A Victory for Children's Mental Health in New York

 A Victory for Children's Mental Health in New York,

Sagamore Children's Psychiatric Center is operated by the Office of Mental Health, which is one of the state agencies being sued in regards to access to mental health care services for children on Medicaid. From a New York State Office of Mental Health video.

New York is now required to ensure Medicaid-eligible kids the access to timely, intensive mental health treatment in their own communities and homes, as part of a class-action settlement reached Monday.

The settlement, which was filed in U.S. District Court with New York's Department of Health and Office of Mental Health, is a significant advance in helping to fill gaps in care for some of the state's most vulnerable citizens.

Almost half of the kids in New York state — over 2.5 million — are covered by Medicaid. But the unavailability of affordable mental health services has led some parents to have to turn to hospitals and residential programs for their children. For children with high-level psychological and behavior disorders, being taken away from families during already traumatic times triggers more trauma, lawyers asserted in a statement Monday.

"Today is a great day for the thousands of kids with serious mental illnesses who reside in communities throughout New York State," said Steven Holinstat, an attorney representing the four child plaintiffs who initiated the lawsuit. "They have waited long enough. This settlement finally begins the process needed to ensure they receive the care they deserve."

The 52-page contract specifies what the state has to do over the next 18 months. A plan for how the agencies will deliver intensive care coordination and at-home behavioral health services needs to be created, and a crisis response plan that doesn't involve the police. The state must also boost Medicaid reimbursement rates for mental health providers who treat children under the settlement. And there also needs to be an annual quality audit of these services.

Justin Mason, a spokesman for the Office of Mental Health, would not comment on the settlement agreement itself, but indicated his office would keep working with the Department of Health in order to "secure an amicable resolution."

"Ultimately, our aim is to make our state provide intensive home and community-based mental health services that meet the needs of all children and youth, including those who are covered by Medicaid," Mason wrote in an email.

The 2022 federal class action lawsuit, C.K. v. McDonald, was brought by two private law firms and two major advocacy organizations, Disability Rights New York and Children's Rights.

The families and plaintiffs claimed that the state did not meet its obligation to deliver intensive mental health and mobile crisis care for the children in their homes and communities. Rather, the families reported, they languished on waitlists for months and had to send their children to restrictive, institutionalized hospitalization for many months.

“The State’s mental health system for Medicaid-eligible children is languishing in a state of dysfunction, providing inadequate, inaccessible, and woefully underfunded mental health services,” the lawsuit stated. 

One Monroe County parent, identified in the lawsuit by her initials, told The Imprint that she struggled with her child’s mental health issues for nearly a decade, with little help from the state.

P.W. has had custody of the girl, a relative, since she was 11 months old. She developed into an energetic, artsy child who enjoyed arts and crafts, dance, and gymnastics. Her behavior and mental health issues surfaced by kindergarten. Doctors diagnosed the girl over the years with a long list of anxiety disorders, unspecified schizophrenia and other behavioral problems. She was prescribed a number of types of psychotropic medications, the court documents stated. But her outbursts of violence and dangerousness intensified. According to P.W., she did everything she could to arrange local treatment for her daughter and keep her out of institutions, but she was stuck on waiting lists for the intensive, therapeutic services the child ought to have been eligible for under Medicaid. P.W. reported instead that she spent many hours in psychiatric emergency rooms whenever her daughter was in trouble.

By the age of 9, the child's behavior created scenes that today are frightening for the Rochester mother to remember. At one point, she recounted, she hid in a locked room, while her daughter hammered a knife against the door.

"As a Black mother, the last thing I wanted to do was call the police, because too often our children are viewed as criminals, and that's not what was happening," P.W. said. "But knowing she wasn't safe, there were times when I had no other option."

The single mother was powerless to witness the police officers "manhandle" her daughter, she claimed. At other times, she resented being forced to refuse to take her home after an emergency room visit because she felt the child had not been helped. Hospital staff would call in Child Protective Services caseworkers to intervene.

Eventually, P.W. explained, she resorted to residential treatment centers and intensive inpatient psychiatric units. In such facilities, the pre-teen was isolated, and physically and medically restrained. P.W. recalls being permitted only virtual visits with her daughter for months amid the pandemic — including even at Christmas.

Children's Rights lawyer Daniele Gerard, who defended the 57-year-old mother, said the family's case illustrates the need for seeking early intervention for children in serious need of services so that a "huge crisis" does not later develop involving traumatic encounters with the police.

Legislators and child advocates nationwide also have demanded more assistance for strained families, some of whom have been forced to put children in foster care after they could not provide for their behavioral and mental health issues.

The initial settlement in the New York case is pending final court approval.

P.W.'s daughter is 16 and back home after three years of staying in a residential facility. Her mother hopes that the settlement will result in a different fate for families that face the same issues as hers.

“I’m hopeful for the thousands of children and family members across the state that continue to lack appropriate, intense mental health services and that find themselves going in and out of the traumatizing psychiatric emergency room,” P.W. said. “I’m hopeful for families that are able to build resilience and heal appropriately.”