Matt Driscoll: Kids suffering COVID mental crises threaten to swamp county's ill-prepared care system

News Tribune (Tacoma, WA)

Oct. 17--It was a crisis before. Now, the situation is much worse.

It was far too difficult for Pierce County kids and families to access mental health care prior to COVID-19. Now, the delicate safety net has now been stretched even thinner.

In some ways, according to Jamie Kautz, director of the Pediatric Care Continuum at MultiCare, the serious mental health ripple effects created by COVID-19 are predictable.

Take a countywide child and adolescent behavioral system with existing gaps, holes and deficiencies, throw in a pandemic, and this is what you get.

In other ways, the stark reality of how bad things have gotten in the last six months is staggering, Kautz said.

As The News Tribune's Josephine Peterson recently reported, mental health-related visits to the Mary Bridge emergency room have increased precipitously.

On Thursday, Kautz elaborated, noting that -- year to date compared to 2019 -- the emergency department has seen a 25 percent increase, and in October alone the increase has been greater than 50 percent.

It's a sign families feel like they have nowhere else to turn, Kautz said, and just one of many tell-tale characteristics of a broken system.

Kautz said that the "vast majority" of the recent increase in child and adolescent mental health emergency room visits are due to children who have either attempted suicide or experienced suicidal ideation.

"Before, it was a troubling ... distinct call to action," Kautz said. "Now, we're shocked and dismayed.

"There are days when you feel a little bit panicked, because you're just so worried about all of it. I don't know how much people can appreciate 18 kids presenting in a shift because they are suicidal. Those are substantial numbers."

Truth is, there's good reason for all of us to worry -- and not just about the immediate impact of the coronavirus on our children's mental health.

What the pandemic has shined a light on is a system that, in many ways, was already failing.

"An intense crisis like this exposes the challenges and the gaps that were already in existence," said Tim Holmes, president of MultiCare's Behavioral Health Network.

As an example, Holmes noted that -- even during non-pandemic times -- it can take a parent or family "up to 26 calls" to find and successfully schedule an appointment with a mental health provider in our region.

"It's really a challenge," Holmes said, providing a good place to start.

According to Holmes and Kautz, the lack of coordinated entry points into the system is where the trouble begins for many kids and families, because the demand for child and adolescent behavioral health services greatly exceeds the number of existing providers.

It's not uncommon for it to take weeks for a family in need to find a mental health professional to turn to, they said, and even then the next appointment is often months out.

A 2017 Pierce County Accountable Community of Health report noted that only 40.8 percent of Pierce County Medicaid recipients with a mental health diagnoses received a services, which was below the state average. The county also has well-known shortage of psychiatric beds.

Specific to children and adolescents, a 2019 statement of needs published by Kids' Mental Health Pierce County noted that Washington ranked 27th in the nation for available mental health resources compared to the number of youth in need. Meanwhile, 90 percent of survey respondents said that youth mental health services in Pierce County are"disorganized and lack coordination."

That's how kids end up in the emergency room, Kautz said.

Between 2017 and 2019 -- long before the coronavirus pandemic -- Mary Bridge experienced a 400 percent increase in the number of children visiting the emergency department with a mental health crisis, she said.

"That, in and of itself, was stunning to us," Kautz said.

Compounding the unmet need, the region also suffers from a lack of available treatment options, explained Ashley Mangum, the project manager for Kids' Mental Health Pierce County, a collaboration between local providers, health care systems and others working to improve child and adolescent mental health care and prevention in Pierce County.

Beyond inpatient care for those in crisis and outpatient care for those lucky enough to access it, Pierce County's child and adolescent behavioral health network has holes from "prevention all the way to recovery and reintegration," and "early intervention and acute intervention through crisis treatment," Mangum said.

Kautz said Pierce County is lacking in what she called "stepped down services" -- which in a functioning system would fill the needs in between outpatient counseling and "full blown crisis."

"We don't have a continuum of care," Kautz said bluntly.

Finally, insurance complexities often make matters worse.

Joe LeRoy, the executive director of Hope Sparks, said that the majority of children are on private insurance, which often covers fewer services than Medicaid.

But Medicaid insurance provides its own challenges, LeRoy said.

While many families assume that health insurance provided through the state would be uniform, LeRoy noted that, in reality, there are a handful of managed care organizations offering Medicaid coverage in Pierce County, and each one has its own contracts and stipulations for care.

That can make things difficult on providers, LeRoy said, even before you take into account the notoriously low Medicaid reimbursement rates.

"People get frustrated with providers, but they don't understand what a cluster it is behind the curtain," LeRoy said. "Even in the Medicaid space ... our providers are for-profit insurance companies, meaning they're driven by profits. There's no alignment, and no incentive in Pierce County for those companies to really come together and create a seamless system."

"Until that happens, providers are just going to continue to have a mess to navigate," LeRoy said.

Ideally, LeRoy, like many who work in child and adolescent behavioral health in Pierce County, envision a system that's far better. He believes efforts like Kids Mental Health Pierce County and endeavors like the 2018 Children's Mental Health Summit in 2018 -- which brought together an array of professionals and community leaders to find ways to improve child and adolescent mental health services -- have shown promise, but more work remains.

Asked about the current crisis, LeRoy said the serious challenges also provide an opportunity for Pierce County to finally identify "a north star" to guide it toward" a unified vision ... for what the behavioral health system should look like." Doing so will require more coordination between providers, more flexibility and cooperation from insurance providers and more dedicated child and adolescent behavioral health funding and support from local government, he said.

For Pierce County kids and families, that day can't come soon enough.

We also didn't need a pandemic to bring the need into focus.

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