May 1-7, 2016 is Children’s Mental Health Awareness Week. We’re sharing this post a day early to begin calling attention to the challenges many families experience finding the right help for their child when their child experiences a mental health crisis.
Parents of kids with emotional, behavioral or developmental disorders frequently experience great frustration negotiating the confusing maze that constitutes our system of mental health care in many communities across the U.S. They often turn to pastors and ministry leaders as trusted resources in times of crisis. My own professional society (the American Academy of Child and Adolescent Psychiatry) encourages parents to seek recommendations from their spiritual leaders. In honor of Children’s Mental Health Week, I want to help ministry leaders appreciate the challenges families face in finding the right help for their kids, and offer resources to share with parents when they look to the church for help.
Among the challenges families face are…
Access to professionals with the training and experience to effectively treat kids. 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. There are approximately 8.000 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 are especially rare in large areas of the South or Midwest…areas where the church tends to have more influence.
Finding professionals who will see kids and know what they’re doing can be a challenge. One difference between child psychiatrists and other clinicians who see kids involves the variability of training experiences and supervision prior to entering practice. 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 (Ohio) who identify children as an area of concentration would have a minimum of 1500 supervised contact hours of treatment with kids before entering independent practice.
Finding professionals who effectively provide evidence-based treatment. Here’s an example…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/region generally accepted to be among the top ten in the U.S. for medical resources, there are a handful of psychologists or counselors therapists in whom I have confidence when it comes to offering therapy of the quality received by the kids who participated in the published research studies.
Getting appointments 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. Sadly, the trend in our public mental health system is headed in the wrong direction. Within the last year, our state issued administrative rules limiting kids in the public system to two hours of psychiatric assessment in a given year. A typical psychiatric assessment of a child or teen takes around three hours in our practice.
The most highly regarded clinicians in private practice (child psychiatrists, psychologists, some counselors) are able to practice without having to join insurance networks for payment. This is our practice model. Waiting lists are 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) have become so great that many clinicians have had to close their practices and accept salaried positions. Economic factors in recent years (markedly higher health insurance costs, higher insurance deductibles, limitations on contributions to flexible spending accounts, increased costs involved with raising children when salaries remain relatively flat) have resulted in our business model becoming unsustainable outside of a few very affluent cities.
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 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. Parents frequently get 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 may not be available 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. 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 who would help parents in search of mental health care connect with resources offered through community agencies, schools, private clinics and their health insurer.
- Families may need some short-term financial assistance from a deacon’s fund or other benevolence fund to obtain a competent assessment in a timely manner when they have a child or teen 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.
Editor’s note…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.
Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families to better understand the nature of trauma in children and teens, Jolene Philo’s series on PTSD in children, and series on other mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.