Tag Archives: mental health
by Jennifer Swayne, Staff Attorney – Health Justice Program
On Friday, December 14, 2012, we once again faced unspeakable tragedy as a gunman broke into Sandy Hook Elementary School in Newtown, CT and opened fire, killing a total of 28 people—20 of whom were children. While many of the initial conversations surrounding this horrible tragedy focused on the ongoing debate about gun control, very few of those conversations focused on mental illness, the stigma surrounding it, and access to mental health care services. Some news sources have reported that the gunman faced mental illness, though it is not clear what, if any, mental health services he and his family may have sought in the past. However, what is certain is that we need to engage in dialogue on mental illness, as there are many individuals who face significant stigma and who are not able to access critical mental health services consistently.
Mental illness knows no race, culture, ethnicity, language, socioeconomic status, age, gender, or religion, yet there is stigma and overwhelming silence surrounding its impact. Many have probably encountered someone with mental illness without even realizing it, especially since about 1 in 4 adults age 18 and over, and about 1 in 5 children age birth to 18 suffer from a diagnosable mental illness at some point in their lives. Because of the stigma surrounding mental illness, however, we continue to miss opportunities to help others get the support and assistance they need, especially when those who exhibit signs of mental illness are simply labeled and dismissed as “crazy.” Instead, we are relegated to hindsight assessment when it is much too late to take action.
The mass shooting that happened in Newtown is an extreme, and there is nothing that excuses the actions of the gunman. However, mental illness is much more complex than this extreme case of violence we have witnessed suggests. For instance, people with mental illness face greater risk of becoming the victim of crime rather than being the perpetrator. Therefore, we must be careful not to let a single person’s actions symbolize our collective understanding of how mental illness manifests and operates.
Further, we have a health care system where mental health parity has been lacking, and sadly, quality mental health services remain a luxury reserved for those who have the ability to pay in cash for those services. The result is that those who have no insurance, those who rely on private insurance with limited mental health benefits, and those who rely on public insurance often go without needed mental health services that can help them live full and productive lives. Untreated mental illness can result in homelessness, incarceration, victimization, high burden placed on families and caretakers, and productivity loss, not to mention the financial costs of healthcare expenditures resulting directly from failure to treat mental illness sooner rather than later.
New York State is in the process of redesigning its system of behavioral health services for some of the most vulnerable people in our society—low-income children from birth to age 21 who use public insurance. This is a group that has suffered immensely from lack of adequate mental health services. Under Medicaid, the system of mental health care for children has been overwhelmingly underfunded and the New York State systems that serve children—Department of Health (DOH), Office of Mental Health (OMH), Office of Children and Family Services (OCFS), Office of Alcoholism and Substance Abuse Services (OASAS), Department of Education (DOE)—and other agencies at the local level, have not coordinated their efforts to serve children, leading to a disjointed system.
It is promising that New York State is engaging in a process to revamp the system of care for our children, but we have to make sure that it is a system that will actually work and result in real change or else children will continue to face dire consequences and suffer from the stigma of mental illness well into adulthood. Children with mental health problems have lower educational achievement, greater involvement with the criminal justice system and fewer stable and long-term placements in the child welfare system than their peers. In attempts to access mental health services, publicly insured children are also more likely to rely on restrictive or costly services such as juvenile detention, residential treatment, emergency rooms, and are more likely to be placed out of their homes in order to obtain critical services, as opposed to being able to readily access outpatient services, especially if they are children of color.
On December 14, NYLPI and the Children’s Defense Fund submitted joint comments (which you can access here) regarding the critical mental health services that children need to New York’s OMH, OASAS, and OCFS. In our comments we:
(1) address the health disparities that impact receipt of mental health care;
(2) list the services that children should receive and who should provide those services;
(3) highlight the importance of cultural and linguistic competency;
(4) discuss the need for early identification and prevention measures such as behavioral health screening; and
(5) stress the need for training and funding so that providers are able to actually provide the appropriate services.
As we can see, mental illness is complex and it is not going away. We must proactively engage in creating a better system of care rather than responding in the aftermath of tragedy. It is vital that we have honest and ongoing conversations about the state of our society, mental illness, stigma, and access to appropriate mental health care services.
Below is a press release we just issued, announcing a major campaign victory!
