This story is part of our “Pandemic Generation” series on the impact of the pandemic on children’s mental health. You can find the full series here.
Mental health care for children in Massachusetts is a confusing web of services. They can be difficult to access, even in normal times.
There never seem to be enough psychiatric beds or outpatient therapists. A child may not even be able to have a therapist if the family does not have some insurance, and some providers do not take any insurance. There are mobile crisis teams, home psychologists, day programs, group homes and residential schools.
The pandemic has put them all to the test.
Outpatient care went virtual during the pandemic, but teletherapy was difficult for some children.
Terry Alves-Hunter of Falmouth recently asked his 9-year-old son what it was like having to see his therapist on a computer screen.
“The Zoom didn’t help me. The person in person helped me a lot, talking about my feelings and all that,” he said.
Alves-Hunter adopted his son from foster care when he was 3 years old. She was diagnosed with Post Traumatic Stress Disorder, Attachment Disorder, ADHD, Autism, Anxiety and Depression.
Alves-Hunter says things got out of hand with Zoom therapy, until his son gave up.
“He was bouncing back and forth on the chair, he couldn’t concentrate, and he just started to get angrier and angrier, breaking things,” she recalls.
Virtual mental health care for children is a mixed bag, according to mental health clinicians. Jillian Erlich is a clinical social worker with Riverside Community Care, which provides mental health care throughout eastern and central Massachusetts. She oversees a team of child and adolescent mental health clinicians in Milford, and she counsels adolescents at Blackstone Valley Regional Vocational Technical High School in Upton.
“When kids were learning remotely in schools, I could still see them every week through telehealth. And they could fit me in between their lessons, and it was working well back then,” Erlich said. “There is a proportion of children who find it difficult. Usually you see those in the younger populations, those who are less verbal. Verbal children generally have had very few problems with telehealth and have it. even appreciated. “
The Erlich clinic has donated “therapy boxes”, and clients can take the boxes of items home.
“And they have a box that matches the one the clinician has in the center. [The therapist] can literally take out the same squishy toy, the shake toy, the card game, the mindfulness tools, and use them at the same time as the child, ”Erlich said.“ This mimics the in-person therapy session, where you ‘we both use the same kind of tools, in a similar environment. “
Erlich says confidentiality during telehealth therapy visits has been a big issue for many older children.
“Because for a child who may have a hard time at home, who may not get along with his parents, they want to make sure their parents don’t hear what they have to say.” , she explained. “The confidentiality of therapy is incredibly important, and this is something telehealth cannot always give us.”
“I’ve had kids who go down to their basements when this happens,” Erlich said. “I often suggest, ‘Is there a car you can sit in? Because, you know… I hope you still have WiFi access from your house. I talked to the kids for hours. in this way. “
Erlich says that Blackstone Valley Tech, the high school where she works, has allowed students to keep their school-provided laptops for the summer if they need them in order to access therapy virtually.
And then there’s the question of how virtual mental health is paid for. Insurers were required to cover it during the pandemic. This coverage is extended for 90 days beyond the lifting of the state’s public health emergency. This was lifted on June 15th.
MassHealth coverage is also extended for this same period. The state says it plans to continue covering telehealth for physical and behavioral health services, and it will issue a long-term policy on this soon.
Terry Alves-Hunter says his son was without in-person mental health services from March to January. He missed meeting his regular therapist, behavioral therapist and mentor. Alves-Hunter says the impact on his son has been profound.
“It has been closed for so long that it is just starting to restart these relationships, so all the progress we have made has been erased,” she said. “We didn’t pick up where we left off, we picked up where we started.”
And here’s something that really troubles Alves-Hunter. She says she cut off intensive home therapy for her son some time before the pandemic hit. She had decided he didn’t need it anymore because he had made good progress. But now, due to the setbacks he suffered during the pandemic, he needs these services again. And because of the pandemic and more children in need of help, he’s on a long waiting list.
Alves-Hunter, who works as an outreach and peer support specialist with several mental health related organizations, wants people to understand that there is a massive shortage of mental health care providers, in especially for children with very complex needs.
“Write to your legislators, write to everyone that we need psychologists and therapists who treat traumatized children,” she said. “Invisible injuries, invisible disabilities count as much as someone who breaks a leg.”
Mobile outreach and inpatient care services
When it comes to psychiatric care for inpatient children, the pressure on the system is immense. The state says there has been a sharp increase in the pandemic among children “interned” in hospital emergency departments – emergency departments – or other medical units while they wait for the opening of psychiatric beds.
Dr Nalan Ward is Psychiatrist and Chief Medical Officer of Behavioral Health Services Beth Israel Lahey. The organization operates outpatient mental health care and mobile crisis teams for children. Team members visit families’ homes 24 hours a day, 7 days a week, to assess children in mental health crisis and connect them with services.
Ward says the mobile crisis program has made further progress in the pandemic as they have been to see children in more places.
“We have been able to increase our types of community mobile crisis interventions for children up to 50-60% in some areas,” said Ward, “which means these children are being diverted from the emergency, and we can seeing them in schools, in pediatric practices, in different places in communities so that we prevent the kids from going to the emergency room in the first place. ”
Erlich and Ward say the state needs better investments and reimbursements in outpatient and mobile crisis services, in order to prevent more children from reaching the point of psychiatric crises that take them to ERs and emergency units. hospitalization.
But everyone seems to agree that more beds are needed. The state says MassHealth has offered additional funding and increased reimbursement to providers who add inpatient beds for children and adolescents. More than 130 new children’s beds have been authorized for this year, according to the State Department of Mental Health. They will be added to the 357 beds that already exist, but 21% of them are currently offline for COVID infection control and other reasons.
Gov. Charlie Baker’s administration also recently released a plan known as the “Behavioral Health Reform Roadmap”. He calls for the establishment of rapid-access community behavioral health centers statewide.
This project is funded in part by a grant from the NIHCM Foundation.