Many children in the US have difficulty accessing mental health services

(CNN) — The pandemic has been tough, but going back to school has also been emotionally difficult for Mary Norris’ 12-year-old daughter.

Norris says her daughter was relentlessly bullied at the school she attended last year in Fresno, Calif., near where her father lives. So she transferred to a school in Madera, where his mother lives. This year is going better, but Norris says his daughter still has emotional issues.

She recently received a call from a school staff member who told her that her daughter had written something disturbing in her journal.

“She wrote that she wished she was dead and that she wanted to kill herself. And my daughter has always been a very happy and very smiley girl,” Norris said.

Norris is one of more than 2,000 adults surveyed this summer by CNN and the Kaiser Family Foundation about mental health issues in the United States. The nationally representative sample includes over 500 parents.

Nearly half of these parents, 47%, say the pandemic has negatively affected their children’s mental health, with 17% saying it has had a serious negative impact.

More than 8 in 10 parents said they are at least somewhat concerned that depression, anxiety, alcohol and drug use are negatively affecting the lives of American teenagers, while about three-quarters said they are concerned about self-harm or pandemic-related loneliness, and isolation.

More than 4 in 10 said they were very concerned about alcohol and drug use, anxiety and depression affecting teenagers. Low-income parents (those earning less than $40,000 a year) are more likely than those in higher-income households to say they are very concerned about self-harm, eating disorders, depression, and alcohol and drug use.

According to the survey, more than half of Americans (55%) believe that most children and adolescents in the US cannot get the mental health services they need.

Many areas lack child and adolescent mental health providers

Norris was one of the parents who responded that they couldn’t get mental health services for their children because they couldn’t find a provider in their area.

She estimates she called more than 20 therapists in Madera and Fresno looking for someone who could see her daughter outside of school.

His daughter is insured, but Norris can’t find anyone willing to take her.

Paying out of pocket for care is not an option: “Unfortunately, my husband and I are on Social Security because we are both disabled. So our funds are limited. There is no way I can afford to pay $120 an hour,” he said.

Norris’ situation is eerily common. The American Psychological Association estimates that half of children in the United States who have mental disorders are not getting the treatment they need, a situation that experts say has only worsened during the pandemic.

According to the association’s latest workforce estimates, released in 2020, there are approximately five child or adolescent psychologists for every 100,000 people under the age of 18 nationwide.

This rough average hides huge differences in access. Mental health providers who specialize in child care are concentrated in urban areas but are lacking in rural communities. According to the association, the majority of US counties, 80%, do not have child or adolescent psychologists.

Other types of mental health professionals also treat children, such as licensed clinical social workers and school counselors, but they are also in short supply.

Eric Sparks, deputy executive director of the American School Counselor Association, says his group doesn’t have hard numbers on the shortage, but “we’ve heard it loud and clear from school districts and state departments of education.”

A 2016 report by the Federal Health Resources Administration, the most recent available, projected a workforce shortage of nearly 50,000 jobs across a spectrum of five mental health occupations by 2025, and that suggests demand will not increase.

Many experts believe that this shortage has been accelerated and deepened by the strain of the pandemic.

Karen Stam leads the American Psychological Association’s effort to survey psychologists who treat children, and says the latest findings from September 2021 show that child psychologists are receiving more referrals and have fewer cancellations or absences than before the pandemic.

“One statistic I found particularly shocking is that 65% of those surveyed in September 2021 did not have the capacity to accept new patients,” he said.

Child psychologists are devastated

Mary Alvord, a psychologist, runs a practice of 19 mental health providers outside of Washington and says her practice focuses primarily on children and teenagers.

“We’ve always had a waiting list, but not like now,” Alvord said. “We tell people that a date can take five to six months, and it kills me.”

His practice has started more therapy groups to try to treat as many children as possible, but even with those groups, they are overwhelmed. None of the therapists in her practice accept insurance, and it’s a situation she knows increases disparities: Families who can’t afford mental health services see their children struggle and fall behind in school, leading to more -fewer economic opportunities and fewer opportunities for them to be able to care for their mental health needs as adults.

Alvord has a full-time employee who returns all calls and says he sends referrals to other providers in the area in an effort to help.

