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.

SHIELD CHILDREN FROM VIOLENCE, SUPPORT CHILDREN'S MENTAL HEALTH

http://blog.timesunion.com/opinion/shield-children-from-violence/31303/

Albany Times Union, December 10, 2014

Now we learn that Adam Lanza did not get the help that was needed and that might have prevented his murderous rampage (“Chances to help were lost as killer evolved,” Nov. 23).

Think about it: After the Sandy Hook shootings, there was not one parent who was able to escape the tyranny of imagining his or her child being murdered in the 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?

New York state has ensured easy access to mental health care for Medicaid recipients and neglected the needs of underinsured middle-class families.

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 in their children’s names. 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.

We need our lawmakers, elected and appointed officials, to wake up. Our children are suffering and dying; families are struggling and desperate. Our leaders can support the constitutional right to bear arms while taking steps to prevent gun violence and providing adequate funding for community-based mental health centers to support the emotional well-being of all of our children.

Andrew Malekoff

Executive director, North Shore Child and Family Guidance Center, Roslyn Heights

We must start treating illnesses above the neck the same as illnesses below the neck?

PARENTING PLUS column for Anton News, Long Island, NY, February 2015

When we hear that our neighbor’s teenage son has been diagnosed with cancer, or that our colleague’s newborn has a heart defect, we shed some tears—and then we move into action. We bring meals; we offer to take their other kids to soccer games or piano lessons; we raise money so the parents can stay home from work to care for their ailing children.

But when we learn that our daughter’s best friend has been hospitalized for depression, or that a boy on our son’s basketball team has stopped going to school because of severe anxiety, we’re often at a loss as to how to respond.

Here’s a fact that may surprise you:  Although more children suffer from psychiatric illness than autism, leukemia, diabetes and AIDS combined, only one of five with an emotional disturbance gets help from a mental health specialist. Moreover, 50 percent of serious mental illness occurs before the age of 14.

People with mental health problems and addictions, along with their families, often suffer in silence, while people with physical health problems evoke the sympathy and support of others. Why do we continue to treat illnesses above the neck differently than illnesses below the neck?

The sad truth is that there’s still a widespread stigma when it comes to mental health. The result? 

Parents who need help often wait months and even years to make that first phone call. A parent whose child is diagnosed with cancer doesn’t wait to ask for help. Waiting only happens with mental illness and addiction.

Fortunately, more than 60 years after our founding, North Shore Child & Family Guidance Center is still here to fight that stigma and provide help to children in need. Let me share a few of their stories.

We met nine-year-old Joey 14 years ago, a few weeks after his father died in the World Trade Center. We soon discovered that he was calling his dad’s cell phone number every day.  As Joey explained, “I call because, what if he is still alive? I don’t want him to be all alone.”

We met seven-year-old Jeremy two years ago. He came to us holding a large flashlight in his tiny hands. He said he needed it in case the lights went out again, like they did after Hurricane Sandy, when Jeremy lost his toys, his home, his daily routine. And, as Joey before him, he lost his belief that the world is a safe place.

While we do respond to headline stories, we more often are called upon to respond to personal dramas and private disasters that are hidden in plain sight. 

For example, we met six-year-old Jerome soon after he attempted to jump out a window because, as he said, “Nobody loves me.” Fifteen-year-old Celeste said the reason that she cuts her arms until they bleed is not to take her life, but to lower her blood pressure. And 14-year-old Maria told us that she lives in a house with a revolving door welcoming men who touch her.

Depression, anxiety, fear, child abuse, school refusal, bullying, isolation, drug addiction, domestic violence . . . we receive more than 100 calls a week, and increasing numbers are emergencies.

All across Long Island, mental health agencies are shuttering their doors, or they’ve been acquired by corporate entities with no roots in the community. That’s tragic, because community-based mental health organizations are as essential to the health and well-being of our children as hospitals or schools.

What can you do? First, tell your representatives that you value the mental health organization that serves your community and would like their support to ensure its future. And if you know someone whose child is suffering from a mental health issue, don’t ignore them. Make that phone call. Let them know you care.

Bio: Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org. 

