DEPRESSION, SUICIDE, DISCRIMINATION AND PARITY

Depression, Suicide, Discrimination and Parity

By Andrew Malekoff© Summer, 2018

In the immediate aftermath of the suicides of Kate Spade and Anthony Bourdain Gov. Cuomo issued a press release about new funding to address the rising rate of suicide.

He stated: "Two high-profile suicides this week put mental illness front and center, but while those names were the ones in the press, every day there are thousands of New Yorkers who struggle with suicidal thoughts, and we must do everything we can to support them. Depression does not discriminate. It affects every part of society and people from all walks of life."

I applaud the Governor for bringing this matter to light. He stated, “Depression does not discriminate.” Nevertheless, health insurers that do not comply with federal parity law, denying timely access to care, do discriminate. When New York State government does not enforce this law, they aid and abet discrimination against the “thousands of New Yorkers,” who the Governor referred to as those “who struggle with suicidal thoughts”.

The difficulty people have accessing mental health and addiction care is not simply a matter of stigma. It is a matter of discrimination. This is a civil rights issue that an announcement of new funding alone will not solve.

On December 15, 2017, North Shore Child and Family Guidance Center held a press conference at its headquarters in Roslyn Heights and issued the results of a research study – Project Access that we conducted in collaboration with LIU Post Department of Social Work. 

In this year-long study, hundreds of Long Islanders were surveyed about their experiences attempting to obtain help for mental health and addiction problems.

Of the 650 Long Islanders who took part in the survey, almost half said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, nearly 40 percent said that their insurance company did not have an adequate number of providers and two-thirds said that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.

NY State Senator Todd Kaminsky, who attended the December 15th press conference, stated that the findings were “Damning.”

In a bipartisan effort, Kaminsky and Senator Elaine Phillips wrote to the Department of Financial Services (DFS) on January 9, 2018 citing the Project Access study and requesting “a thorough investigation to determine why insurance companies are not being held accountable for network adequacy.” Network adequacy is the part of the federal parity law that states that health insurers who cover mental health and addiction care must have an adequate number of providers in their network. Many more people wrote directly to Gov. Cuomo, requesting the same.

Almost five months later Scott Fischer, Executive Deputy Superintendent for Insurance, a division of DFS, responded in writing to the Senators. Fischer wrote: “DFS’s review of the various networks has confirmed that each of the insurance companies in Long Island exceeds the standards for mental health and substance use providers, for the purpose of the commercial products sold outside of NYSOH.”

Translation: There is no problem. There is nothing more to do. This does not square with the results of Project Access.

Health insurers and government ignoring federal parity law is discrimination. When it comes to suicide prevention: access delayed, is access denied.

Discrimination deserves a place alongside stigma when the conversation turns to access to care.

It’s a matter of civil rights.

Long after the tragic deaths of Kate Spade and Anthony Bourdain fade from the front pages, the lack of compliance and enforcement of federal parity law will persist and the thousands of people that the Governor spoke of in hispress release will still be unable to access care.

Published in the New York State Behavioral Health News, Summer 2018 issue

COMMUNITY MENTAL HEALTH WOES

Community mental health woes

 

in Long Island Business News, LIBN.COM - April 17-23, 2015, p. 14

Andrew Malekoff

When Nassau residents decided that speed cameras in school zones were unfair, their outrage got the attention of local politicians. The cameras were gone in record time. And when taxpayers told their representatives to keep gambling off the block, the pols backed down, knowing they were waging a losing bet.

So why are our state leaders closing their ears to the pleas of children and families in desperate need of mental health services?

Across Long Island, the agencies that care for the most vulnerable are dropping like flies, victims of a mentality that stigmatizes psychiatric illness and a short-sighted healthcare system more interested in managing costs than managing care. This year alone, FEGS, a $250 million agency, closed after 80 years. Catholic Charities will close its outpatient mental health clinic in Freeport in May. Previous L.I. victims were South Shore Child Guidance, the Family and Children's Association, Peninsula Counseling Center and Pederson-Krag Center.

