The crisis in children's mental health is not a new issue in New York State, where approximately 367,000 children are seriously mentally ill and more than 90,000 of these children do not receive needed mental health treatment services. As a result, they are falling into the child welfare and juvenile justice systems—in crisis, at higher cost and in growing numbers. Foster children are at particular risk: estimates are that 29 percent to 80 percent of children in foster care have a mental health problem serious enough to warrant treatment, yet most remain undiagnosed and untreated. This means that between 15,370 and 42,400 foster children in New York State have a serious mental health problem.

Children's mental health is an issue that has received national attention in recent months. In December 1999, the U.S. Surgeon General released Mental Health: A Report of the Surgeon General, which stated that, "about five percent of all children experience what professionals term extreme functional impairment." A series of articles in the New York Times and other papers further detailed the problems in children's mental health, describing the overuse of psychotropic medication for very young children by HMO's because other clinical treatment services were unavailable.

The Roots of the Crisis
The children's mental health system in New York State has been historically underfunded. In FY2000, the State Office of Mental Health spent only 10% of its total budget on children's services. Yet, children age 0-18 years represent 25 percent of the state's population. This underfunding has resulted in an uneven distribution and chronic shortages of children's residential, support and treatment services across the State, resulting in "kidlock". Kidlock describes an all-too-common situation where children stay longer than is clinically necessary in inpatient and residential mental health programs because of a lack of services in their community. When children are unable to leave inpatient and residential mental health programs, which have a limited number of beds, other more acutely ill children in need of these services are unable to receive the care they need. Kidlock has a domino effect on all children's mental health services, creating backlogs and long waits for care, forcing children into programs that are either not secure or intensive enough to keep them safe or into services or programs that are more restrictive than they need.

New York's Efforts to Address the Crisis
Governor George E. Pataki and the New York State Legislature have taken steps to address the crisis by adopting a $36.2 million residential and support services package as part of the New York State Health Care Reform Act (HCRA) 2000 and the addition of $2.85 million to expand clinical treatment services for children in the FY2001 budget. This investment will go a long way toward eliminating kidlock and long waits for care. But more needs to be done.

Next Steps: Removing Barriers to Care

The Medicaid cap must be lifted.
Five years ago New York State implemented a policy to cap Medicaid funding for children's (and adult) outpatient mental health treatment services. Historically, New York State shared the cost of funding children's mental health treatment services with the federal and county governments. But now New York State refuses to pay its share, claiming that the budget neutrality provisions it negotiated with the federal government under the 1115 Waiver bars the state from spending any more money on children's outpatient mental health treatment services. The Medicaid cap has created insurmountable barriers to the creation or expansion of children's mental health treatment services for seriously ill children. It forces children to wait weeks and months for essential services, even if they have insurance coverage through Medicaid or Child Health Plus to pay for care.

End discrimination against foster children with serious emotional disturbance (SED).
The Medicaid cap has had disastrous affects on mentally ill children in foster care, for whom the Medicaid rate available for health and mental health services is between $3.00 and $6.00 a day—a meager $42.00 per week. This rate is grossly insufficient to cover the cost of care—the cost of children's mental health services average $150 per day for Home and Community-Based Services Waiver, $47 for Day Treatment services and up to $102 per clinic visit.

Until May 2000, foster children with SED were ineligible to participate in the Home and Community-Based Services Waiver. After one and one-half years of advocacy and negotiations between the State Office of Mental Health and the State Department of Health, the eligibility ban has been lifted, and for the first time SED children in approved or certified foster homes can participate in the program. Lifting the ban makes it possible to meet some of the demand for community-based services for foster children with SED. But the Governor and the Legislature must do more to remove the additional barriers these children face in securing mental health treatment. First, they must work with the New York State Department of Health to increase Medicaid payments to providers of mental health services to foster children, to a level comparable to rates paid for identical care to children who live at home with their parents. Second, they must work with the New York State Department of Health to enable clinical social workers employed by foster care agencies to deliver clinical treatment services to children in foster care, and bill Medicaid for those services.

New York State has taken the first and important step to addressing the crisis in children's mental health. But there is more to be done to ensure that children with SED in New York State receive the range of treatment, residential and support services they need to meet the challenges presented by their illness.