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Sadly, the Governor's proposal to relocate four state children's psychiatric centers onto the grounds of adult psychiatric centers has triggered fears that have filled the ensuing debate with more heat than light.

The Governor and the Office of Mental Health (OMH) argue that it makes no financial sense to spend tens of millions of dollars to rehabilitate existing children's psychiatric centers when there are empty, new facilities that were built for adults. They proposed to use the money saved to bolster the community mental health system.

Their supporters note that there is a desperate need to increase funding for community mental health providers, whose programs are in jeopardy because funding is far behind inflation over past decade.
The unions, which represent the state workforce argue that the children's psychiatric centers provide excellent service and should be preserved.

Families of children with serious emotional disturbances -- particularly those whose children have been in the children's psychiatric centers that would be relocated -- defend the facilities because of their quality of care and because they are terrified that their children will be in danger if they are in close proximity to adults with serious mental illnesses. They also believe that the image of state hospitals for adults discourages families from seeking the help they need.

In addition, at least one group of community mental health advocates has wondered why so many children and adolescents are in "institutions" in and out of New York State when they should be receiving care in the community. Essentially they are criticizing the Governor's proposal as irrelevant to the core problem of child mental health in New York State (NYS).

What's amazing about this debate is that everyone is right (to some extent). But the imagery that has emerged seems to make it impossible for people to mediate their differences.

The word that most evokes passions is "institution." For families and for many of us who remember what state institutions for adults used to be like, the specter raised by the proposal to relocate children's hospitals to adult hospitals is of putting kids in dangerous "snake pits." It is not so long ago that adult state hospitals were ugly and rundown places where fifty or more people shared a large barracks-like room and where abuse and assault were commonplace. Years ago, great effort went into getting kids out of such places, and the idea of putting them back is intolerable.

But that, of course, is not what OMH is proposing. State Hospitals in NYS are far better places today than they were years ago and OMH wants to move kids into new, state-of-the-art units on the grounds of state adult hospitals where they were built because NYS anticipated that there would be more of a need for adult hospitals beds than there is. OMH promises to provide appropriate separations between the co-located child and adult facilities -- assuring both safety and a distinct identity for the children's facility.

In at least one case, it is hard to imagine how separation of program and identity can be assured because the adults and children would share a building and elevator. By questioning the specifics of a particular proposal is far different from assuming a shared snake pit.

The other misleading image that emerges from the term "institution" is that "institutionalized" children are always everywhere inappropriately cut off from their families and their communities. There is no doubt that some children in hospitals and residential treatment could be better served in the community if adequate community services were available. But hospitals and residential treatment facilities also provide a form of treatment which is beneficial to some children and adolescents and which cannot be provided in community settings. Hospitals and residential treatment facilities are not the enemy, as I know from personal experience. They are important elements of a comprehensive continuum of care for kids.

Once we get the fearful images out of the way, we are left with a fairly clear course of action:

The State should attempt to save as much money as possible by closing unneeded facilities;
Savings should be reinvested in community services;
No changes should be made in children's psychiatric centers without careful public scrutiny of each specific proposal to assure continued safety and high quality of treatment;
Specialized child mental health workers in state facilities should continue to serve children and should not be bumped by staff without expertise in care for children;
Adequate capacity should be maintained in hospitals and residential treatment to treat kids who need that level of care and
There should be a very substantial increase in community-based services for kids, which would reduce inappropriate treatment in hospitals and residential treatment.
All of this is achievable, but I am afraid that the political forces which fear has set in motion will preserve the physical plants of child psychiatric centers, but permit dangerous decline in quality of care. We cannot let that happen.