Americans statistically deal with mental illness/disorder more than any other high-income nation in the world. Almost one in four adults in the United States suffers from a mental illness of some kind, including anxiety, high stress, or depression. But as 50% of mental health issues are established by age 14-17, signs of mental illness are commonly exhibited in adolescents and teens.

Likewise, our mental health crisis has manifested in younger generations as more children in schools have exhibited discernible signs of mental illness. Aside from anxiety and depression, which are present in 4.4% and 9.4% in the child population, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are all becoming increasingly common in adolescents and pre-teens.

Black students with mental illness are proportionally among the least likely to pursue and receive mental health services, along with Hispanic and Asian students.

Black children are more susceptible to depression, anxiety, and other challenges in maintaining mental health than non-Black peers, as issues are typically more persistent. Additionally, statistics report that suicide among Black youth is increasing at a faster rate than any other racial group at 36.6%. Among other causes, racism against Black children is attributable as a huge factor and cause of poor mental health.  Black adolescents are also much less likely than their white peers to seek and find mental health care.

As mental illness and behavior disorders have the potential to derail students subjected to the typical classroom environment, educators have taken steps to adapt in order to provide the best support in achieving academic success. Across states such as California, Texas, Colorado, and Maryland, education has been made more accessible for students with obstacles in mental wellness either through the work of teachers or school boards. 

Here in Dallas, Momentous School provides an educational space that emphasizes emotional understanding and social learning as much as it does the core curriculum to a student body that is 99.5% non-white. Breathing exercises, consistent testing to monitor progress, and highly-curated learning exercises  are instrumented. Lessons crafted under the guidance of child psychologists and other professionals trained to work with students that need additional support or alternative learning structures. These concepts not only provide the best foundation for educational success, but for personal growth and development as well.

Momentous School’s implementation of Social-Emotional Learning runs deep and draws upon training usually only readily accessible in graduate schools. Students not only learn techniques to gain greater understanding and control of their behavior but learn about the brain itself. Thereby, teaching students not only how to communicate what they’re feeling but to understand why.

However, public schools within the Dallas Independent School District are not as fortunate as to have the comparatively vast funding of a private laboratory school.The staff has implemented some methods to promote mental wellness, but don’t necessarily provide as dynamic of a lesson plan as a school that requires tuition for enrollment.

“As a counselor I do my best. One thing I do is mentally check on each child every day at lunch,” Juanita MacFarlane at James Bowie Elementary School says. “Just by doing that I’ve caught a few kids that’ve needed help. As a counselor that’s what I do.” MacFarlane also explained that breathing exercises and stress management techniques have become more commonplace in classrooms since lockdown was lifted.

Counselors at Cedar Crest Elementary also confirm the integration of these methods, citing mental breaks, breathing exercises, and check-ins with students to maintain mental wellness among the student body. However, a student’s struggles are typically more personalized and emphasized within a specific child’s issues, helping them overcome these issues to attune to public mainline or special education rather than being directly accustomed to integrate these techniques in the curriculum’s design.

Mental Health Director of DISD Dr. Tracey Brown explains that counseling is one composite aspect of how mental health is addressed in more serious cases.

 “We work with all our students directly to ensure that they’re mentally in good health,” Dr. Brown says. “We train our teachers and staff to recognize symptoms. At that point, we send them to counselors to determine the cause of those issues, whether that’s something at home or things just aren’t connecting in their understanding.We then get a referral from the counselor to receive help from our clinician on-staff and get parental consent to include them when coming up with solutions.”

These solutions can also include psychiatry or child therapy services. If at this point a student is qualified for specialized learning or needs additional attention, a child will be transferred to the appropriate classrooms within their school. 

While accessibility to specialized learning for students struggling with behavioral issues arising from poor mental health is available for children attending public school, primary curricula with integration of more dynamic concepts is expectedly centralized to private institutions with more freedom and capital to experiment. As Texas public education does not enact initiatives  – let alone allocate funding – for a more full-fledged approach, deeply comprehensive learning experiences for children struggling with depression, anxiety, or behavioral challenges remain more attainable for the middle and upper-class.

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Mindfulness-Based Behavioral Health Rehabilitation Market

The Mindfulness-Based Behavioral Health Rehabilitation Market research report provides a detailed picture of the market by way of study, synthesis, and summation of data from multiple sources. The data thus presented is reliable, comprehensive and the result of extensive research both primary and secondary. The analysts have presented the various facets of the market with a particular focus on identifying the key industry influencers. Moreover, the data underlines the primary and secondary drivers, market share, size, growth, demand, trends, leading segments, and geographical analysis.

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❖ Rehabilitation Facilities

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MIMH Associate Director Rachel Kryah is leading a project with the Missouri Department of Mental Health and Missouri Behavioral Health Council to help raise awareness and guide treatment of individuals who experience first-episode psychosis. (Photo courtesy of Rachel Kryah)

Psychosis often begins to affect people as early as their late teens. They experience some loss of contact with reality, including hearing or seeing things. They can become suspicious of others, have difficulty concentrating or experience other symptoms.

