The Sagamore Children's Psychiatric Center in Dix Hills is a rarity: a state-run institution for juveniles that is heartily praised as a metaphorical and literal lifesaver. That's why New York State's decision to close it as part of its Regions of Excellence raises so many concerns. We have something in our region that many already consider excellent.
Even so, it's possible that a plan to properly treat the mental health problems of Long Island children without Sagamore's 54 inpatient beds could be devised. But moving ahead to close Sagamore without a detailed blueprint for what comes next is a mistake.
The way health care is delivered and paid for is changing across the board, with an increasing reliance on managed care. The state Office of Mental Health has been tasked with adapting this shift to its programs. In July, the agency released a plan that divides the state into five Regions of Excellence, describing which state facilities and services will remain in the future.
Long Island is combined with New York City into one region, resulting in a loss of child and adolescent inpatient mental health services.
Anyone younger than 18 needing what Sagamore offers -- long-term care for mental illness, delivered in conjunction with academic classes, and with family participation in the counseling -- would have to go to facilities in Queens or the Bronx. This would in many cases mean a disconnect from their families with added costs and longer commutes to visit.
One justification the state offers for removing inpatient services from Sagamore is that the move would eliminate $19 million in capital spending the facility will need soon. But to avoid spending that $19 million on roof repairs and equipment replacement, Sagamore must be shuttered completely.
Officials have spoken as if only Sagamore's inpatient services are ending, but later admit the plan is to shift any service now at Sagamore that is to be continued: possibly including day treatment, outpatient treatment, mobile mental health teams, crisis services and community training. There are not yet details on where these services go.
One of the most vehement arguments Office of Mental Health officials have made for ending inpatient care at Sagamore is the fact that 52 percent of its admissions are ordered by family court judges, an unusually high number. But these admissions account for only 8 to 10 percent of Sagamore's patient load. While the referrals are usually for 14 days or fewer, the median stay at the facility is 120 days.
The Office of Mental Health plan stresses the fact that no state workers will be laid off as facilities are closed across the state, as if state health care is a jobs program. Juvenile stays in state hospitals cost $1,500 per day, about double the cost in private hospitals, so the real question is whether the state should even be in this business. If we want to save money, let local private operators deliver the care and pay them, while the cost is the state's responsibility.
A sane overhaul of our mental health care system wouldn't start with the assumption that no jobs can be lost.
Officials with the Office of Mental Health say they want to see more problems detected and treated earlier, before inpatient care is necessary. That's good.
They say they want to expand the range of services on Long Island to reduce the need for Sagamore's beds, which are often on a waiting list. That's good.
And they say young people who truly need inpatient mental health care, and their families, will be well served by facilities in New York City. That's not a given.
What they don't say is how any of this is going to happen. There are no details.
Long Island's state legislators, luckily, aren't going to let any of this go forward without scrutiny. Nassau and Suffolk counties, with nearly 3 million people, need and deserve strong local mental health services, including inpatient care.
The Office of Mental Health's top priority is to provide for the mental health needs of Long island's children. A convincing case has yet to be made.