By: Elisha Freeman, Executive Director
I’ve heard two comments in the past week that are disturbing. One was from a local pediatrician who lamented that there was only one pediatric psychiatrist (a different level of training than a psychiatrist who treats adults) in WNC who accepts Medicaid, leaving many of the children in her care without quick access to the help they need.
A few days later I listened as a local Kindergarten teacher talked of a student who, at age five, suffers from PTSD (Post Traumatic Stress Disorder) and how it affects his young life in the classroom, as a learner and a peer. I shudder to think of what must have happened to him.
To some extent, I’ve avoided writing about this critical need for children because I’m certainly no expert. The issues are complex and layered and, while a whole lot of people are talking about them, the solutions seem elusive. The American Psychological Association reports that “an estimated 15 million of our nation’s young people can currently be diagnosed with a mental health disorder.” The NC Infant Mental Health Association notes that social and emotional problems impair up to 10-14% of children nationally and in North Carolina, that equates to 91,000 children. As stated in their annual report, social and emotional health is the foundation for everything that is critical to well-being in life, from physical health to our ability to learn, to connect with others, to thrive. And it must be cultivated from the very beginning through nurturing relationships, positive experiences and supportive environments.
Improving access to mental health care services for children was identified as a priority back in 2007 when the local citizens came together to set our community’s priorities for our children at the United Agenda for Children’s Speak Out for Kids event. As a result, two area providers, Blue Ridge Community Health Services and Family Preservation Services, are providing onsite mental health services to students in nine of our local schools. They both accept Medicaid and NC Health Choice, they both accept sliding scale fees based on family income, and they both provide individual, group and family services. At least one utilizes telemedicine to access a Psychiatrist when needed. Although headway has been made, the problem hasn’t been solved. In fact, it continues to grow as a critical need for people of all ages.
Among human service providers, there is frustration over lack of appropriate services and the wait times it takes to get much needed help. Local parents have few choices for their children and children suffer without interventions. The impact carries into the home, into schools and into our community. Changes to how mental health services are delivered were implemented in 2001 (what we refer to as mental healthcare reform) with the establishments of Local Management Entities. The intent was to privatize mental health service because the government was running everything. On the surface, that sounded great, but private providers could not financially stay afloat. Unfortunately, lack of clear guidelines and reduced reimbursement rates led to frustration among providers and many experienced mental health professionals left the field. Additionally, access to services was confusing; services became unavailable to clients, and the numbers of people with mental illness that ended up in emergency rooms and jails significantly increased.
Recognizing this growing crisis, the State made changes in 2012 (shifting to Managed Care Organizations) with the goal of reducing costs and improving the quality of care. “The risks are high and if successful, NC would become a national leader in solving the problem of Medicaid financing for mental health services,” says Rose Hoban, health reporter for North Carolina Public Radio-WUNC, states in a five part series on NC’s mental health reform. “If it fails, it could cost billions to fix.”
Our General Assembly provides the infrastructure and funding that make things work through our state’s budget. To work as its intended, the money side and the policy side need to match. Jack Register with the National Association of the Mentally Ill (NAMI) of North Carolina reminds, “the intent was that all “savings” accrued by the Local Management Entity (LME) –Managed Care Organization (MCO) system were to be reinvested into creating and broadening innovative services.”
Currently, the Senate version of the budget proposes more funding cuts to the LME-MCO systems (in the millions). Mental Health advocates are speaking out against these cuts saying they will simply hold us in a steady-state of current services (which remain confusing and inadequate) and not allow reinvestment into those innovative solutions.
I’m still not sure what all the answers are, I just know they are needed and I think we can learn something from our friends who are coming together in great quantities to oppose Duke Energy’s transmission lines project. Until we get mad enough to demand something better, nothing is likely to change. Improving mental health access for children (and adults as well), is something we all need to get a little more noisy about.
If you are the parent or care provider of a child with mental illness, NAMI of WNC can help you navigate the system of care and provide support services for your entire family. Their number is (828) 505-7353 or email [email protected] If you or a loved one is experiencing a mental health crisis, contact our local Managed Care Organization, Smoky Mountain Center at (800) 849-6127 for 24/7 crisis response.