Children’s mental health care faces ‘perfect storm’

COEUR d’ALENE — Idaho is facing a crisis. A problem that arose before the pandemic has snowballed into a much larger issue due to a lack of pediatric mental and behavioral health providers that reflects the size of the population.

“It’s a perfect storm,” said Sandy Mueller, executive director of behavioral health services at Kootenai Health.

Even if families are able to provide pediatric mental health services to their children, they will need to pay $150-200 per week out of pocket to pay for one hour of care because most insurance companies, including Idaho Medicaid, do not cover it well Land reimbursement.

“This creates a gap between rich and poor,” Mueller said.

Early intervention is critical, but it often takes six months before pediatric patients are seen with complex conditions such as severe depression, anxiety, psychosis or bipolar disorder.

Pediatricians are the last line of defense for families who cannot afford to pay out of pocket, and they often lack the specialized training provided by mental health professionals. The sooner pediatricians and families recognize a mental health crisis, the sooner children can receive care.

“We can have a huge impact by supporting pediatricians. When it comes to mental health, we tend to wait and see. We need to sound the alarm as quickly as possible to get resources. It needs to be very community-based,” Mueller said.

The more mental health care providers and pediatricians can provide personalized care with shared responsibility, the more can be done for children in the long run.

Dr. Duane Craddock of Coeur d’Alene Pediatric Center said generally it has become more difficult to get help from mental health counselors and social workers for child patients in need.

“Challenged is probably an understatement. We’ve had problems for the past 10 years, but since COVID-19 it’s gotten worse. In the medical field, we’re in trouble because our insurance companies aren’t paying either There’s no reimbursement, which makes it harder to provide care,” Craddock said.

For children with disabilities such as autism, obtaining necessary behavioral health resources can be extremely difficult, and families can quickly become discouraged trying to figure out all the steps of the process.

“Everyone was very surprised that it was so difficult to see a medical provider. There was no child psychiatrist you could call, and you could have to wait 9 to 12 months for comprehensive neurological testing,” Crado said K said.

Craddock believes the current situation requires significant action by health care providers and the state to begin building the infrastructure to close the current gaps in mental and behavioral health coverage.

“Recruit more psychologists to do testing. Add services to help with crisis management. If you have the support, you can succeed,” Craddock said.

children in crisis

Mueller’s biggest concern about the pediatric health care crisis is that children and young adults facing suicidal ideation have few options outside of the pediatrician’s office.

“This was a failed detection and a failed support system,” Mueller said.

There needs to be tools in place to help flag young people struggling with mental health. The district’s ratio of school counselors or mental health professionals can also use the increased numbers to expand the mental health safety net and better measure the emotional health of North Idaho children.

“Across the country, children’s behavioral health needs are rising significantly, but we don’t necessarily have a place to refer them,” Mueller said.

When she was involved with behavioral health urgent care in San Diego, staff worked as part of a comprehensive behavioral health team. The practice requires a more comprehensive approach that blends care of medical conditions and behavioral health factors in one setting.

“There’s some here, but the need is huge,” Mueller said.

Laying the foundation for more intensive outpatient programs for pediatric patients beyond medical management will provide a better understanding of the range of issues children face. One way medical and mental health professionals can begin to address this issue is to establish a pediatric behavioral health care network comprised of local, state, and federal resources.

“The current list of resources means there are more tools in their toolbox to hand out. Pediatricians need to take the time to dig and find it all,” Mueller said.

‘It’s just a glitch in the system’

Craddock said he has seen an increase in mental health issues among the younger patients he sees at Coeur d’Alene Pediatrics, as well as an increase in the severity of the problems.

“It’s not uncommon to wait three to six months to see a counselor. Our system wasn’t keeping up before, so it’s just a glitch in the system,” he said.

“When it comes to residential care, we have to send our children out of state for residential care, which is very expensive. The state doesn’t have a lot of resources available and families have to travel as far away as North Carolina, Colorado or Wyoming. Regardless. That’s not good,” Craddock said.

Due to physical distance, it is difficult for families to contact them in person as they have to travel long distances to see them.

Telehealth mental health services are a lifeline for young patients in need of mental health services, especially for brooding teens. But Craddock worries that video conferencing can eliminate body language indicators that can tell more about the full story of what’s troubling a child.

“If you get a one-word answer, usually it’s not ‘very good,’ ‘ok,’ or ‘good.’ Let’s dig a little deeper,” Craddock said.

Pediatricians are feeling the burden of a lack of behavioral health providers, and many of them, like Craddock, are getting more training in mental health to fill the gap.

“This is beyond traditional and beyond what I trained for,” Craddock said. “Primary care is where it’s really difficult. You’re going to completely drain all the primary care physicians. When they feel like they have less, we’re asking for more.”

Fewer Clinicians, Higher Needs

The mental and behavioral health workforce has changed during the time Mueller has been in the field. She cited a number of reasons for the decline in the number of mainstream providers.

When the pandemic hit, like many areas of health care, there was an exodus from the field as burnout among mental health providers increased. Of those who remain in the field, many turn to private practice rather than clinical work. Clinical work requires eight years in the field before mental health providers can work independently, creating time-related barriers. Low wages also plague clinicians in the mental and behavioral health fields.

“Interest rates have not increased in 15 years,” Mueller said.

weather the storm

The best way to try and get through the current crisis is to launch a comprehensive children’s awareness campaign. Families, schools, doctors and government agencies need to focus on plugging some of the existing holes in the system.

“When we talk about mental health, people need to realize this is a storm. People think kids are more resilient than they are. Maybe our Legislature can help us go after the insurance companies,” Mueller said.

More people need to speak up and fight for better testing, community support and additional resources.

“We need to get through this,” Mueller said.

Mental Health Hotline

As another potential lifeline for Idaho’s pediatric mental health needs, Kootenai Health has sent a letter to the Idaho Medicaid Office requesting an access line connecting doctors to children’s mental and behavioral health specialists.

“This will help Idaho, not just doctors. There is currently no child psychiatrist you can call. We hope that will be the case in Idaho in the future. The challenge is that it requires a state agency to sign off, and The state has to put in 20 percent of the money,” Craddock said.

Robert Hilt is the founder and creator of the Patient Access Line and works at Seattle Children’s Hospital. Washington is the second state to implement a children’s mental health helpline, providing pediatric caregivers with direct consultation about issues.

“Idaho doesn’t have a program yet, and federal grants require an agency and people on the ground. They also need state funding. It’s very possible to create access lines, we’ve created them in Wyoming and Alaska as well, but you can’t Waiting for a provider to show up,” Shildt said.

The hotline is a Monday-Friday hotline that all primary care physicians in Washington can call and connect with a child psychiatrist when they have a child’s mental health issue.

“We’ve done a lot of that. It’s been widely used and as an optional advice line we’ve heard a lot from some providers. There are some providers we’ve never heard from. If they want to reach out It’s all up to them to lend a hand and get help,” Shildt said.

Because of this resource, many physicians have been able to increase their ability to follow through on children’s mental health needs, and over time, patient skills and outcomes have improved by consulting psychiatrists on the Patient Advice Line.

“It’s actually consistent with medical education principles, if a doctor goes to a lecture to learn something, that’s not the best way to learn, but when it’s your patient and you’re learning how to do something for your patient, that’s That’s the best way to learn. A teachable moment. They can retain it and pass it on to the next patient,” Hilt said.


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