The relationship between insurance companies, mental health agencies and private therapists is a complex one anywhere, but the East End’s geography has created unique challenges for both people who need mental health care and the health care providers who can help them.
Nancy Beckett-Lawless, who serves as the Director of Provider Relations at the Seafield Center detox and rehabilitation center in Westhampton Beach, noticed several years ago that there wasn’t a network of mental health providers on the East End.
She teamed up with her husband, pastoral counselor Richard Lawless, clinical psychologist Valarie King, and several other mental health care professionals to form East End Clinical Connection, a group that meets the third Tuesday of every month at Southampton Hospital to discuss mental health care on the East End.
East End Clinical Connection now has a directory of more than 250 mental health care practitioners on the South Fork, which the group is looking to put online, and is partnering up with Communities of Solution, a western-Suffolk based network of mental health care providers, to form the East End Communities of Solution this spring.
Ms. King and Ms. Beckett-Lawless discussed their work with participants at the East End Mental Health Awareness Day conference, sponsored by Southampton Town, at Southampton High School April 12. The conference included performances by the town’s “Act Two: Thespians with Opinions” theater group and Creative Expressions, a group of artists facing mental heath and substance abuse issues.
“We’re only skimming the surface. It’s a beginning,” said Ms. Beckett-Lawless of the group’s work thus far. We’re on a journey. We’re looking to be on a journey together.”
Dr. King said several events in late 2012 led professionals in her field to realize how critical the mental health situation here has become, including Superstorm Sandy, the suicides of two South Fork high school students and the massacre at Sandy Hook Elementary School in Connecticut.
That fall, she met with Southampton Hospital CEO Robert Chaloner to develop a task force that interviewed 30 primary care doctors, psychiatrists, heads of agencies that provide psychiatric services and hospitals.
Their findings, released in the fall of 2013, are “not going to surprise anyone,” she said.
One of the most critical needs, she said, is for inpatient psychiatric services for children. The nearest treatment center is at Stony Brook University Medical Center. There is also just one pediatric psychiatrist east of Southampton on the South Fork.
The task force also found that there are long waiting lists at agencies that provide mental health services, many providers don’t take insurance, and few providers speak more than one language.
Another problem, said Ms. Beckett-Lawless, is that insurance companies in New York are allowed to determine whether psychiatric care is medically necessary. She told a story of a young man who was shooting 15 bags of heroin a day but could not get into treatment because he only met nine of the 11 criteria his insurance company would use to determine if it was medically necessary.
The two criteria he didn’t meet, she said, were that he wasn’t pregnant and he wasn’t a danger to himself or others. If he had been a danger to himself or others, she said, the rehab where she works wouldn’t have accepted him as a patient anyway.
“Right now you’re set up to fail,” she said. “Access to care needs to be determined by a medical care professional, not by the health insurance companies.”
Ms. Beckett-Lawless said two bills currently before the state legislature would allow that decision to be made by health care providers. Those bills are Assembly bill A07003A and Senate bill S4623, she said, and both have the support of East End lawmakers.
State Assemblyman Fred Theile helped get $150,000 earmarked in the state budget finalized earlier this month, seed money to provide psychiatric services outside of school hours for young people on the South Fork, a mobile unit for psychiatric care and ultimately to bring Stony Brook psychologists to Southampton Hospital.
The two hospitals the midst of hammering out an agreement that would bring resident doctors from Stony Brook, a teaching hospital, to a new Southampton Hospital facility at the campus of Stony Brook Southampton.
Former East Hampton Town Human Services Director Edna Steck, who was in the audience at Saturday’s forum, said a mobile unit was recommended for East Hampton more than a decade ago.
Ms. Steck also pointed out that some people in Montauk are having trouble with insurance companies who won’t let them see out-of-network providers because the insurance companies claim there are in-network providers within a 20 mile radius of them. The problem, she says, is those in-network providers are in Connecticut.
Ms. Beckett-Lawless said better health insurance coverage for mental health, which is a requirement of the Affordable Care Act, is essential to the access effort.
“We don’t want to lose any more of our young people because they can’t get the services they need,” said Dr. King.
East End Clinical Connection will hold its next breakfast meeting at the Parrish Hall at Southampton Hospital tomorrow, April 15, beginning at 8 a.m. Shane Gregory Owens, director of the New York State Psychological Association Suicide Prevention Task Force, will discuss basic suicide assessment and treatment planning with participants.
The meeting is free and open to the public.