The Sagamore Children's Psychiatric Center in Dix Hills is a rarity: a state-run institution for juveniles that is heartily praised as a lifesaver. That's why New York State's decision to close it as part of a Regional Centers of Excellence Plan raises so many concerns. We already have a center in our region that many consider excellent. Although it might be possible to devise a plan to treat the mental health problems of Long Island children without Sagamore's 54 inpatient beds, moving ahead to close the center in the next four years without a detailed blueprint is a mistake.
The way health care is delivered and paid for is changing, with an increasing reliance on managed care and tighter funding. The state Office of Mental Health is adapting to this shift. In July, the agency released a plan that divides the state into five regions, describing which state facilities and services will remain in the future.
Of those five regions, Long Island is the only one that would, locally, lack child inpatient mental health services. Anyone younger than 18 needing what Sagamore offers -- long-term care for mental illness, including suicidal or violent behavior, depression, hostility and other problems, delivered along with academic classes, and with family participation in the counseling -- would have to go to Queens or the Bronx. For many, this would mean a disconnect from families, with longer commutes to visit.
One justification the state offers for removing inpatient services from Sagamore is that the change 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. Officials had spoken as if only Sagamore's inpatient services would end, but later admitted that they plan 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 no details yet on where these services would go.
One of the most vehement arguments Office of Mental Health officials make for ending inpatient care at Sagamore is the fact that 52 percent of its admissions are evaluations ordered by family court judges, and state officials say many are unnecessary. These admissions account for 8 to 10 percent of Sagamore's patient load. These referred patients usually stay for 14 days or fewer; the median stay at the facility is 120 days.
The state's plan stresses that no workers will be laid off as facilities close, as if state health care is an employment program. A sane overhaul of our mental health care system wouldn't start with the assumption that no jobs can be lost.
Stays of minors in state mental hospitals cost $1,500 per day, double the cost of private hospitals: Should the state even be in this business? If we want to cut costs, let local private operators deliver the care and be paid by the state.
Officials with the Office of Mental Health say they want to see problems detected and treated earlier, before inpatient care is necessary. That's good.
They say they want to expand services on Long Island to reduce the need for Sagamore's beds, where there is often a waiting list. That's good.
And they say young people who need inpatient mental health care, and their families, would 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, fortunately, aren't going to let this plan go forward without more scrutiny. Nassau and Suffolk counties, with nearly 3 million people, need and deserve strong local mental health services, including public 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.