New York State failed to provide legally required mental health care to children, court claims

New York state has failed to provide children on Medicaid with the mental health care they are entitled to under law, according to a lawsuit filed Thursday in federal court by two teenagers acting on behalf of hundreds of thousands children eligible for Medicaid.

As a result, the lawsuit says, young people with serious mental health issues are suffering needlessly and ending up in hospitals and residential treatment programs because they don’t have access to services that would keep them safe at home. .

New York’s children’s mental health system “languishes in a state of dysfunction, providing inadequate, inaccessible, and woefully underfunded mental health services,” according to the complaint, filed in U.S. District Court in Central Islip, Long Island, by attorneys from the advocacy groups Disability Rights New York, Children’s Rights and the National Health Law Program, as well as the law firm Proskauer Rose LLP.

THE CITY and ProPublica reported on Monday how New York’s vow to transform mental health care for children has left young people with insufficient access to outpatient treatment and inpatient care. As part of a plan launched in 2014 by the then government. Andrew Cuomo, New York, has cut the number of beds in state-run children’s mental hospitals by almost a third. Although the plan redirected savings to outpatient and community services, it did not reduce the demand for hospitalization in the first five years and increased waiting times for hospital beds for children suffering mental health emergencies.

For children with serious mental health issues, the stakes are life and death, said the mother of a plaintiff in the case, who lives on Long Island. “If I relied on the system, my son would have already left,” the mother, identified by the initials PK in the complaint, told THE CITY and ProPublica.

Her son, who is now 15, first showed signs of mental health issues when he was still a toddler. He was hospitalized for a psychiatric emergency when he was 4 years old, then walked in and out of hospitals about 16 times by the time he was 10 – often following violent episodes in which he hallucinated and tried to hurt himself or his mother, PK mentioned. His symptoms became frightening enough that he spent two years, from age 10 to 12, in a residential treatment program for children with very serious mental disorders.

At the residential program, he learned skills to cope with his symptoms and was taken off several psychiatric medications, his mother said. Eventually, he was released with a plan to receive intensive mental health services that were supposed to help him stay well at home.

But when the mother contacted mental health agencies in her area, she was told that all programs were full. “I call everyone, and there’s nothing,” she told THE CITY and ProPublica. Her son went months without receiving mental health services at home, according to the lawsuit. When providers were finally assigned to her case, they disappeared after a session or two, moving on to other jobs, the mother said. “It’s just: Boom, they’re gone. They never even really started.

As she struggled to find help for her son, she saw him fall dangerously ill. He started cutting himself, she said, and ended up in the emergency room and in hospital beds after several suicide attempts. “I’m scared every day to go home and not find my son alive,” she said. “I watch him at night as if he were a newborn. Does he breathe? Is he okay? It’s heartbreaking. I still cry every day.

“Honestly, I think if he had these services when he got home, he would be in a whole different place today,” she continued. “I know he was let down by the system. I fought and fought. But my heart also says, if something happens, it’s my fault. In the end, I am his mother. He’s my child.”

“Too late for us”

New York has long known that its mental health system is failing children’s needs, according to the lawsuit, which names New York Department of Health Commissioner Mary Bassett and Office of Mental Health Commissioner as defendants. of the state, Ann Sullivan.

The DOH and OMH declined to comment on pending litigation.

Under federal rules, the state is required to provide intensive mental health services to any child with a medical need enrolled in Medicaid, the federal state health insurance program that covers more than 2.2 million people under the age of 21 in New York. Services are meant to be provided in children’s homes, schools and other places where a child would naturally be – a model that mental health providers say works best for many children with severe problems than having them sit in clinicians’ desks like little adults.

In 2011, a Cuomo-created Medicaid overhaul team recognized that the state’s mental health system was underfunded and inadequate, with “little accountability for delivering quality care and improving outcomes.” for patients/consumers”. As a result, the task force found that “harmful and costly developmental trajectories continue to form early in life.”

In response, the state created two new sets of services meant to be available to hundreds of thousands of children. The first, called Child and Family Treatment and Support Services, would provide clinical help to any child on Medicaid with a medical need. Children would have access not only to home therapy, but also to providers who would take them out into the community so they could work on their coping skills in public, and to mental health professionals who could respond to a crisis, which would make it less likely that a family would have to call the police for help with an abusive or suicidal child.

The second set, called Home and Community Based Services, would provide intensive support for children at imminent risk of ending up in a hospital or residential program.

But, according to the lawsuit, while the state “purports” to make these services available, they are not intensive enough to meet the requirements of federal law. And even if they were, the programs are not available for the number of children who are entitled to them.

The state does not track the number of children on waiting lists for mental health care, but OMH data shows that community services are reaching a tiny fraction of the children who are supposed to receive them.

In 2017, the OMH projected that more than 200,000 children and youth in the state’s Medicaid program would have a medical need for child and family treatment and support services. In 2020, less than 16,000 children received these services. That’s less than 8% of eligible children, according to OMH data cited in the complaint.

Similarly, the state estimated that 65,000 children and adolescents would require its more intensive home and community services. As of July 2020, about a tenth of that number was enrolled in the programs, according to the complaint.

Without the care to which they are entitled, “the mental health conditions of young people continue to deteriorate, causing disruption and damage to children, their education, their families and relationships, their future adult life and their life itself”, accuses the lawsuit. The plaintiffs are asking that a judge compel the state to provide children with mental health services mandated by federal law.

The 15-year-old complainant’s mother said she thought her son may have missed his chance to receive the kinds of services he was supposed to receive when he returned from the residential treatment program three years ago. years. “Those are prime years for him,” she said. “He missed all those years of development, when he should have learned social skills and how to cope.”

“I just hope this lawsuit comes along and makes a difference,” she said. “It’s a little too late for us, but I hope it’s not too late for the others.”