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Jennifer Blossom is a clinical child psychologist and assistant professor at the University of Maine. These are her views and do not represent those of the University of Maine System or the UMaine. She is a member of the Maine chapter of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.
I have had more than a decade of experience as a youth mental health provider. One of the most challenging parts of my job is meeting youth and families at a crisis point. In many cases, this meeting takes place in a less than desirable location, such as behind a curtain in a busy emergency department. Often families are stressed, anxious and unsure what to expect.
In many cases, this crisis could have been avoided — if only families were able to access treatment earlier. In most cases, families struggled to access care due to factors outside of their control. For example, they could not find a local mental health provider. Local providers had really long waitlists. Local providers did not offer youth treatment. Or the treatment they were getting was not evidence-based and not working. Many of the youth and families I worked with had troubling stories to share about desperately trying to get connected to care.
One of the primary issues when youth and families try to get mental health treatment is that the number of youth who need treatment vastly outpaces the number of available providers. Even when youth are able to get treatment, few clinicians provide treatments that we know work. This means that youth and families spend time and money on treatment that may not be helpful. Such experiences may decrease families’ willingness to seek treatment in the future. In turn, clinicians have fewer openings to take on new patients.
We can’t rely on traditional outpatient mental health care. The traditional model requires clinicians to complete multiple years of schooling and supervised practice. This process takes multiple years. Even if we were able to increase the number of therapists by 50 percent, we still would not meet the need. We can’t wait.
Luckily, there are promising ways to help kids and families get mental health treatment that works when and where they need it. Maine needs collaborative care to address our youth mental health crisis. Collaborative care brings mental health services to primary care settings. Specifically, collaborative care requires insurance companies to cover the cost of these services.
Adopting collaborative care in Maine could increase the availability of youth mental health services. Maine’s primary care and family medicine practices could offer compensated mental health services. Collaborative care could decrease stress on Maine’s already stretched health system. In a recent review of state data (“Nonfatal Intentional Self-Harm and Health Care Usage in Maine,” by Kimberley Fox, Bridget Noé, Catherine McGuire, Sheila Nelson, Mary Caron and Pamela Foster Albert), my colleagues found that 91 percent of people seen in Maine emergency departments for self-harm visited primary care in the preceding year; 47 percent of those individuals visited their primary care doctor within one month of the event. These primary care visits were missed opportunities. For many of those individuals, getting treatment earlier could have kept them safe and out of the emergency department.
Enacting collaborative care would allow Maine to change the way we provide youth mental health treatment. Collaborative care increases the number of clinicians eligible to provide reimbursable mental health treatment. States get to decide the specific services and providers that can bill for collaborative care.
Ways that Maine can increase providers under collaborative care include expanding statewide efforts to integrate community health workers into mental health. Or allowing reimbursement for supervised mental health clinicians (e.g., University of Maine System graduate students) who provide mental health services throughout the state. There is a growing number of brief and flexible evidence-based mental health treatments that can be used in primary care. Adopting collaborative care promises that youth and families can get scientifically sound treatment when and where they need it.
Our youth and families need us to act now. Please call your local representative and ask them to support collaborative care.