The pattern is clear: For decades, big government has cut funding to mental health services across the nation, and the cuts just keep on coming.

Failed state and federal leadership has enabled insurance companies to make it nearly impossible for community-based mental health clinics to survive, unless they reduce the time spent with clients to squeeze in more billable hours; refuse to handle crisis situations that require greater resources; restrict access, taking only patients who have Medicaid, which pays a higher rate than commercial insurers; and/or fire salaried employees and hire per diem staff who have little stake in the agency’s values.

When the “community” is taken out of community-based mental health care, it’s not just semantics. Time-honored practices fall by the wayside. Cultures fall apart. Quality of care crumbles.

Government powerbrokers continue to slash funding for lifesaving programs. Why? Follow the money. Insurance company lobbyists pay them big bucks to turn their backs on those in need.

But politicians also listen when constituents make noise. Isn’t it time we get loud about something as critical as the health and well-being of our children?

 

Andrew Malekoff is executive director of North Shore Child & Family Guidance Center, a nonprofit children’s mental health center in Roslyn Heights, NY.

CRISIS IN THE CLINICS by Laura Figueroa

CRISIS IN THE CLINICS…as demand grows, mental health facilities dwindle on Long Island

April 12, 2015 by LAURA FIGUEROA / laura.figueroa@newsday.com

Increasing numbers of nonprofit mental health clinics on Long Island are closing or being sold to other mental health networks, following years of declines in government funding and a growing demand for services.

In the past four years, at least four clinics have closed in Nassau and Suffolk, including one that has closed and one about to close this year, and four clinics have been acquired by other nonprofits.

The closures have prompted several local social service advocates to ramp up fundraising efforts while lobbying for increases in government aid. They say treatment options are dwindling for low- and middle-income patients who earn too much to qualify for Medicaid.

"There is somewhat of a crisis in the system," said Jeffrey Steigman, chief administrative officer of the nonprofit Family Service League, of Huntington, which provides counseling services for children and families.

In February, the league acquired the Huntington clinic of Pederson-Krag, a social service agency founded in 1957. But "it's not just the clinic we took over," Steigman said. Mental health agencies "throughout the state are transferring their licenses or closing clinics because of the financial burden and the deficits that occur. The fiscal model is broken in certain ways," he said.

Currently, there are 18 licensed nonprofit mental health facilities in Nassau and 48 in Suffolk, according to the State Office of Mental Health Services. The clinics provide services, including family counseling and drug rehabilitation, for low- and middle-income residents who cannot afford private care.

More than 10,000 individuals sought treatment at nonprofit clinics in Nassau last year, according to the county's Office of Mental Health, Chemical Dependency, and Developmental Disabilities Services.

Suffolk's Office of Mental Hygiene said it did not have overall figures. But state data show that nearly 4,000 Suffolk adults and 1,200 children enrolled in Medicaid sought mental health services in 2013. In Nassau, there were 3,600 adults and 850 children on Medicaid who received mental health services.

Freeport clinic forced shut

In May, Catholic Charities Outpatient Mental Health Clinic in Freeport, which has treated 550 patients a year, will shutter after more than 50 years in operation. Earlier this year, the 81-year-old nonprofit Federation Employment and Guidance Services, which provided mental health services throughout Long Island, announced it was closing.

The closures came as Peninsula Counseling Center, a Valley Stream nonprofit founded 102 years ago, and three clinics operated by Pederson-Krag were acquired by other nonprofit mental health agencies in recent months, after years of struggling to stay afloat financially.

Laura A. Cassell, CEO of Catholic Charities of the Diocese of Rockville Centre, said the organization decided it no longer could afford to run its Freeport clinic, because of insufficient reimbursement rates and declining government funding to subsidize care. Over the past three years, Catholic Charities had to raise $1.26 million in private donations to keep Freeport open, Cassell said.

"While Catholic Charities is blessed with generous donations to support our ministries, we cannot direct such a large portion to just one service site," Cassell said. "Many other mental health providers were forced to close their doors for the same reason."