Studies have shown that it’s common for individuals to encounter these psychotic symptoms for more than a year before they’re ever treated.

There’s a concerted effort underway in Missouri to prevent that from happening. The Missouri Department of Mental Health has teamed up with the Missouri Institute of Mental Health at the University of Missouri–St. Louis and Missouri Behavioral Health Council to create an Early Psychosis Care Center with funding from the federal Substance Abuse and Mental Health Services Administration, or SAMHSA. It aims to help connect behavioral health providers and individuals impacted by first episode of psychosis with the resources and support they need.

“There are quite a few early psychosis best practice centers set up across the United States, and that’s just happened in this past decade,” said JJ Gossrau, the director of young adult services for the Department of Mental Health. “I think it’s because of the national focus that this population has received, and it’s also not just limited to the United States. Actually, the UK and other European countries have also had a strong focus in this area, and it is because we know using evidence-based practices to support this population can make such a positive impact in their lives and for their families.”

Early identification and intervention has been shown to shorten the duration of untreated psychosis and can work to lessen the severity of the symptoms. The ultimate goal is to prevent future episodes and, thereby, reduce the frequency of disruptions such as hospitalization and time out of school or employment. A reduction in disruptions can help maintain their routine and continue to reach their life goals.

“We are bringing to the forefront the importance of early identification and intervention to reduce the impact of psychosis on affected individuals,” said Rachel Kryah, associate director at MIMH, who is leading the project. “We’re doing that through educational opportunities and outreach.”

Kryah and her team have been organizing a free Psychosis 101 webinar, bringing in speakers from Stanford University to share information about the coordinated specialty care model. It includes psychotherapy, including cognitive behavioral therapy for psychosis; family education, support and involvement; support from peers recovering from mental illness; psychotropic medications as prescribed by a mental health professional; and assistance with educational and employment goals.

They’re also working to engage community mental health centers and certified behavioral health organizations to build their own coordinated specialty care teams, which are best-practice supports that provide collaborative treatment planning between clients and behavioral health clinicians, psychiatrists and case managers. They take a holistic approach to delivering care and providing services, including assistance with employment and education.

“We are grateful to the CMHCs and CCBHOs for their support,” Kryah said. “We’re glad they are excited because the training to deliver coordinated specialty care can be pretty intense. A coordinated specialty care team has many levels and it is a complex care delivery method.”

Two CCBHOs are in the process of establishing such teams to assist individuals experiencing their first episode of psychosis.

“We’re going be able to help the agencies launch their teams and also provide fidelity, which is just helping the teams stay true to the model moving forward,” Gossrau said. “One of the biggest goals of this whole initiative is to help Missouri find the resources to bring up those teams.”

Gossrau met with a national expert referred to DMH by SAMHSA last fall who told her about initiatives other states were undertaking to treat individuals experiencing their first episode of psychosis. The more Gossrau listened, the more she realized she was going to need more help.

Having worked on previous projects with Kryah and Associate Research Professor Jodi Woodruff, Gossrau found MIMH a logical partner.

“The Missouri Institute of Mental Health has a long history of partnering with the Department of Mental Health, and my relationship with MIMH has strengthened over the years,” Gossrau said. “I think the work that we do together has informed some of the decisions that we make at the department. The work that I’ve done with Dr. Jodi Woodruff – it’s just an easy collaboration. She has a broad scope and knowledge and expertise that she brings, so she’s really good at connecting the dots, at seeing the bigger picture.”

“Rachel is super organized, and she has an eye for not letting the ball drop. She can move things forward, keep people accountable, and she’s truly invested in the work that she does.”

They worked collaboratively to hold the first of what they hope will become an annual conference last April. About 150 people attended in person at the Meridien Hotel in Clayton, Missouri, and nearly 200 more tuned in virtually to hear from speakers from around the country. They are scheduled to hold their second conference April 10-11 at the Courtyard by Marriott in Blue Springs, Missouri.

On Oct. 3, the Early Psychosis Care Center will hold a networking event beginning at 6 p.m. at the Hi-Pointe Theatre. It will feature a free screening of “The Directors,” a film created by the Artangel art collective and directed by Marcus Coates in partnership with people in recovery from psychosis. Attendees will also have opportunities to learn more about the center and can engage in dialogue, foster understanding and show support for individuals who experience psychosis. For more information, email Kryah at Rachel.Kryah@mimh.edu.

Short URL: https://blogs.umsl.edu/news/?p=99943

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After years of work, Larimer County officials gathered in southwest Fort Collins Friday morning to officially cut the ribbon on the Larimer County Behavioral Health Services at Longview Campus building.

