“What do you mean I’ve been discharged?“
“You’ve missed two sessions. Our clinic policy mandates discharge after two consecutive absences.“
“But this could land me in the hospital!“
“You can reapply for treatment when you’re ready to commit to your mental health.“
Do you think this conversation sounds familiar to you? Perhaps you’ve been a part of it, or worse, you agree. Yet, commitment to therapy is more than just showing up. It’s a two-way street where quality of care should be more than just a function of attendance or frequency of sessions.
Across New York State and Westchester County, this scenario is a common practice in outpatient mental health clinics, including those accepting state Medicaid/Medicare benefits. Under the auspices of the NYS- Office of Mental Health, these ‘Article 31 clinics’ are often the primary mental health outpatient resource for low-income and disabled Americans. However, under immense pressure to manage finances, clinic directors may move to discharge clients who miss sessions, as these are often non-reimbursable by Medicaid.
Shotty practices, driven by financial constraints, overlook patients’ real needs. It fails to acknowledge the various barriers these individuals face, such as transportation difficulties or the need to prioritize necessities like food. This approach is especially detrimental to African American families and other oppressed populations, who often face systemic hurdles in accessing consistent mental health care. Often, as in the case of many resource-deprived areas of Westchester, outpatient programs are not tailored to meet the specific needs of the surrounding community, failing to take into account cultural sensitivities and language barriers. Programs need to foster a sense of ownership and involvement, helping reduce the stigma associated with mental health care in these communities.
There is a dire need for more research and data collection focused on understanding the specific mental health needs of marginalized communities. The New York State Office of Mental Health’s solution to this issue has yet to be to relax stringent regulations. Programs like HARP (Health and Recovery Plans) have been introduced to evaluate and address the shortcomings of the Medicaid system.
Data from HARP is beginning to inform policy and practice, leading to more targeted and effective interventions. HARP and other internal mechanisms within the New York State Office of Mental Health evaluate their best practices. However, the pace of change could be faster. Preliminary findings from HARP suggest the need for more flexibility in treatment approaches. For example, solutions-focused therapy could be offered as a billable treatment option, allowing patients to seek help as needed rather than adhering to a prescribed schedule.
However, the adherence to Evidence-Based Treatment (EBT) as the gold standard in care raises questions about its suitability for BIPOC communities. Why should clinics adhere strictly to ‘best practices’ that may not be the ‘best fit’ for everyone? This one-size-fits-all approach fails to address the unique challenges faced by minority communities. Training mental health professionals in cultural competence needs to be non-negotiable. This includes understanding and respecting patients’ cultural backgrounds, beliefs and needs from diverse communities. Training can lead to more empathetic and effective care, improving patient outcomes.
In conclusion, we must urgently address these disparities. We need to ask critical questions about the systemic issues in our mental health care system and actively seek solutions that are inclusive and effective. As mental health advocates, professionals, and community members, it’s our collective responsibility to push for a system that is inclusive, accessible, and effective for all. Let’s work together to ensure that mental health care is not a privilege but a right accessible to everyone, regardless of their background or circumstances.
Leave a Reply