Your Voice: Mass. Residents Debate Mental Health Issues

By Dave Shaw
Feb 7, 2011, 6:55 AM
4 Comments

The WBUR series, “Are The Kids All Right?,” which ran on Morning Edition and All Things Considered, sparked a lot of conversation on the Web.

WBUR’s Managing Editor Dave Shaw joined Morning Edition Monday to talk about what people have been saying about the series.

Deborah Becker: What are people saying?

Dave Shaw: A theme that emerged in the comments throughout the week is the idea that mental health problems can’t only be treated with medication. Commenters had plenty of suggestions — exercise, meditation, comprehensive therapy. “Children don’t exist in a vacuum,” wrote a commenter who used the handle “My Word,” citing school environments and families as big parts of children’s well being.

Crystal Smith of Natick also commented, saying it’s “very scary that not only do we want to brush mental illness under the rug, the way we sweep is with psychotropic drugs.”

“Drugs come first, and then maybe we deal with it using therapy, or acupuncture, or any of the other things that are out there,” Smith said.

And Dave, we heard from many people who shared the experiences of the families and providers that we spoke with during our series. And what they all seem to agree with is that children’s mental health care is extremely complicated, and its treatment can be very complex.

One thing that helps is the Rosie D. lawsuit, which requires the state to provide appropriate services to children on public health insurance, but those services tend to be comprehensive, in-home programs, which of course are very expensive.

Rosie D. of course referring to the plaintiff in that lawsuit from five years ago.

Michael Jellinek is chief of child psychiatry at Mass. General Hospital, and president of Newton Wellesley Hospital. He commented online, and told us later on the phone that the trouble in getting that kind of care is that it’s not reimbursed by insurance companies that same way medication is.

“So unfortunately, what happens is medication use gets rewarded by reimbursement, and almost everything else doesn’t,” Jellinek said.

That of course then led to questions and a conversation about insurance coverage for kids on public versus private insurance.

Yeah, there was a little back and forth over the benefits of Mass. Health, public insurance for people in Massachusetts. When it comes to mental health, Mass. Health offers far more comprehensive coverage than many private insurers. That prompted an anonymous commenter to say, “all you hard working middle-class people pay so that the low-class people can have better insurance than you.”

In all fairness, Dave, we should say that not all the comments were positive, and in some cases people questioned whether we are over-diagnosing mental health issues in kids as a way to excuse bad behavior.

A commenter named “No way” said what some call mental health issues really stem from bad parenting. “Stop being your kids’ friend and start putting your food down!” he (or she) wrote.

More broadly, commenter E.J. Hayden said it’s up to parents, professionals, and society at large to solve the problem. “Let’s get our heads out of the sand,” Hayden wrote.

More:

WBUR Series: Are The Kids All Right?

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SpedLaw60

Mass health provides services better only for mental health in theory because of Rosie D – and even then- the fact is mental health services for children is woefully lacking. Secondly, as a parent of a child with multiple special needs – therapy is a long road – children cannot use it the same way as adults can – their brains are still developing and often the comorbid conditions such as learning disabilities effect their ability to use what is learner or discussed in therapy.

Medications are helpful when properly prescribed and monitored but that als requires time and office visits and parents being involved. Kids are not little adults – how they respond to meds is very different – I know my son did very well on one antidepressant and yet I know of other kids same age and diagnosis who had a horrible reaction.

As to those who say bad parenting – you have no idea what you are talking about – mental illness is neurological and biological not environmental – the stigma attached is so overwhelming that many kids are not properly serviced. Please stop being so judegmental- we parents of special needs children have enough of it – you have no idea what it is to have a child with disabilities – what works for your neurotypical kids does not for ours –

Esantelmann

Well said regarding the stigma of mental illness. No parent wants their child to be disabled with mental health issues, and many delay treatment as they try to forge ahead alone as “good parents”. It takes a village to support these children… parents and psychiatrists and social workers and schools. When people who have never walked in the shoes of a parent with a emotionally disabled child pass judgment, they only perpetuate the stigma which discourages people from getting the help they need. A little compassion would go a long way here.
http://cfpsych.org Michael A. Goldberg, Ph.D.

1) Evidence based psychotherapy does not always equal talk therapy dependent on a child processing information in a psychotherapy session. There are many ways to change cognitions and behavior. For example, parents can be taught cognitive and behavioral interventions that have been demonstrated to decrease symptoms of depression, anxiety, oppostional defiant behavior, etc.
2) While medication is often an effective part of a comprehensive treatment plan, the research is overwhemling that medication alone is almost never the treatment of choice if you want the most effective long term outcomes. Proper psychotherapy is associated with equal or superior outcomes in many studies and is typically associated with better long term effects than medication alone.
3) The debate on biology vs. environment has been over for years. The evidence is clear that almost all mental illness is impacted by biology and environment and can be changed by the right interventions at either level. For example, brain scan studies of patients with OCD who have successful behavior therapy show the same changes in neurochemistry as brains of patients who have sucessful response to medication. Likewise, patterns of thinking and other environmental factors can be identified in childhood that increase likelihood of depression and interventions to change these patterns dramatically decrease the numbers of individuals who become depressed. Saying that all problems are caused by biology and therefore can only be changed by medication is common but illogical thinking based on the wealth of real evidence.
4) Unfortunately, policy makers, doctors, and parents come to conclusions too often based on their own personal experiences, values and biases rather than on a thoughtful analysis of meaningful and credible data.

http://cfpsych.org Michael A. Goldberg, Ph.D.

It is impressive that Michael Jellinek, M.D., a psychiatrist, makes the point that the private health plans have set financial and utilization management policies that encourage medication and discourage all other evidence based treatments. These policies also inhibit comprehensive evidence based psychological evaluations of complicated cases, and promote quick prescribing without giving the clinician sufficient time to collect and analyze the data necessary to develop and implement a comprehensive and evidence based treatment plan. The research on the effectiveness of many psychotherapies is clear and that in most cases, the right psychotherapy is equally or more effective than any medication.

Why do health plans do this? There are at least two reasons that are apparent. First, health plans are competing to score on high on the NCQA HEDIS report card that sets psychiatric goals that promote medication and do not adequately support psychotherapy. Health plans are driven to use their “#1 National Rank” as a marketing tool and scoring high on this report card is what they need to do. Likewise, the policy makers within the health plans tend to be individuals who are not trained or experienced in providing effective psychotherapy and have not developed professionally in setting in which effective psychotherapy has been provided. Therefore, they have formed opininons that are skewed about psychotherapy and since they are prescribers themselves have a bias toward thinking what they do is most effective, regardless of the effectiveness and cost effectiveness data.

I have personally sat with the policy makers for two of the major Massachusets health plans for years and have tried to collaborate with them to develop policies to make effective psychotherapy more available to consumers. Although they pay lip service toward these goals they continue to set policies that decimate access to effective and comprehensive evidence based evaluation and treatment service and promote prescribing of psychotropic drugs to children and adults.