TRANSFORMING HEALTH - Speaking to state House Democrats, Dr. Adrienne Johnson painted a harrowing picture she says is all too common.
"Seven-year-old child presents to my office with nausea, attended by a caregiver," she said. "This child is significantly underweight, speaks very little, has bruising on the shins, and the adult states that the child sleeps very poorly and frequently has nightmares."
The child shows signs of trauma, Johnson said. As is often the case, general practitioners like her are the first to discover that a child may be a victim of abuse.
She can refer the child to a specialist, and if appropriate, contact authorities. However, physicians don't see patients frequently enough to address long-term mental health issues, and there aren't enough psychiatrists and therapists to meet demand.
Johnson was one of nine York County experts to speak to Democratic state representatives March 28 in a policy committee hearing focused on childhood mental health. They were there to make the case for more funding and resources as the school district grapples with what it calls "overwhelming mental health needs."
Panelists repeated many of the same problems: Long wait times for services. A shortage of psychiatrists and therapists. Massive case loads for social workers. And children who need mental health services, but who are not getting them.
Children in urban school districts such as York "are exposed to trauma at alarming rates, far surpassing what the human brain was meant to tolerate," said Dr. Kristin Shillingsford.
In written testimony, the York school district occupational therapist said one of every five children has symptoms that meet the diagnosis for a mental health disorder. Eighty percent of those children go untreated.
The lack of resources is having a devastating effect on students' lives, Johnson said. And trauma is more common than some may think.
One in three women, and at least one in 16 men, survive sexual assault during their lifetimes, Johnson noted. That's just one type of trauma.
She said experts are looking more at "adverse childhood experiences," showing how people with several instances of untreated childhood trauma are more likely to commit crimes, use drugs and die by suicide.
In York City, where the school district says almost 70 percent of students live below the federal poverty level, the number who have dealt with four or more adverse childhood experiences is likely to be higher than average.
Johnson and others who work with children in the district made their cases to lawmakers, pointing to some of the problems keeping children from getting the care they need.
In a report summary, the school district flagged 10 barriers to access students face:
- Limited access to psychiatric services in York County, with waits as long as one year for an initial appointment
- Inadequate insurance coverage, with some services denied through private insurance
- Inconsistent parental involvement with mental health recommendations
- Community and cultural stigma
- Limited access to transportation, due partly to socioeconomic status
- Long waitlists for services, with agencies often lacking sufficient staff to fill positions even when services are authorized for payment by managed care organizations
- Lack of "meaningful and predictable communication"
- Inadequate discharge plans from community providers
- Abrupt discharges from community providers
- Language and cultural barriers, with an inadequate number of Spanish-speaking mental health service providers
The Democrats, who are part of the bipartisan mental health caucus, listened. However, if previous legislative sessions are a guide, the passage of mental health legislation is a long-shot, and any funding increases are unlikely.
Pennsylvanians are paying for that inaction in other ways, said Democratic State Rep. Mike Sturla of Lancaster County.
Sturla said it's taken years to show lawmakers, including himself, at times, that untreated mental illness contributes to so many other public health problems.
"We have to convince a lot of our colleagues that this isn't just psycho mumbo-jumbo," Sturla said in an interview. "If they want to say, 'We're never going to raise taxes,' you can't keep going with the same system that says we only treat people after they've gotten in jail."
While this event was led by Democrats, the effort is bipartisan.
Republican state Rep. Tom Murt of Montgomery County is also part of the legislature's mental health caucus. He recently addressed plans to add funding to mental health services.
"We want to get more resources to our counties, so they can push out the money to their human services missions," Murt said.
He said he wants to see an increase to one key funding source for counties, though he hasn't yet introduced any legislation that would do that. That funding stream hasn't increased in over two decades, and it decreased by 10 percent in 2012.
Murt is also sponsoring legislation for mental health parity, which requires insurers to treat mental health conditions the same as physical conditions.
That's not the case with most insurers, he said.
"Someone might get three or four visits with a therapist to address an anxiety disorder, but we know that three or four visits with a therapist is never going to cure post-traumatic stress, or anxiety, or anything else for that matter."
The bipartisan effort gives lawmakers a better chance to make meaningful change happen, said Democratic state Rep. Margo Davidson of Delaware County. And listening sessions like that one help them to target their efforts.
"We just have to keep fighting the fight, and the fights that matter," Davidson said.