MENTAL HEALTH CENTERS IN DECLINE

Mental Health Centers in Decline

LONG ISLAND WEEKLY - MARCH 11-17, 2015

by Andrew Malekoff

So here's the deal folks. Last week it was announced that Catholic Charities is giving up their Freeport mental health clinic. In January, $250 million, 81-year-old FEGS announced it was closing; before that Peninsula Counseling Center (PCC) in Valley Stream and Pederson-Krag Center (PK) in Huntington gave up their mental health clinics. (Actually it is more insidious than that. PSCH, an NYC-based $100 million operation, took over PK and PCC and then dumped their mental health clinics). Before that, South Shore Child Guidance was taken over by the Epilepsy Foundation. And before that, Family and Children's Association let go of their mental health clinics in Roosevelt and West Hempstead. And, there is more to come.

Now, one might ask, "Well, aren't they being picked up by other organizations?” That may be so; but these mental health clinics were tied to reputable organizations with venerable histories and committed local boards of directors. In other words, they were grounded in community-based cultures.

Culture matters when growing an organization! Change the culture and the values follow. Change the values and time-honored practices change too. Managed care becomes managed cost, and vulnerable children and their families are then shortchanged as a factory mentality prevails.

Why is this happening? Because New York State government leadership is neglectful, misguided and lacking in humane leadership. And, because they can get away with it.

The State has systematically stripped funding from well-established, community-based organizations and, in so doing, has restricted access to care to Medicaid recipients only. Meanwhile, private insurance companies pay substandard rates. Consequently, fewer and fewer providers will contract with them, leaving hundreds of thousands of middle class families in NYS with nowhere to turn for affordable, community-based outpatient mental health care for their children.

Government leaders won't address the fact that insurers do not have adequate networks of providers because providers don't like their substandard rates of pay. Why doesn't the government better regulate them? Because the insurance companies' lobbyists pay elected officials big bucks for their silence. Elected officials can apply pressure or ease pressure depending on what best suits them and their campaign treasuries.

Now, back to those that let go of the mental health clinics and those that picked up their business. The only profitable way for the latter to proceed, with few exceptions, if any, is to restrict access to care to clients with the best insurance rates (that's Medicaid); to see clients for shorter amounts of billable time to pack more revenue into a day; to eliminate salaried employees to save expenses by eliminating fringe benefits; to not respond to time-consuming and labor-intensive crisis situations; to cut parents out of the equation; and to eliminate consistent clinical supervision and team meetings that are essential to quality of care. In other words, build a factory to maximize revenues and minimize quality care.

In the end, what you get are fewer and fewer vulnerable children who are able to access the best care and more and more services that slide from a gold standard of care to a bronze standard or worse. This is because New York State plays us for fools. Do you know what they refer to their "transformation" initiative as? CLINIC REFORM and REGIONAL CENTERS OF EXCELLENCE. They deform clinics and call it reform, and they offer mediocrity and call it excellence. Factories and propaganda.

So why are North Shore Child & Family Guidance Center and a few others still standing and providing universal access to care with diverse (including bilingual), salaried employees? Because their boards of directors won't have it any other way. For now, that is. Whether they can continue to weather the scorched earth policy of New York State remains to be seen. Nevertheless, the public deserves to know what our government and the insurance industry are up to. What are they up to? NO GOOD.

Which kids’ lives are at stake? What kinds of issues are they facing? Depression, anxiety, abuse, neglect, trauma, domestic, violence, isolation, school failure, demoralization, bias, bullying, family unrest, learning problems, posttraumatic stress, loss and grief, gang exposure, rape, incest, poverty, dislocation, suicide, homicide, obesity, eating disorders, alcohol and drug addiction, gambling, cutting and burning oneself, immigration (including unaccompanied minors), adjusting to foster care, loneliness, and more.

These are the children that a community-based mental health center sees every day. Lots of them each week, thousands each year. This is what is at stake. This is what is being neglected and eroded by New York State.

What will come of this? More tragedy for more families and, ultimately, more cost to warehouse vulnerable children and youths who will not be able to access preventive care or more intensive outpatient care early on.

How will tragedy manifest itself? Probably not horrifically, like Sandy Hook where the outcry and ocean of tears changed nothing of significance that anyone sees or feels on the ground. It will happen more insidiously and slowly, in drip, drip, drip fashion. That is, unless there is pushback.

