will pay later for elevated pension benefits for State employees, a number of whom have left the Office of Mental Health to take on lucrative administrative positions with large conglomerates that state officials encourage smaller clinics to “merge with”; a euphemism for “be taken over by”.

To sum up, the State claims that there is no additional local assistance funding for community-based clinics to provide universal mental health care; clinics are then “encouraged” to take State-funded efficiency classes to reduce their cost of service by dropping underinsured middle class and working poor clients; The New York State Office of Mental Health generates overtime expenses of $94 million per year (plus increased employee pension benefits in perpetuity, at taxpayer expense); private health insurance companies present only the illusion of network adequacy and hide behind lobbying payoffs; community-based mental health clinics are closing or turning away all but Medicaid applicants or are being taken over by conglomerates administered by ex-OMH officials who are collecting overtime-time inflated State pensions on top of lucrative salaries from the takeover institutions; and kids and families who don’t have Medicaid insurance are being turned away from community-based care.

If New York State will not support essential community-based mental health services for the most vulnerable members of our communities – our children – then who will?

 

Andrew Malekoff, executive director and CEO of North Shore Child and Family Guidance Center in Roslyn Heights, NY. amalekoff@northshorechildguidance.org

Public Hearing to examine the impact of the NYS Office of Mental Health’s plan to establish Regional Centers of Excellence on affected communities

http://www.nynp.biz/index.php/points-of-view/17210-what-is-excellence-without-universal-access

September 19, 2013, Middletown Common, Middletown, New York

By Andrew Malekoff, Executive Director and CEO, North Shore Child and Family Guidance Center, Roslyn Heights, New York, 11577

 Good afternoon. My name is Andrew Malekoff. I am executive director of the North Shore Child and Family Guidance Center, a community-based outpatient children’s mental health agency located in Nassau County. This is our 60^th anniversary. I have been with the Guidance Center since 1977. I thank you for the opportunity to be heard today.

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 family support, day treatment, a variety of in-home community support services, community residences, mobile crisis intervention, and respite care.  Many of these services were originally funded with the reinvestment dollars saved from the 1990’s reduction in state hospital beds.  The largest of these programs, Home and Community Based Services (HCBS) Waiver and Intensive Case Management, 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 funds. 

More low- and middle-income families than ever are in need of low-cost, high-quality community-based mental health care.  Yet in New York State continued access to care is assured only to children and families with Medicaid and Medicaid Managed Care insurance coverage. This leaves a significant number of children in the lurch. 

Here is a true story to illustrate. About 25-years ago I was swimming in the ocean in Long Beach, NY, and someone pointed to a group of girls that had drifted towards the jetty. The girls must have been pulled out by the undertow and were unnoticed by the lifeguards. I swam to them. When I arrived, there were three little girls; one looked about nine-years-old. The others, who were crying and holding on to the older girl, appeared to be six or seven. The older girl was trembling and barely in control of her emotions. I wrapped my arms around the three of them and said, “Hang on.”

Finally, the lifeguards arrived and took over. I swam to shore and went back to my beach chair. When I recall this encounter, I realize that the four of us were strangers who spent maybe 90 seconds together. I said only two words to them: “Hang on.” Ninety seconds, two words and 25-years and I still think about them often. We were so close that I could see their freckles.

Now, let’s consider another scenario. Try to imagine me swimming out to the three girls. Now, imagine if, instead of telling them to hang on, if I treaded water at a safe distance and asked them if they had Medicaid insurance. Imagine if they answered, “No mister.” And, if I then said to them, “Sorry, girls,” and turned my back on them and swam to shore.

This is the situation that we now face as New York State has made a dramatic departure from its responsibility to make sure that our most vulnerable citizens – our children – get community-based mental health care, regardless of their family’s economic status. They expect us to throw the underinsured middle class and working poor overboard with no life preserver. I see nothing to suggest that Regional Centers of Excellence will change this.

The American reality today is 1 out of 5 children has a serious emotional disturbance and more children suffer from psychiatric illness than from autism, leukemia, diabetes and AIDS combined. Seventy-five percent of all serious mental illness occurs before the age of 24; and 50% before the age of 14. Yet, only one out of five children who have emotional problems receives treatment from a mental health specialist.