“The problem is that everyone else has a full schedule, too,” he said.

In 2016, Alvord started a nonprofit called Resilience Across Borders, which creates training videos for teachers to try to help increase the reach of these services. The videos explain how to teach kids things like self-regulation and conversation skills, topics chosen based on surveys of their teachers during the pandemic, and what they think will be most helpful for their students.

Other organizations are also trying to be creative in reaching underserved children.

One, TeamUp for Kids, placed full-time mental health providers in seven federally qualified health centers in the Boston area. These clinics provide outpatient primary care regardless of a person’s ability to pay.

With this system, a primary care physician can detect an emerging emotional concern at an annual well-child visit, such as a teenager who reports sleep problems due to anxiety. That doctor would then refer a mental health professional to come see the young man at the same visit to address the concern. A team of community health workers (volunteers) can follow up with the family after they return home to see how they are doing.

“I think we’ve really focused a lot on making sure that they get quick access and that the care that they get is as comprehensive as we can provide,” said Anita Morris, project manager for TeamUp.

She says this model, which integrates mental health services into primary care, is being replicated to varying degrees in pilot projects across the country.

Long journeys, long waits for help

Mary Norris’ daughter gets support at school. She sees a counselor for group therapy sessions twice a week, but the sessions end after six weeks. Norris says she’s not sure what the family will do next.

A friend who is a licensed therapist offered to see her daughter, but she is an hour away. Norris says the price of gas alone will force some tough decisions.

“I’ll have to pay for it by dropping the bills or having less food. Something has to give for that to happen,” Norris said. “Your mental well-being is more valuable than any other bill or any type of food you might want to eat.”

Jenny Walker and her husband feel the same way. Walker is a coach, a professional who works with teachers to improve the quality of lessons at a school in Traverse City, Michigan. She says she sees children’s mental health issues firsthand. His family has them too.

Walker also responded to CNN and KFF’s survey and said he also had trouble finding a provider.

Her youngest son has obsessive-compulsive disorder. Her oldest son has mild autism and ADHD (attention deficit disorder). When her children needed to see a child psychiatrist, there were only two in town who could treat them. One had a waiting list of more than six months and the other did not accept insurance.

“We ended up driving two and a half hours to Grand Rapids to take our kids to a place that accepted insurance,” he said.

Her children were diagnosed before Covid-19 hit, she said, but the pandemic made everything worse. One of them was traveling fine by car before the pandemic, but now he gets sick and vomits on almost every trip.

“That wasn’t there before the pandemic,” Walker said.

She says he also hated online learning and developed a compulsive new behavior of sitting in front of the computer all day.

Eventually, the family was transferred to the city’s psychiatrist, who did not accept insurance. They use money from a health savings account to pay for it.

“We’re putting in as much money as we can,” he said.

But the family makes sacrifices to do so. “My husband drives a battered old Jeep that is struggling to keep going because we can’t afford to buy another vehicle if we’re going to be paying out of pocket for these services.” They can’t afford to fix their house or get family vacations.

But they also feel lucky, Walker says, because many of the families she works with don’t have those options. Like Norris’ daughter, some get help in school, but may not get the full range of services they need.

Walker says she sees the results of not having access to these services at the school.

“Unfortunately, what happens to these kids, we often see it affects their ability to learn in the classroom,” he said. They are anxious, worried, depressed and unable to focus on their schoolwork, which ultimately affects the level of education they receive and possibly their job prospects.”

“And they kind of fall through the cracks,” Walker said. “So maybe they’ll graduate, maybe they won’t, you know?”

The KFF CNN Mental Health Survey was conducted by SSRS from July 28 to August 9 among a random national sample of 2,004 adults. The study included 1,603 adults who were surveyed online after being recruited using probability-based methods and 401 adults who were selected by random digit dialing and contacted via landlines by a live interviewer or Mobile phones. Results for the full sample have a margin of sampling error of plus or minus 3 percentage points.

The study also included a supersample of people with children under the age of 18 for a total subsample of 509 parents. This subgroup was weighted against the corresponding share of the total US adult population. Results among parents have a margin of sampling error of plus or minus 6 percentage points.

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