It’s five o’clock in the afternoon and the school bus stops to let children off. One mother (we will call her Sue) peers out the window looking for her child (we will call her Jane) to get off the school bus. Jane is usually the last one off the bus as she has always been the slow poke of the family.
The children clear the street and the school bus pulls away, but today, there Is no Jane. The mother walks out into the street to question some of Jane’s friends. They reassure the mother that Jane is OK because the bus dropped her off at the afterschool program at the church near the school. Relieved that her child is OK, but confused, the mother goes inside and calls the school. Why would Jane be at this program she has never attended before?
When Sue calls the school, she is told that the services that Jane needs are contracted with a local church, so they sent her there. Sue’s car is currently being repaired, so she finds a friend that can take her to the church to pick up Jane. When Sue arrives at the church, she is told by the program director that Jane is not there. Jane did not qualify for the program at the church, so she was sent to a local community organization down the street.
At this point Sue is beside herself with worry and frustration, she just wants to get her daughter and take her home. Sue and her friend arrive at the local community organization to find that the director has never heard of Jane…and her daughter apparently never made it to the building. Worry turns to panic!
An Amber Alert is issued, and all hands are now on deck to find Jane. Teams of people meet and discuss the best way to find Jane. They construct elaborate plans with amazing accuracy about where they will look and at what times. Maps are created and search teams that consist of every type of specialist possible to find Jane. Copies of the maps are distributed to all involved, even her mother has a copy. There is no way she will not be found, every inch on this map will be covered.
Despite all these resources and all these advanced plans, sadly, Jane will never be found. Not because she was abducted and taken far away, but because she was hiding in plain sight…right on the back steps of the school. No one thought to look for her there because…well… it just seemed too obvious.
And that is where we find ourselves today my friends…where we have lost all common sense in problem solving. We have managed to transform our once inter working community agencies into a big bunch of bureaucracy that no longer effectively serves our children and communities.
While this is a fictitious story, it is intended to illustrate just about how ludicrous it is for families and professionals to navigate our current broken mental health system. Everyday I try to help families navigate their way through the various hoops they need to simply get some help. Meanwhile, my fellow colleagues and I have to stress about if we will be able to make enough money to stay in our chosen profession.
While each entity is planning and drawing boundaries, passing the buck to another system, or thinking that another group is taking care of that issue, precious children are lost in this system forever. THIS IS EVERYONE’S PROBLEM!
While I have been fired up about this for some time, yesterday just took me to a new orbit. The recent report card that was released on North Carolina Child Health, now ranks suicide as the SECOND leading cause of death of children age 10-17. Let’s just let that sink in…besides a car crash, your kid is the most likely to die from a 100% preventable death…at their own hand.
As if that was not enough salt in our wound, a recent study published in the JAMA Pediatrics found that North Carolina is DEAD LAST in providing mental health services to our children. This study also found that 72% of children in NC diagnosed with a mental health condition were unable to meet with a licensed mental health provider in the last year.
North Carolina is my home state and I am generally a fierce Southern advocate for this state…but Governor Roy Cooper… this is absolutely beyond embarrassing and if I might be so bold …borderline criminal. As a mental health provider, I want to share with you all the barriers that are in the way of people accessing mental health but especially children in Eastern NC.
Access to Providers Who Accept Private Health Insurance
Particularly in rural communities, like where I practice in Eastern NC, there are just not enough of us to go around. The process that we must go through to become licensed is only the first hurdle to being able to offer services. As a Mastered level provider, once we complete our master’s degree ( depending on your board), you do about 3,000 additional clinical hours of training to gain your state license. No problem, people playing around in other people’s minds should be well trained!
Most people do not realize that the majority of mental health therapists are independent contractors. Most of us make our income in the managed healthcare world as fee for services providers which means we are either paid by our client or paid by insurance companies to do our work. We are not salaried, we only get paid if clients show up, we have no benefits, no retirement, we are self-employed with all the pros and cons that comes with that life.There really are not many government agencies providing mental health services these days for providers to find jobs (more on that coming up).
Once a clinician is licensed, they are still not ready to work with managed care organizations. We must then go through what is called “paneling” to be approved as a provider to serve and be able to accept payment from each insurance company. This process can take months to a year to complete. In the meantime, this provider cannot offer services to any patients with that particular insurance.
So, in order for a child to see a therapist, the healthcare provider or school must first find a therapist in network with the insurance company. Once they find a provider then, the family has to deal with insurance co payments. Depending on the plan, the average office co payment for plans can range from $30-$90 dollars per session. For most conditions, a child needs to attend therapy a minimum of twice per month, sometimes more depending on the issue. What if you have two children who need these services?
Is your head spinning yet…hold on …. I am just getting started.
