Parents of kids with significant mental health disorders all too frequently experience great frustration in negotiating the confusing maze that constitutes our mental health care system. When services are available, families then confront our extraordinarily complex system of paying for professional services, therapy, medication and other recommended treatments.
Quite frequently, pastors and ministry leaders are sought out as trusted resources by parents of kids in crisis. My professional society encourages parents seeking help for their kids to look to their spiritual leaders for referrals. In recognition of Children’s Mental Health Day on May 8th, our team at Key Ministry seeks to help ministry leaders better appreciate the challenges families face in finding the proper help for their kids with emotional or behavioral disorders and offer resources when parents turn to churches in search of help.
Several major challenges families face include:
Access to appropriate mental health professionals with the training and experience to effectively treat kids and teens. I’m a child and adolescent psychiatrist by training…after medical school, I did a three year residency in general psychiatry at Cleveland Clinic prior to two additional years of training with kids at University Hospitals of Cleveland. According to a 2009 article, there are 7418 child psychiatrists actively practicing in a country with approximately 75 million children and teens. The vast preponderance of child psychiatrists are clustered in major cities, and docs who do what I do are especially rare in areas of the South or Midwest where the church tends to have more influence in the lives of families.
Finding professionals who will see kids and know what they’re doing can be a challenge. One difference between child psychiatrists and non-physician clinicians who see kids involves the variability of training experiences and supervision prior to entering practice among the non-physicians. Child psychiatrists have a minimum of five years of training and supervision following med school. In contrast, psychologists have the option of doing a one year internship in child psychology. Counselors in our state who identify children as an area of concentration would have a minimum of 1500 supervised contact hours of treatment with kids.
Here’s one example of the challenges families face…Cognitive-Behavioral therapy (CBT) has been shown to be an effective alternative to medication in the treatment of kids with anxiety disorders or depression. In a city recognized to be in the top five in the U.S. for medical resources, there are only a handful of therapists I would feel confident in sending my child to with the expectation that their treatment will be of the quality of that offered to kids in the research studies.
Getting an appointment in a timely manner. Because professionals with the training and experience to work with kids are in short supply, getting an appointment with the best people (assuming you have people in your area) can take a very long time. Even in large cities such as Boston and Washington D.C. with a relatively larger supply of professionals, appointment wait times have reached crisis proportions. In areas such as rural Wisconsin, waits for an appointment can reach two years!
Finding affordable care of high quality. In Northeast Ohio, we have a three-tiered healthcare system. Kids who qualify for Medicaid can access services through our teaching hospitals and community mental health centers. In some counties the available services for kids are outstanding and far exceed anything families with private insurance can access. In other counties, services are available, but child psychiatry access is limited to very brief appointments focused entirely upon prescribing of medication and counseling provided by inexperienced trainees.
The most highly regarded clinicians in private practice (child psychiatrists, psychologists, some counselors) are able to practice without having to accept insurance payments. Waiting lists are generally shorter, but such practices are becoming fewer and fewer in number as the hours spent in uncompensated tasks (phone calls, emails, paperwork, coordinating care with other professionals, working with schools, dealing with pharmacy benefit managers) become so overwhelming that many clinicians have had to close their practices and accept salaried positions. A couple of years ago, we couldn’t hire child psychiatrists for our practice because we can’t compete with the salaries offered by our publicly funded mental health centers. Now, we’re reluctant to hire another child psychiatrist because the volume of administrative support we need to handle the blizzard of bureaucracy and micromanagement we encounter each time we give a family a prescription or send a bill an insurance company is growing so quickly that we can’t hire enough staff to meet the need without making our services unaffordable for most families.
Middle class families who depend upon their health insurance benefits may be in the most difficult situation of all. From a psychiatry perspective, the only way a physician can earn a salary comparable with those offered by public agencies while accepting insurance is to run an “assembly-line” practice composed of seeing high volumes of patients for very brief appointments. The billing codes used by psychiatry were changed last year to more closely resemble those used by primary care physicians. The large teaching hospitals in our area who contract with the big insurance companies won’t hire an adequate supply of clinicians to see kids with mental health issues because it’s impossible for those clinicians to see enough kids to generate the revenue necessary to cover the costs of their salaries, benefits and overhead on the reimbursement rates they get from insurance. Increasingly, hospitals in our region are replacing child psychiatrists with nurse practitioners…families may only see the doctor briefly, if at all. Parents obtain names of clinicians who are allegedly “in-network” from insurance company websites only to find that they’re not taking new patients, they don’t see kids, their offices are closed, they don’t accept the insurance in question, or that they’re scheduling six months in advance. Appointment times are frequently unavailable outside of work or school hours.
These are just a few of the struggles experienced by the parents of the kids who are acting out in Sunday School or dropping out of youth group. What can the church do?
Pastors and ministry leaders can become familiar with the resources available in their immediate communities to help kids and families in crisis. Many churches will have members and attendees who are pediatricians, psychologists or counselors who might make recommendations as to local resources for families in need. The local chapter of NAMI may be an excellent resource for church leaders in search of resources for kids and families.
One way in which a church could provide a much-needed service to families in their immediate area would be to make available advocates or consultants who would help parents seeking mental health care for their kids to connect with resources offered through other churches, community agencies, schools, private clinics and their health insurer…people willing to come alongside families and help them to find their way through the maze. Another way churches can help is through providing practical assistance to families in need. Respite care is greatly appreciated by families of kids with mental illness. Tutoring help, transportation assistance and money to help meet emergency medical needs can be immensely helpful to families in crisis.
The church can also provide a powerful demonstration of the love of Christ by creating ministry environments in which families of kids with mental health disorders are welcomed and valued.
Today’s Resource: Facts for Families…The AACAP developed Facts for Families to provide concise and up-to-date information on issues that affect children, teenagers, and their families. The AACAP provides this important information as a public service and the Facts for Families may be duplicated and distributed free of charge as long as the American Academy of Child and Adolescent Psychiatry is properly credited and no profit is gained from their use. Here are links to information on When to Seek Help for Your Child, Where to Find Help for Your Child and Understanding Your Mental Health Insurance.
This is one of the best and truest articles I’ve read – it absolutely resonates with our experience. Again and again, in desperation, we called the Community Mental Health drop-in clinic (when our son was breaking windows, weeping because he saw “devils” who were trying to get him to do bad things, or doing other risky behaviors like jumping from the roof)….. The response was always “Do you have private insurance?” Yes! But it doesn’t cover mental health care! In any case, we were in the desperation of the moment and the psychiatrists available had appointments in six months. In the end our son killed himself, unable to get the care he needed.
His sister (both children are adopted) has fared better – but only after seeing three psychiatrists. If someone told me the first one we say was an impostor, I wouldn’t be surprised. He seemed to think her most severe symptoms were “play-acting” and he recommended parenting classes. Yes; I left there in tears. The next psychiatrist, by the grace of God, prescribed medication which helped immediately – but I think she got lucky – she spoke with my daughter for twenty minutes and with me for twenty minutes. Finally, we found an extraordinary child psychiatrist, who did a complete study of her, of our family, had an educational specialist do testing. And, best of all, we were told about the SED Waiver, that allows her to be receive medicaid – and finally – the therapeutic help offered by our excellent Community Mental Health.
I work in a church and am trying to be a resource for families….thank you for the specific suggestions about how we might do that.