“We’re at a Crisis Point”: NY Attorney General Hearing Spotlights Child Mental Health Care Failures

Series: Crisis Point

How New York Wrecked Mental Health Care for Kids

By slashing inpatient psychiatric care, New York has left people with too few places to turn for treatment of serious mental health conditions, state Attorney General Letitia James said at a hearing held by her office Wednesday.

James called the hearing following reports by THE CITY and ProPublica on New York state’s failure to provide mental health care to children and adolescents. Our investigation found that state officials have closed nearly one-third of the beds for children in state-run psychiatric hospitals since 2014, under a “Transformation Plan” rolled out by former Gov. Andrew Cuomo. During the same period, nonprofit groups shut down more than half of the beds in New York’s residential treatment facilities for kids, in large part because state payments were too low to keep the programs running.

“We’re at a crisis point, and we certainly need action,” James said at the hearing. “Emergency departments are overwhelmed by individuals who require more intensive psychiatric services but are unable to access necessary psychiatric inpatient beds or services in the community.

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

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

In return for closing beds, state officials promised to expand access to outpatient and community-based mental health services that aim to keep kids safe at home. But those programs were never adequately funded, and providers say they can’t afford to hire or retain enough staff. According to a lawsuit filed in March, New York fails to provide community-based mental health services to the vast majority of children who are entitled to them under federal law. (The state officials named in the suit have not yet responded to the complaint.)

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

The problems are “driven by chronic underinvestment in the children’s behavioral health system,” both by New York state and by private insurance plans, which underpay mental health providers and fail to ensure access to preventive mental health care, Bufkin said.

In March, Rich Azzopardi, a spokesperson for Cuomo, told THE CITY and ProPublica that facility closures were part of a larger effort to shift funds out of hospital beds and into outpatient care. The Cuomo administration significantly increased investment in community-based 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 of the new money has been distributed, and that the increases, while valuable, will not go far enough to reverse decades of underfunding.

It can be all but impossible to access hospital care for kids experiencing mental health emergencies, said Ronald Richter, New York City’s former child welfare commissioner and the current CEO of JCCA, which runs residential programs for children in foster care in Westchester County. Kids in crisis are turned away by the Westchester Medical Center, Richter said. “These emergency rooms are unable to evaluate young people because they are overwhelmed. They are afraid to admit young people into their ERs because they have no place to discharge these young people to. There are simply not enough psychiatric beds for children who are suffering.”

From 2014 to 2021, New York closed 32% of its state-run hospital beds for kids, cutting the total from 460 to 314. The biggest reduction took place at the New York City Children’s Center, where the bed total was cut nearly in half — down to 92 in 2021. Meanwhile, in the first five years after the Transformation Plan’s launch, the number of mental health emergency room visits by young people on New York’s Medicaid program — the public health insurance plan that covers more than 7 million lower-income state residents — shot up by nearly 25%.

JCCA staffers sometimes resort to bringing kids to Bellevue, a public hospital in New York City, for a better chance that they will be evaluated or admitted, Richter said.

In response to Richter’s testimony, James noted that hospitals are legally required to evaluate and stabilize anyone who presents at the emergency room with a medical crisis, and she asked New Yorkers who are turned away for emergency mental health care to contact her office “so we can look at these complaints to determine whether individuals are complying with the law.”

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

In all, more than two dozen people testified at the hearing, including elected officials, health care providers and New York residents who said they couldn’t access mental health care when they or their children needed it.

Among them was a mother from Long Island named Tamara Begel, whom we identified in our reporting by her middle name, Rae. Begel’s son started cycling in and out of psychiatric emergency rooms after he attempted suicide at age 9. Most times, he was not admitted to an inpatient bed. When he was, he had to wait several days in the ER because all of the psychiatric hospital beds for kids were full. “The problems started way before COVID,” Begel said at the hearing.

During his most recent hospitalization, doctors said that Begel’s son needed care at a longer-term state psychiatric facility, but beds were full there too. He waited two months in a hospital unit designed for short-term stays, where he was assaulted by other patients and restrained multiple times, both physically and with injected medication, his mom testified.

“The system of care on Long Island in general has completely collapsed,” Begel told James. “Parents are at the breaking point because we cannot get the health care for our children. We need people to step in.”