With demand among children increasing, Manchin comes out against bill with funding for mental health

Mental health professionals in West Virginia say there aren’t enough of them and they lack enough resources to help all the children newly seeking help in the state. 

As I outlined in a post this weekend, kids in crisis are ending up in emergency rooms in West Virginia with nowhere to send them. The state lacks both earlier intervention services, like at-home visits and outpatient care, as well as more intensive treatments, like hospitalization and partial hospitalization.

According to the Georgetown University Health Policy Institute Center for Children and Families, the Build Back Better Act would have increased Medicaid funding for states that offer more of the community-based services that providers told me would keep kids from ending up in ERs, as well as grants for that purpose. West Virginia Senator Joe Manchin torpedoed that bill this weekend.

Senator Joe Manchin

Manchin, a Democrat, expressed concerns about the cost of the “mammoth” legislation, among other criticisms; it’s true that the wide-ranging bill included numerous other provisions.

Waitlists and trouble with recruitment

Lisa Zappia, who is on the board of the West Virginia Behavioral Healthcare Providers Association, said calls have increased statewide.

“This is not typically a good time of year for people,” she said.

Adults and children are already experiencing pandemic-related stress and anxiety. Spending time alone at the holidays adds to the struggle.

Following an investigation by the U.S. Department of Justice focused on out-of-state child placements, state officials announced in 2019 they would increase services meant to keep children at home. 

Zappia, who is the CEO of the Prestera mental health center, explained that families also need help from people like case workers to help families with other problems, like hunger and lack of affordable housing. 

But right now, they’re forced to focus on crises.

Zappia said they don’t have a waitlist. They take walk-ins and can use telehealth for walk-ins when needed.

“We’re going to provide what they need,” she said. “Right now the problem will be the wait time to get them back in sometimes.”

But she estimated they had 800 staff members five years ago. Now, they have fewer than 600.

“I could still hire 100 people more easily,” she said, adding that Prestera can’t afford higher salaries. 

Dr. Eric Limegrover, chief clinical director of Westbrook Health Services, said crisis calls have gone “through the roof.” Westbrook is sending mobile units to hospitals and schools, but they still lack places to send kids after that.

“For instance, we had an individual that we tried for two weeks to get placed into a hospital and we worked with one of our partners to continue to monitor,” he said. “This kid needed services and there was no bed anywhere in the state that we could get them in.”

Limegrover said providers have tried to meet the increased need by expanding access to telehealth and providing services through phone calls. And he would like to see expansion continue. But those options come with limitations. Limegrover previously said kids dealing with pandemic-related anxiety and loss of structure and routine are already having trouble with concentration.

Westbrook has a fluctuating waitlist. Limegrover said it’s difficult to recruit in West Virginia, and not enough in-state students are choosing mental health fields. Those that do are less likely to be interested in child mental health, specifically. So Westbrook has contracted with out-of-state providers to offer telehealth.

“It’s so easy to get distracted, especially if you’re doing it at home or in other environments,” he said. “And so the access to care, even with the telephone or computer, misses the mark with us. It’s really important for them to have the structure of a therapeutic session in an office with a provider face to face.”

And young children miss out on services completely. Telehealth behavioral healthcare doesn’t work with elementary schoolers, he said.

Dr. Lauren Swager, division chief for child and adolescent psychiatry at WVU Medicine, said there was no waitlist for child psychiatry in November, but there was a waitlist when I checked back last week. They’d been using a temporary provider who leaves in January, she said.

“I suspect we will rapidly be back to a 6-8 month waitlist quickly again,” she said.

While there is a long-standing waitlist for child therapy services, the waitlist for child psychiatry is more recent. They have the most trouble serving kids with intellectual disabilities because of the lack of providers trained to work with that population.

Swager said Chestnut Ridge is one of few providers that takes Medicaid, which pays less (almost a $100 difference an hour, she said) and which partly explains the wait.

Staffing is down. The hospital has numerous open positions, she said.

“Health care is facing a great resignation and burnout in its staff over the pandemic and staffing on top of long-standing issues,” she said. “Child and Adolescent Psychiatry has been in a provider shortage for decades.”

We have a wonderful group of core providers who give 100% and are super dedicated to their job but it is hard for everyone right now in the firehose of need we face.”

She hopes to see increased salaries, especially for those willing to develop the skills needed to work with kids, greater Medicaid reimbursements, and more funding for the “intermediate level of care,” meaning care that could potentially keep kids from ending up in emergency rooms.

Jamie Hudson, CEO of Pendleton Community Care, said they have grant money but have been searching for a school-based behavioral healthcare provider to work in Pendleton County schools for more than a year.

The state Department of Health and Human Resources recently promoted a program to partially repay student loans for mental health professionals. I reached out to see if there were other recruitment efforts to promote, but haven’t heard back.

Build Back Better

The Build Back Better bill would have expanded mental health crisis services through: funding for the National Suicide Prevention Lifeline and making permanent an increase in Medicaid funding for mobile crisis response.

Also according to the Georgetown Center for Children and Families, the Build Back Better Act included funding for outreach to help kids get and stay enrolled in Medicaid and CHIP health insurance programs and made CHIP funding permanent (so the program wouldn’t have to be repeatedly reauthorized.)

In addition, the bill upped funding for the National Health Service Corps,  which provides loan repayment and scholarship programs to medical, dental, and behavioral health professionals for working in clinics located in areas that lack providers, from $120 million per year to $2 billion, according to Health Affairs.

It also included provisions for kids’ health for other states that West Virginia already has in place, including Medicaid coverage for mothers 12 months postpartum.

Mental health conditions that lead to crises are also treatable. Get help:

From HELP4WV: “When it comes to children, it’s easy to see that something is wrong, but scary and difficult to know where to look for help. We are available 24 hours a day and seven days a week to assist in finding the most appropriate and available treatment for an array of youth behavioral health needs. From parenting support to immediate crisis response, contact 1-844-HELP4WV to talk to a trained Helpline Specialist who can help you understand options and link you directly to treatment providers.”

If you’re in crisis, get immediate help: Call the National Suicide Prevention Lifeline at 1-800-273- 8255, chat with trained counselors 24/7, or get help in other ways through the Lifeline.

This is the last in a four-part series on child mental health in West Virginia, following the declaration of a child mental health emergency by national healthcare groups. Read the previous posts in this series: 

COVID-19 caused more chaos for struggling WV children

Vaccines, civil rights, misinformation: political problems harming kids’ health, too

WV kids in crises ending up at ERs with nowhere to treat them