Mental Health Centers In Decline

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Andrew Malekoff
Andrew Malekoff

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.

7 COMMENTS

  1. All of Andrew’s concerns are valid. Add onerous, micro-managed New York State regulations that drive up cost and limit access to mental health clinics. On the national level, employers are moving their employees to high co-pay and high-deductible health plans to save money at the same time depression is becoming the leading cause for missed work.

  2. The answer to “How will tragedy manifest itself?” is, more people locked up in prisons because they didn’t have mental health services for prevention. The results are clearly shown in the ACE study.

  3. As we look at the near future there are two very big items on our agendas that are more closely related than most think and I am wondering how we can connect them.

    We have discussed payment reform and efficiencies in the mental health system diligently over the past few months and over the last decade. Unfortunately, what we do not talk about is embracing the concept of “value”, which comes in many different forms, including value to the tax paying citizens, value to those of whom we provide services, and value to the systems of government responsible for ensuring that the network of organizations providing services is top notch. Yet, do we really know what we value now? I think not.

    As we enter this age of payment reform, we enter it with no mention of volume vs. value and these are two very different worlds. We undoubtedly will continue to point out that the “system” wants value. That is a given. However, I hope we also associate this with the words “volume” and “cost”. We never talk about cost. Never.

    I’m fairly confident that most of us in the service delivery field don’t even know the true costs of providing services. What we do know is that with pending rate reductions, it is getting dangerously close to the boiling point of our service provision costs surpassing the reimbursement rate. It appears that those in charge of the payment reform initiative believe that using evidence-based medicine to standardize our clinical practices will go a long way toward controlling the cost of care and eliminating waste. That would be very difficult to debate. What is constantly overlooked is that the biggest waste in our mental health and substance abuse field is the overburdened and overregulated paperwork, processes, and regulations. This is something that the new Governor continues to point out through other examples including education and I firmly believe that the time is right for us to bring about change. Change that will streamline the system that helps provide “value” to the tax paying citizens, value to those of whom we provide services, and value to the systems of government responsible for ensuring the quality of the service providers.

    I mentioned it last week at our advocacy committee meeting and believe that I am accurate when I say that nobody, including our legislature, AHCCCS and DBHS systems, RBHA’s, and individual providers, really understands just how overburdened and overregulated our system has become. That would include me and I have immersed myself in this over the past five years. When you look at the stack of paperwork in paper form, you will have little to debate too! The image above demonstrates this point. The larger stack is required paperwork from the mental health field and the smaller stack is the paperwork required in the primary care setting. Wasteful?

    I strongly believe that no approach to payment reform will ever work unless it coexists and cohabits with serious efficiencies in the system that address wasteful expenditures of clinical time, something that has really lost its’ “value”. There was a time when 75%-80% of our clinical providers time was spent in front of the client in therapy. That percentage has reduced drastically. I guess what I am saying is that payment reform and efficiencies are related. Oh, I said that already. However, what I did not say clearly enough was “payment reform” must include a realigned approach TOWARDS paying for things that are of significant value and that should not be paperwork or processes.

    What is it that we value anymore? The answer? Uniform paperwork and adherence to process, not much more. I would dare to say that our “outcomes” with clients are fairly equivalent to outcomes in the 1990’s because we lost focus on what we truly should value which is quality time with our clients. Sure, there have been some great roll-outs of new initiatives over the past decade such as the Child and Family Teams and increased Peer Support Services which have brought with it some great outcomes, just to name a few. However, we should be able to have even loftier outcomes if we get back to valuing time with our clients and this cannot be accomplished with the stack of required paperwork.

    In the book The Inmates Are Ruling The Asylum, the author continually points out how “systems” must rethink their relationships in deep and novel ways, for the fault for our burgeoning problems lies not in the system, but with us. We are the ones who must demand change for we are truly the ones running this asylum! Thank about it. The secret lies in redefining the way we interact with the system. In another book called The Oz Principle, the writer clearly identifies the difference in the power of accountability vs. victimization and how the attitude of victimization has captured businesses everywhere in a choking stronghold. I feel it, and I for one am tired of being the victim. Let’s put the effort in and change directions.

  4. The onerous, micro-managed regulations are being seen nationwide in the way the payment system is fragmenting our healthcare “systems” (or lack thereof). I work for one of those venerable charitable organizations with a great reputation, local community Board of Directors, and long history in the community. We risk extinction with the move into behavioral health of these national health care monopolies who care little about community investment but sit on profits as high as in the billions annually.

    The service system is breaking down as we have this debate. The constant and chronic demands of working with children who have behavioral health needs is daunting enough. Even worse is the review and auditing of meaningless paperwork process flow that exhausts and discourages staff. We are overburdened with regulation, micro-managed in meaningless process flow, and aren’t reimbursed at a level to recruit and retain talented staff.

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