Nicholas, a 15-year-old New Yorker with autism, an intellectual disability, and significant mental health needs, has been to the emergency room nearly 15 times since last summer. Each time, he was sent home without a plan.
New York’s behavioral health system is not built to care for young people with the most complex needs. Attorney General James recently announced she is mandating major mental health reforms at New York-Presbyterian Hospital because of its “repeated pattern of failures that put vulnerable patients at risk”. This follows a similar announcement regarding Westchester Medical Center.
It shouldn’t require the involvement of the State AG for children–or adults–to get the mental health care they need. And, it’s not just about hospitals. There are too many gaps and wait lists in the system, leaving people cycling from crisis to crisis without getting the care they need. The city and state have the opportunity–and the responsibility–to fix that now.
Nicholas has spent much of his life navigating systems meant to care for him. He was in foster care from birth until age two. At seven, he entered residential care, where he remained for years before returning home again. In recent months, his crises escalated beyond hospitalizations, and he had encounters with the legal system. Despite all his years in the “system,” he is still in need of more care than we can support.
His case is not rare. According to the Citizens Committee for Children, 1 in 10 children in New York experience mental health challenges serious enough to affect their daily functioning in family and school life.
Organizations like JCCA, the nonprofit where I work, are charged with serving children and families in need of mental and behavioral health services. We struggle to serve the children with the most acute needs because options are often unavailable due to gaps in services, long waitlists, and staffing shortages. New York City and State can change this, but it will require targeted investment.
We need the City and State to expand intensive, home- and community-based services that can step in before crises escalate, especially for youth with both developmental disabilities and serious mental health needs. There are still too few program options available for young people, like Nicholas, which is why he keeps winding up in the hospital.
There is also a need beyond the most acute cases. Estimates suggest that three in four children covered by Medicaid in New York are not receiving the mental health care they need. We need to expand programming, both existing services with waitlists and new programs that meet more complex needs. But to expand and stand up new programming, we need the staff to provide the services.
To address staffing needs, our government partners must invest in the behavioral health workforce through loan forgiveness, tuition assistance, and support for training and licensure so providers can recruit and retain qualified staff. Today, the cost of attaining the right degree and licensure, like for social work, is a significant barrier for aspiring clinicians without significant resources. We also need the state to raise service rates and relax barriers to billing for higher acuity youth. Service providers across the state have called for the Governor to invest $200 million in home and community-based behavioral health services to begin addressing this need. Agencies like JCCA often have 20%+ vacancy rates because of the workforce shortage, making it impossible to serve all the children who come to us for care.
These are practical steps that would provide young people with the support they lack today. This will require a significant investment of funding. But our children and families need and deserve the ability to build stable, healthy, independent lives. And in the long term, this investment won’t just be the right thing to do for youth like Nicholas and their families, it will help build stronger communities and a better city for all. It will also help reduce expensive emergency services that today, for children like Nicholas, function as an outrageously expensive band-aid.
Lauren Pack is the Director of Health Homes and Non-Medicaid Coordination at JCCA.