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This article was produced for the ProPublica Local Reporting Network in partnership with CITY. Subscribe to newsletters to receive stories like this as soon as they are published.


By slashing inpatient mental health care, there are too few places left in New York City to seek treatment for serious mental illness, state attorney general Letitia James said at a hearing held in her office on Wednesday.

James called the hearing next reports The CITY and ProPublica about New York State’s failure to provide mental health care to children and adolescents. Our investigation found that government officials have closed almost a third of the child beds in public mental hospitals since 2014, in accordance with the “Transformation Plan” devised by former Governor Andrew Cuomo. During the same period, nonprofit groups closed more than half of the beds in New York’s boarding schools for children, largely because government payments were too low to keep the programs running.

“We are at a critical point and we certainly need action,” James said at the hearing. “Emergency departments are overwhelmed by people who require more intensive mental health care but cannot access the necessary psychiatric inpatient beds or community services.

“When a child is in crisis,” James continued, “parents or guardians have only two options: go to the emergency room or call 911. And all too often, as we saw in our office, they had run-ins with the police, who only exacerbates the situation. These children have been waiting months for treatment.”

The lack of care is largely a direct result of the cost-saving measures and deliberate closure of hospital beds enacted during the Cuomo administration, James said, referring to our report at the hearing.

In exchange for closing beds, government officials promised to increase access to outpatient and community mental health services aimed at keeping children safe at home. But these programs have never been properly funded, and providers say they cannot afford to hire or retain enough staff. According to a lawsuit filed in March, New York State does not provide community mental health services to the vast majority of children who are eligible under federal law. (Government officials named in the lawsuit have not yet responded to the complaint.)

“Things are desperate out there,” testified Alice Bufkin, deputy executive director for policy and advocacy for the New York City Citizens Committee on Children. “Children are coming in with serious mental illness at an earlier and earlier age. Families at every stage cannot get help. Young people cycle to and from emergency rooms and hospitals because they cannot get the care they need early on.”

Bufkin said the problems “are caused by a chronic lack of investment in child mental health” by both New York State and private insurance plans that underpay mental health providers and do not provide access to preventive mental health care.

In March, Cuomo’s spokesman Rich Azzopardi told THE CITY and ProPublica that the facility closures were part of a larger effort to shift funds from hospital beds to outpatient care. The Cuomo administration has significantly increased investment in community mental health services, writes Azzopardi.

In this year’s session, the New York Legislature approved increased funding for many mental health programs. However, several vendors and lawyers testified at the hearing that very little new money had been distributed and that the increases, while valuable, would not be enough to reverse decades of underfunding.

According to Ronald Richter, former New York City Children’s Commissioner and current CEO of JCCA, which operates residential programs for children in foster care in Westchester County, it can be nearly impossible to access hospital care for children experiencing mental health emergencies. Children in crisis are being turned away at Westchester Medical Center, Richter said. “These emergency rooms can’t evaluate young people because they’re overwhelmed. They are afraid to take young people into their emergency room, because they have nowhere to discharge these young people. There are simply not enough psychiatric beds for suffering children.”

From 2014 to 2021, New York closed 32% of its public hospital beds for children, reducing the total from 460 to 314. The largest reduction was at the New York Children’s Center, where the total number of beds was almost halved. – up to 92 in 2021. Meanwhile, in the first five years after the launch of the Transformation Plan, mental health emergency room visits by young people under New York’s Medicaid program — a public health insurance plan that covers more than 7 million less in the state’s income — jumped nearly 25%.

Richter said JCCA employees sometimes bring children to Bellevue, a public hospital in New York City, to improve their chances of being examined or hospitalized.

In response to Richter’s testimony, James noted that hospitals are required by law to evaluate and stabilize anyone who presents to the emergency room with a medical crisis, and she asked New Yorkers denied emergency mental health care to contact her office “to we can look into these complaints to determine if people are following the law.”

“This hearing is dedicated to exploring potential areas for 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 Yorkers who said they could not access mental health care when they or their children needed it.

Among them was a Long Island mother named Tamara Begel, whom we referred to in our report by her middle name, Ray. Begel’s son began cycling to psychiatric emergency rooms after a suicide attempt at the age of 9. In most cases, he was not placed in an inpatient bed. When he was, he had to wait several days in the emergency room because all the children’s psychiatric hospital beds were full. “The problems started long before COVID,” Begel said at the hearing.

During his last hospitalization, doctors said that Begel’s son needed treatment in a long-term state psychiatric institution, but even there the beds were overcrowded. He waited two months in the hospital’s short-stay ward, where he was assaulted by other patients and held down several times, both physically and with injections, his mother testified.

“The care system on Long Island as a whole has completely collapsed,” Begel told James. “Parents are in critical condition because we cannot provide medical care for our children. We need people to intervene.”

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