Long waiting lists, long driving trips and costly care hinder many children’s access to mental health care


The pandemic was tough, but returning to personal education was also emotionally difficult for Mary Norris’ 12-year-old daughter.

Norris says her daughter was bullied relentlessly at the school she attended last year in Fresno, California, near where her father lives. So she moved to a school in Madeira, where her mother lives. This year is going better, but Norris says her daughter is still struggling emotionally.

She recently received a call from a school employee who said her daughter had written something upsetting in her diary.

She wrote in her book that she wished she had died, and that she wanted to kill herself. “And my daughter is always a very happy, really smiling baby,” Norris said.

Norris is one of over 2,000 adults Survey This summer by CNN and the Kaiser Family Foundation on mental health issues in America. The nationally representative sample included more than 500 parents.

Nearly half of these parents, 47%, say the pandemic has negatively affected their children’s mental health, while 17% say it has had a significant negative impact.

More than 8 in 10 parents said they were at least somewhat concerned about depression, anxiety, and alcohol and drug use negatively affecting the lives of American teens, while nearly three-quarters said they were concerned about the self-harm or loneliness associated with the pandemic. and isolation.

More than 4 in 10 said they are very Concerned about alcohol and drug use, anxiety and depression in teens. Low-income parents—those who earn less than $40,000 a year—were more likely than those living in higher-income families to say they were very concerned about self-harm, eating disorders, depression, and alcohol and drug use.

According to the survey, more than half (55%) of Americans believe that most children and teens in the United States are unable to get the mental health services they need.

Norris was one of many parents who responded that they were unable to obtain mental health services for their children because they could not find a provider.

She estimates that she contacted more than 20 therapists in Madeira and Fresno, looking for someone who could see her daughter outside of school. Her daughter is covered by insurance, but Norris can’t find anyone willing to have it.

Paying out of my pocket for care is not an option: “Unfortunately, my husband and I are on Social Security because we are both disabled. So our money is quite limited. There is no way I can pay $120 an hour,” she said.

Norris’ situation is alarmingly common. American Psychological Association Estimates That half of children in the United States with a mental health disorder are not receiving the treatment they need, a condition experts say has worsened during the pandemic.

according to Latest Labor Force Estimates Of the association, published in 2020, there are approximately five child or adolescent psychologists for every 100,000 people under 18 across the country.

This rough average masks huge disparities in access. Mental health providers who specialize in child care are concentrated in urban areas but are missing from rural communities. According to the association, the vast majority of counties in the United States — 80% — have no child or adolescent psychologists at all.

There are other types of mental health professionals who treat children as well, such as licensed clinical social workers and school counselors, but they are also in short supply.

Eric Sparks, associate executive director of the American School Counselors Association, says his group doesn’t have firm numbers on shortages, but “we hear it loud and clear from school districts and state education departments.”

2016 Report From the Federal Health Resource Services Administration – the latest available – projected workforce shortages of nearly 50,000 jobs across a pool of five mental health professions by 2025, that was assuming no increase in demand.

Many experts feel that this scarcity has been accelerated and deepened by the pressures of the pandemic.

Karen Stam has led the American Psychological Association’s effort to survey psychologists who treat children, and says the latest findings, from September 2021, showed that child psychologists were getting more referrals from patients and had fewer cancellations or no-shows than before the pandemic. .

“One statistic that I found particularly striking is that 65% of respondents in September of 2021 did not have the capacity to take in new patients,” she said.

Mary Alford, a psychologist, runs a large clinic for 19 mental health providers outside of Washington, DC, and says her practice focuses mostly on children and teens.

“We always had a waiting list, but not like now,” Alford said. “We tell people five to six months, and that’s killing me.”

I’ve started her practice in more treatment groups to try to treat as many children as possible, but even with these groups, they are drowning. None of the therapists in her clinic get insurance, and it’s a condition that she knows widens the disparities: Families who can’t afford mental health services see their children struggling and falling behind in school, leading to fewer economic opportunities and a persistent ability not to. Be able to meet their mental health needs as adults.

Alford has a full-time worker answering every call, and she says she freely refers to other service providers in the area in an effort to help.

“The problem is everyone else is booked, too,” she said.

