Emergency room doctors in Virginia are reporting ERs filled with children waiting for an open bed at psychiatric hospitals. Pediatricians are hearing kids as young as 10 talk about having thoughts of suicide. At least 90,000 Virginians under 18 have had at least one major depressive episode.
Less than half received mental health treatment, according to the Virginia Department of Health.
And as the pandemic worsens an already existing mental health crisis, the state does not have the workforce to meet the need — lagging as far behind as 41st in the country, according to the State of Mental Health in America’s 2020 report.
Virginia is working to change that through the Virginia Mental Health Access Program, an initiative officially launched last week aimed at connecting children to mental health care sooner and bridging the gap that has left the state with 13 child and adolescent psychiatrists available for every 100,000 children.
Access depends largely on income and proximity to a major city.
Albemarle County, Charlottesville, Fairfax, Rappahannock County and Staunton are the only five localities to have a “mostly sufficient” number of mental health providers. Three of the five have a higher median income than the state average. Staunton, one of the remaining two, is the site of the only state-run psychiatric hospital for kids.
Chesterfield and Hanover counties are deemed as having a severe shortage by the American Academy of Child and Adolescent Psychiatry — along with 24 other localities — while Richmond and Henrico County’s shortages are two of the 15 in Virginia classified as “high.”
The rest, roughly 65% of the state, do not have any child psychiatrists at all.
Dr. Sandy Chung, medical director of VMAP and a pediatrician, said in an interview that psychologists are often centralized around large hospital systems or academic centers, which leaves rural locations behind — even as 80% of health care providers surveyed by VMAP this past year said they’re seeing more youth with anxiety, depression and other behavioral conditions.
“Generally, access to care is not necessarily equitable, so we’re addressing this through primary care,” Chung said. “Underlying that, we also have to make sure that primary care is accessible in an equitable manner for this to work. ... Today, at least with VMAP, we’re able to say that any primary care provider that is in place today can provide mental health care and that is an improvement.”
The four pillars of the program are education, access, care navigation and telehealth visits. Ongoing education from VMAP to primary care providers would help pediatricians or family medicine physicians screen, diagnose and treat patients for mental health conditions. Once a mental health condition is flagged, providers can connect with regional hubs staffed with on-hand psychiatrists and social workers for a consultation within 30 minutes.
One of its hubs is located at VCU Health.
Then, VMAP can help families navigate additional mental health services offered in their communities when needed, which Chung said removes the barrier of leaving it up to patients who might not know where to look. Telehealth will available later in 2021.
VMAP has been underway since 2018 through grants from the Virginia Department of Health, $5.2 million in total funds allocated by the General Assembly and in partnership with the Department of Behavioral Health and Developmental Services.
Its program has trained more than 450 providers and conducted more than 1,000 consultations. Nearly 62% of patients were between the ages of 6 and 15, and more than a third of patients were youth of color — an effort that Dr. Daniel Carey, the state’s secretary of health, said in a recent news conference reflects VMAP’s intentional focus on equity.
Data from Virginia Kids Count, a research center tracking children’s well-being statewide, showed that in March, 46% of Latino adults with children felt anxious nearly every day in the last week. More than a third reported being depressed in the same time frame, a figure that’s almost double the percentages of every other age group.
The state average was 20%.
Nationally, the Centers for Disease Control and Prevention reported that between April 28 and May 10, Black Americans were the second-most likely to report needing therapy but not receiving it in the past month. First were people who identified with multiple races.
“We currently have two dual crises going on here. We have the COVID-19 pandemic, which is a trauma ... and trauma can have lifelong impacts on children socially, emotionally, physically and more,” said Chloe Edwards, a policy analyst with Virginia Kids Count. “We’re also looking at racism as a public health crisis, so not only are children witnessing the pandemic, but they’re witnessing the entire role of reckoning with America’s past as it relates to racism and oppression.”
Edwards, who is also on VMAP’s equity advisory committee, added that solutions underway include school-based mental health services, maximizing Medicaid funding, implementing more call centers and the start of the Marcus Alert, which has behavioral health experts respond to crises.
Major gaps that remain, said Edwards, include diversification of the mental health workforce — which is part of VMAP’s goals — mobile crisis teams and language accessibility, which Edwards said “has been a consistent theme across every single network that I’ve spoken to.”
Chung said a priority for VMAP is developing a statewide resource database that features language capabilities and whom to connect non-English speakers with, noting how “to be successful in the management of mental health, we have to be culturally, linguistically and racially sensitive and appropriate.”
For Chung, it’s also personal. Her parents, who are Chinese, are not fluent English speakers and in medical settings, cultural and language barriers have been a deterrent to receiving accurate information. With mental health services largely being verbal, language access is critical, Chung said.
“The reality is, mental health is something that we all deal with. It’s not something unusual. It’s not something where you’re alone,” Chung said. “Teaching parents is a role we have as pediatricians, to tell parents, ‘Your child may be struggling, but you won’t ever know if you don’t ask.’ ”
If children feel more comfortable speaking with another trusted adult, Edwards added, VMAP can help connect them.