Unfortunately, the mental health system has become largely Medicaid-driven. For example, my agency, at any given time, sees over 75% of children who do not have Medicaid or Medicaid Managed Care.  It is a constant struggle to provide what is needed for the majority of our clients who are either uninsured or underinsured middle class and working poor families.

In Nassau County, and I suspect elsewhere, there are community-based outpatient mental health programs that have closed their doors, have been taken over by larger corporate entities with no community roots, have transformed their operations into per-diem factories with little capacity for dealing with complex or crisis situations, or have decided to turn away all clients who do not have some form of Medicaid.

When I raise the problem of inadequate access to care, I am advised by government officials that the marketplace – meaning private practitioners – would take care of children without Medicaid or Medicaid Managed Care. This belies reality, which is that (1) a great many private practitioners do not accept commercial insurance; and, (2) among those private practitioners who do accept commercial insurance, most are unwilling or ill-equipped to address the highly-complex, crisis-oriented needs of children with serious emotional problems.

The reality is that only quality community-based children’s mental health organizations with salaried employees, interdisciplinary teams and dedicated time for staff supervision are capable of providing the labor-intensive quality of care necessary to address the mental health needs of children with serious emotional disturbances and their families.

What’s more, for those children who need a longer period of hospitalization, Sagamore Children’s Psychiatric Center has been the answer for the children on Long Island. Unless another alternative is developed as part of the Regional Centers of Excellence planning (i.e. dedicated long term beds supported by OMH in not-for-profit community hospitals), these children will be dramatically underserved. 

Queens and the Bronx are not viable alternatives for most families. For seamless transitions back to community, the children should be in the community; not in a distant community that would make transportation, visits, home passes, and attending meetings impossible for some families. 

The increasingly swinging doors of the community-acute care hospitals, which, 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.

For example, as many sister agencies have stopped accepting this population, our agency has become a major landing point for these kids, as seen by our increasingly active triage and emergency service. And, the kids who really need a hospital have already experienced intensive community based services and have had at least one or multiple hospitalizations and emergency room visits which did not work. 

With our current community system, and inability to provide an adequate level of outpatient clinical care without losing money, we cannot support these kids. We need all levels of care, including a children’s psychiatric hospital as a local part of the continuum. But, we also need more well-supported and expanded outpatient services.  Waiver slots, Intensive Case Management and Coordinated Children’s Service Initiative are all good, but these kids still require clinical care, and often not just once a week. 

In conclusion, thinking back to my Atlantic Ocean memory, it is a story that is about more than me and three little girls. It is about all of us and the thousands of children that community-based mental health agencies across New York State guide safely to shore every year, and offer them the chance to see a brighter day. To do this we need to provide ready access to quality mental health care for all children who need it.

To ensure universal access for all children in New York State, regardless of socio-economic status, requires a commitment from the State to enhance local assistance. When agency, client, community, and government work together and contribute collectively we all win. Then, and only then, can we refer to any entity formed on behalf of children with mental health problems as a “center of excellence.”

 

 

Andrew Malekoff, North Shore Child and Family Guidance Center, 480 Old Westbury Road, Roslyn Heights, New York, 11577; E-mail: amalekoff@northshorechildguidance.org

Our Kids’ Mental Issues Are Shortchanged

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

IN THE WAKE OF SANDY HOOK - SIX MONTHS LATER

In the Wake of Sandy Hook - Six Months Later

by Andrew Malekoff

On June 3, 2013, at a White House conference on mental health, President Obama urged Americans to “help bring mental illness out of the shadows” and pledged that his administration will provide new resources to support the effort. He called for an open dialogue on mental illness. He said a lack of public understanding about mental illness leads to a lack of treatment. These are timely and encouraging words.

On April 3, 2013, I participated as a panelist in a National Public Health Week event, organized by Hofstra University School Health Sciences and Human Services, on mental health issues in the wake of Sandy Hook. My emphasis was on eradicating stigma and improving access to quality mental health care and child care.

The American reality today is one out of five 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. It is shameful that the editors of major metropolitan newspapers exploit and discredit people suffering with mental illnesses with malicious name-calling that reinforces fear, mistrust and stigma, causing labeled persons to lose status and experience discrimination.

We know that the most violent acts are not committed by people with mental illness. In fact, people with mental illness are disproportionately the victims of violence. New gun laws require that the names of designated individuals with severe mental illness be recorded in a national data-base. Whether this will improve public safety or generate a witch hunt that further stigmatizes the mentally ill remains to be seen. In any case, what it does not do is address the problem of better access to quality mental health care.