"Unfortunately, with no hope of permanent additional funding to match the real costs of providing quality services in the future and increasing unfunded government regulatory mandates, this painful decision had to be made," Cassell said.

In a newsletter to Long Island mental health providers last month, Martha A. Carlin, director of the Long Island field office of the state Office of Mental Health, noted that with the closures and acquisitions, the "beginning of 2015 has been challenging for the Long Island region."

Declining reimbursements

Mental health providers say some of their fiscal strain is due to low reimbursement rates by private insurers.

Under Medicaid, clinics are reimbursed an average $130 per visit for an adult patient and $137 for children, according to state figures.

Commercial insurance providers pay anywhere from 20 percent to 50 percent less, several local mental health providers said. Officials with the New York Health Plan Association, which represents commercial health insurance providers, said they could not provide data on reimbursement rates because each company negotiates rates with clinics.

The incentive to treat higher-paying Medicaid patients means that some clinics are opting to see fewer patients covered by commercial insurance, said Andrew Malekoff, executive director of the North Shore Child and Family Guidance Center in Roslyn Heights, a nonprofit that has about 5,000 clients annually.

Malekoff, who has testified before state lawmakers about the challenges faced by nonprofit mental health providers, said that with fewer clinics accepting privately insured patients, many families who earn too much to qualify for Medicaid are "left with nowhere to turn for affordable community-based outpatient mental health care."

The closure of one nonprofit clinic often causes a ripple effect among the small group of Long Island nonprofit clinics, where phones are "ringing off the hook," with queries from displaced patients looking for affordable care, said Jeffrey Friedman, CEO of Central Nassau Guidance Services in Hicksville.

"As a result of the closures, we've had an influx of people calling us," Friedman said. "I think for us the landscape is changing drastically because the reimbursement from insurance companies is not adequate. We're losing money on that visit."

Leslie Moran, spokeswoman for the New York Health Plan Association, said each provider negotiates reimbursement rates with clinics, aiming to control costs to keep plan rates down for consumers.

"The reality is, in our health care system, affordability is something we have to keep an eye on," Moran said.

In 2012, the nonprofit Family & Children's Association, of Mineola, closed its mental health clinics in Roosevelt and West Hempstead, after years of deficits stemming from services provided to low-income patients.

Jeffrey Reynolds, executive director of the association, said losses at both clinics in 2011 totaled $1.6 million. Keeping them open would have "threatened the livelihood" of other operations, including homeless shelters for seniors and runaways, Reynolds said.

"What happens when you lose these clinics is you're driving people into chemical dependency, ERs or jails," he said.

State taking steps to aid LI

State Office of Mental Health spokesman Ben Rosen, to whom Carlin referred questions, said the agency has "taken several steps to help Long Island's mental health clinics remain fiscally viable." Rosen said $60 million has been allocated over the next three years to fiscally distressed clinics statewide, including seven in Nassau and Suffolk. The clinics, which include the former Pederson-Krag clinics, each were assigned "strategic planners" to improve their finances over the next three years, Rosen said.

The agencies acquiring some of the local facilities say the transition is going as seamlessly as possible.

Herrick Lipton, administrative and financial director of New Horizon Counseling Center, said that since taking over Peninsula, the agency has done repair work at the clinic and installed a flat-screen TV in the waiting room. New Horizon, which also runs clinics in Ozone Park, East Elmhurst and the Rockaways, also is planning to add Saturday service hours at Peninsula, Lipton said.

"Peninsula was losing money, it didn't have the ability to invest in repairs . . . they were in dire straits," Lipton said. "Our goal is to create a sustainable solution for mental health services for Nassau County. In today's environment, many health care providers are struggling to survive."

RESPONDING TO COMMENTARY BY NEW YORK STATE OMH

 

As director of the only specialty children’s mental health agency on Long Island, after reading the New York State OMH Long Island Field Office (LIFO) News from the Field, Winter 2015 edition, I was left with few thoughts. In the cover story, From the Director’s Chair, by LIFO Director Dr. Martha Carlin, she comments on multiple outpatient clinic closings and acquisitions on Long Island.

