Are The Kids All Right?

Jesse Costa/WBUR

IT’S BEEN FIVE YEARS since a federal judge issued a scathing ruling accusing Massachusetts of not providing adequate mental health services to children on public health insurance. The landmark case, Rosie D. v. Romney, has had broad implications on the diagnosis and treatment of all Massachusetts children who need mental health care. Although there have been many reforms in the five years since the suit, several challenges remain. We check in on how care has changed since Rosie D.

WBUR’s Deborah Becker and Monica Brady-Myerov report.

Listen to the full series:

Part 1: One Family’s ‘Traumatic’ Struggle For Mental Health Care

To open our series on children’s mental health care in Massachusetts, one local family speaks candidly about its struggle for a clear diagnosis and a helpful treatment plan. It’s a years-long story of doctors, tests, medications, addiction, treatments and the continued search for the best way forward.

Part 2: Parents Divided By The Medication Debate

The most controversial topic surrounding children and mental health issues is medication. In the second report, we examine the divergent choices two families have made about whether to put a child on psychiatric drugs.

Part 3: Mental Health Screening Exposes Access Problems

In the third report of our week-long series, we look at how doctors screen children for mental illness. Recently they’ve started giving parents a questionnaire to more clearly identify problems, but this tool has uncovered a bigger issue: getting kids help for their mental illness.

Part 4: Provider Shortage Leaves Parents Searching, Doctors Overwhelmed

In the fourth report of our week-long series, we look at a disheartening problem: the shortage of pediatric mental health providers in Massachusetts means many of the kids who need help aren’t getting it. It’s a doctor shortage that’s expected to get even worse.

Listen: Free Hotline Connects Pediatricians With On-Call Child Psychiatrists

Part 5: Stakes High For Improving Mass. Children’s Mental Health System

All this week, we’ve gotten a glimpse of some of the deficiencies in children’s mental health care in Massachusetts. To close our series, we hosted an in-studio discussion to explore what can be done to improve care in the state.

This series aired Jan. 31 to Feb. 4, 2011 on WBUR 90.9

C Parent35

I was surprised at the excerpt used to promote the show. It seemed extremely sensationalistic and very atypical of WBUR to choose to air the clip of the boy describing his experience receiving mental health treatment: “The worst was when I was in youth psychiatrics,” Will said. “Once they restrain you in youth psychiatrics if you’re acting too violently, they take syringes full of Thorazine … so you’re on your stomach, they pull down your pants and they stick a needle in your muscle in your a– and they shoot the drug. It’s a sedative. It basically passes you out for a bit.” Both my son and I have had to listen to this promotional clip several times while driving, and we both voiced our discomfort with it. I am surprised that WBUR did not choose a less graphic clip to promote a very serious issue. The clip used had the ring of reality tv rather than the serious journalism I expect from WBUR.
Phil

I completely agree with CParent35. I’m not a parent but I am familiar with this topic and was very surprised and disappointed by WBUR’s choice of the clip to describe the series. Nevertheless, I’m happy they are covering such an important health topic.
Al Dorman

Get a grip, CParent35.
Martha

No one who hasn’t lived through the experience of dealing with a child with serious psychiatric or psychological conditions can truly understand the sense of fear and helplessness both the child and his/her parent(s) feel in dealing with the condition and the “mental health” system. “System” is far to kind a word. The lead quote from the young man describing his experience being injected with Thorazine and hearing the younger kids being dragged away to be sedated or restrained was exactly the right piece to air. It is not sensationalizing the story. It is telling it like it is, so that policy makers and health insurance executives “get it.”

