Today, Manhattan Borough President Gale A. Brewer issued “Who’s Caring: The State of School-Based Mental Health Care in NYC Schools,” (PDF) a report opening a window for parents and concerned New Yorkers into the city’s school mental health system.
The report describes a fractured system. Some schools benefit from a patchwork of clinics funded from sources like state Medicaid programs, or from permanent social workers funded to provide mandated services to individual students with special needs. More than 100 of Manhattan’s 307 public schools, however, have no mental health services beyond the Mental Health Consultants provided through ThriveNYC. Privately funded through the Mayor’s Fund to Advance New York City, these consultants are stretched far too thin, with each one acting as the lead mental health representative for up to 10 different campuses serving 8,000 students.
Meanwhile the clinic system, already under-resourced, is faced with a new threat this year. One round of state cuts hit clinic programs serving New York City schools in June, affecting 55 different Manhattan public schools at 28 campuses throughout the borough. Changes to the state’s Medicaid program threaten to cut additional funding from Article 28 clinics, which serve 103 Manhattan public schools, this coming October.
“Our school mental health system, if you can call it that, is a quilt of mismatched pieces slapped together to do more with less. But when it comes to our kids’ futures, we should be doing more with more,” said Manhattan Borough President Gale A. Brewer. “School-based mental health services – and dedicated staff members who are part of their schools, not occasional visitors – can make an enormous difference, literally changing the course of students’ entire lives for the better. We need to fund a comprehensive system that’s built to work well, and transition away from less-effective stopgap measures.”
The result of this patchwork system, constructed to take advantage of a variety of funding streams, is a school system with only one social per worker per 800 Manhattan public school students, where dozens of schools go without a single full-time social worker or mental health professional on staff.
Snapshot of a fractured system
- School-based clinics threatened by state Medicaid changes: 103 Manhattan schools have “Article 28” clinics, which receive more than 90 percent of their funding through Medicaid reimbursements. However, changes to the state’s Medicaid program slated to begin in October could slash more than $16 million in funding from these clinics. 62 Manhattan schools have Article 31 clinics that offer more limited services, and (unlike Article 28 clinics) cannot bill Medicaid directly.
- In-house social workers stretched beyond mandated services: Of Manhattan’s 307 public schools, 164 have in-house social workers, which are primarily funded through special needs students’ Individualized Education Plan allotments. But this funding exists to provide these students with mandated services, not to provide services for the school’s general population. Consequently these social workers are stretched too thin, forced to do far more than the funding scheme was designed to allow.
- Mental health consultants serving up to 10 different schools at a time: 114 Manhattan public schools have been assigned mental health consultants. Schools without their own clinics rely on these consultants, made available through the Mayor’s Fund to Advance New York City as part of ThriveNYC. But each consultant is assigned up to ten campuses, which enroll up to 8,000 students. This results in a bureaucratized process where students, teachers, and administrators have difficulty making use of these consultants’ services.
- Mobile response teams on call for crises, but not a substitute for permanent services: Manhattan public schools also have access to Mobile Response Teams, which are on call to offer temporary services during and after crisis situations. The Borough President’s office found seven Manhattan schools receiving ongoing service from these teams currently.
Brewer’s report offers a slate of recommended actions for the city Department of Education and the state to take to improve the situation including:
State of New York
- Keep Medicaid reimbursement rates constant for Article 28 clinics for an additional two years, to give in-school providers time to adapt to the Medicaid managed-care changes and new billing structures.
- Create new permanent operational funding sources for preventative and administrative services like in-classroom outreach to students and mental health training for teachers.
- Create a centralized billing system to help all school-based mental health centers bill insurers efficiently.
City Dept. of Education
- Conduct a pilot study of school-based mental health centers to measure their effectiveness and the potential benefits with respect to suspension, graduation, attendance, and other outcomes if they were deployed more comprehensively.
- Create funding structures to provide school-based mental health services at schools that do not currently have them.
- Leverage underutilized youth services budgets that already exist for multiple city agencies, such as the Dept. of Corrections, to provide school-based mental health services.
- Create a mechanism for social work interns to provide services at schools with off-site supervision, so schools without full-time social workers can still host social work interns for field placements.
- Provide comprehensive bystander intervention, anti-racism, and anti-bullying training to school staff.