Oregon youth mental health professionals are frustrated.
At a roundtable discussion Thursday, medical providers and representatives from a tribal health agency and Portland Public Schools expressed frustration that public and private health insurance plans have left too many young people untreated.
They called for an expansion of the mental health care workforce in schools and an overhaul of outdated regulations that restrict care settings and providers. They also said the federal government should hold insurers accountable for denying behavioral health care coverage to children.
The roundtable was convened on a southwest Portland campus of Oregon Health & Science University by Oregon’s US Senator Ron Wyden. He was joined by Chiquita Brooks-LaSure, head of the federal Centers for Medicare and Medicaid Services, as well as parents and students, to discuss youth mental health care in the new school year.
Wyden said children in Oregon have “sounded the alarm loud and clear” that more mental health support is needed.
The other participants agreed.
A survey of about one-third of Oregon students conducted in 2020 by the Oregon Health Authority and the Oregon Department of Education found that nearly half felt sad or hopeless for more than a two-week period. And a report published this week by Annie E. Casey Foundationfound that the number of Oregon children struggling with mental health issues rose from 11% in 2016 to 16% in 2020, a 40% increase.
Wyden said the pandemic exacerbated the mental health crisis among Oregon children. “This has been an issue before the pandemic and it has mushroomed,” he said.
Wyden, Brooks-LaSure and health care providers agreed that schools need more counselors and therapists. They said Medicaid needed to provide greater access to mental health care.
In Oregon, about two out of five children are insured through Medicaid, the federal program that covers low-income families. Nationwide, nearly half of children receive free coverage from Medicaid and the Children’s Health Insurance Program, or CHIP.
Expanding the workforce
In 2019, the state appropriated more than $1 billion for the Student Success Act of 2019, which helped pay for mental health care in schools. In addition, Oregon received millions from the American Rescue Plan during the pandemic, with directives to use some of it for mental health staff and programs.
But the money hasn’t solved the problems, according to Colt Gill, director of the Oregon Department of Education.
“The Student Success Act gave us money for more counselors,” Gill said at a November meeting of the Oregon Senate Education Committee. “We can’t find them.”
One mother said during the discussion that her son has been on the waiting list to see a school counselor for six months.
Brooks-LaSure said her agency is accepting public comment on a policy that would increase the number of mental health care providers in schools while giving counselors more flexibility in who they treat and their focus. For example, they can treat school children and veterans, or they can work in schools, but also provide family counseling. This would bring professionals who do not currently work in schools. The public can submit comments until the end of August.
Rep. Lisa Reynolds, D-Portland and a pediatrician, said about 30% of her patients are on Medicaid. Some wait weeks or months to see a therapist because of a shortage of mental health professionals.
Reynolds said more doctors should be trained in mental health care and that pay for social workers, counselors and therapists should increase. Although Oregon regulations require equal payment for physical and mental health care, therapists are typically paid less than those who provide physical care. The increase in payments would increase the number of professionals, she said. “We need to compensate mental health care providers the same way we do physical health care providers,” she said.
Randy Kamphaus, director of the University of Oregon’s new Ballmer Institute for Child Behavioral Health in Portland, which offers training programs for students interested in the field, added that interns should be paid while they are being trained. The institute’s first class of 200 students will intern in Portland Public Schools in the fall of 2023, Kamphaus said. They will begin by screening students to identify those at risk or susceptible to mental health problems.
Outdated regulations hinder progress
Many of the medical providers on the panel expressed frustration with policies under Medicaid that limit care.
Laura Platero, executive director of the Portland Northwest Area Indian Health Board, said a restriction that allows providers to seek only one reimbursement when care is provided at a facility has been particularly restrictive. She told Brooks-LaSure that Medicaid should be extended to tribal practices, such as the Healing of Canoe program for Native American youth. The curriculum incorporates tribal traditions and practices to strengthen children’s ties to their culture and to combat suicide and substance abuse.
She said her agency has struggled to help children with their mental health.
“We’ve had a hard time getting hospital treatment for young people, and when we do, we have to wait or it’s very expensive,” she said.
Robin Henderson, chief executive officer for Providence Behavioral Health, said she oversees the only children’s psychiatric unit in the state and that it often has a waiting list. She said administrators face the biggest problem with reimbursements from private insurers. All insurers in Oregon are supposed to include the clinic in their network, but she said many are not.
“We need regulators to hold insurers accountable,” she said.
She criticized some insurers’ requirement for prior authorizations before allowing treatment. Too often they are denied coverage, she said.
“I can’t tell you how many times I’ve heard ‘well this is a behavioral health problem,'” Henderson said. She called on Wyden to continue pushing insurance reforms in Congress.
Money approved for school counselors
Wyden said a “powerful cry for help” from students pushed the recent Safe Communities Act over the finish line. The act, which includes $1 billion for school counselors over five years, was included in a gun safety bill that Congress passed in June.
Oregon student Trace Terrell, a senior at La Pine High School, testified in favor of the measure before the US Senate Finance Committee, which Wyden chairs. Terrell said about 80% of his peers who were referred for counseling had never heard from a counselor.
Wyden said Thursday that Terrell’s testimony had a profound impact on the committee, which played a major role in writing the gun safety bill.
Wyden said more help is on the way. He indicated that Congress is likely to pass a “major bipartisan package” to help states add youth mental health professionals.
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