The multi-level building that sits on a 40-acre lot at the northwest corner of Trilby and Taft Hill Roads serves as the culmination of a mental health initiative led by the county and funded by a 2018 sales tax of 0.25%.

Larimer County Commissioner John Kefalas, left, participates in a Native American sweet grass blessing with Zach Rockwell, right, at the opening ceremony for the new Larimer County Behavioral Health at Longview Campus in south Fort Collins. (Jenny Sparks/Loveland Reporter-Herald)

Jody Shadduck-McNally, Larimer County commissioner, welcomed the large group of county and other local officials Friday morning, starting off by asking if anyone there had been themselves or had family impacted by mental health issues; many of those gathered raised their hands.

“It (is) important to know that this impacts our community more than people may know,” she said.

The facility, which will be operated by SummitStone Health Partners who will work in collaboration with area hospitals and outpatient behavioral health providers, is meant to serve as a single location for a variety of mental health crises, according to previous reporting. The building houses its own pharmacy, therapy rooms, a full withdrawal management — or detox — wing, a full-service kitchen and a docking bay for ambulances and law enforcement dropping patients off.

Patients are expected to be accepted into the center by early December.

Shadduck-McNally spent several minutes thanking the large group of individuals who helped make the building possible, from those who were with the county years ago to those who are still there today. She also thanked the SummitStone team, who she described as a “cornerstone” partner, as well as the county voters who “overwhelmingly” supported it, adding this creation of this facility may not have been possible in other communities but was in Larimer County because of how everyone worked together.

People walk through the lobby of the new Larimer County Behavioral Health Services at Longview Campus Friday. (Jenny Sparks/Loveland Reporter-Herald)

“This took a community,” she said. “This took a village. And this took an entire county.”

Michael Allen, CEO of SummitStone, also thanked the many people who made the project possible and who came to celebrate Friday. He said that as of now, the facility has hired 75% of the staff that will be needed to run it.

“We will be ready for you when we open in December,” he said.

Friday’s event also included a land acknowledgement, which featured a sweet grass blessing to a large portion of the crowd and several dances by the Iron Family, a third-generation group of Native American performers; each dance represented different stories and ideals such as love for the earth and relief from grief and mourning, among others.

Jan Iron, in speaking to the crowd, said that being able to come and be part of land acknowledgements and being able to perform like this helps continue the memory of those who came before them and and celebrate their lives.

She added she appreciates those who will work to save and help those in need no matter what.

An official ribbon-cutting on the building and self-guided tours followed, allowing those who came to go inside and see what there is to offer.

Allen said getting to see the building after the years it took to get it finished was surreal but important, saying that it is going to change the Larimer County community.

“This facility is one more tool in our arsenal to (lower) suicide rates,” he said. “Because one suicide is too many.”

Shadduck-McNally said the campus was named both for the literal view around the facility and its proximity to the Long View Trail, but also for its connection to how the building will approach mental and behavioral health care, focusing on the long view of helping those in need. She said the center will show compassion, equity and a belief that mental health is a “fundamental right for all.”

“This is only the beginning of our journey for mental health and behavioral health (services) in our county,” she  said.

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LINCOLN — Ahead of the 2024 legislative session, one Nebraska lawmaker is investigating state mental and behavioral health care needs amid a state and national “crisis.”

State Sen. John Fredrickson of Omaha introduced Legislative Resolution 202 to determine the severity of mental and behavioral health provider shortages. Fredrickson said he is evaluating ways to increase health care access, which could involve legislation or non-legislative work.

“As a mental health professional myself, I have seen many of these issues firsthand,” Fredrickson told the Health and Human Services Committee on Wednesday. “The struggle is real, and we must do more.”

Mental Health America this year ranked Nebraska 44th in the nation for a higher prevalence of mental illness coupled with lower access to care. For specific populations, Nebraska ranked 34th for adults and 49th for children. The ranking includes all states and Washington, D.C.

Shortages statewide

Dr. Marley Doyle, director of the Behavioral Health Education Center of Nebraska at the University of Nebraska Medical Center, said 88 of the state’s 93 counties are considered mental health professional shortage areas and Nebraska has 48% of needed behavioral providers, according to the U.S. Health Resources and Services Administration.

However, Doyle said, funding for workforce recruitment has gotten more students in seats for such programs, and providers have been “shocked” at the level of interest. She said it’s hard to say how many more students could be eligible if more funding was available.

Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations. (Zach Wendling/Nebraska Examiner)

Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations and a former state senator, said building a strong foundation is critical to success. For behavioral health, much of that includes provider rates.

“Rates are the bread and butter of every behavioral health provider’s ability to provide care,” Dubas said.

Tami Lewis-Ahrendt, executive vice president and COO of the nonprofit CenterPointe, said many industries shut down during the COVID-19 pandemic, but not community behavioral health providers.

“We kept our doors open, providing support and services to those struggling with new issues and isolation and loss of normalcy,” Lewis-Ahrendt testified.

