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Polish Originally posted at Hartford Courant
A promising, active 11-year-old girl suddenly becomes withdrawn at home. Her mother suspects depression. Mom calls her insurance provider for an in-network list and finds most therapists, psychiatrists and nurse practitioners with openings have cash-only private practices. Those few taking insurance are not accepting new patients. Without an appointment, she is desperate for somewhere to turn.
As a psychiatrist and mother of two young children, people often ask me where to turn for mental health services for their children. The barrage of inquiries come from parents and guardians from all walks of life and all regions. It was true before 2020, and the urgency has grown to a fever pitch since the pandemic began. African Americans, long culturally resistant to mental health care, have joined the swelling ranks of those seeking interventions. An encouraging trend, but still the demand must be met.
One of my first questions to parents is, “What school does your child attend?”
This question comes after 10 years working at a federally qualified health center organization providing integrated primary care to 150,000 state residents. Of the nearly 18,000 patients who sought our mental health services in 2021, more than 8,000 were children — a 22% spike in just two years. Some came through our outpatient clinics, but many found mental health care down the hall from their classrooms, in one of the 150-plus school-based health centers (SBHCs) we run across Connecticut.
Children with access to SBHCs experience one of the most effective routes to mental health care in the country. SBHCs are functioning partnerships between schools and local health care organizations, to address lack of access for children living in vulnerable communities. These full-service clinics deliver integrated medical, dental health and behavioral health care right on school grounds, serving all children in attendance, regardless of insurance status.
The data is compelling. Studies show that in schools with SBHCs, children had fewer school absences, discipline problems and course failures. One study showed the rate of emergency and urgent care visits by adolescents dropped by as much as 38% to 55%. Another revealed health care costs decreased significantly as well. African American and Latinx adolescents in urban districts who relied on SBHCs were 21 times more likely to seek mental health care than their peers. Having readily accessible school-based mental health services also helps destigmatize such care.
Our opening scenario is typical: A young African American girl’s grades suddenly plummet. She is withdrawn. Mom’s search for a therapist hits one obstacle after another. The child’s concerned teacher directs her mother to our SBHC’s online enrollment form. Mom signs the consents online and within 48 hours, a licensed SBHC therapist has scheduled an intake.
The beauty of this intervention? Time. Timely access to care. Mother and child don’t miss hours of school or work traveling to appointments, mom can join by video. Later, the child is able to walk into the therapist’s office without appointments, empowered to open up when she feels ready. The therapy reveals she has been a victim of bullying by a classmate, triggering a loss of self-esteem. The student learns, in a safe space with a trusted therapist, that she is not alone. She finally feels comfortable sharing the pain of the harassment. Now, the adults can help.
Often, that can be enough. But sometimes, depression persists. An evaluation with a psychiatrist in our organization is only a click away. If medication is indicated, it can be administered in a timely manner, with parents’ consent. Within weeks, a problem that could have seriously escalated, is effectively addressed.
SBHC-provided mental health care helps overcome the hurdles children and families often face when seeking such services. Mental health professionals often appear in-network for hospital hours. But the extra paperwork and delayed payment for outpatient services often drive mental health clinicians to not accept insurance for their practices. Also, many providers are simply stretched beyond capacity.
There has been some growth in clinician numbers in recent years. Yet there is still a severe dearth of mental health care workers to meet the crushing demand. The shortage is most acute in low-income and rural communities.
America’s children are experiencing a mental health crisis. SBHCs are both a sustainable and high-impact solution to this critical problem. SBHCs remove obstacles to mental health care access, diminish stigma around mental health care for children, address racial disparities and keep children in school.
This story of a promising 6th grader might have ended tragically like so many others, another headline of bullying and depression, evident only after that child who suffered in silence is gone. Prevention and access not only saves money. It also saves children’s lives.
There should always be a place to turn.