NYC Youth Need Better Access to Mental Health Care and The City Can Make Investments That Support Them
Testimony & Public Comments
May 13, 2024
On Monday, May 13, Alice Bufkin, Associate Executive Director of Policy and Advocacy, submitted testimony to both the New York City Council Committee on Finance, Committee on Mental Health, Disabilities and Addiction and on Health for a FY25 Executive Budget Oversight Hearing. On behalf of CCC, the testimony urges city leaders to prioritize specific investments that would help tackle the growing youth mental health crisis in New York and increase access to care for youth in need. The testimony makes specific recommendations for program and initiative investments that would make a big difference for families and youth.
Read the testimony below.
Testimony of Alice Bufkin
Associate Executive Director of Policy and Advocacy
Citizens’ Committee for Children of New York
Submitted to New York City Council Committee on Finance, Committee on Mental Health, Disabilities and Addiction and the Committee on Health Oversight Hearing on the FY2025 Executive Budget
May 13, 2024
Since 1944, Citizens’ Committee for Children of New York has served as an independent, multi-issue child advocacy organization. CCC does not accept or receive public resources, provide direct services, or represent a sector or workforce; our priority is improving outcomes for children and families through civic engagement, research, and advocacy. We document the facts, engage and mobilize New Yorkers, and advocate for solutions to ensure that every New York child is healthy, housed, educated, and safe.
We would like to thank Chair Brannan, Chair Lee, Chair Schulman, and all the members of the City Council Committees on Finance, Health and on Mental Health, Disabilities, and Addiction for holding today’s important hearing on the Mayor’s FY25 Executive Budget and its impact on the health and mental health of New Yorkers.
Addressing the Children’s Behavioral Health Crisis
Throughout New York, families are sitting on waitlists for weeks, months, and even years for behavioral health services their children urgently need today. These challenges are borne out in New York City, where.15.6 percent of adolescents report seriously considering suicide and 36 percent of high schoolers report persistent feelings of sadness and hopelessness.i In February 2021, youth advocates launched a Voicing Our Futures survey that collected responses from more than 1,300 young people across New York City. More than a third said they wanted or needed mental health services from a professional, but only 42 percent who needed services reported receiving them.ii
As a result of a lack of adequate care, children are cycling in and out of emergency rooms and hospitals. In 2019 32% of young people discharged from a psychiatric stay at a general hospital in New York City ended up back in an emergency room within 90 days; 22% end up back in an inpatient bed. Parents are left desperately searching for services that just aren’t there.iii
As city leaders negotiate the FY25 City budget, we urge you to prioritize the following city investments to support the mental, emotional, and behavioral health needs of young people.
Restore Funding for City Council Mental Health Initiatives
The City Council Mental Health Initiatives have for years used non-traditional, community-based settings to help identify children and families in need and offer developmentally appropriate services and support. These trusted community services have been able to adapt to the specific needs of communities and support programs that are challenging to fund through state and federal sources.
The FY25 budget must restore total funding for City Council Mental Health initiatives to $25,472,879 and add funds to start a new Youth Mental Health initiative. It is critical to invest in these services as New York continues to experience both mental health and overdose crises, including addressing the complex mental health needs of incoming asylum seekers and refugees. Council funds go directly to community-based organizations who provide behavioral health services throughout NYC in several languages. These funds provide vital resources for programs that would often not have any other City support. As the City Council negotiates the Fiscal Year 2025 budget, we urge you to restore and maintain funding for essential City Council Mental Health Initiatives, including:
- Mental Health Services for Vulnerable Populations — $3,933,000. This initiative supports community-based behavioral health programs, including medication for individuals in transitional housing and mental health services for families with child welfare This initiative was cut by $270,000 in FY24 and was funded at $3,933,000 in FY23.
- Children Under Five — $1,787,000. This initiative funds mental health treatment for children under 5, including screening and clinical evaluation, individual and child- parent psychotherapy, consultations with child-serving agencies, and trauma-informed interventions. Early childhood is a critical time to identify, prevent and treat stress & trauma, and to build resilience for kids and families. This initiative was cut by $230,769 in FY24 and was funded at $1,787,000 in FY23.
- Autism Awareness — $3,316,846. This initiative supports wraparound services for autistic children in after-school, weekend, summer programs and during school closings. The programs also provide training to teach coping skills to families and caregivers impacted by autism. Approximately 2,000 children and families are served annually with this funding, including individuals without access to OPWDD services. This initiative was cut by $55,000 in FY24 and was funded at $3,316,846 in FY23.
- Court-Involved Youth Mental Health — $3,425,000. This initiative funds assessments and connects youth and families with criminal justice involvement and mental health needs to mental health services. 3,000 youth are served annually with these funds.
