— Senate committee gets schooled on how the country needs to escalate response
by Shannon Firth, Washington Correspondent, MedPage Today April 28, 2021
Psychiatrist Tami Benton, MD, had a 5-year-old patient threaten to run into traffic to end her life.
When Benton asked the girl what she thought would happen after she died, the girl replied, “‘I will come back tomorrow, and I’ll be a good girl, and my parents will be happy again.'”
The child’s parents lost their jobs during the pandemic.
As a result, her mother slid into depression, and the girl’s parents were unable to care for her, explained Benton, the psychiatrist-in-chief and executive director and chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia.
At a hearing Wednesday, Benton told members of the Senate Health, Education, Labor, and Pensions (HELP) Committee that she sought inpatient or outpatient treatment options that could address the mental health needs of the family, but came up empty.
“There was no place for this youngster and … family to receive the care that they deserved,” she said.
Ultimately, the child was placed in an inpatient medical facility, which kept the girl safe, but didn’t provide the mental health care she needed.
These types of stories have become too common during the pandemic, Benton told committee members.
Her health system’s facilities have seen a 30% to 50% rise in mental health visits among young people who previously had no mental health problems, but are now expressing concerns about depression, anxiety, and eating disorders, as well as suicidal ideation and behavior.
Some kids have to be transported across state lines to receive care, she added.
The committee met to discuss the country’s response to mental health and substance use disorders (SUDs) during the COVID-19 pandemic.
Chairwoman Patty Murray (D-Wash.) cited similar challenges in her state. For instance, Seattle Children’s Hospital has seen visits by children experiencing mental health emergencies more than triple, from 50 visits per week pre-pandemic to 170 visits per week, and youth suicide rates in King County have risen 30%, she said.
Murray emphasized that the problem isn’t only that more people need mental health care, but that accessing care has proven difficult for many. She called for “significant investments” in existing programs that help communities to address mental health and SUDs.
Murray applauded passage of the SUPPORT Act of 2018 to address opioid abuse, and the CARES Act of 2021, which supports expanded access to mental health care via telehealth, but said neither bill is sufficient to address the current challenges.
Telehealth is convenient and discreet but is not a replacement for access to quality, affordable providers in the community, Murray said. She called for recruiting, training, and retaining enough mental health care professionals to truly meet the needs of the country.
Benton pointed out that an estimated 15 million children in the U.S. require mental health services, yet there are only about 8,000 to 9,000 child psychiatrists serving the most severely impacted children.
That same workforce shortage extends to psychologists, social workers, nurse practitioners, nurses, and community health workers who could address some of these children’s needs, she added.
“And [student] loan forgiveness would allow these professionals to remain in the workforce to provide this care,” Benton said.
Sen. Jacky Rosen (D-Nev.) said the Clark County school district in her state has lost 19 students to suicide since March of last year.
Nevada is at the top of a list “that nobody wants to be in the top of,” said Rosen, and asked witnesses for their advice on developing and expanding trauma-informed training.
Benton pointed to “successful” partnerships in Pennsylvania between community mental health centers and a “cluster of schools” to assure that they are conducting trauma-informed training for teachers, school administrators, and for families.
She also highlighted peer-to-peer counseling/support with trained young people. Experts can and should encourage young people to seek out a trusted adult when they are in crisis, but they are far more likely to approach their friends, and those friends often do not know how to respond to someone who says, “‘I feel like killing myself.'”
But Benton cited “tremendous success“ with peer counselors who are trained to respond to suicidal youth.
“Providing opportunities for identification of suicidal youth in all community settings, is essential,” and “making that training available in one of its many forms … could save lives,” she said.
Jonathan Muther, PhD, a psychologist and vice president of Medical Services-Behavioral Health for Salud Family Health Centers in Commerce City, Colorado, highlighted the benefits of an integrated primary care model to address patients’ mental and behavioral health needs.
Such models reinforce primary care as “the backbone of healthcare,” entail upfront investments in behavioral health specialists, and promote a collaborative, holistic approach that improves health outcomes and reduces healthcare inequities, he said.
More than 50% of people who have suicidal feelings have seen a primary care provider in the week before making a suicide attempt, Benton said.
She encouraged primary care providers and those in community settings to seek out training on suicide screening.
“There are many opportunities to just ask someone the questions; to get comfortable with knowing what to say [and] understanding that asking a question about suicide won’t make that person suicidal,” she stated. These elements are “essential to suicide prevention,” Benton said.
If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.