Research shows: Services and needs outnumber providers.
Imagine this image: If all Missouri children and youth with behavioral problems were lined up three feet apart on Interstate 70, the line would be 206 miles, or Kansas City to Wentzville. almost reach the distance to Now use the same parameters to order the number of child and adolescent psychiatrists in the state.
That row only needs 1.5 soccer fields.
This figure from the National Alliance on Mental Illness (NAMI) is an important perspective and context for conversations about the state of mental health care in Boone County and Columbia. Passed in 2012 with his 57% approval of voters, the county tax has generated about $59.5 million since its inception. The Boone County Board of Children’s Services works with school districts, several nonprofits, and authorizes spending to fund a variety of preventive services, helping prevent incidents or incidents that require police involvement before they become chronic or require police involvement. Funded targeted programs aimed at addressing mental health needs before they lead to crime. .
Annual reports detailing funding and programs show success in preventing suicides and converting young people out of the legal system into caregivers. However, there is one notable exception. The number of child and adolescent psychiatrists and general mental health providers is still insufficient to provide services.
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A shortage of adult psychiatrists is also a problem, state officials said in their 2021 budget report. One of the more common observations, and incredibly frustrating for families in need, is that waiting lists for these services stretch as long as nine months or even a year. And while health insurance plans cover mental health care, these policies often limit the number of treatment visits or spend on other treatments for mental and behavioral health problems. limits the amount of money that can be used.
All 10 health insurance plans offered on the open market (Obamacare) in Boone County in 2023 have mental health benefits, each with varying levels and tolerances. Eligibility for compensation requires a diagnosis in which a psychiatrist plays an important role.
“We tend to look at mental health differently than health in general. But it’s all about health,” says Boone County Northern District Commissioner Janet Thompson. Avoiding open discussion about mental health and embracing it in the same way as physical health clouds the way the topic is discussed and how it is treated in public policy decisions, she said. say.
“Mental illness is the only non-casserole disease,” Janet says. “If someone has cancer, they eat casseroles. But if it’s a mental health issue, people run away.” Too often, she adds, it influences whether or not to invest.
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The Missouri Department of Mental Health cites increased employment, less incarceration, less strain on families, lower future costs, and higher levels of care as benefits of mental health care.
Children’s mental health sales taxes are putting Columbia and Boone County ahead of cities and counties of similar size. Few counties have tax-funded general mental health resources. But most of the states qualify as mental health deserts simply because they lack qualified providers.
Why are health care providers qualified to treat mental illness, and why can’t that treatment be provided by primary care or a family doctor?
Psychiatrists have specialized training in diagnosing and treating mental health disorders. Psychiatrists are best suited to prescribe drugs and other treatments for mental and behavioral health, whether the patient is a child or an adult. Without a diagnosis, health insurance is not covered or some medical interventions are restricted. A recent survey by the American Academy of Pediatrics found that 65% of pediatricians surveyed reported a lack of training in treating children and adolescents with mental health problems. 40% said they were not confident in recognizing these health concerns.
Surveys of general practice or primary care providers have shown similar results.
From grassroots to voting.
New programs, including the Missouri Child Psychiatry Access Project, are now in place to better prepare participating pediatric care providers to care for children with mild to moderate mental health problems We provide training and support for Some of these approaches are offered to primary care physicians and their staff, and the Peer Specialist Program is a way of bridging the gap to intervene in more serious cases where specialists do not receive immediate care. is in the pilot project stage.
Boone County’s Children’s Mental Health Tax was achieved as a result of an initiative petition process that saw the peak of the summer heat in 2012 overcome the county commission’s submission of the bill to a ballot in November. A group of enthusiastic advocates worked to gather enough signatures to make the demand.. Among the many issues with the ballot was the election of a new Northern District Commissioner, and Janet’s 54 votes for the county’s Northern District. won by a percentage.
With a staggering 79.3% voter turnout, the Child Services Tax, listed as Proposition 1 on the ballot, received 57% of the votes in favor. (The tally was 41,388 votes in favor and 30,917 votes against.)
