Mental health care – a crisis for teens and children in Western MassDate: 2/18/2022 GREATER SPRINGFIELD – If the coronavirus pandemic has had one positive effect, it’s been to shine a much-needed light on the emotional and behavioral health needs of America’s children and young adults.
In December 2021, U. S. Surgeon General Vivek Murthy issued an urgent advisory for what he considered a growing crisis in mental health care for the country’s youth.
“Mental health challenges in children, adolescents and young adults are real and widespread. Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression and thoughts of suicide – and rates have increased over the past decade,” said Murthy in a release addressing children’s mental health “The COVID-19 pandemic further altered their experiences at home, school and in the community, and the effect on their mental health has been devastating.”
According to the release even before the pandemic hit “mental health challenges were the leading cause of disability and poor life outcomes in young people, with up to one in five children ages 3 to 17 in the U.S. having a mental, emotional, developmental or behavioral disorder. Additionally, from 2009 to 2019, the share of high school students who reported persistent feelings of sadness or hopelessness increased by 40 percent, to more than 1 in 3 students.”
The effect of the coronavirus pandemic – with disruptions to schooling, family life and social connections has only “added to the pre-existing challenges that America’s youth faced,” the release emphasized.
On Jan. 4, the Massachusetts House of Representatives took note of this situation as well, when it referred Bill H.3782 – an Act Providing Mental Health Sick Days to Public School Students – presented by Rep. Tami L. Gouveia of Acton, to the Joint Committee on Education for review.
The bill, one of two addressing the need for mental health sick days for students in Massachusetts presented that day, would, if eventually approved, specify “that cases of necessary absence shall include absences for the mental or behavioral health of the student.”
The state of care for kids in Western Mass.
The surgeon general’s observations – and the need to legitimize mental health as a valid illness within school settings – came as no surprise to Dr. Elaine F. Campbell, senior director of outpatient services and clinical director at River Valley Counseling Center and Dr. Anhdao Zabarsky, assistant program director for in-home therapy and therapeutic mentoring services for the Children’s Behavioral Health Initiative (CBHI) at the Center for Human Development in Springfield.
“We’re seeing a lot of anxiety, depression and behavioral problems,” Zabarsky noted. “Our family counselors are seeing some grief, and children dealing with trauma.”
Campbell added that her offices have seen an increase in issues with substance abuse as well, and that the uptick in all these conditions has shown a spotlight on the state of children’s behavioral health services in Western Mass.
“The greater Springfield area has been a chronically under-resourced area with regards to mental health treatment,” Campbell said, noting that the shortage is true of all age groups, not just children and youth. “Currently there are extensive wait lists at all mental health clinics. In school services are very hard to come by and COVID[-19] restrictions have limited these even further due to space restrictions and limiting non-school staff in the buildings.
There is only one partial hospital program in the area (which is supposed to be a diversion and/or step-down from hospitalization) and this always has a long wait list…which defeats the purpose of a diversion program.”
Campbell noted that CBHI services – which work specifically with children and families – were designed to assist with these issues, but that ‘they too, are chronically understaffed with long wait lists.”
Zabarsky concurred, noting, “Since COVID-19 the need for mental health services has been increasing, and providing them has been more challenging … there’s been a shortage of staff, the waitlist is greater now and we aren’t able to assign cases as quickly because of the hiring shortage.”
Zabarsky said that waitlists for care referrals can run from “one to three months,” adding she always “encourages families to get on as many waitlists as possible to assist in making the needed connections to increase the chances of them being assigned to a caseworker sooner rather than later.” Among the websites she directs families to for waitlists and resources are Massachusetts Behavioral Health Access (MBHA) and Mass.gov to search for service waitlists in their area.
As Campbell noted, child psychiatrists and medication providers are “very hard to come by… this shortage has been around for 20 years…with no improvement.
“The acuity of the behavioral health challenges that youth are coping with during the pandemic is overwhelming the already stressed system of care,” Campbell said. “Services are overall too little too late. In-patient services, in general, are all about safety, containment and medication changes…not real treatment. In-patient stays are very short and units understaffed…so they really should only be used for the most serious of issues. Unfortunately, the services in the community get so stressed and overwhelmed that in-patient services get used to when they should not be.”
A shift in services
One positive outcome of the pandemic, Zabarsky noted, has been the shift by her agency to using telehealth to provide its services.
“We’ve been able to service clients in catchment areas where we don’t usually travel to in person. It’s also easier for families to schedule care” using telehealth, though there are some drawbacks. Providing telehealth services often “depends on a family’s access to equipment and Wi-Fi, and sometimes finding a private space [in the home] for treatment is challenging,” Zabarsky said.
She added that the move to providing mental health services via telehealth has also posed challenges for providers. “People have become creative to engage [patients], using other resources on the internet to engage youth and to make [telehealth visits] more fun – virtual therapeutic rooms, hyperlinks to different games, using music to express different thoughts and feelings, engaging in calming skills using video.” Younger patients, however, have been a challenge, Zabrasky said. “In person you can engage them in play; trying to get [and] keep their attention in telehealth is challenging, you need to work with the parents.”
Care in 2022 and beyond
Zabarsky said that her agency has seen a growth in “just telehealth providers popping up” to help serve the emotional and behavioral health needs of children and families, though she hasn’t researched these service providers extensively to date. “The way things are going [with COVID-19 and the new variants] it may be that people are more comfortable with seeing providers remotely,” she opined.
Overall, Zabarsky said she believes mental health providers will continue to see a high level of need for their services among young people in 2022 and beyond. “I think these issues are going to continue, I hope providers are able to hire clinicians and provide the services to youth and adults.”
Campbell expressed concern as COVID-19 continues to effect children and teens. “Mental health professionals are burnt out…they have been so flexible and committed to serving the needs of the community throughout the pandemic while also managing the impact of the pandemic within their own families.” She noted the switch to providing care via telehealth and the “creativity and commitment” of mental health providers has been “impressive.”
“Unfortunately, the need is so overwhelming that therapists are struggling to keep up,” Campbell added. She said the crux of the problem lies in the allotment of resources.
“The issue at the heart of the mental health crisis for children is that behavioral health treatment has never been adequately funded across the board,” Campbell said. “Insurance company reimbursement rates, state funding, the issue of parody with medical services…it has all been chronically neglected…despite behavioral health providers raising the alarm for over 20 years. You add a pandemic to these long-standing issues and you have a mental health crisis for our children.”
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