Here are the facts: seventy-five percent of all serious mental illness occurs before the age of 24; and 50% before the age of 14. Yet, only one out of five children who have emotional disturbances receive treatment from a mental health specialist. We must do more to identify mental health problems early and then, when indicated, provide ready access to quality community-based mental health care.

Early screening by schools and pediatricians is a promising development. Yet, New York State has implemented a "clinic reform" plan that assures continued access to care only to children and families with Medicaid insurance coverage. This leaves a significant number of children and adults in the lurch. 

What’s more, New York State does not support universal access to quality child care, which is critical to a child’s healthy emotional development. By lowering income-eligibility levels for child-care subsidies, thousands of Long Island children are now being denied quality child care, leaving parents to either curtail work or leave their children in unlicensed child-care settings.

When elected representatives and appointed officials champion early mental health screening in schools and pediatrician’s offices, while denying universal access to child care and community-based mental health care, there is only the illusion of caring, political sleight of hand and insult to the children and adults who died at Sandy Hook.

 

SIXTY YEARS OF INSTILLING HOPE, RESTORING MORALE AND MORE

Sixty Years of Instilling Hope, Restoring Morale and More

Andrew Malekoff© March 2013

This year marks the 60th anniversary of North Shore Child and Family Guidance Center. I wonder if its founders, a small group of parents, could have imagined in 1953 that six decades later the Guidance Center would be taking more than 100 calls a week from parents concerned about their children’s emotional well-being. The callers tell stories about children and teens who are troubled, in trouble or causing trouble. Handling their first call sensitively is a hallmark of the Guidance Center. That first person-to-person contact makes all the difference in whether a parent chooses to take the next step forward towards hope or retreats into a sense of despair.

In the early 1950’s, the north shore communities of Long Island were experiencing rapid change. What was once a bucolic landscape peppered with small villages and large estates was being converted into a vast array of suburban developments. The last remaining farms were leveled as roads. Housing developments and schools suddenly popped up, many clustered near the most prominent new roadway, the Long Island Expressway.

According to Bob Smith, who penned a reflection on the first 50 years of the Guidance Center, “In the beginning there were the parents; a generation of mostly young professionals and middle-class workers who had come of age in the great depression, been tempered by the crucible of war, and then came marching home to an increasingly troubled urban environment. These young men and women came to the suburbs in search of a safer, healthier place to raise their children.” The new residents had come with little children or the expectation of children. They came as a single generation, not as an extended family. The priority of the suburbs became raising children.

The Guidance Center’s beginnings were rooted in a community-based model, where progressive-minded suburban activists organized to establish a children’s mental health clinic for members of the community in need of such services. The message to new suburbanites was that, despite their relocation into more affluent communities, mental health problems were not confined to the underprivileged and poor.

Smith recalled that the founders, “made it understood that the oft repeated remark – ‘wherever you go – there YOU are’ was, in fact, true; that the need for services crossed financial, educational, ethnic and class barriers. And that the suburban environment, because of its isolation, might even be more stressful for these young families than the urban environment might have been, with its close-knit neighborhoods and extended families for support.” This remains true today, despite dramatic changes in the intervening years.

Sixty years later, we are blessed to have modern technological innovations such as the Internet and cell phones that provide us with the capacity to make connections anywhere and anytime. Yet, instant access and social media are no replacements for more intimate face-to-face interaction, the essential medium of a community-based agency.

The 100-plus calls we receive every week tell different stories, yet are similar with characteristics of demoralization such as a sense of helplessness and hopelessness, inability to cope, self-blame, feelings of worthlessness and a sense of alienation. Perhaps the most enduring quality of the Guidance Center, over 60 years, is its ability to connect with struggling families of all backgrounds, up close and personal, and to instill hope and restore morale.

Happy 60th Anniversary North Shore Child and Family Guidance Center!

SHORTSIGHTED CUTS TO DRUG TREATMENT

http://www.newsday.com/opinion/letters/letter-shortsighted-cuts-to-drug-treatment-1.4809203

Shortsighted cuts to drug treatment

Andrew Malekoff

March 14, 2013

Regarding the escalating drug problem on Long Island ["Deadly turn to heroin," News, March 11], six months ago, County Executive Edward Mangano held a news conference on the growing heroin and prescription pill problem in Nassau County. He stood with the mothers of children who died from drug overdoses.