Pushback against speed cameras and slot machines brought about change in Nassau County in the snap of the finger. But children's mental health? Nah, nobody's going to stand up for that. Until it is their child who is suffering and can't get quality care. And then, too often, they fight alone. After all, STIGMA rules. And it crushes.

It is more convenient for the masses to pretend that children's mental health problems are the result of bad upbringing or moral failing. Bad government counts on that. Everyone rallies around kids with cancer. But who rallies around kids with mental illness?

You?

You CAN make a difference.

TAKE ACTION AND BE A VOICE FOR VULNERABLE CHILDREN!

Here’s how to help:

· Share this with your friends and colleagues via Facebook, email and other social media

· Write to your local newspaper

· Contact your local, state and federal legislators (see below for contact information)

To find your congressperson: http://www.house.gov/representatives/find/

To find your senator: http://www.senate.gov/general/contact_information/senators_cfm.cfm

To find your New York State Senator in Albany: http://www.nysenate.gov/senators

To find your New York State Assembly member: http://assembly.state.ny.us/mem/search/

Andrew Malekoff is executive director and CEO of the nonprofit North Shore Child & Family Guidance Center in Roslyn Heights, NY

THE DAWNING OF THE MENTAL HEALTH WALMART

THE DAWNING OF THE MENTAL HEALTH WALMART

Submitted to the New York Nonprofit News 12/6/14

Andrew Malekoff, Executive Director / CEO, North Shore Child and Family Guidance Center, Roslyn Heights, NY

New York State's scorched earth policy against mid-size and smaller community-based mental health centers and middle-class children and families has come to fruition on Long Island. Recently PSCH, a $100 million NYC-based agency led by a number former OMH officials, decided to let go of the mental health clinics of two long-standing and highly reputable Long Island-based agencies that they took-over just a few years ago with the blessing of OMH. Pederson Krag and Peninsula Counseling Center's (PCC) mental health programs are gone or on their way out, left to be scooped up by other willing suitors. My friend and colleague the late Herb Ruben, a true mental health advocate who led and built PCC during a 50-year period, must be rolling over in his grave.

OMH has been encouraging mergers (aka takeovers) for years. In this case, two deeply-rooted organizations with more than a combined 100 years on Long Island have seen their mental health services thrown to the wind to be picked up and absorbed elsewhere, never to retain what took the better part of a century to build, a strong, trusted and undeniable presence in the local community.

This is the dawning of the age of the Mental Health Walmart. We are in early stages of a sad time of proliferating Medicaid mills, where children and adolescents with mental health problems will be shuffled along a conveyer of would-be evidence-based care administered by fee-for-service workers with no time to address crisis situations or to make even adequate collateral contacts with schools and other relevant people in the children’s lives. Middle-class families are being pushed out of the so-called “system transformation” process and poorer families are seeing the quality of care erode into to a series of half hour, revenue-maximizing, individual sessions.

The transition from a gold standard to a bronze standard of care is well underway. And, this is happening at the same time that almost $6.5 billion is being thrown at the Medicaid-driven acronym-of-the-year DSRIP – Delivery System Reform Incentive Program, a hospital-conglomerate-run initiative with the admirable goal of reducing emergency room visits and hospital readmissions, for Medicaid patients, of course. Another $1.2 billion is being made available for capital projects.

The other acronyms receiving mere millions are the $7 million to CTAC – Children’s Technical Assistance Center that trains agencies how to best serve Medicaid clients and send those with private insurance packing.  And, most recently on board is the $30 million to VAP – Vital Access Provider initiative aimed at helping agencies that are on life support to find ways to become fiscally self-sustaining on a diet of Medicaid-only clients or take steps to be taken over as Pederson Krag and Peninsula before them. And, oh yes, there is another acronym I almost forgot to mention. That is OT – Overtime. According to NYS Comptroller Tom DiNapoli, the New York State Office of Mental Health spends $100 million annually on overtime expenses.

At North Shore Child and Family Guidance Center, founded in 1953, the only specialty children’s mental health agency on Long Island, we have not received an increase in our Article 31 contract funding in more than 30 years.  If not for our community supporters we would have disappeared long ago, along with our sister agencies. A very small percentage of the billions being spent could make a difference and would go a long way to sustaining needed children’s mental health services on Long Island. But all appeals continue to fall on deaf ears, from the governor to the legislators to the commissioners.

