Op-Ed: Review of children’s mental healthcare is vital
Pediatric mental health services are about to undergo a much needed transformation in Connecticut.
Because of a recent bill, PA 13-178, the delivery of mental health services for children in Connecticut are being reviewed and redesigned. The bill was passed last July to develop a “comprehensive” plan to improve child and adolescent mental health care access in our state. These changes are currently being developed with a goal for implementation in fall 2014.
As a pediatrician, I can endorse the vital importance of this work. I know how difficult it can be to get children enrolled and engaged in mental health services. The reasons vary but all share some underlying themes, as illustrated by the poignant story of one of my young patients with ADHD who I’ll call TJ.
Eight years old, TJ has problems focusing in school and suffers from hyperactivity. When he initially came to my office, he had been seen by mental health services in another state. When we tried to get him services in Connecticut, his mother, who has disabilities of her own, brought him to a couple sessions then stopped because it was too much for her to handle.
We have no pediatric mental health services in our town. TJ’s mother was unable to maneuver bus routes to get him to appointments out of town and simultaneously take care of her other children.
TJ was being bullied at school and verbally lashed out at other children. He was given multiple suspensions and at one point was even taken away by police. School officials agreed with me that TJ needed further behavioral health services, but attempts to get him connected were next to impossible. Too many barriers. Too little access. Due to fighting, TJ was permanently prohibited from riding the school bus, which left his mother struggling to find alternative transportation even for their daily routine. She is unable to drive.
TJ’s behavior continued to spiral out of control. This ultimately led his mother to enter him into foster care because she could not take it any longer and because this choice provided TJ access to intensive therapy. How many parents would have been able to choose this brave route?
Eventually, TJ was able to go home and finally has therapy services available to him there. His behavior has improved and he is back in school. But it should never have gotten to this point. He should have been able to access therapy sooner.
It is a sad fact that the majority of U.S. children with a definable/diagnosable mental illness are not even recognized, let alone diagnosed, and never receive services. This must change.
We need to provide accessible care for our children and their families with a system that has an evidence-based, multifaceted approach to mental health care, including outpatient and home-based services as well as support in the schools. We also need more mental health providers if we want to ensure that care is given by those who are not overwhelmed with too heavy a patient load. This means investing in workforce expansion, supporting providers to go into the field, and offering incentives for their acceptance of insurance.
We also need to encourage conversations about mental health in our communities. Families, pediatricians, teachers, guidance counselors, and daycare providers all need the skills to recognize signs of mental illness and to respond supportively. This will only be possible in the context of a robust, well integrated mental health system.
In short: now is the time to share your stories and concerns. Families are central to a successful approach and your input to policymakers is critically important.
Alicia M. Dodson, M.D., is a board certified pediatrician and internist who works in a community health center in Connecticut. She is a member of the Steering Committee of the Connecticut Chapter of the National Physicians Alliance (www.npalliance.org) and a 2013 NPA Coppello Fellow.
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