Janet was an attorney with the state’s public defender’s office before turning her attention to the role and duties of the county commissioner. She is often assigned some of the most difficult criminal cases and has the enviable experience of being a witness in the execution of clients. It has become a strong proponent of taxes and other measures that provide crisis intervention rather than arrest when dealing with mental health issues.
Janet says her first “wake-up call” came more than 30 years ago when states began closing mental hospitals due to budget cuts.
“And my case numbers skyrocketed,” she recalls. “When a hospital closes, there is public outrage.
Regardless of whether mental health needs and access to services are generally recognized or discussed, and whether or not providers are in short supply, or why, these factors have ramifications. Janet says.
Heather Harlan is a health educator for the Columbia/Boone County Department of Public Health and Human Services and a longtime facilitator of NAMI events and conferences in Columbia and Missouri. (City/county health departments also facilitate family support group meetings.) Heather is personally aware of the gaps in local mental health services, and she is acutely aware of them. Her son, Micah, committed suicide in February 2019.
“People don’t know that you may have to wait quite a while for a psychological evaluation or psychiatric appointment,” she says. I blame my broken brain and mental health and my broken system.”
He was discharged from the hospital in May 2018, but had to wait four months for follow-up.
“If a diabetic’s numbers are so bad, they should be hospitalized in May. Don’t say ‘I’ll put you in.’ [for an assessment] In August,” adds Heather. She described her son as a “very bright man” who died just days before his 39th birthday and months before graduating from Columbia University with a degree in English. . His degree was awarded posthumously.
“He struggled with mood issues for most of his life,” she said, adding that he also had other neurological problems. I feel like that.”
He didn’t have a substance abuse problem — he didn’t use alcohol, didn’t smoke or use other drugs — he took drugs to help him “feel like himself.” I was taking it, says Heather.
“By February 2019, everything caught up with him,” she explains. “A perfect storm of despair, gloom and opportunity”
A shortage of providers, as demonstrated by a 2014 report and a 2019 follow-up report commissioned by the Boone County Children’s Services Commission, and the closure of the psychiatric unit by Boone Hospital a few years earlier. is not a new challenge. (A hospital run by BJC Health Care at the time said the unit was closed because the hospital was unable to hire a psychiatrist to keep the unit functioning.)
The bright spot: “He’s still alive.”
One bright spot in the county’s mental health tax, though limited to use on children and their families, is a bridge program that provides mental health screenings for approximately 26,000 public (and some private) students. . Screening and other parts of the program provide a large amount of data that most counties and communities across the state are missing to help children’s service boards decide where to allocate sales tax resources.
Janet gives one example that she’s convinced she’s multiplied many times. A teacher was evaluating her fourth grade at a school in Boone County and found that not only was the child showing signs of mental illness, but she said, “The child had plans to commit suicide. Fourth grade. When was that a question?”
With rapid intervention and follow-up services for children and their families, Janet explains, “He’s still alive.”
Boone County’s Family Access Center of Excellence (FACE) is another service created and funded by the county’s specific sales tax. FACE centers are often the first point of contact for children and families experiencing mental health crises. FACE provides screening and evaluation and referral to health care providers for appropriate treatment or intervention.
These are favorable outcomes for individuals with access to screening and care. The scenario is more difficult for adults, and having health insurance is not a panacea, especially if access is limited or there are not enough healthcare providers. Many private mental health therapists and clinics (those unaffiliated with large organizations) avoid health insurance because the complexity and requirements drive up overhead. Some of these clinics also offer sliding payment options. Others do not.
The state budget is stable, with approximately 7% of total spending going to the Department of Mental Health. (Approximately $2.48 billion in the fiscal 2021 budget.) These funds will be used to access care for approximately 170,000 adults and children suffering from serious mental illness, substance abuse, or developmental disabilities. . A network of over 1,300 community-based, non-profit partners have contracted with the division to provide these services.
In Columbia, individuals and families with mental health challenges can connect with NAMI Columbia, which has onsite gatherings and virtual support connections at Broadway Christian Churches.
Connect with NAMI Colombia