By Sandi Rosenbaum and Marion Walsh, Esq.

According to new CDC data (https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html), in 2021, more than a third (37%) of high school students reported they experienced poor mental health during the COVID-19 pandemic, and 44% reported they persistently felt sad or hopeless during the past year. Undoubtedly, mental health needs for all increased in the past few years.

The term “mental health needs” covers a broad array of challenges and severity levels.  Many people who receive mental health counseling and/or require psychotropic medications maintain full time employment in fulfilling careers.  However, when serious mental illness prevents someone from functioning independently and/or behaving safely, appropriately, and legally, either on its own or because it compounds existing challenges like poverty, difficult or tedious responsibilities, learning disabilities, or mild cognitive delays, it is not always sufficient or appropriate for family to step in, if they are even available.   Supports are available through the New York State Office of Mental Health (OMH). 

Mental health services, while funded by New York State, are administered at the county level (or by New York City).  Each county has a department that affords access to community mental health services through a SPOA (Single Point of Access) system.  To get more information and to apply, you can access your region’s respective SPOA Website, for example, New York City (https://www1.nyc.gov/site/doh/providers/resources/mental-illness-single-point-of-access.page or Westchester. (https://mentalhealth.westchestergov.com/single-point-of-access). 

For children ages 5-17, as well as those aged 18-21 who remain in school, services are available through a separate application to Children’s SPOA (CSPOA).  CSPOA supports are available to school-aged children and adolescents who require intensive mental health services in order to stay at home or in the community.  However, when mental health needs also interfere with learning, as they often do, it is appropriate to seek a therapeutic day or residential special education placement through your child’s school district. OMH services should not replace this needed educational support.  

Eligibility

NYS OMH services are available to individuals whose serious mental illness significantly impairs their ability to access housing or other essential services.  There is a limited list of serious psychiatric diagnoses required for qualification, including Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depressive Disorder, Psychosis, and PTSD.  Eligible individuals frequently present with significant hospitalization history or involvement with the criminal justice system.  However, if an individual is already receiving SSI or SSDI on the basis of any mental health diagnosis, including Anxiety or Obsessive-Compulsive Disorder, then Social Security’s Determination of Disability will qualify them for SPOA services. 

Documentation Required

In addition to the SPOA application, OMH generally requires the following documents:

• Comprehensive psychosocial assessment
• Psychiatric assessment including DSM-IV diagnosis
• Hospital admission and discharge plan as appropriate
• Consent to release information form

For an application to community residence or treatment apartment, additional documents are required as well:

• Copy of a physical examination (current within six months)
• Authorization for restorative services, to be signed by a physician

All documentation must be current within 90 days of the application unless otherwise indicated.

After Application Submitted

Upon submission of the application and appropriate supporting documentation, OMH will review each request for service at the housing and/or case management SPOA meeting.   A committee then reviews the SPOA application and assigns to a service provider. In Westchester, the county expects that the recipient will be contacted within five business days to schedule an interview.

If OMH determines that an individual is  eligible for SPOA services, they are referred immediately to case management (either through a Medicaid Health Home or a non-Medicaid-funded agency).  Direct services generally have waiting lists; the individual, with the help of their case manager, can apply to waiting lists for various types of services and will be notified when an agency within their county has capacity to take them. 

In general, services are available both through Medicaid and non-Medicaid funding streams (although certain services may only be available via Medicaid).  There are day programs, prevocational and supported employment programs. 

Housing Supports Limited but Available

Housing supports are available at four different tiers, all of which have waiting lists, some years long:

• Community Residence Group home with 24/7 staff)
• Apartment Treatment Program (staff is scheduled to come in several times per week to assist a small group of residents)
• SRO (single room occupancy – staff on site at the building part time to serve many residents)
• Supported Housing (rental subsidy reducing resident’s rent to 30% of income; residential case management to come in to assist with budgeting, household management, community access, etc.)

The residential priority system has 5 tiers, with the waitlist shortest for the highest tier and getting progressively longer.  Also, within categories people can be deemed critical, emergent or current:

• Court mandated (Assisted Outpatient Treatment (AOT))
• Homeless/discharge from inpatient/exiting residential treatment facility
• Transitioning into a different level of care within the residential system
• Everyone else in the county or locality
• People currently living out of county who have applied for services

Comorbidities and Eligibility Across Systems of Care

Mental health issues often coexist with other serious concerns, and it can be difficult to obtain coordinated care for someone whose needs appear to be consistent with the criteria for more than one system.  New York State offers separate and discrete systems for mental health (OMH), substance use disorders (OASAS – Office of Addiction Services and Supports), and developmental disabilities (OPWDD – Office for People with Developmental Disabilities).  Sometimes it is not possible to obtain services through several systems at once.  When this is the case, it is important to choose the service that has the best chance to meet all of the person’s needs.  An attorney specializing in special needs planning may be able to assist you.