Children’s behavioral health services in New York have been underfunded for years, something that was acknowledged by the Medicaid Redesign Team.

But in addition to that basic underfunding, there’s a dangerous combination of factors that has allowed New York’s mental health safety net for children to become threadbare.

According to Andrea Smyth, executive director of the New York State Coalition for Children’s Behavioral Health, the state has been closing residential programs much too quickly, yet at the same time, it is lagging behind when it comes to investing in community services. The residential closures have saved $40 million but, as Smyth says, there’s no evidence that that money has been re-invested in community based services.

"It’s a deadly combination not to have enough residential placements and to also have a severe shortage of community services," Smyth told Capital Tonight.

"The intent of the Children’s Mental Health Medicaid Redesign was to expand innovative and effective community-based services. Because that never happened, the downsizing of residential treatment centers is harming families’ ability to get any care," Smyth explained.

Smyth shared the story of a 12-year-old boy on Long Island, who was in residential care, which was working for him. But because residences are under pressure to keep lengths of stay short, he was discharged back to his family.

The next 12 months at home, while he waited for another residential placement, were extremely difficult. Cody ended up in the emergency room a number of times. Once, he assaulted his mother while in a psychotic state and she ended up in the hospital. He attempted suicide twice.

"These services are life-changing and life-saving," Smyth said.

COVID has made these situations even more dire.

"We should be focusing on investing in COVID-recovery for children who have been disrupted and who have suffered loss," Smyth explained.

While the executive budget exempted children’s community services from a 1% Medicaid cut, it did nothing to speed the expansion of, or invest in, the sector.  

Neither did the legislature. However, Smyth is heartened by the legislature’s decision to create a committee that will advise it on how to distribute $32 million from the McKinsey opioid settlement.

Smyth is also hopeful that lawmakers will acknowledge the receipt of more than $300 million in enhanced block grant funding for mental and addiction services provided by the December stimulus package. As of now, that funding can be used by the governor for the Office of Alcohol and Substance Abuse Services (OASAS) and the Office of Mental Health Services (OMH).

When asked how she would like that money spent, Smyth said she has a long wish list.

"We want family care coordination for families with children who have lost a family member or caregiver to the opioid epidemic, or have lost a family member or caregiver who has lost employment, housing or insurance from addiction," she said. 

Other services Smyth is hoping to fund include:

• Additional services for family re-unification and education discharge planning from residential rehabilitation for youth programs. 
• Additional youth mobile crisis services, and school-based services that are alternatives to crisis removal and that are "trauma informed."

"This goes to the police interaction, right? We want youth mobile crisis services, youth ACT teams, and school-based removal techniques that are trauma-informed," Smyth said. "These are all timely things for which we can spend money that’s only going to last two years."