At the Children’s Hospital of Philadelphia’s Primary Care office in Doylestown, Dr. Naline Lai has seen children so anxious that they can’t eat, or have trouble going to school. One mother told her she called 20 therapists before finding one to see her daughter, but the first appointment she could get was for a month later.
On any given day, 20 to 30 children with mental health issues are waiting in beds at the hospital because there aren’t enough regional facilities in the Delaware Valley, and across the country, to handle all the kids who need care, said Dr. Joseph W. St. Geme, CHOP physician-in-chief.
“Often when services are finally identified, they’re far away from the child’s family or support system, creating additional stressors,” said St. Geme. And each hospital bed a child occupies while waiting for mental care is “no longer available for its intended use.”
The two doctors and other CHOP officials, including Psychiatrist-in-Chief Tami Benton, focused attention on the issue of care for children in crisis and the lack of resources for them at a news conference Tuesday in Doylestown. They urged change and touted several bills in Congress that they say will address the critical shortage of services nationwide for children and adolescents with mental health needs. Brigid Garvin, a psychologist at St. Christopher’s Hospital for Children, also joined in the conference.
Benton said there are about 15 million children in need of mental health services nationwide and only 8,000 to 9,000 youth psychiatrists.
“There are severe shortages of child mental health professionals in our country right now,” she said, citing that 80% of counties don’t have a licensed child psychiatrist. She said children who are disenfranchised, particularly minorities, have less access to mental health care but are more likely to be exposed to violence and trauma.
The COVID crisis has not helped the situation, she added.
But the shortgage doesn’t affect just children living in poorer urban or rural areas. Lai, who directs the CHOP location in Doylestown, said that up to 50% of pediatrician visits involve a mental health component.
“With the severe shortage in pediatric mental health providers, us general pediatricians have had to help to fill this gap. Many have sought additional training” she said, during their free time and at their own expense.
When patients are referred to separate psychological services, only about a quarter to half attend a mental health appointment. But when CHOP started a “Healthy Mind, Healthy Kids” program to incorporate mental health care with regular pediatric services, attendance “dramatically improved,” she said. That’s why she said the bills that U.S. Rep. Brian Fitzpatrick, R-1, of Middletown, Bucks County, are co-sponsoring to increase federal support for pediatric mental health care integrated with other medical services are so important.
The bills include:
The Children’s Mental Health Infrastructure Act (House Resolution 4943) that would provide funding to children’s hospitals for additional pediatric care capacity for behavioral and mental health services.
The Helping Kids Cope ACT (H.R. 4944), which would “provide funding supporting pediatric behavioral health care integration and coordination” with other health care services.
The Strengthen Kids’ Mental Health Now Act (H.R. 7236) would “bolster the pediatric mental health workforce” and ensure that children have a “full continuum of care.”
Fitzpatrick said he is working with Rep. Anna Eshoo, a Democrat from California, on H.R. 7236 and Rep. Blunt Rochester, a Democrat from Delaware who introduced H.R. 4943 and 4944, to garner bipartisan support for the pieces of legislation. They hope to get 290 co-sponsors per bill so that the bills could bypass House leadership and come directly to the floor for votes before the Congressional session expires in January 2023.
Fitzpatrick said mental illness must have the same parity as other diseases or medical conditions when it comes to treatment options and insurance coverage, and like physical education, there must be education about mental health in the schools. He said schools also should have both a school nurse and school psychologist.
“For a long time, certainly my entire life, our country has treated illness from the neck down much differently than we treat illnesses from the neck up … Mental health issues (are) stigmatized….If you suffer an emotionally or psychologically tragic incident, and seek treatment for that, it’s viewed very differently,” he said at the conference. “I can’t think of a better investment we can make in our country than to create heath parity across the board from a health insurance standpoint…Complete parity across the board is the way you end stigma.”
Fitzpatrick continued that mental health problems are “a root cause for so many other challenges we face in our country” including addiction and gun violence. “We owe this to our children…We have no higher calling as practitioners, as elected officials, as human beings than to take care of our kids. That’s the highest calling we all have.”
Benton said CHOP will open its new Center for Advanced Behavioral Health, a 47,000-square foot center with 64 offices and consultation rooms, this week in Philadelphia. Next spring, it plans to open an in-patient behavioral facility for acute pediatric care with 56 beds, including 10 for crisis care at the PHMC (Public Health Management Corp.) Campus on Cedar Avenue in West Philadelphia. The campus is the former Mercy Catholic Medical Center which is now run by the PHMC with Penn Medicine and CHOP overseeing the facility.
John Grove, a behavioral health clinician with CHOP’s Healthy Minds program, said the fundamental reforms in the legislation are “essential, absolutely essential. We must not wait until our children are in crisis before addressing their needs and helping them …. It’s time to pivot the system to preventative care. Preventative care has far reaching benefits.”
He said that 50 to 75% of youths in juvenile detention facilities have underlying, mental health issues. “Preventative care to prevent low acuity issues prevents high acuity issues. It saves lives.”
Garvin thanked Fitzpatrick for supporting the three legislative bills, saying she would echo the comments from the CHOP doctors about the need for more psychological care for children and adolescents, changes in insurance reimbursement and more education on mental health care for pediatric practitioners.
The CHOP officials also said they were grateful to the congressman for his leadership.
“Clearly our children are in crisis and when our children are in crisis, our nation is in crisis,” said St. Geme. But with the legislation before Congress, “there’s reason for optimism,” he said.
Fitzpatrick said that Pennsylvania Sen. Bob Casey is also taking a lead on legislation in the Senate, saying that the commonwealth has long played a prime role in healthcare history and legislation. According to Casey’s website, he and Republican Sen. Bill Cassidy of Louisiana introduced a Health Care Capacity for Pediatric Mental Health Act bill in the Senate in June that would provide grants to help health care providers expand mental health services for youth.