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Health
Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

Children's Mental Health

(Feb '01) The Surgeon General issued a report recently calling children's mental health problems "a public health crisis," and asking for increased spending and a new emphasis on research-based treatment. Acknowledging that at least half of the kids in the juvenile justice system have a diagnosable mental illness which is often left untreated, the report sought to spotlight a problem which has long been ignored

While the media has recently focused on whether mental illnesses like attention-deficit disorder are over-diagnosed and over-medicated in children, few have looked at the minimal access most kids have to comprehensive treatment for such conditions in the first place.

In New York State, however, Governor Pataki has just enacted a major initiative to improve children's access to care. In November, 1999, he released a proposal to add $36.2 million to support mental health treatment for children, an increase of 20 percent from the previous year. That money is just now reaching agencies who won contracts to increase services. Whether this can make a real difference in a system that has suffered years of neglect is another question.

Researchers estimate that there are 367,000 children with mental illness serious enough to require regular treatment in New York state-- 146,000 of these live in New York City. Common conditions include depression, attention-deficit disorder, bipolar disorder and autism. The Children's Mental Health Alliance estimates that there are at least 159,000 children in the state who need mental health services but don't get them.

"We know there is a terrible problem getting access to care," says Dr. Peter Jensen, Director of the Center for the Advancement of Children's Mental Health at Columbia University and former director of research on child and adolescent psychiatry for the National Institute on Mental Health. "There are very few specialists, there are long waiting lists and parents are frequently told that care is just not available."

A survey of clinics found that some of them opened to children with attention-deficit disorder at the beginning of each school year in September -- but by October, many were closed to new patients for the rest of the year because the shortage of staff and money was so acute.

Another problem, according to Jensen, is continuity of care. Kids are often moving through so many systems -- the schools, the juvenile justice system, foster care, etc. -- that they aren't seen consistently by the same providers and a long-term plan for dealing with the illness is never realized.

Funding streams also don't follow the children. "If you spend now in one system, you might save in another system later. You can spend on mental health now or wait till it's bad enough that the child winds up in the criminal justice system." says Jensen, but since savings in one agency don't help another, there's little incentive to do this.

The new funding from the state will help, he adds, saying that the amount is "substantial" and is being directed to expanding a number of needed services.

Tara Sherr, Staff Associate for Health and Mental Health for the Citizen's Committee for Children, also applauded the new monies. "It's the single largest investment in children's mental health in New York State history," she says. An important aspect of the plan is something called a "single point of accountability" which will have one agency assigned to keep track of a particular child's case. Nonetheless, advocates calculate that to properly treat those who need it at the lowest cost possible, an additional $300 million would be needed. And because Medicaid has a limit on funding for outpatient mental health treatment for children -- but none on the more expensive inpatient care -- a bizarre situation results in which kids who could be released from hospitals or residential treatment to less intensive care are not because there is nothing available for them, while waiting lists of seriously ill children who need immediate inpatient care build.

So what can parents do to ensure their children get the help that they need and are not lost in this chaotic system? For those who can afford it, private health insurance helps, but even there, many policies don't cover mental health at all or put strict limits on payments, so out-of-pocket costs can become excessive.

Jensen recommends first talking with other parents whose kids have similar problems. If you don't know anyone who has experience with the system, each borough of the city has a Parent Resource Center which offers support for parents of children with mental illness. (These are not on the web -- look in the local phone book). Also, Internet support groups for parents dealing with similar conditions can be extremely helpful and can provide recommendations about what type of care has been useful and where to find it.

Please note, however, that there are a lot of myths about mental illness and that some unproven treatments can be harmful. Always be sure that you research any facility or treatment approach you are considering and be sure that there is independent research data showing that it is effective. Also, only choose licensed facilities and always ask about patient complaint procedures. Any program that does not have a written policy to cope with patient grievances could harbor abusive staff.

A hotline, 1-800-LIFENET, can provide immediate assistance and referrals to local care in the city. There is also an overview of children's mental health resources provided by the city online, as well as information from the state, The National Alliance for the Mentally Ill and its NY chapter, also provide support, resources and information for families dealing with mental illness.


Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.


Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • AccentHealth.com - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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