Access to Providers Who Accept Medicaid
Around 2001, North Carolina along with many other states moved from a community based mental health center model to Managed Care Organizations (MCO). Since them the state has gone from approximately 37 MCO agencies for mental health services to 6 and we are preparing for more change. So, for us as mental health professionals who serve multiple counties, we must contract with several organizations with different rules to take the same North Carolina Medicaid dollar.
That means a different set of paperwork, a different computer system to upload treatment information….I think you get my point. I am all for accountability and showing that I do good work and yes, Medicaid fraud is a big problem however these organizations have put a noose around the necks of mental health providers until we have all just had it.
In the last 3 months, I have had two well established therapists in my circle to be “kicked out” of the network due to errors on the MCO part, and it literally took getting a local politician involved to get one of them back in. Meanwhile, months go by and they have NO income.
THESE are the reasons that many providers do not accept Medicaid… it is not that they do no want to work with the patient…it is the fact that we lie awake at night in a panic hoping we can get paid and make enough to keep out practices open to serve our clients.
Seasoned Providers Are Leaving the Field
As if that wasn’t enough, to add to the deficit of not enough providers, seasoned professional are leaving this field in mass exodus. Yes, while working in mental health does have a high burnout rate on the provider, it is not the largest factor. In reading the reports I shared above you would think with two advanced degrees and a clinical license with eighteen years of experience,I would be the hottest tickets in town for hire. What if I told you that last year I spent over 6 months unemployed as I sought to work outside of the private practice system. There are truly few else places for us to work due to the privatization of this system, which given the state of mental health is absurd.
Also in what career field do you make less money with the more years of experience? That would be anyone who works in managed healthcare system. When the news stories flash up about politicians have cut Medicaid by 30% …the way they do that is they cut the amount of money they reimburse the provider. Most of us who have been in this field for the long haul can testify that we make significantly less money than we did years ago. This factor has run many great clinicians into other career fields to make a better salary with significantly less stress.
Mental Health Services belong IN the Schools
Why yes, Governor Cooper thank you for asking…I do have an answer to this Beyond Broken System. Mental Health services belong in the school where children spend more time than sometimes their own homes. This cuts all barriers related to access as well as removes the stigma related to mental health. We need more school counselors, social workers, and psychologists who are allowed to REALLY work with students…not required to push papers around. I was one school counselor to 800 kids in one elementary school…beyond ridiculous. I left the school system because I went to school to be a counselor not an administrator.
We also need more school-based health centers that fund mental health providers through grants or other state funding versus fee for service. I work once a week in one of these model centers where kids have access to a healthcare team that includes: nurse practitioners, health educators, nutritionists,and mental health.I love serving the kids in this integrative care setting, but as fee for services providers we cannot sustain a living here. A funded position would allow the counselor to work with students one on one, in groups, in classrooms as well as offer training and support to school staff who are overburdened with the mental health of their students.
Politicians need to understand that schools are more than academic regurgitation houses and allow schools to be relieved from this testing pressure nonsense. We have kids that have not had their basic needs met for the day such as food, shelter, safety, and love. Do you really think academics is a priority for this child? No, survival is! We have to stop and get these issues settled before we can focus on learning algebra.
Mental Health Services belong IN the Communities they serve
Sometimes we have to be willing to say that we tried something, and it was an epic fail. If the changes to our mental health system were successful over the years in NC, the data would show it and it most certainly does not. We are in a crisis of gross negligence in mental healthcare.
The push back is always funding but prevention is ALWAYS in the long run cheaper than treatment. How much money is NC currently hemorrhaging to fund treatment for the opioid crisis? Most of these addicts have mental health issues such as depression or anxiety that they are self-medicating due to lack of access in this failed system. Things that should have been addressed long ago…in childhood.
So, the report card is out, as politicians you hold our kids accountable by their test scores…well today they are holding you accountable and you failed. Something has to give. We can either spend the money upfront to set our citizens up for success or we can spend it later treating mental illness, addiction and disability. The children of North Carolina deserve better than to to be lost in a sea of red tape or to show up as another failing health statistic. Our NC state motto is “Esse Quam Videri”, meaning to BE rather than SEEM, Let’s not just seem like we are finding answers forming one task force after another, let us be actually doing something about this today!.
Thank you for reading this, if you want to make an impact for children in NC on mental health, please share this with #wakeupnc and tag every person with any political influence.
As always, may you be well, may you be loved, and may you know true peace.
***The views I express in this blog do not reflect on any one employer or agency that I contract with, these are solely my opinions based on my experiences.
The purpose of this blog is to offer educational information related to mental wellness. Resiliency Counseling & Consulting, PLLC and Melissa Harrell do not offer diagnosis or treatment through this medium. If you feel that you or a family member needs to access mental health services, first contact your primary care physician for assessment and direction in your area. If you need immediate help, please contact the National Suicide Prevention Lifeline at 1-800-273-8255.