Dr. Carlin stated that the closures “point to a myriad of difficulties among providers, which impacts on the provision of quality clinical care.” However, nothing was mentioned in her report about the impact of New York State’s Clinic Reform policy, which has been the major contributor in advancing clinic closures, restricting access to care and compromising quality clinical care for New Yorkers in need of community-based care.

Regarding Dr. Carlin’s reference to recent closures of mental health clinics at Peninsula Counseling Center in Nassau and Pederson-Krag in Suffolk, what her commentary did not address is that both of these long-standing and highly-respected organizations were acquired by Queens-based PSCH. Then, after only a few years, PSCH decided to let go of the mental health clinics operated by both of these esteemed organizations.

Consequently, an acquisition by a $100 million organization (PSCH) that was implemented and did not hold, led to a second round of acquisitions. Which begs the questions, what went wrong? and what has been and will be the impact on consumers?

Some of the ways that clinics stay afloat in this environment, beyond fundraising, is to restrict access to care only to consumers with the best insurance rates (Medicaid), to see consumers for shorter periods of billable time in order to pack more revenue into a day, to remove salaried employees to save expenses by eliminating fringe benefits, to not respond to time-consuming and labor-intensive crisis situations, to cut parents and other relevant family members out of the clinical equation, and to curtail consistent clinical supervision and team meetings. In other words: build a factory to maximize revenues and minimize quality care.

In another article, in the March 5, 2015 issue of Crain’s Business Health Plus, it was reported that “Mergers and acquisitions activity among behavioral health nonprofits with budgets under $25 million is expected to increase substantially this year . . . given that the state’s Office of Mental Health has made its desire for consolidation an open secret. From a government perspective, it simplifies the number of contacts and number of relationships that they need to have. The unknown is the impact on program services.”

It seems to me that what is impacting quality clinical care most, are the actions of New York State that have resulted in restricted access to care and the development of a business environment that is least conducive to a community-based, mission-driven clinic. In other words, the focus is on managing cost as opposed to managing care.

Dr. Carlin stated that, “although the challenges continue there are many exciting changes happening within our system which will help better the lives of people we serve.” She cited telepsychiatry, DSRIP (Delivery System Reform Incentive Payment Program) and Managed Medicaid as examples.

I do not feel encouraged by a system that restricts access to care to one population and dilutes quality care to drive up revenue. Long Islanders – children and families – who need quality community-based mental health care deserve better.

Andrew Malekoff is executive director of the nonprofit children's mental health center, North Shore Child & Family Guidance Center in Roslyn Heights, NY.

More focus, money for mental health

NEWSDAY

December 4, 2014

Immediately after the Dec. 14, 2012, shootings in Newtown, Conn., mental health experts offered tips to speechless parents about how to soothe their children ["Report: Sandy Hook killer enabled," News, Nov. 22]. 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.

I imagine many parents were thinking, instead, "It's a cruel world, evil is everywhere, watch your back, and don't trust anyone."

After the Sandy Hook shootings there was probably not one parent in the United States able to escape the tyranny of imagining his or her child being killed in a neighborhood school. How many more children will be taken before lawmakers devote energy and resources to safeguarding our children?

Take steps to prevent gun violence -- within the constitutional right to bear arms -- and provide adequate funding for community-based mental health centers for the emotional well-being of all of our children.

Andrew Malekoff, Long Beach

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

Give legislators a raise? No way

NEWSDAY - February 13, 2015

Long-time and valued community human service organizations are routinely folding because of New York State's neglect and lack of vision. Meanwhile, Newsday's solution to corruption in Albany is to use taxpayer dollars to give salary increases and ban outside income of elected officials to deter extortion, embezzlement, tax evasion, bribery and obstruction of justice ["More pay for less play," Feb. 8]?

I don't think so! Investigate and, if they are found guilty, take away their pensions for starters.

Andrew Malekoff, Long Beach

The writer is the director of the nonprofit North Shore Child & Family Guidance Center.