COVID-19 exacerbated challenges

Doyle, Dubas, Lewis-Ahrendt and other health professionals testified that health care problems existed prior to COVID-19 but have become more acute. 

For example, Lewis-Ahrendt said, telehealth services increased during the pandemic, often with contractors from other states, but it’s sometimes challenging to coordinate licensure across state lines.

State Sen. Tom Brewer of Gordon, with Fredrickson’s support, successfully led Legislative Bill 256 this year so telehealth insurance, particularly in rural Nebraska, would not cost more than in-person visits.

Tami Lewis-Ahrendt, executive vice president and COO of the nonprofit CenterPointe. (Zach Wendling/Nebraska Examiner)

Dubas and Lewis-Ahrendt said there are multiple problems in licensing new providers and backlogs, leaving providers waiting sometimes as long as three or six months with no response.

“Folks who are waiting six months for licensure — those are folks who are ready to go, who are ready to see patients,” Fredrickson said.

Community health and long-term care

The Legislature this spring passed LB 276, proposed by State Sen. Anna Wishart of Lincoln, to create Certified Community Behavioral Health Clinics, or CCBHCs, throughout Nebraska. The clinics are designed to ensure access to coordinated comprehensive behavioral care. 

Lewis-Ahrendt said there is “hope on the horizon” with CCBHCs, but more support is needed.

Kierstin Reed, president and CEO of Leading Age Nebraska, said the rates of mental illness, behavioral health concerns and chronic health conditions are expected to rise for older adults. 

Reed said 198 skilled nursing facilities are currently in Nebraska’s long-term care system, but only 17 of those are designated to support behavioral health needs. Four of those 17 are designated for use only within the state’s correctional system. 

Kierstin Reed, president and CEO of Leading Age Nebraska. (Zach Wendling/Nebraska Examiner)

Without proper facilities, Reed continued, there is a risk for nurses who have a duty to protect their patients but who often are not prepared to address behavioral health.

‘Move the needle’

Despite such challenges, Fredrickson noted the success Nebraska had in the first-year rollout of the nationwide 988 Suicide & Crisis Lifeline, a 24/7 suicide prevention line available to anyone experiencing a mental health-related crisis. Boys Town in Omaha manages the 988 lifeline.

Kyle Kinney, manager of the Nebraska Family Helpline and the 988 lifeline at Boys Town, said that when 988 calls need additional support, such as police or emergency medical services, there is a direct connection. However, the same is not true if someone first calls 911. 

Fredrickson told the Nebraska Examiner he’s looking forward to compiling the information from the “big success” of Wednesday’s hearing. He said LR 202 is a personal “passion project.”

He noted to the committee there is a broad spectrum of support in society at large for supporting behavioral and mental health initiatives.

“I think this is something that we as a Legislature can really come together on and hopefully move the needle on a little bit,” Fredrickson told the health committee.

Fredrickson is leading a related resolution, LR 201, in the Judiciary Committee related to mental health and addiction issues in the Nebraska criminal and juvenile justice systems. He told the Examiner he’s been in touch with the committee and is awaiting further details, though it appears a hearing could come in the next few months.

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FORT CAVAZOS, Texas – The Carl R. Darnall Army Medical Center will implement a three-tiered approach to consolidate from seven unit-aligned Embedded Behavioral Health clinics to five unit-aligned Outpatient Behavioral Health Clinics. This consolidation will help improve health and build readiness by better aligning our talent and stabilizing our organizational structure. Further, it will allow us to continue to ensure real-time access to urgent behavioral health needs and improve unit-aligned quality of care.

The Fort Cavazos behavioral health team understands that the mental health and well-being of service members are vital to the overall readiness and effectiveness of our military force. This consolidation initiative aligns with our commitment to supporting our troops and their families, ensuring they have the resources they need to thrive.

Our amazing Healthcare workers have been under significant pressure these past few years and that pressure has taken a toll. Many have taken a temporary hiatus or left the profession entirely. We’ve struggled to replace these staff, forcing those who remain to carry the load, which increases the risk of burnout and causes us to lose more staff. These enterprise-wide staffing problems exist across the entire health care landscape, not just in military medicine.

Tier 1: 1st Cavalry Division’s 1st and 2nd Brigade Units
The Embedded Behavioral Health (EBH) clinics for 1st and 2nd Brigade units are now consolidated at Outpatient Behavioral Health Clinic (OBH) 1, Building 37016, 147 Manila drive, next to the Ironhorse Chapel. By bringing these units together at one centralized location, we aim to foster a stronger support network and streamline the delivery of mental health services for our brave Soldiers. This consolidation will facilitate improved coordination between the units, ensuring that the personnel can readily access the care they need.