FOR IMMEDIATE RELEASE
After advocacy groups’ campaign on behalf of parents of kids with special needs, NYU designates providers who will accept Medicaid and,Child Health Plus
New York, NY, June 1, 2010 – New York Lawyers for the Public Interest (NYLPI), a civil rights law firm whose practice includes health justice and disability rights, along with co-counsel, Cleary Gottlieb Steen & Hamilton LLP and LatinoJustice/PRLDEF, announced today that they successfully campaigned for the Child Study Center of the New York University Medical Center to designate certain doctors who will accept Medicaid and other health insurance. Previously, NYU’s Child Study Center had a cash-only policy for patients, which meant that they did not accept any insurance at all.
As part of the advocacy campaign, which included threats of litigation, a group of parents represented by NYLPI and co-counsel met with NYU leadership and explained how the cash only policy impacted them and the thousands of other families who were unable to access the Center’s state-of-the-art evaluations and medical services for children with disabilities. These services are in extremely short supply across New York City, and without access to the facility at NYU’s Child Study Center, many low-income and minority children were unable to obtain the medical attention they needed.
“NYU has taken a step in the right direction towards eradicating a few of the many institutional barriers keeping low-income New Yorkers from accessing quality health care,” said Nisha Agarwal, director of NYLPI’s Health Justice program. “We still have a long way to go to ensure that all children, regardless of their financial circumstance or background, have equal access to high-quality mental and behavioral health services, but this is one step forward.”
As a result of NYLPI’s action, the Child Study Center has announced that it will designate certain providers who will begin accepting fee-for-service Medicaid and Child Health Plus. Before this change, children and their parents who could not afford to pay cash for evaluations and medical services often went without necessary and recommended medical treatment for serious illnesses.
According to Lorraine Ali, “No mother wants to be told she can’t provide her child with the medical attention he needs. Now I can finally get my son to a doctor who can treat him. It’s the best news we’ve gotten in a long time.”
Although NYU’s Child Study Center has agreed to take the important step of accepting fee-for-service Medicaid and Child Health Plus, it does not have plans to accept any Medicaid managed care plans. “There continues to be an acute shortage of evaluative and medical services for children with psychiatric disabilities in New York City,” said Kelly McAnnany, director of the Opportunity & Access Program at NYLPI. “We will continue to work with providers and with state agencies to open the doors to quality health care and educational opportunity for low-income children with disabilities.”
This weekend the New York Times reported on a new study which finds that kids on Medicaid are four times more likely to be prescribed antipsychotic drugs than their privately insured counterparts, and often for conditions for which the drugs are not FDA approved such as A.D.H.D. and conduct disorders. These drugs may not only have significant psychological impacts on the children who take them, but they also cause long-term physical harm. This is terrible no matter what, of course, but let us be very clear about what we are talking about here. In places like New York City, where African-Americans and Latinos are 3.5 times more likely to be on Medicaid than whites, the kids we are talking about are black and brown.
The children who are being systematically over-medicated and denied high quality mental and behavioral health services are disproportionately young people of color. What we are talking about, then, is race even if all but the most oblique reference to it has been scrubbed from the lines of the mainstream media coverage.
Let us also be clear about how this may be happening. The Times piece implies that certain problems with the Medicaid program, such as low reimbursement rates for therapy, contribute to the over-medication of children by creating incentives for doctors to prescribe antipsychotics or by reducing the availability of psychiatrists who accept Medicaid, thus funneling low-income kids to non-specialists who are more likely to provide treatment through drugs. This may very well be true, but let us unpack these dynamics as well from the racial justice tip.
In New York City, where I work, there are large, well-respected institutions providing high quality mental health services for children that refuse to accept Medicaid patients ostensibly because they don’t pay that well. This can be viewed as a rational dollars-and-cents reaction to an inadequate Medicaid system, but when you consider the close relationship between insurance and race, it starts to look like a modern version of Whites Only. Such policies become all the more difficult to swallow when you compare them to the approach of some community-based health care providers that also exist in the city and manage to make mental health services available effectively and equitably.
The directors of clinical services at these community health centers will tell you about how they’ve figured out their administrative and billing infrastructure so they can work around some of Medicaid’s challenges to provide high quality mental health care to all patients, regardless of their insurance. Providers like these fight alongside consumer advocates to preserve Medicaid and make it better because they recognize how critical it is to the lives of their patients. They don’t retreat from the system or take shortcuts, hoping that poor kids of color and their mental health problems will just go somewhere else. Indeed, they bear responsibility for their colleagues at other institutions, who disguise their discrimination in the form of a “rational” economic calculus.
You can expect to hear more about the doping of America’s children in the coming year, as more studies are released and blue-ribbon policy panels convened to address the problem. What you probably won’t see are many efforts to write race into the story or the solution. That is our job as racial justice advocates: to read between the lines and move in from the margins.