- Developmental, Psychological and Behavioral Health — $2,255,493. This initiative helps individuals with behavioral health needs and developmental disabilities, supporting harm reduction, clubhouses and The funding may support medically supervised outpatient programs, transition management programs, Article 16 clinics, recreation programs, or other behavioral health services.
- LGBTQIA Youth All-Borough Mental Health — $1,200,00. This initiative supports comprehensive mental health services for vulnerable LGBTQ youth.
- Mental Health Workforce Retention and Development — $250,000. This was a new initiative in FY24 and supports the retention and recruitment of public-mental health professionals working at public-facing agencies/organizations.
- New Initiative: Youth Mental Health — $3,000,000. This new initiative would provide flexible mental health services for youth programs run by CBOs – such as Beacons, Cornerstones, COMPASS/SONYC, and others–with a focus on out-of-school Programs would be able to hire mental health professionals, lead structured group activities, or test other innovative, hyper-local solutions to youth mental health needs.
Enhance Students’ Access to Community-Based Services Provided through School-Based Mental Health Clinics
Article 31 School-Based Mental Health clinics provide on-site services to children during the school day, including diagnosis, psychiatry, and individual and family counseling. SBMHC staff work closely with school staff to identify children in need and coordinate services. SBMHCs work to engage the whole family and can serve family members at their community location. SBMHCs provide crisis mental health services, ensuring children receive a compassionate response when they are in need and reducing the use of suspensions, detentions and punitive measures.
These clinics are primarily funded by billing Medicaid and, when available, private insurance for services provided to students. However, this funding is deeply insufficient. For example, Medicaid does not cover services to children without a diagnosis, and clinics are not reimbursed for services provided to children without health coverage. Other essential supports that clinics can offer schools – such as mental health education and training for staff or de-escalating a child-in-crisis scenario to prevent law enforcement involvement – are not compensated.
This is where the City can step in. Wraparound funding for existing clinics – specifically $75,000 per clinic – will enable clinics to offer a more comprehensive and inclusive array of services, including for uninsured children and children without a diagnosis, as well as trainings and support for school staff and the school population more broadly. It will, in short, help ensure the financial stability and effectiveness of these important community clinics.
We urge city leaders to invest $3.75 million to expand school-based mental health clinic services in 50 clinics. Ultimately, we recommend a long-term goal in the future of expanding funding to SBHC’s across the city.
Invest in School-Based Behavioral Health Supports
Schools play an essential role in meeting the behavioral health needs of children, yet New York City’s approach to addressing the social-emotional needs of students in schools has often been fragmented and insufficient. Far too many students experiencing an emotional crisis are still sent to emergency rooms, subjected to police intervention, or punished with disciplinary practices such as suspension. Schools need the resources and training necessary to support the mental health of all students, rather than relying on punitive and traumatizing responses to student behavior.
We are grateful for the City Council’s staunch advocacy with the Administration to ensure critical Education programs are not lost as a result of expiring federal COVID relief funding. Many of the restorations we saw in the Executive Budget will directly impact the mental and emotional health of students, including the $74 million for school social workers and psychologists and the $54 million for Community Schools.
However, several vital mental health programs were also left behind. Chief among these is the Mental Health Continuum, an innovative model that integrates a range of direct services, including expedited mental healthcare, a NYC Well hotline to advise school staff, mobile response teams to respond to students in crisis, training for school staff in Collaborative Problem Solving, and culturally-responsive family engagement to students with significant mental health challenges. This cross-agency partnership (NYCPS, Health + Hospitals, Department of Health & Mental Hygiene) supports students at 50 high needs schools. City leaders must not only extend funding for this program, but also permanently baseline funding to give it the security necessary for long-term hiring, planning, and expansion. We urge city leaders to baseline $5 million for the mental health continuum to fully implement and sustain the program.
We were also deeply disappointed that restorative justice funding was not restored. Restorative practices address the root causes of behavior, hold students accountable while keeping them in school learning, build and heal relationships, and teach positive behaviors. They also correlate with improved academic outcomes, school climate, and staff-student relationships. We urge city leaders to protect the $12 million in expiring COVID-19 relief funding for restorative justice practices in schools.
We were grateful that the Executive Budget restores $54 million in expiring federal funds for Community Schools. However, the Budget still includes a $14M gap due to expiring one-year city funding.
Community schools provide students and families with wrap-around supports and services, including mental healthcare and the types of material and social supports that prevent the emergence of heightened behavioral health needs. This initiative, which expanded from 266 to more than 400 schools thanks to expiring federal and city funds, has proven effective at lowering chronic absenteeism and increasing on- time high school graduation rates. We demand a full restoration for community schools, as they serve as pivotal resources in their communities and provide holistic supports for students.
Thank you for your time and attention to these critical issues.