Tier 2: Outpatient Behavioral Health Clinic 8 Consolidation
On 15 SEP 2023, Embedded Behavioral Health (EBH) Clinic 8 will consolidate with Embedded Behavioral Health (EBH) 4, which will now be Outpatient Behavioral Health Clinic (OBH) 4, located at Building 9410, 397 N. 19th Street, across from Burba Gym. This consolidation will further bolster our capacity to address mental health challenges by creating a more comprehensive and efficient care center.

Tier 2 realignment units are:

1st CAV SUST BDE supported by OBH 3

1st CAV AVN BDE supported by OBH 4

3rd SFAB supported by OBH 4

69th ADA BDE supported by OBH 5

36th ENG BDE supported by OBH 5

DIVARTY/ HHBN 1 CAV DIV/0056ADA BN/ TR DEF Counsel/ 1st CAV DIV Band/ and 23rd ADJ General Center supported by Multi-D

Tier 3: Substance Use Disorder Clinical Care (SUDCC) Program
Tier 3 move includes all SUDCC staff moving into OBH 8 on Friday 15 SEP 2023. All Ft. Cavazos Soldiers receiving Substance Use Disorder care will be supported by a unit aligned, centralized SUDCC campus (formally EBH 8). The SUDCC campus will now be situated at the former Embedded Behavioral Health (EBH) 8, specifically at Buildings 424, 415, and 413. This strategic move allows us to better provide specialized care for those in need of substance use disorder support while leveraging existing facilities.

Points of Contact REMAIN THE SAME: Front desk staff:

Outpatient Behavioral Health Clinic 1 254-553-8711 or 8714

Outpatient Behavioral Health Clinic 3 254-553-5720 or 5702

Outpatient Behavioral Health Clinic 4 254-553-8671 or 8760

Outpatient Behavioral Health Clinic 5 254-288-1560 or 6474

Multi-D 254-553-3623 or 3624

Substance Use Disorder Clinical Care 254-287-0183/1893 or 254-553-3150

Emergency protocols and hospitalization processes REMAIN THE SAME

Hours of operation REMAIN THE SAME. M-F, 0730-1630

As it embarks on this important journey to strengthen mental health services and suicide prevention measures, CRDAMC’s behavioral health team hopes that together with the community it can continue a positive impact on the lives of our service members.

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Oklahoma is transforming its approach to treating and preventing mental health issues. Evidence of this transformation is abundant. In March, state and local leaders broke ground on a new $70 million, 106-bed psychiatric hospital in Tulsa. Since its launch last July, 988 ― the three-digit lifeline anyone can call at any time for help with a mental health challenge ― has received nearly 40,000 calls from Oklahoma. And communities across the state have dedicated millions of dollars in local funds to launch new mental health services and resources for their most vulnerable residents.

This unprecedented level of investment has generated significant momentum for improving mental health outcomes in our state. To sustain that momentum, we must continue to remove the barriers too many Oklahomans face in accessing care.

For more than 2 million Oklahomans with private health insurance, a persistent barrier has been finding an in-network behavioral health provider who can be seen in a reasonable amount of time. In a recent survey of licensed behavioral health providers conducted by Healthy Minds Policy Initiative, 23% of actively practicing psychiatrists said it takes one to three months to get an appointment.

Gov. Kevin Stitt signed two bills this year that are among the strongest reforms anywhere in the country to address the issue of “ghost networks” ― insurance plans that appear robust on paper but in fact include inaccessible or nonexistent providers. Such networks commonly force patients to wait months for care, incur higher costs to see an out-of-network provider or go without care altogether.

Senate Bill 442 addresses high patient costs and excessive wait times for appointments by ensuring the accuracy of commercial health insurance plans’ directories of in-network providers. Senate Bill 254 caps out-of-pocket costs for consumers with private insurance when an insurer can’t arrange a timely appointment with an in-network provider. These bills address key takeaways of a report released earlier this year by Healthy Minds that found most behavioral health providers listed on health plan directories can’t be reached, aren’t actually in-network or can’t schedule an appointment in a timely manner.

We commend Sen. Jessica Garvin, former Sen. John Michael Montgomery, and Reps. Chris Sneed and Jeff Boatman for their leadership in tackling this issue. Oklahomans with private health insurance should be prepared to hold their carriers accountable when the new laws take effect on Nov. 1. The Oklahoma Department of Insurance’s Consumer Assistance Division provides resources and support to consumers navigating issues with insurance companies.

The biggest opportunity now ahead of Oklahoma is to increase the size and reach of the state’s behavioral health workforce. We face an acute shortage of critical professions that is projected to worsen if left unchecked. According to the Oklahoma Legislative Office of Fiscal Transparency, 2021 marked a 10-year low in the number of mental health-related degrees conferred by Oklahoma higher education institutions. And research published in the American Psychiatric Association’s journal Psychiatry Services found that the number of psychiatrists leaving the workforce will be more than twice that of those joining the workforce by 2024.