Hello, hello, anyone out there! Does anyone in Albany care?

NEW VAP FUNDING SKIRTS THE ISSUE OF UNIVERSAL ACCESS

New VAP funding skirts the issue of universal access by Andrew Malekoff in the New York Nonprofit News, November, 25, 2014 http://www.nynp.biz/index.php/points-of-view/23292-new-vap-funding-initiative-skirts-issue-of-universal-access

By Andrew Malekoff, Executive Director and CEO, North Shore Child and Family Guidance Center Recently, I participated in a New York State Office of Mental Health Clinic Vital Access Provider (VAP) webinar. The webinar is a first step towards Article 31 mental health clinics applying for funding to preserve long term critical access to community-based mental health services. A total of $60 million in funding, over a three year period, is available. The intention of the VAP funding opportunity is for community-based mental health clinics that are “fiscally challenged” to develop plans that will demonstrate fiscal viability after three years. The funds can be used for such things as incremental costs for staffing and billing software, for example. Each clinic that receives a VAP award will be assigned a “strategic planner,” who would be a financial specialist, to help them to complete their final application, to include measurable outcomes. The ongoing achievement of measurable metrics will be tied to continued payments to agencies that have been awarded funding. The ultimate goal of the project, whether through mergers, improved efficiencies such as centralized scheduling, or agency sharing of back office functions, will be to ensure long term fiscal viability. I thought that the webinar was very informative. Webinar participants were given an opportunity to ask questions by typing them into a chat box function during the presentation. At the end of the almost two hour webinar, the moderator thanked the participants and concluded the session by stating that all questions had been addressed. Not so! Here are three questions that I typed in that the moderator did not acknowledge or respond to: Is the VAP funding initiative biased against middle class and working poor non-Medicaid children and their families who have no other viable access to labor-intensive community-based mental health care? Our specialty children's mental health agency [North Shore Child and Family Guidance Center] works with approximately 68% non-Medicaid and 32% Medicaid and Medicaid Managed Care families? Would a viable VAP proposal look to severely restrict access to care for children in Nassau County who need our outpatient care? It appears that you are supporting mergers. Is there any concern about what has come of the New York City-based PSCH takeovers in Nassau and Suffolk Counties? I felt that I had to ask these questions since, in my attending one webinar after another sponsored by OMH’s Children’s Technical Assistance Center (CTAC), the issue of universal access to children’s outpatient mental health care is routinely skirted. The sole focus of OMH webinars, regarding children in need of mental health care, are Medicaid-eligible children. North Shore Child and Family Guidance Center is a proponent of universal access for children and their families. New York State is not. On the issue of access to care, earlier in the year I asked Governor Cuomo about this and he directed my letter to OMH Commissioner Dr. Ann Marie T. Sullivan, who responded by stating that there is a work group looking into the issue of the non-Medicaid population. One outcome would be to get commercial insurers to increase their rates which, on average, are significantly lower than Medicaid rates. However, the State Department of Financial Services, within which the State Insurance Department is subsumed, does not have the authority to regulate commercial rates. Statute change, which is unlikely, would be required for this to happen. Presently, commercial insurance network adequacy, including for behavioral health care, is monitored every three years by the Department of Financial Services. However, I think it is unlikely that this will lead to significant penalties that would bring about change for entities that do not provide adequate networks of care. After all, the health insurance lobby is well-healed and well-connected in Albany. On the issue of mergers, a few years ago New York City-based PSCH took over Pederson Krag in Suffolk County and Peninsula Counseling Center in Nassau County, both well-established and well-respected community-based mental health agencies on Long Island. When a larger entity takes over a smaller one, the smaller one’s board of directors is dissolved and, at best, becomes an advisory committee, with a few select board members joining the larger entity’s board of directors. This is a step toward diluting the local community’s investment in the organization and its mission. It appears that PSCH has given up on Pederson Krag and its clinics are being dispersed and made available to other interested parties. Will this also be the fate of Peninsula Counseling Center? What are the consequences of decades of dedicated professional and lay leaders building a community-based culture, and then having it demolished by a takeover by a $100 million dollar organization that did not take. And, so, I thought it was a reasonable question to ask the VAP moderator whose agenda would appear to promote mergers and takeovers. What do you think?