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Parents struggle to find mental health services for children

Kokomo Tribune (IN) - 10/20/2014

Oct. 19--Kathy Peters' son was 4 years old the first time he tried to kill his little brother.

Her son had become enraged. He picked up the TV in the living room and threw it, trying to crush the 1-year-old child.

That's when Peters realized her son had a serious problem.

Psychiatrists confirmed what Peters suspected: Her son suffered from bipolar and explosive disorders, as well as anxiety and attention-deficit disorders.

The child needed help, but help was hard to find. It took two years after the diagnosis to get her son into a long-term residential program in Terre Haute. Three months later, he was back at home because Medicaid had stopped paying for his stay.

The story repeated over the years. Peters would find a long-term facility for her son, but after a few months he'd be back at home where his attempts to kill his little brother continued.

Peters said it got so bad that she sent her youngest son from their home in Valparaiso to live with his father in Kokomo, where their oldest son comes two weekends a month to visit.

Her son is now 10 years old, and his violent tendencies continue. Earlier this month he tried to stab a classmate. A few weeks later, he tried to kill himself.

Nowhere to go

Peters took the child to the local hospital in Valparaiso. The hospital wouldn't admit him to the pediatric unit because he was too violent. It wouldn't admit him to the mental health unit because he is a child.

The only hospital Peters could find with a bed available for a 10 year old was in Terre Haute. It's a 3 hour drive, and he will likely only stay for around a week.

"I don't believe my son is the only child like this," she said. "I know there's got to be other parents out there struggling just as much to find help for their child."

Peters is right. Throughout the state, a dire shortage of inpatient services for children suffering from a mental illness and a national shortage of child psychiatrists has left families scrambling to find treatment.

In the end, many don't. The National Survey of Children's Health reported last year nearly half of children up to age 5 in Indiana don't receive the mental-health services they need, compared to 33 percent of Hoosiers aged 12 to 17.

Nationally, only about 20 percent of children and adolescents with mental illnesses end up receiving some kind of mental health services, according to a 1999 study by the U.S. Surgeon General.

Of those who do see a professional, only a small fraction of them get an evaluation and treatment by a child and adolescent psychiatrist, the study reports.

It's a bad situation for families dealing with a child suffering from a severe mental illness, and it's one that has gotten worse in Howard County.

Need help? Take a drive

In Kokomo, kids who needed acute inpatient treatment used to be able to head to Community Howard Regional Health, which maintained a 12-bed unit for children and adolescents.

Not anymore. Late last year, the hospital closed the unit due to what hospital officials said were inconsistent referrals.

Now, any child under the age of 15 who needs inpatient care must travel outside the county for help. The closest facilities are located in Indianapolis or Plymouth, both about an hour away.

"It puts a big burden on the family to transport their kid who's probably having a crisis to Indy or Plymouth while confined in a car," said Donald Wilka, a clinical therapist at Kokomo Family Psychiatric Center. "Most likely, the kid's combative, and that makes it tough."

Chuck Michel, executive director of the psychiatric center, said it's difficult to blame hospitals for reducing service options for kids. After all, they need to make money to stay open, he said, and there's little government funding to help pay for children's mental health services.

"Clinics are cutting back because there just isn't enough money in it," he said. "And from a cost-analysis standpoint, who can blame them? But it comes with a steep trade off: a serious lack accessibility."

In Howard County, both Community Howard Regional Health and St. Joseph Hospital offer intensive outpatient treatment for children with mental-health issues. Children can meet with therapists after school. Mental-health workers visit families at home to provide counseling.

But for kids in crisis who need treatment in a hospital with clinical supervision, the only option is to jump in the car and drive.

Erik May, who deals with kids suffering from a mental illness as the referee for Howard County Juvenile Probation, said he understands hospitals' struggle to offer quality services while still trying to pay the bills.

But, he said, the resources exist at community facilities to offer more services to children.

"I would love it we could offer the whole package of mental health services in this county, and I think we have the infrastructure to do it," he said. "There's no reason why in a community with two hospitals we can't offer the same services as any other county in the state."

Shortage of child psychiatrists

Although children can get into outpatient mental-health or therapy services without much of a wait in Howard County, it's not so easy to get an appointment with an actual child psychiatrist, who has the most expertise and experience prescribing medication.

In fact, there's only four child psychiatrists in the county. Two are employed at Community Howard. St. Joe currently has a temporary psychiatrist who hospital officials say is leaving this year, as well as one general psychiatrist who sees children. The Kokomo Family Psychiatric Center also employs one, but he works part time.

Compared to most counties, that's high. Out of Indiana's 92 counties, 68 don't have any child psychiatrists, according to a 2012 report by the American Academy of Child and Adolescent Psychiatry.

"Psychiatrists are rare these days, and child psychiatrists are even rarer," said Dr. Alan Schmetzer, professor emeritus at the Indiana University School of Medicine. "It's a problem everywhere, and it's gotten worse."

The numbers tell the story. In 2012, there were approximately 8,300 practicing child and adolescent psychiatrists in the country, according to the American Medical Association.

However, the need was projected to be 30,000 by 2000, according to a report by the Council on Graduate Medical Education.

The need is only going to get more severe. The Bureau of Health Professions reported in 2000 that the demand for child and adolescent psychiatry services is projected to increase by 100 percent between 1995 and 2020.

Even with four child psychiatrists employed in Howard County, it can still be up to a month before parents can get their child in to see a psychiatrist to begin receiving medication.

"In that time of waiting, there's a whole lot of bad stuff that could happen to a child," said clinical therapist Wilka.

No end in sight

Indiana needs more child psychiatrists, but it likely won't be getting anymore anytime soon.

The Indiana University School of Medicine offers the only residency program in child psychiatry in the state, and it currently only has two spots.

IU Professor Emeritus Schmetzer said the school can graduate up to four child psychiatrists through a specialized program, but that's still woefully inadequate the meet the need for services.

The lack of child psychiatrists is a problem St. Joseph Hospital has experienced firsthand.

John Rudy, executive director of diagnostic and treatment services, said the hospital has been trying for months to bring on a permanent psychiatrist, but there aren't any out there to hire.

"It's become difficult to recruit and attract child psychiatrists to our sized community," he said. "It didn't use to be that difficult 20 years ago ... Now, our coverage for children and adolescents is shaky at best."

Family Psychiatric Center's Michel said it's difficult to convince students to spend up to eight years in school to become a child psychiatrist. They graduate with up to $200,000 in debt, he said, and once they get a job, they receive one of the lowest payouts in the healthcare industry.

"If you're smart enough to be a doctor, you're smart enough to do other things," he said. "So why would you become a child psychiatrist when you could specialize in something that paid you way more money?"

Kathy Peters said she's run up against that shortage of psychiatrists and mental-health services ever since her 10-year-old son tried to kill his little brother six years ago.

If he starts getting the treatment he needs now, she said he might just have a chance at a normal life when he grows up.

But with the shortage of psychiatrists and long-term treatment options in Indiana, that chance grows smaller every day.

"Right now, he's in such a state that he shouldn't be out in the public," Peters said. "But that's the problem. There's nowhere for these kids, and they're just going to grow up to be bigger, stronger and meaner. The state needs to nip this in the bud before all that happens."

Carson Gerber can be reached at 765-854-6739, carson.gerber@kokomotribune.com or on Twitter @carsongerber1.

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