Earlier this year, the Legislature created two new behavioral health workforce development funds to retain existing professionals and support clinicians who want to advance their careers. However, only one fund received an appropriation, leaving the full potential of these workforce development tools unrealized. Several legislators have requested interim studies on Oklahoma’s behavioral health workforce. We encourage legislative leaders to seriously consider this issue and explore innovative funding solutions that incentivize growth in high-need occupations.

By investing in the development, retention and recruitment of behavioral health care providers, our state can sustain its momentum on mental health and improve the availability and accessibility of services that benefit all Oklahomans.

Zack Stoycoff is executive director of Healthy Minds Policy Initiative, a policy think tank working to improve mental health outcomes in Oklahoma.

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August 21, 2023

4 min read

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Key takeaways:

• New guidance aims to help emergency physicians dealing with pediatric mental and behavioral health emergencies.
• Experts called for systemic changes, more resources and a focus on inequities within the system.

The AAP published guidance for emergency physicians that addresses best practices for managing pediatric mental and behavioral health emergencies, its first since 2018.

The American College of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA) collaborated with the AAP on the guidance, which calls for systemic changes, more resources and a focus on inequities.

We spoke with Mohsen Saidinejad, MD, MS, MBA, FAAP, FACEP, a professor of clinical emergency medicine and pediatrics at the David Geffen School of Medicine at UCLA and member of the AAP and ACEP committees on pediatric emergency medicine, on the changing landscape of pediatric mental health, updates to the guidance and takeaways for providers. Saidinejad’s responses have been lightly edited for clarity.

Healio: How has the landscape of pediatric mental health changed from the most recent policy statement on the subject?

Saidinejad: The last policy statement that we had was in 2018. The AAP, the ACEP and the ENA each had their own policy statement with their own variations. So, one of the things that we decided to do is to have the three organizations be invited at the table together and make a joint statement. We really felt strongly that a lot has changed [in pediatric mental health].

Clearly, the scope of the problem has become much greater. A lot more children and youth are coming to the ED with these complaints related to mental and behavioral health issues. The complexity has also increased. They are not just simple one-time visits, but these are kids who seem to have a history of having mental health issues. The other thing that has changed is that we’re starting to see kids younger and younger. We never used to see a 5-year-old child come to the ED with a mental or behavioral health problem, and that’s another thing that’s completely new to us.

The urgency has really increased quite a bit, and in 2021, the AAP, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association, published a joint statement calling this pediatric mental health problem a crisis and a public health emergency. This is definitely getting a lot of attention nationally; it’s a moving target. We continue to get increased burden [in] the ED, and we’re just not well equipped to handle this because prolonged wait times for children to be assessed. There’s also boarding in the ED, and all of those have increased to a point where we felt that we need to provide some kind of resource guide for what EDs can do to manage this increase in the number of children.

Healio: Can you outline some of the more prominent updates?

Saidinejad: The general theme was that we wanted to address the entire spectrum of emergency care. We do have sections in our policy statement that specifically address a screening and assessment part. Then there’s the ED-based interventions, and then there’s the safe discharge planning.

We’ve mentioned things like use of telehealth, use of preagreed arrangements with psychiatrists to come and cover your hospital. In other words, know who you’re going to consult, and how you’re going to do that, and invest in the infrastructure to get that psychiatric referral.

The other thing is screening, so you can identify which child really needs to be expedited when it comes to mental health. We also know that the majority of children who come to the ED with mental and behavioral health problems can be safely discharged. So, it’s really important to add more resources for those children who are acutely addressed for harming themselves or others.

The problem is overwhelming, but if you were able to safely discharge 80% to 90% of the children, then you have 10% to 20% scope of the overall problems. So, we talk a little bit about screening, and we talk about things to do with telehealth.

We also talk about having standing protocols about how you manage to talk about potentially having a space that children with mental or behavioral health (issues) can be taken care of that might be further away from the rest of the ED. It’s safer for them and safer for the rest of the ED, especially those general EDs that don’t have even a pediatric space.

We also talk a lot about things to do with safe discharge planning. For example, if you feel that a child has access to lethal means, being able to provide … counseling and trying to figure a way that maybe access to that lethal means can be either eliminated or decreased by you know, engaging the family. And one last view is in the schools. We wanted the schools to also [be involved] in recognizing identifying and referring children for care.

Healio: What would you most like providers to take away from this?

Saidinejad: The most important thing is that this problem [has] a great scope. It is a problem that continues to escalate. We are unfortunately seeing a lot of these children coming in with mental behavioral health issues. We don’t really completely understand the underlying cause of it, although we can make some guesses.

It is important to realize that, first of all, it is important to screen and identify those who are at lower risk, and then be able to connect them with mental health follow ups. The other thing we want them to take away is that a primary care doctor or a medical home really should be more engaged in identifying and being able to find opportunities for mental health follow-ups for these children before the problem becomes an emergency. Early recognition should be part of the initial annual visits for a child to their primary care doctor.

