Youth mental health professionals in Oregon are frustrated.
During a roundtable discussion Thursday, Aug. 11, health professionals and representatives from the Portland Public Schools and Tribal Health Agency expressed frustration that public and private health insurance plans are leaving many young people without treatment.
They called for an increase in the number of mental health professionals in schools and a review of outdated rules that limit facilities and service providers. They also said the federal government should hold insurers accountable for refusing to cover behavioral health services for children.
The roundtable was convened at Oregon Health & Science University’s Southwest Portland campus by Oregon US Senator Ron Wyden. He was joined by Chiquita Brooks-LaSure, chair of the federal Centers for Medicare and Medicaid Services, as well as parents and students to discuss youth mental health in the new school year.
Wyden said children in Oregon are “sounding the alarm loud and clear” that more mental health support is needed.
Other participants agreed.
A 2020 survey of about one-third of Oregon students by the Oregon Health Authority and the Oregon Department of Education found that nearly half had felt sad or hopeless for more than two weeks. And the report released this week Annie E. Casey Foundationfound that the number of Oregon children with mental health problems increased from 11% in 2016 to 16% in 2020, a 40% increase.
Wyden said the pandemic has exacerbated Oregon’s children’s mental health crisis. “This problem existed even before the pandemic, and it grew like mushrooms,” he said.
Wyden, Brooks-LaSure and health care providers agreed that schools need more counselors and therapists. They said Medicaid should provide more 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 (CHIP).
Expanding the workforce
In 2019, the state allocated more than $1 billion for the Student Success Act of 2019, which helped pay for mental health services in schools. In addition, Oregon received millions from America’s Pandemic Rescue Plan, with directives to use some of it for mental health staff and programs.
But the money didn’t solve the problem, 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 psychologist for six months.
Brooks-LaSour said her agency is accepting public comment on the policy, which would increase the number of mental health providers in schools, giving counselors more flexibility in who they treat and their focus. As an example, they could treat school-aged children and veterans, or they could work in schools but also offer family counseling. This would make it possible to attract specialists who do not currently work in schools. The public can submit comments until the end of August.
Congresswoman Lisa Reynolds, a Portland doctor and pediatrician, said about 30 percent of her patients receive Medicaid. Some wait weeks or months to see a therapist because of the lack of mental health professionals.
Reynolds said more doctors need to be trained in mental health care and payments to social workers, counselors and therapists need to increase. Although Oregon regulations require equal payment for physical and mental health care, therapists are generally paid less than those who provide physical care. According to her, the increase in payments will increase the number of professionals. “We need to compensate mental health providers the same way we compensate physical providers,” she said.
Randy Kamphaus, director of the new Ballmer Institute for Child Behavioral Health at the University of Oregon in Portland, which offers training programs for students interested in the field, added that interns need to be paid while they learn. The institute’s first class of 200 students will complete internships in Portland Public Schools in the fall of 2023, Kamphaus said. They will begin by screening students to identify those who are at risk or prone to mental health problems.
Outdated rules hinder progress
Many of the health care providers in the group expressed frustration with Medicaid policies that limit health care coverage.
Laura Platero, executive director of the Northwest Portland Indian Health Council, said the restriction, which only allows providers to seek reimbursement when care is provided in a facility, is particularly restrictive. She told Brooks-LaSure that Medicaid should be extended to tribal practices, such as the Healing Canoe program for Native American youth. The curriculum incorporates tribal traditions and practices to strengthen children’s connections to their culture and to combat suicide and substance abuse.
She said her agency is trying to help children with their mental health.
“We’ve had a hard time finding inpatient treatment for young people, and when we do, we have to wait or it’s too expensive,” she said.
Robyn Henderson, executive director of the Providence Department of Behavioral Health, said she runs the only child psychiatric unit in the state, and it often has a waiting list. According to her, administrators face the biggest problem with reimbursements from private insurers. All insurance companies in Oregon are required to include the clinic in their network, but she said many do not.
“We need regulators to hold insurers accountable,” she said.
She criticized some insurance companies’ pre-authorization requirements before allowing treatment. Many often deny coverage, she said.
“I can’t tell you how many times I’ve heard back, ‘Well, it’s a behavioral health problem,'” Henderson said. She urged Wyden to continue pushing insurance reforms through Congress.
Money is approved for school counselors
Wyden said a “loud cry for help” from students pushed the recent Safe Communities Act across the finish line. The legislation, which provides $1 billion for school counselors over five years, was included in the 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 is chaired by Wyden. Terrell said about 80 percent of his peers who were referred for counseling had never heard of a counselor.
Wyden said Thursday that Terrell’s testimony had a profound effect on the committee, which was instrumental in writing the gun safety bill.
Wyden said help is coming. He noted that Congress is likely to pass a “major bipartisan package” to help states add youth mental health professionals.
Alex Baumhardt, press partner Oregon Capital Chronicle