‘We’re at a point of crisis’: New York Attorney General’s hearing highlights failures in children’s mental health care

This article was produced for ProPublica’s Local Reporting Network in partnership with THE CITY. Subscribe to dispatches to get stories like this as soon as they are published.

By cutting back on inpatient psychiatric care, New York has left people with too few places to turn to for treatment of serious mental health issues, state Attorney General Letitia James said during a briefing. a hearing held by his office on Wednesday.

James called the hearing following reports from THE CITY and ProPublica about New York State’s failure to provide mental health care for children and adolescents. Our investigation found that state officials have closed nearly a third of children’s beds in public psychiatric hospitals since 2014, as part of a “transformation plan” put in place by former Governor Andrew Cuomo. During the same period, nonprofit groups closed more than half of the beds in New York City’s children’s residential treatment centers, largely because state payments were too low to maintain children’s homes. ongoing programs.

“We are at a critical point, and we definitely need action,” James said during the hearing. “Emergency departments are overwhelmed with people who need more intensive psychiatric services, but are unable to access needed psychiatric beds or inpatient services in the community.

“When a child is in crisis,” James continued, “parents or caregivers have only two options: go to the emergency room or call 911. And too often, as we’ve seen in our office, they have had run-ins with the police which only make the situation worse.These children are waiting months and months for treatment.

The lack of care is, in large part, a direct result of cost-cutting measures and deliberate hospital bed closures taken under the Cuomo administration, said James, who cited our reporting in the hearing.

In exchange for closing beds, state officials have promised to expand access to outpatient and community mental health services that aim to keep children safe at home. But these programs have never been adequately funded, and providers say they cannot afford to hire or retain enough staff. According to a lawsuit filed in March, New York does not provide community mental health services to the vast majority of children who are entitled to them under federal law. (State officials named in the lawsuit have yet to respond to the complaint.)

“Things are desperate out there,” testified Alice Bufkin, associate executive director for policy and advocacy at the New York City Citizens Committee for Children. “Children are presenting at increasingly younger ages with serious mental illness. Families are prevented at every stage from finding care. Young people cycle in and out of emergency rooms and hospitals because they can’t get the care they need early.

The problems are “caused by chronic underinvestment in the children’s behavioral health system,” both by New York State and private insurance plans, which underpay mental health providers and do not guarantee access to preventive mental health care, Bufkin said.

In March, Rich Azzopardi, a spokesperson for Cuomo, told THE CITY and ProPublica that the facility closures were part of a larger effort to shift funds from hospital beds to outpatient care. The Cuomo administration has dramatically increased investments in community mental health services, Azzopardi wrote.

During this year’s session, the New York Legislature approved funding increases for many mental health programs. However, several providers and advocates testified at the hearing that very little new funding has been distributed and that the increases, while valuable, will not go far enough to reverse decades of underfunding.

It can be nearly impossible to access hospital care for children with mental health emergencies, said Ronald Richter, former New York child welfare commissioner and current CEO of JCCA, which runs programs residential homes for foster children in Westchester County. Children in crisis are turned away by Westchester Medical Center, Richter said. “These emergencies are unable to assess young people because they are overwhelmed. They are afraid to admit young people to their emergency rooms because they have no place to discharge them. There simply aren’t enough psychiatric beds for children who are suffering.

From 2014 to 2021, New York closed 32% of its state-run hospital beds for children, reducing the total from 460 to 314. The biggest reduction was at the New York City Children’s Center, where the total number of beds has been reduced by almost half. – up to 92 in 2021. Meanwhile, in the first five years after the launch of the transformation plan, the number of mental health emergency room visits by young people on New York’s Medicaid program – the plan of Public health insurance that covers more than 7 million lower-income state residents – rose nearly 25%.

JCCA staff members sometimes resort to bringing children to Bellevue, a public hospital in New York City, to have a better chance of them being evaluated or admitted, Richter said.

In response to Richter’s testimony, James noted that hospitals are legally required to assess and stabilize anyone who presents to the ER with a medical crisis, and she asked New Yorkers who are turned away for health care Emergency Mental Health to contact his office “so that we can review these complaints to determine whether the individuals are complying with the law.”

“This hearing is intended to explore potential areas for reform and inform my office of future investigations into allegations of inadequate mental health treatment or lack of parity,” James said.

In total, more than two dozen people testified at the hearing, including elected officials, health care providers and New York residents who said they could not access mental health care when they- themselves or their children needed it.

Among them was a mother from Long Island named Tamara Begel, whom we identified in our report by her middle name, Rae. Begel’s son started cycling in psychiatric emergency rooms after attempting suicide at age 9. Most of the time, he was not admitted to an inpatient bed. When he was, he had to wait several days in the emergency room because all the beds in psychiatric hospitals for children were full. “The problems started long before COVID,” Begel said during the hearing.

When he was last hospitalized, doctors said Begel’s son needed care at a long-term public mental institution, but the beds there were also full. He waited two months in a hospital unit designed for short stays, where he was assaulted by other patients and repeatedly restrained, both physically and with injected drugs, his mother testified.

“The Long Island healthcare system in general has completely collapsed,” Begel told James. “Parents are at breaking point because we cannot get health care for our children. People have to intervene. »