To remedy this he announced that Nassau had been certified by the New York State Department of Health to train its employees, as well as families of at-risk individuals, in administering the overdose-reversal agent Narcan to anyone who has ingested large amounts of opioids like heroin.

Any step to save lives is welcome. However, at the news conference there was no mention of $7.3 million in human services funding that was cut on July 5, 2012, which included $1.75 million for outpatient drug treatment.

I am reminded of the parable about the small village on the edge of a river. One day a villager saw a baby floating down the river. He jumped in the river and saved the baby. The next day he saw two babies floating down the river. He and another villager dived in and saved them. Each day that followed, more babies were found floating down the river. The villagers organized themselves, training teams of swimmers to rescue the babies. They were soon working around the clock.

Although they could not save all the babies, the rescue squad members felt good and were lauded for saving as many babies as they could. However, one day, one of the villagers asked: "Where are all these babies coming from? Why don't we organize a team to head upstream to find out who's throwing the babies into the river in the first place!"

Mobilizing county resources to pull babies from the river while simultaneously cutting back on activities to prevent the babies from being tossed into the river in the first place makes no sense.

Andrew Malekoff

Editor's note: The writer is the executive director of the nonprofit North Shore Child and Family Guidance Center in Roslyn Heights.

THEY LOBBY FROM THEIR GRAVES

THEY LOBBY FROM THEIR GRAVES

by Andrew Malekoff © 2013

It was not necessary for the slaughter of innocents at Sandy Hook Elementary School to validate what we are reminded of daily - that there is evil in the world. But what it did do is to affirm that if the massacre of six- and seven-year-old children is not off limits, then nothing is.

Immediately after the murderous rampage in Newtown, CT, mental health experts offered tips to speechless parents about how to soothe their children. The advice sounded like this: Be available emotionally, be compassionate, limit media exposure, reassure safety, offer distractions to prevent obsessive worry, monitor for angry outbursts and depression and, if symptoms persist, seek professional help.

Can you imagine how the advice might have sounded if parents spoke from their guts instead of their heads and hearts? The advice might have sounded like this: It’s a cruel world, evil is everywhere, toughen up, watch your back, be vigilant, don’t trust anyone and (for older children) just because you’re paranoid doesn’t mean that they’re not out to get you.

In the last 30 years, America has mourned at least 61 mass murders. After some time passes, the latest homegrown massacre will become another tombstone in our collective psyche, alongside Columbine, the World Trade Center, the Long Island Railroad, Virginia Tech, Oak Creek, Aurora and more.

We seem always to move forward believing that we have seen the last and worst of it; until the next time. Denial is a healthy defense when the alternative is all-consuming, paralyzing and debilitating fear. We do all we can to protect our children emotionally, as well as physically. And, so we support their denial, using psychological bromides to seal their emotional scars.

The two major talking points since Newtown are preventing gun violence and promoting mental health. On the issue of gun violence, I wholeheartedly support the right to bear arms and taking steps to get certain guns out of uncertain hands. On the issue of mental health care, the chronic under-funding of children's outpatient community-based mental health services in Nassau County and New York State, is a disgrace.

New York State has ensured easy access to community-based mental health care for Medicaid recipients and neglected the needs of underinsured middle class and working poor families. Their answer is always that the marketplace will take care of it. It won’t. They know full well that private practitioners often do not accept private insurance and will not provide the labor-intensive services that licensed community-based mental health agencies do.

The gun lobby is formidable and well-heeled. Children, on the other hand, don’t have a voice until they are in the ground. Children are killed, grieving parents become tireless advocates and laws are passed. Timothy’s Law (mental health parity), Megan’s Law (making information available to the public regarding registered sex offenders) and Katie’s Law (making aggravated vehicular homicide a crime) come to mind.

Think about it. After the Newtown shootings there was not one parent in the United States who was able to escape the tyranny of imagining their child being murdered in their neighborhood school. How many more children will be taken from us before lawmakers devote the same energy and resources it takes to launch their re-election campaigns, to safeguarding our children?

Wake up lawmakers, elected and appointed officials, and government bureaucrats. Our children are suffering and dying, families are struggling and desperate. Support the constitutional right to bear arms, take steps to prevent gun violence and provide adequate funding for community-based mental health centers to support the emotional well-being of all of our children.