Finally, we want to recognize the role that schools play in being able to help children get access to resources. The take-home message is that the problem is great, but there are some strategies that can make things a little bit easier.

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Mary Greeley Medical Center’s new, 24-bed behavioral unit is expected to drastically improve the hospital’s mental health services.

As the need for mental health services continued to rise in recent years, Story County’s biggest hospital couldn’t keep up, hampered by Iowa’s limited offerings. Just 995 inpatient psychiatric beds were licensed at 26 hospitals for a state of more than 3 million people, according to the Iowa Department of Health and Human Services in November 2022.

Mary Greeley was forced to deny services to more than 2,000 patients last year, often running at capacity. Local physicians still attended to 631 patients in the old unit, an average of 13.4 per day.

The Ames facility previously offered long-term mental health services on a portion of the sixth floor, offering 18 beds. Limited space meant seven rooms housed two beds, sometimes used for just one person.

The entire fourth floor of the south tower is the new home of the behavioral unit, which opens Wednesday.

The floor boasts 20 single rooms, with only two double occupancy rooms, an upgrade director of behavioral services Chris Mayfield said will “really increase our access.”

“I would say we at least doubled our occupancy,” Mayfield said.

A single room in the Behavioral Health Unit at Mary Greeley Medical Center has many safety features to protect the patient and the staff. The new unit offers 24 beds, including 20 single-bed rooms to accommodate more patients at any given time.

Recent bed shortages have forced hospitals to turn away psychiatric patients, with Mary Greeley getting hit hard. An average patient’s length of stay is between six and seven days.

“In the past, we have turned away approximately 300 patients a month,” Mayfield said. “So, definitely increasing that access is the most important thing.”

Behavioral Health Unit offers many safety features

Safety was a top priority as hospital officials designed the unit. From the layout, which provides staff members a good line of sight, to construction details, such as safety screws that eliminate possible ligatures.

With three distinct areas, the behavioral unit has six single rooms for high-acuity patients and six single rooms for those with moderate conditions. The general unit offers eight single rooms and two doubles.

Each room offers a uniform design and a wealth of safety features. The built-in beds have a one-piece, quilted mattress cover and bedspread that are thick enough to discourage use as ligatures.

The rooms also have a large, heavily weighted foam-rubber table, non-ligature fixtures, and breakaway bathroom doors.

The door to each room sounds an automatic alarm if more than two pounds of pressure are applied to the top, which can only be turned off with a key.

Even the plumbing system and drain have been designed to eliminate the potential for self-harm, Mayfield said.

Water can be individually shut off in each room, which Mayfield said is helpful when a patient tries to flood a sink or toilet.

“I really appreciate all the safety features because I think that your patients as well as your staff understand whether they’re someplace that’s safe,” Story County Supervisor Linda Murken during a tour of the new unit. “They’ll see and know they’re safe.”

For patients who want to be out of their rooms but don’t want to immerse themselves with a group, a bench in the hallway is an optional place to sit in Mary Greeley’s new Behavioral Health Unit.

Rooms for therapy, entertainment and quiet time offer

Patient comfort and entertainment were also considered in the design phase. Social areas complete with large TVs and gaming systems were built into the unit, while several bench areas were constructed throughout the hallways,

The benches were recommended by the Mental Health Patient-Family Advisory Council, which had input on the unit’s plan, Mayfield said.

Corners in public areas are rounded, also recommended by the advisory council.

“I really appreciate that you used some of the suggestions from the advisory committee,” Murken said.

Quiet activity rooms were built for patients wanting alone time outside their rooms.

Stations in the moderate-acuity and general areas of the unit allow patients access to drinking water, which frees up staff for other tasks.

Three seclusion rooms with padded walls and floors were built as well. A therapy room will be used for various activities, including group therapy, pet therapy and music therapy.

Currently, 28 nurses, including two administrators, are stationed in the Behavioral Health Unit, seven of which are psychiatric board certified. The staff includes 10 psychiatric assistants, a nurse case worker and two licensed social workers.

With plans to add a mental health therapist soon, the unit employs one psychiatrist and two psychiatric nurse practitioners.

A single room in the Behavioral Health Unit at Mary Greeley Medical Center has many safety features to protect the patient and the staff. The new unit offers 24 beds, including 20 single-bed rooms to accommodate more patients at any given time.

Ronna Faaborg is a reporter for the Ames Tribune. Reach her at rlawless@gannett.com.

This article originally appeared on Ames Tribune: Safety, comfort highlight new Mary Greeley Behavioral Health Unit

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In partnership with The Repository, every Monday, Stark Community Foundation highlights positive happenings in our community. Here’s to Good News Mondays!

After behavioral health emerged as the top concern during the 2022 Stark County Health Improvement Summit, a dedicated group of community leaders, convened by Stark Community Foundation, joined forces to address the issue and seek collaborative solutions to enhance health outcomes.