In 2016, Alford created a nonprofit organization called Resilience Across Borders that makes teacher training videos to try to help increase the reach of these services. The videos explain how to teach children things like self-regulation and conversation skills – topics chosen based on surveys they have given teachers during the pandemic and what they thought would be most beneficial for their students.

Other organizations are also trying to be creative to reach disadvantaged children.

One, TeamUp for Kids, has recruited full-time mental health providers at seven federally qualified health centers throughout the Boston area. These clinics provide primary outpatient care, regardless of a person’s ability to pay.

Using this system, a primary care physician may capture an emerging emotional concern at an annual child health visit—for example, a teen who reports sleep problems due to anxiety. This doctor then performs a “warm delivery,” where the mental health professional comes to see the young man at the same visit to address this concern. A team of CHWs – volunteers – can follow up with the family after they return home to see what they are doing.

“I think we really focused a lot on making sure that there is fast access and that the care they receive is as comprehensive as we can provide,” said Anita Morris, Project Manager at TeamUp.

She says this model – the integration of mental health services into primary care – is being replicated to varying degrees in pilot projects across the country.

Mary Norris’ daughter is getting some support at school. You meet with a counselor for group therapy sessions twice a week, but sessions will end after six weeks. Norris says she’s not sure what the family will do next.

A friend who is a licensed therapist has offered to see her daughter, but she is an hour away. Norris says the cost of gas alone will force some tough choices.

“I’m going to have to pay for it either by lowering the bills or eating less. We have to give something in order to make it happen,” Norris said. “Her mental health is more valuable than any other bill or any kind of food I could possibly want to eat.”

Jenny Walker and her husband feel the same way. Walker is an instructional coach—a professional who works with teachers to improve the quality of lessons—at a school in Traverse City, Michigan. She says she sees children’s mental suffering firsthand. Her family has them too.

Walker also responded to the CNN and KFF poll, saying she also struggled to find a provider.

Her youngest son suffers from obsessive-compulsive disorder. The eldest has mild autism and ADHD. When her children needed to see a child psychiatrist, there were only two in town who could treat them. One had a waiting list of more than six months, and the other had no insurance.

“We ended up traveling two and a half hours to Grand Rapids to take our kids to a place that accepts insurance,” she said.

Her two sons were diagnosed before they contracted Covid-19, she said, but the pandemic made matters worse. Someone rode a car fine before the pandemic, but now gets car sickness and vomits on nearly every trip.

“It wasn’t there at all before the pandemic,” Walker said.

She says he hated online learning and developed new compulsive behaviors sitting in front of a computer all day.

Eventually the family was taken to the city psychiatrist who does not have insurance. They use money from a health savings account to pay for it.

“Our savings account is our HSA, which is what pays my kids to get treatment. We’re throwing as much money as we can into it,” she said.

But the family makes sacrifices to do so. “My husband drives a crowded old jeep he uses to keep going because we can’t buy another car if we’re going to pay out of our pockets for these services.” They cannot afford to repair their home or take family vacations.

But they feel lucky, too, Walker says, because a lot of the families she works with don’t have those options. Like Norris’ daughter, some get some help at school, but they may not get the full range of services they need.

Walker says she sees the consequences of not having access to these services at school.

“Unfortunately, what happens to these kids, we often see, affects their ability to learn in the classroom,” she said. They are anxious, busy, depressed or anxious, and can’t focus on their homework – which ultimately affects the level of education they receive and possibly their job prospects as well.

“And they kind of fall through the cracks,” Walker said. “So maybe they graduate, maybe they don’t, you know?”

The KFF CNN Mental Health Survey was conducted by the SSRS from July 28 through August 9 among a random national sample of 2,004 adults. The survey includes 1,603 adults surveyed online after being recruited using probability-based methods and 401 adults selected by random dialing and reached on landlines or cell phones by the direct interviewer. Results for the full sample have a sampling error margin of plus or minus 3 percentage points.

The survey also includes an excess sample of people with children under 18 years of age for a total subsample of 509 parents. This subgroup has been weighted to its correct share of the total US adult population. Results among parents have a sampling error margin of plus or minus 6 percentage points.

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