Families are really struggling, and kids who might be helped before they develop chronic problems that shortchange them their entire lives or lead them to occasionally go ballistic (as in the recent Arizona shootings–not that most kids become violent as adults, since they don’t) need better care. The schools won’t (and can’t) touch this with a ten-foot pole. pediatricians are at a loss, and nobody seems to know what to do. THANK YOU WBUR for not shying away from what others don’t want to face. The other story you ran on Intenive Energy Psychology, http://commonhealth.wbur.org/2011/01/trauma-chronic-pain-energy-psychology/# ,
should also be required reading for anybody interested in integrative therapies in conjunction with psychiatric/physiological responses to mental illness and other trauma.
molldoll

Im just one example that range far and wide. I was misdiagnosed as bipolar during my teen years. During that time I was heavily medicated and now suffer from severe memory loss due to the meds. I tried to explain to the doctors that i didnt need them, but they insisted on making me take high doses of multiple meds. I have been off them for three years now and my life has never been better and more stable. Take what you want from this story but I believe it is a prime example of the psychiatric field of medicine today in Massachusetts.
Lstm

There is a great new book for parents:

Mental Health Disorders in Adolescents: A Guide for Parents, Teachers, and Professionals [Paperback]
Eric P. Hazen M.D. (Author), Mark A. Goldstein M.D. (Author), Myrna Chandler Goldstein M.A. (Author), Michael S. Jellinek M.D. (Foreword)
http://www.childrensmentalhealthcampaign.org CMHC

Thank you WBUR!!! The Children’s Mental Health Campaign (CMHC) is a group of more than 135 family support, advocacy and provider groups. This series is bringing much needed attention to the core issues of CMHC; early identification, care quality and access, coordination of services, appropriate insurance coverage and reducing stigma. Join us!! http://www.childrensmentalhealthcampaign.org.
Systems of Care Advocate!

You need to talk to Dr. Katherine Grimes. She ran the MHSPY (Mental Health Service Program for Youth) the only true system of care program in MA. She is a psychiatrist who is an expert in the area of child mental health and systems of care. Her program touched hundreds of youth and was the precursor to what is now in place as per Rosie D. She has data that the MHSPY program specifically made a difference for children with significant mental health concerns who were trying to transition home from residential care and those who were at risk of being placed. Her program worked intimately with the Department of Mental Health, Child Welfare, Juvenile Justice, Schools, and local providers (mental health and physical health). This integrative approach is essential. MA has implemented a version of what Dr. Grimes created, but it lacks a couple key features that could save families and taxpayers significantly. Dr. Grimes is an associate professor at Harvard. Consider interviewing her, you will be impressed by what she has to say.
Troubled Youth

What happens to voiceless abandoned kids in state custody who turn 18, who have severe mental illness? And shdn’t be on their own — or in “halfway” homes — even w/counseling + meds?

A homeless helpless 19-yr-old w/a violent history (allegedly) fatally stabbed Lowell shelter worker Jose Roldan . At 17, he fractured a worker’s eye socket at Lowell Youth Treatment Center.

Why don’t more specialized homes+care exist for such adults with (refractory?) illness?

Could WBUR have a separate look at this issue?
It’s a matter of public health AND crime (prevention) — and how we value all youth.
- Troubled Youth
  
  To be clear, most people with mental illness are not violent or criminals.
  Let’s not stigmatize or sensationalize….or politicize.
Therapist

I’m a therapist in Boston and have tried for three years to get accepted into MBHP’s (Mass Health behavioral health manger) network as a independant practitioner. All attempts have failed because the network is closed. I get calls from parents weekly who are on waiting lists at hospitals such as Children’s Hospital and clinics for outpatient therapy for children. I’ve been working with children for years and parents call looking for a male therapist to work with their son for example, and I can’t assist. It’s very frustrating. So my pracitce is filling up with children on all the major private insurances, but I can’t work with some of the most vulnerable kids and families in the area. Its frustrating to hear the the guests on todays show talking about training more psychistrists, though I know there is a shortage in this area, there is also a need for highly trained therapists as well. Many of my peers avoid working with kids because the cases are more complex, more liability, and more problematic because your not just trying to work with the beahviors or sit with the child’s feeling and tension states while helping them to talk, but also trying to sit with the intensity of family’s inductions and dynamics. There is also the potential for more case management and interface with school, etc… So in short its a lot more work. The real problem however is the fast food model of treatment that the entire system is based on–just addressing the symptoms, medications mask the problem (which in some cases is certainly needed), but stop the medicaitons and the problem often returns. More therapists are needed to help work on the core conflicts. Its an unfortunate circumstance that what is needed requires the establishment of a relationship and its working through which takes time. Something MBHP and for that matter most insurances are willing to recognize or address. Its hard to sit on the terrible feelings that would need to be sat on and experienced in order to help a child and this is why everywhere parents, psychiatrists, children, therapists, etc… are struggling with helping children. The pull to go into action (action being a defense agaisnt thinking and feeling) in the face of the problem the child is presenting is great, but until we get highly trained professions who can sit on there own feelings and tension states and help their clients to do the same and help them to at the same time talk about it in the treatment along the way, putting it into words, then little will change. While medications are indeed needed, therapists need to be a main part of the treatment and not just an augment to psychiatrists. I know I’m all over the place, just really frustrated. Good luck to everyone who is trying to navigate through the systems and get themselves and their child help.
- Abecenna
  
