A lack of resources, long wait times and insurance issues are just some of the challenges for youth mental health, experts in the Valley say.
Using data from Pennsylvania Youth Survey (PAYS), the Greater Susquehanna Valley United Way released the Addressing Youth Mental Health in Rural Central Pennsylvania report in January 2020. The report showed that youth in rural areas are 1.8 times more likely to take their own life and nearly 40 percent of youth in the Valley feel sad or depressed most days. The COVID-19 pandemic highlighted the need to address issues surrounding mental health, especially since any updates this year to the data are likely only to increase the numbers, according to GSV United Way President/CEO Joanne Troutman.
“One hundred percent,” Troutman said about whether the numbers will get worse. “Part of the reason the numbers are higher in rural communities is we are so isolated already. People are feeling that even more now than they were a year ago. The next time we see this data we anticipate it will be higher.”
The key issues in the United Way report include:
-- Under-resourced community-based mental health providers and services.
-- Limited school-based resources and training.
-- Ongoing mental health stigma.
-- The emergence of toxic communities.
Troutman anticipates that an update to the United Way report will be available by the end of the year.
The United Way is working on two grants in order to contract with a company for teletherapy that will enable the school districts to provide the service in a school setting. Resources can be accessed on a mobile device or computer and students can talk directly to a therapist. One company is working on a budget proposal and it’s expected to be rolled out by the fall, said Troutman.
“If we can get grant funding, we can get professionals to work with school districts for students who are falling through the cracks, for kids who are on long waiting lists to see professionals, who are under-insured or uninsured or have a really high co-pay,” said Troutman. “You may have insurance, but if it’s two to three times a week and $30 a shot, that’s a lot for a struggling family. The goal is to eliminate financial, geographic or workforce barriers for families.”
If a student has Medicaid, they can access School-Based Behavior Health (SBBH), meaning they can get services right in school from an outside therapist and others. Generally speaking, this means kids who have some type of commercial insurance cannot universally access SBBH unless the school has a budgeted amount for kids without Medicaid. However, if a student receives a mental health diagnosis from a qualified doctor, that diagnosis would automatically qualify the child for Medicaid, said Troutman.
“There are several challenges with this,” she said. “First, child/adolescent psych docs are hard to come by everywhere and even harder to come by in rural communities like ours. This means wait lists are long. I’ve heard, at best, four months and, at worst, up to a year and a half, families often have to travel far distances (to State College, Hershey, Wilkes Barre) to see these docs which means taking off work and arranging for transportation.”
Second, she said, not everyone who needs therapy has a mental health diagnosis or can get one.
“This all boils down to a population of kids who can’t access SBBH and have to often see a therapist outside of school hours,” she said. “At a minimum, this comes with a co-pay and, often with high deductible plans or plans that don’t cover mental health services, fully out-of-pocket payment to the tune of hundreds or thousands of dollars. If a child has a dual diagnosis like autism? Forget it. There are so few providers who do this type of work, and these families often live in constant crisis.”
COVID magnifies problems
COVID has revealed “significant weaknesses,” she said.
“It has taken every existing challenge, difficulties or weaknesses and magnified it,” she said. “How do we stop it? It feels like putting a cork in a hole in the Hoover Dam. I feel like this report was a wake-up call for people and it’s even worse now. It’s going to take a lot of partnerships and collaboration to get us back on track.”
Stacy Piecuch, senior director of community impact for the United Way, works with the impact council on youth mental health. She said the plan going forward is to create strong partnerships and built resources in the community.
Bucknell University psychology Professor Dr. Anna Baker’s research program focuses on how child/adolescent/parent psychopathology and behavioral factors, such as self-management and transition, relate to health outcomes in chronic illness populations. She also focuses on the implementation of treatments and programs to better address these mental health and behavioral problems in health care settings. She runs a Pediatric Behavioral Health Laboratory and also teaches PSYC 375: Child Health Psychology.