With representation from various sectors across Stark County, the Stark County Behavioral Health Collective embarked on a journey to create a roadmap for fostering a north star for behavioral health: everyone struggles; no one struggles alone.

Amy Krebs, vice president of grants and community initiatives at Stark Community Foundation, highlighted the urgency of the situation, sharing, “During last year’s Health Summit, 76% of community leaders expressed concerns about the insufficient mental health services in Stark County. Challenges such as staffing shortages, limited access to care, stigma reduction, affordability and the lack of integration of mental health into other health care services were identified.”

As a foundation with a deep community commitment, convening role and collaborative approach, Stark Community Foundation took the lead in bringing a growing network of community partners together to discuss the complex challenge of behavioral health and explore opportunities for collaboration.

Through months of guided discussions and brainstorming sessions, a shared community vision for behavioral health was developed, resulting in the development of nearly 125 health improvement experiments and strategies.

To streamline the process and obtain a more focused approach, facilitators assisted in reducing the extensive list of strategies to a final selection of 10. These 10 strategies were presented for discussion and voting at the 2023 Health Summit.

More Heart of Stark:Stark County Imagination Library celebrates enrollment milestone

What are the top strategies?

At the Health Summit, local participants chose five of the selected strategies to address the priority health need of mental health access, as identified in the 2022 Community Health Needs Assessment.

“Working with entities across various sectors and through data collection, the five selected strategies will be utilized to monitor incremental change in improving mental health in Stark County,” said Dr. Anju Mader, chief integration officer at Stark County Mental Health & Addiction Recovery. “We encourage agencies and organizations to explore the 120+ collective work strategies to address and improve mental health access. While no one strategy is definitive, collaborating on concurrent multiple strategies can have a cumulative effect.”

This year’s strategies are:

1. No cellphone usage in schools to improve mood and focus. In May 2023, the U.S. Surgeon General Dr. Vivek Murthy issued an advisory on the impact of social media use on the mental health of youth. The advisory highlighted concerns about the harmful effects of social media, including exposure to violent and sexual content, bullying, compromised sleep and limited personal interactions. The surgeon general emphasized the lack of evidence supporting the safety of social media for young people and the growing evidence linking its use to mental health issues. To address this national youth mental health crisis, our proposed strategy is to implement a “no cellphone usage in schools to improve mood and focus” policy. This approach aims to minimize students’ exposure to social media during the school day, with the hypothesis that it will lead to improved mood, increased attentiveness and a better learning environment.
2. Guaranteed funding for addressing non-treatment barriers for behavioral health access. When individuals who are already struggling with mental health issues face non-treatment barriers to seeking clinical care, it can further increase their stress and anxiety levels. To address this problem, our strategy aims to help individuals overcome these barriers, such as transportation and childcare. Resources will be made available through various avenues to alleviate these barriers and ensure easier access to necessary healthcare services.
3. Behavioral health support for school staff within their school district. Our school districts are facing the challenging responsibility of not only educating students but also addressing their behavioral and mental health challenges. Furthermore, schools are now extending their support to help families meet basic needs. As a result, the school staff is experiencing significant burdens. To address this issue, behavioral health support will be provided specifically for staff members. This support will include education, clinical services and non-clinical, evidence-based programming.
4. Formalized partnerships between behavioral health providers and medical offices/urgent care centers for streamlined and efficient care. With this strategy, patients who have been identified by their primary care office or local urgent care centers as having mental health struggles and requiring mental health services will receive priority in scheduling appointments at behavioral health partner agencies.
5. Digital technology platform to unify health and human services through shared data. Collaborative partners from the health and human services sectors will come together to utilize a data entry platform that serves as a unified record of care for our most vulnerable populations. This platform will enable screenings to assess basic needs and facilitate connections to community resources. By doing so, the platform will generate comprehensive and up-to-date data. This data will help identify improvements in individuals’ health outcomes, as well as highlight any gaps in resources and services. This valuable information will allow for better allocation of resources and improved support for those in need.

What are the next steps?

“As part of our Community Health Improvement Plan, these strategies need support from everyone in the community, not just agencies or programs,” said Kay Conley, director of administration and support services for the Stark County Health Department. “Any agency or individual can support and adopt some of the processes, behaviors or systems under one or more of these strategies. First, people need to be aware of and get behind the strategy, and then they have to figure out how they can support the work on a personal, agency or systems change level.”

Each strategy will be supported by a working committee consisting of dedicated volunteers who are committed to advancing that particular strategy. If you are interested in participating in one or more of these working groups, reach out to Conley at conleyk@starkhealth.org or 330-451-1446.

Stark Community Foundation helps individuals, families, businesses and nonprofits achieve their philanthropic goals through a variety of charitable funds and strategic initiatives. Ranked in the top 10% of community foundations in the country, the foundation and its family of donors have granted $230 million to nonprofits since 1963. Learn more at www.starkcf.org.

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