Health Care

Bill Schubart: Our mental health system is under pressure and needs help

Heather Legacy of Northeast Kingdom Organizing speaks during a press conference held in Barton to discuss the lack of mental health services in the Northeast Kingdom on Monday, May 10, 2021. File photo by Glenn Russell/VTDigger

In September, Marian Wright Edelman, a lifelong champion of the well-being of children and the founder of the Children’s Defense Fund, said, “If we don't stand up for children, then we don't stand for much.”

There is a nationwide crisis in mental health among our young people. The American Academy of Pediatrics has called it a national emergency. In spite of our perceived quality of life, Vermont is no exception.

According to its president, Dr. John Brumsted, it’s not unusual for the UVM Medical Center’s emergency department to have 10 to 25 people in psychiatric crisis on any given day. Many are young people and may be there for days at a time waiting for inpatient care or a referral. But emergency department admissions are only one indicator and don’t adequately account for the full breadth of the crisis.

The sanctuary-care psychiatric infrastructure that existed when I was a kid in Morrisville was taken apart, for the most part, with good intention. I grew up under the cloud of the Waterbury State Asylum for the Insane, the Weeks School, also called “The Vermont Reform School” in Vergennes, and the Brandon Training School, founded in 1915 as “The Vermont School for Feebleminded Children,” all threatened destinations for the ill-behaved among us or those who could not manage in society.

The goal when we closed the sanctuary-care institutions was to transfer that care to the communities, along with the money that funded them. But when we closed the hospitals, we never adequately funded the community alternatives. Today, many of our most vulnerable now live in tent encampments, single-room-occupancy motels, or prison cells.

It makes sense for mental health services to reside in our communities precisely because they’re managed by and accountable to the populations they serve. Services are personal yet remain confidential, and most mental illness has family and social context.

Of necessity, community mental health centers are providing services at about two-thirds the expense if the state were to deliver such services, simply based on comparative compensation scales — to the detriment of those committed to working locally.

About five years ago, local facilities began seeing serious workforce shortages and have become increasingly subject to poaching by hospitals, private pediatric offices, and school systems, all of which realized they must expand their services to include mental health counseling for the young.

Typically, a licensed master’s in social work will go to work in a community setting to fulfill their three-year residential requirement but then double their salary by moving to a private firm. Remaining in a community facility means giving up market-level compensation and requires an inordinate personal commitment to community well-being. In addition, such workers may simply burn out from the emotional and time commitment of caring for teens or adults in crisis.

In 2003, the Department of Developmental and Mental Health Services, now the Department of Mental Health, put into place the plan that established the 12 designated agencies around the state to offer services to those who need help. They also work with six regional hospitals to provide psychiatric inpatient care when beds are available.

The mental health community’s goals are to identify and intervene prior to self-harm, provide rapid access to help, minimize stigma, manage costs, and, finally, secure ongoing inpatient or outpatient care. The recent media discussions among Olympians and media figures has helped destigmatize a condition long associated with shame. But we are far from supporting the infrastructure or personnel sufficient to manage the current crisis.

One designated special service agency is Northeastern Family Institute, which has 10 locations around Vermont. It serves only teens 12-18 and, between its two residential hospital-diversion facilities in South Burlington and Brattleboro, can handle about a dozen kids, and those slots are typically full.

The institute’s executive director, Chuck Myers indicated that the acuity of young people presenting for help is much higher than his organization has previously experienced and that the agency’s current funding is inadequate, both for operations and staffing to fulfill the mission.

More typically, the Department of Mental Health assigns one designated agency in each geographic region of the state to provide the department’s mental health programs for adults and children, whereas Northeastern Family Institute and Pathways Vermont operate outside designated areas.

Designated agencies have a statutory responsibility to meet the developmental and mental health service needs of their region consistent with available funding. These nonprofits receive the state’s “designated” status in exchange for taking “all comers.” But there is no commensurate guarantee of legislative funding to achieve this goal.

Why the surge?

What’s causing this spike in psychiatric need among our young (and by the way, it’s growing across all age sectors)?

There are several reasons that have become apparent:

The pandemic necessitated remote learning, depriving kids of their vital personal connections in school. Related to this is the dominance of social media and its negative impact on interpersonal relationships among the young. Young people spend as much as four to eight hours a day looking at screens and often judge themselves against “influencers” and peers with whom they have no personal connection. 

The increase in depression, anxiety, eating disorders, self-harm and suicidal ideation often begins online. Time is a zero-sum game, and on-screen time takes away from sleep time, time with family and friends, and time in nature, all of which are known to be healing influences.

Also mentioned is what we used to call in the 1960s “existential dread,” a general sense that conditions are deteriorating, whether community, environmental, social-economic or geo-political. For my generation, it was the specter of nuclear annihilation.

There’s also an evident shift in the social contract between our government and its citizenry. By design, government is meant to be an element around which diverse people rally. The role of government and politicians is to instill unity of purpose and action.  

But in recent decades, some elected officials have begun to use their power and position to sow discord among us, dividing us on countless issues — from the efficacy of protective masks and vaccines to trust in election results, race relations, immigration, family planning, educational curriculum, and environmental stewardship.

The final driver is the decline of family and community. Nuclear, multigenerational families, while not a prerequisite for raising healthy children or a guarantee of good parenting, have nevertheless been an important element in well-being, as have churches, Granges, schools, community sports teams, and gathering places like the soda fountains I knew as a child.

We tend to look at the cost of caring for our children through a health care lens, but the cost of the current mental health crisis in our schools is becoming significant, according to several superintendents. Across the state, special education alone now exceeds the cost of basic education, and the total for the state was reported to be $683 million-plus in 2019.  Some superintendents report having to spend as much time managing the mental health of their students as they do their education.

I will not recount the precipitous decline in the social determinants of health, about which I wrote two weeks ago, but will only repeat that the U.S. remains an outlier internationally in our support for the well-being of families, communities and our young.

Societal and economic pressures

This is important precisely because of the common understanding among pediatric professionals dealing with the teen crisis that the dominant causal effects are not the common psychiatric diagnoses such as bipolar disorder, clinical depression, or schizophrenia. Instead, they’re more often attributable to societal and economic pressures, such as individual childhood trauma and toxic levels of circumstantial anxiety.

As on so many issues, the Build Back Better Initiative is now being used by some to further divide the nation, even as it includes many of the provisions that would greatly enhance quality of life for Americans and their children.

Our legislators must understand that without adequate funding and staffing, the community-based system will wither and our children will suffer. The massive federal infusion of capital headed to Vermont is an opportunity to shore up this vital infrastructure.

We know that upstream investments in the well-being of our kids — such as early education and child care, intervention and trauma-informed counseling — pay massive benefits downstream.

If we don’t soon join the civilized world and begin to fund the very initiatives that decrease acute mental and physical illness, we will be doomed to continue to pay more than anyone else in the world for health care and get worse results.

We will also jeopardize our very future — our children and grandchildren.

Online mental health resources:

  • Dial 211 for local mental health services
  • Suicide prevention (national) 800-273-8255
  • VT Peer Support line 833-888-2557 or text VT to 741741

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