Recently, it was announced that Catholic Charities is giving up its Freeport mental health clinic. Also in recent weeks, the $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, a New York City-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 Center (EPIC). 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, however these MH 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. It is also happening 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. And, private insurance companies pay substandard rates. Consequently, fewer and fewer providers will contract with them, leaving hundreds of thousands of middle class families in New York State with nowhere to turn for affordable community-based outpatient mental health care for their children. Plus, 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. And, 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 MH 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. And, 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.
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? This is 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.
What 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, post-traumatic 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. They see 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 what about the mental health of children? Nobody’s going to stand up for that. People will when it is their child who is suffering and parents can’t find them 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?
Andrew Malekoff is executive director/CEO for the North Shore Child and Family Guidance Center in Roslyn Heights.