  Thank you.
CMHC

The Children’s Mental Health Campaign wishes to thank PPAL for keeping the voices of kids and families are at the center of this discussion. A special thanks also to the families that participated in this series. Their decision to face down the stigma attached to mental illness in order to bring public attention to this issue is generous, courageous and inspirational. We are indebted to you all.
Patti Jacobs

The Massachusetts School of Professional Psychology (MSPP) applauds your series “Are the Kids All Right.” We believe the series captures the essence of the growing children’s mental health crisis that we — as a graduate school of psychology — have been committed to addressing for the past decade. We thought you and your listeners might be interested in what MSPP is doing to increase the workforce of highly trained mental health providers for children in Massachusetts and to form partnerships and linkages between schools, communities, hospitals and social service agencies to streamline access to existing care.

In the past five years, we have created a master’s and a doctoral program in school psychology to increase the number of psychologists available in schools for assessment and therapy. And, we have formed the Freedman Center for Child and Family Development that is specifically dedicated to connecting children and families with appropriate information, resources, and to each other in order to serve their mental health needs.

The Freedman Center has also acquired WarmLines, a social service agency that has provided referral and educational services to families for 30 years. In addition to being a place where parents can come for group support and lectures on such issues as bullying and parenting and where psychology students can have hands-on learning, The Freedman Center also provides a very practical service through its Project Interface. Project Interface is a child/youth mental health and wellness initiative offering resource information and a referral Helpline that counsels and connects families to mental health services providers in participating communities throughout Massachusetts.

Please let us know if you are interested in learning more about the work we are doing to address the crisis you describe so well in your series. And, please consider broadcasting the availability of services through MSPP’s Freedman Center for Child and Family Development, such as Warmlines and Project Interface, which can be found at http://www.mspp.edu/freedman.

Submitted by the Massachusetts School of Professional Psychology
Emily Sherwood

WBUR reporters Deborah Becker and Monica Brady-Myerov should be commended for their recent well-researched series, “Are the Kids Alright?” which accurately captured the challenges experienced by many families seeking mental health care for their children.

Although the information was generally clear, the reporters’ description of the disparity between services available to children enrolled in MassHealth and those with private commercial insurance (“If I had a child with a serious emotional disorder in … Massachusetts I would do everything I could to have them on Medicaid than on private commercial insurance”) was not entirely accurate. There is an important additional detail: Massachusetts families with private commercial insurance can access MassHealth behavioral health services for their child if he or she has a significant mental health problem that meets state and federal disability criteria. If these criteria are met, the child may be eligible for MassHealth CommonHealth, a widely used MassHealth coverage type that can provide access to several new family-centered behavioral health services that are currently unavailable through private insurers. There is no income limit for MassHealth CommonHealth. Families with incomes above a certain level may have to pay a monthly premium or meet a one-time deductible.

Families seeking information about MassHealth CommonHealth are encouraged to visit MassHealth’s website (www.mass.gov/masshealth).

Thank you Ms. Becker, Ms. Brady-Myerov and WBUR for covering this important issue.

Emily Sherwood, Director of Children’s Behavioral Health Interagency Iniatives, Massachusetts Executive Office of Health and Human Services

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