There are clearly high costs to children, families, communities and taxpayers when children’s mental health needs are unmet including worsening mental health, school difficulties, increased suicidality and a cycle of poverty.1 Given how critical it is to identify children with mental health needs and treat these needs as soon as possible, Citizens’ Committee for Children of New York, Inc. (CCC), in conjunction with the New York City Citywide Children’s Committee and the New York City Early Childhood Strategic Mental Health Workgroup sought to estimate the gap between the need for treatment slots and the number of treatment slots available for children throughout New York City.

Through our analysis we found that an estimated 47,407 children ages 0-4 in New York City have a behavioral problem and 268,743 children ages 5-17 in New York City are estimated to have a mental health disorder. While we were unable to identify the citywide unmet need, due to the lack of data for Queens and Manhattan, our analysis of slot capacity for Brooklyn, Bronx and Staten Island suggests that that there are only treatment slots for 1% of children ages 0-4 and 12% of children ages 5-17 who have treatment needs. This analysis lays bare that there are insufficient treatment slots to meet children’s treatment needs in New York City.

This gap analysis (between need and capacity) is particularly timely because the delivery of mental health services to children in New York State has recently undergone some significant changes and is due to experience additional changes in the near future, making understanding children’s need and the system’s capacity to address them both critical and valuable.

In recent years, in order to improve access to assessment and treatment for children and contain costs, the State Office Mental Health (OMH) has made several changes to Article 312 mental health clinics regarding how clinical treatment is accessed and funded.

First, in 2006, OMH attempted to expand children’s access to mental health services through Child and Family Clinic Plus, which aimed to assess children in normative settings such as schools, early childhood programs and child abuse prevention programs and then link those children in need with treatment services. Unfortunately, the take-up rate for screenings, the lynchpin of the Child and Family Clinic Plus program, was lower than anticipated. As a result, the program has been phased-out at the end of calendar year 2011.

Second, in October 2010, OMH restructured the clinic reimbursement rates for mental health services. Clinic rate restructuring includes an opportunity for the state to make clinic reimbursement more uniform and consistent, to bring the state into compliance with the federal Health Insurance Portability and Accountability Act3 and to streamline clinic practices to implement best practices. It also includes the gradual elimination of Comprehensive Outpatient Services (COPS) funding by 25% a year over a four- year period. COPS funding had historically supplemented clinic reimbursement, making up for the costs of providing services for the uninsured and low private insurance reimbursement rates. To replace COPS, the State is going to establish an uncompensated care pool to offset some of the cost of providing for the uninsured or underinsured.

Most recently, the State has begun working to streamline and improve care through the expansion of Medicaid managed care and the creation of Behavioral Health Organizations (BHOs)4 but these reforms are not yet fully implemented. There remains much uncertainty about the impact of reforms, particularly on children, when they are fully operationalized in April 2013. It remains critical that sufficient resources are dedicated and capacity developed, to be able to treat all children in need of mental health treatment.

The gap analysis developed by CCC, in conjunction with the New York City Citywide Children’s Committee and the New York City Early Childhood Strategic Mental Health Workgroup, reveals that there is currently insufficient capacity to serve children in need of mental health treatment. In particular, our work revealed that many Community Districts (CD) do not have children’s mental health treatment slots. Moreover, when we examined the gap between need (based on prevalence) and available slots at the CD level, we saw large gaps in CDs where risks to children’s well being concentrate. Our work also revealed that the State and City lack a centralized means of tracking clinic capacity to serve children.

We urge the State and the City to use this Gap Analysis to strategically determine how to 1) establish a process through which the State and City can regularly determine clinic capacity and unmet need; 2) target the expansion and support of services to communities where children are underserved; and 3) inform the move toward implementation of state reforms related to the establishment of health homes, Behavioral Health Organizations (BHOs), and the expansion of Medicaid managed care.