“Right now, we’re going through a period that is unprecedented,” she said. “The more stressors you have in your life the more likely you are to develop a problem. There’s anxiety about the virus. as a society, we’re going through some pretty stressful life experiences. That will increase anyone’s risk at developing a disorder.”
Children and adolescents are more likely to develop a disorder after the pandemic. All children are experiencing risk factors: social issues, changes to schedules, anxiety related to the health of themselves and others, food insecurity and falling behind in school because they lack resources, said Baker.
Baker said the lack of providers and practitioners as well as long waiting lists has been an ongoing issue in the area for youth but the pandemic has caused telehealth to be a focus. Virtual counseling won’t be the normal practice in the future but it is a solution that had to be rapidly adopted, especially for rural areas, she said
“The earlier you deal with these issues the less likely you will have long-term problems in adulthood,” said Baker. “It’s easier to teach coping skills as a young child. If they have the skills and get help, they might be able to identify it in the future and ask for help as an adult.”
Mental health affects physical health as well, she said.
Frequent connection to students is broken
Selinsgrove Area Intermediate School counselor Judy Fatchaline said she is concerned about not having a frequent connection with distance learners.
“There’s an overarching issue with the pandemic: kids continuing to experience social isolation from their peers, not being able to see their extended family members, worries about family members who may have contracted COVID or have been hospitalized, and generalized anxiety. These issues are starting to surface more as the year progresses,” said Fatchaline.
Fatchaline said schools have a responsibility to address mental health needs.
“We have these kids the majority of the day,” said Fatchaline. “I feel like it’s our job to make sure kids are safe. We want to have a pulse on what the students may be dealing with both at home and at school.”
Fatchaline said students are dealing with more anxiety now than they have in the past. There’s a feeling of nothing being in control of situations mixed with normal stressors of school, she said.
Fatchaline said the area is “quite limited” in mental health resources for youth. They work with Geisinger and CMSU, both in Danville.
But, she said, there are challenges. Virtual counseling sessions are not the best option for students; there are limited practitioners so the waiting lists are long; and there are financial setbacks. Even with insurance, families may not be able to afford co-pays.
Children’s Mental Health Program Specialist William Brecker and mental health director Joe Laposky, both of Northumberland County Behavioral Health and Intelectual Disabilities Services, said the referrals for children and adolescents in need of mental health services are down, but that doesn’t mean it’s a good thing.
“There’s no doubt in my mind at all that issues are still predominant,” said Brecker. “From 2016 to 2019, we averaged 590 referrals a year. Last year was 390. Most of our referrals come from the school system. The kids are not physically in school, the schools do not have an opportunity to identify kids with behavioral or mental health needs.”
Parents have a “fear factor or embarrassment factor” or don’t have the resources or expertise to identify mental health needs until the issues rise to crisis levels, said Brecker.
The dangerous behaviors of suicidal threats or self-harming take up the majority of the referrals right now, but that means preventative and proactive strategies and early intervention are not as prominent at this time, they said.
Plus, parents are going through their own mental health issues related to anxiety and isolation, unemployment, new roles, said Laposky.
“This has been a major disruption, to say the least for everyone,” he said.
Age or gender don’t matter
Age or gender does not necessarily affect a person’s ability to cope or navigate through the pandemic or other stressful situations, said Baker.
“A lot of factors go into it,” she said. “If a person has pre-existing issues, genetic vulnerability, how their family life is, what are their other stressors in life, what is their school situation?”
Fatchaline said she sees no pattern at the intermediate level when it comes to gender or age regarding coping skills and COVID situations — everybody is different and reacts in unique ways regardless of their demographic, she said.
Troutman said mental health is related to all things.
“You can’t expect a child to do well in life or in school if they are stressed, or taxed, or collapsing,” said Troutman. “It’s shortsighted to think that we can move on as if nothing happens. If you are struggling emotionally, you can’t problem solve and you can’t get through your day and act like nothing is wrong.”
Piecuch added, “These are the leaders we’ll have in a decade. We need to make sure they are taken care of and completing school. We want to move away from toxic environments and produce emotionally healthy people moving forward.”