Remove Barriers to Quality Mental Health Services

The messages brought to legislators by dozens of parents and family members on Tuesday in a hearing of the Bipartisan Task Force on Gun Violence and Children to address mental health bore an eerie similarity to the stories I heard almost ten years ago during a hearing of then-Lt. Governor Kevin Sullivan’s Mental Health Cabinet in Norwich. 

Today, as in 2004, parents experience frustration and heartbreak over barriers to behavioral health services for their children.  Little is being done to ensure early identification of mental health problems, and when a problem is identified, the tragic shortage of mental health professionals trained to work with children and adolescents all too often means that there are no services for a child in trouble. 

Even if a parent manages to find services, the struggles aren’t over.  Insurance companies often approve only a limited number of therapy sessions, and frequently hamper the physician’s ability to prescribe effective medications with formularies and “prior authorization” requirements.  At best, these barriers cause delays in getting a person started on medication, and at worst, can lead to a patient never filling a prescription at all, sometimes with tragic consequences.  Insurance companies often pay such low rates to providers that the providers won’t accept insurance at all.  Add to that the lack of private insurance coverage for wrap-around supports that offer case management, family interventions, skills teaching and other resources that are just as important as medication and therapy.  

But possibly the worst and most enduring barrier to getting help is the stigma that mental illness continues to carry in our society.  The lack of understanding about the true nature of mental illness leads to prejudice and discrimination against those with psychiatric illnesses and their families.  Some people never seek help at all, due to the fear of how family and friends will react. 

As the parent of an adult child with depression and Asperger’s Syndrome, I know these fears are not unfounded.  Throughout his grade school years, my son was ostracized and excluded, and eventually openly bullied.  While teachers and administrators were eager to complain of my son’s behavioral issues and to blame his problems on poor parenting and his lack of “self control”, they were far less forthcoming when I asked for help with my son.  They lacked understanding of behavioral health issues, as well as the insight to de-escalate potential crises.  Their negative attitudes toward my son did little to encourage acceptance or tolerance among his peers, exacerbating his sense of isolation.  Worse, they made it clear that they felt his problems were a result of poor parenting on my part and poor self control on my son’s part.

We were lucky—when I realized that no referrals to help would be forthcoming from his school, my son’s pediatrician helped us find a child and adolescent psychiatrist, who, although her practice was full, agreed to see my son.  He bonded with her immediately, and began to get better.  In those days, we were fortunate to have decent health insurance, along with the means to meet expensive co-pays. 

Since then, however, I have become a single mom.  In my current circumstances, I lack the resources to get my son the kind of help he needed when he was younger.    As a nonprofit employee, my earnings lag far behind the cost of living in Connecticut.  My health insurance costs have increased dramatically since my divorce, while my coverage is barely adequate.  Working full time, I no longer have the freedom to serve as my son’s de-facto case manager—making sense of special education law, health insurance, and the mental health system; coaching my son on social skills and doing role-plays with him on a daily basis; teaching him basic living skills and preparing him for the transition to independent living; and helping him to learn how to cope with problems—not to mention driving him to weekly appointments over 30 miles away from home. 

With one in five of our children suffering from a diagnosable mental health condition, and only 20 percent of those actually receiving mental health services, we are a nation in crisis.  According to the National Institutes of Mental Health, half of all lifetime cases of mental disorders begin by age 14.  But due to huge delays between onset of symptoms and treatment—sometimes decades—the consequences can be dire:  poor school performance, substance abuse, involvement in the criminal justice system, even suicide, which is the third leading cause of death in youth ages 15 to 24. 

Research shows that early identification and intervention in child mental health problems is the single most important factor in improving lifetime outcomes.  We owe it to our nation’s most precious resource—our youth—to eliminate the shame of having a mental illness and seeking help, offer better training for the professionals to whom we entrust our children, and ensure unimpeded access for all to quality behavioral health services.