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Mental health crisis: Help eludes even the youngest San Diegans

San Diego Union-Tribune - 9/26/2022

The crisis in mental health care for kids can be seen at all levels, but especially in the 24-bed psychiatric unit at Rady Children's hospital.

"Currently, at all times, we have a waiting list for our inpatient psychiatric beds at Rady," said Dr. Benjamin Maxwell, the hospital's interim director of child and adolescent psychiatry in a recent interview.

"There was already a crisis in pediatric mental health, and the pandemic really amplified it," adds Dr. Willough Jenkins, a psychiatrist and director in Rady's emergency behavioral health unit.

Treatment beds, she said, have been perennially full, not just at Rady, but at the handful of other facilities able to admit children. Often, kids will spend time in non-psychiatric units waiting for space to come available.

"When you show up in an emergency room, you are not getting to an inpatient unit that day; it's impossible," Jenkins said.

Both said that the hospital is able to manage by treating kids in other parts of the hospital, so kids in immediate need are not being turned away.

Rady is far from alone, with peer facilities across the nation often reporting even more severe capacity problems. The situation is critical and broad enough to attract national attention, with U.S. Surgeon General Vivek Murthy issuing an advisory on America's "Youth Mental Health Crisis" in December 2021. In August, Gov. Gavin Newsom signed a $4.7 billion "master plan" for children's mental health.

But big plans take time to deliver results and many broad solutions are still years away. Rady, for example, is working with the county on a significant expansion plan but it is not expected to break ground until 2025.

Meanwhile, it's clear that many kids are just not getting what they need. A survey of 1,200 California students in 2020 and 2021 found that 68 percent said they feel they may require mental health services but are not receiving them. Sources of stress ranged from family and financial pressure to missing peers and friends during the pandemic.

While broad solutions will not appear immediately, some organizations are doing what they can in the meantime to expand their programs.

Episcopal Community Services in San Diego recently announced that it will expand its Para Las Familias program serving under-resourced families in San Ysidro with the help of a nearly $250,000 county grant while the San Diego Center for Children, San Diego's oldest child-serving nonprofit, just received a $1 million grant from Rest Haven Children's Health Fund to add capacity to its existing services serving children with mental health care needs.

The need, said psychologist Moisés Barón, director of San Diego Center for Children, has long been the most severely impacted for families with the least resources."

"The pandemic didn't cause this situation, but it has made it worse," Barón said. "It may take them weeks, if not a couple of months, to be able to make an appointment for their child with commercial insurance.

Increasingly, charitable organizations are stepping up to fill the gap. In 2017, for example, the David C. Copley Foundation contributed $5 million, with another $1 million from a fundraising event matched by local philanthropist Ernest Rady, to build the hospital's psychiatric emergency department, which has been full since opening in 2020.

San Diego's Price Philanthropies has also made children's mental health issues a focus for years, giving more than $1 million to create a behavioral health urgent care clinic inside an existing Rady facility in 2017, working with schools to increase mental health care availability and now working to expand training opportunities, helping UC San Diego create a post-graduate fellowship program for nurse practitioners focusing on mental health care for children and adolescents.

The latest grants are focused on increasing treatment capacity outside hospitals and emergency rooms as quickly as possible.

Elizabeth Fitzsimons, chief executive officer at Episcopal Community Services, said the organization's Para Las Familias program, which has traditionally offered bilingual mental health services to kids younger than age 5 will be able to expand to age 12 with the help of the county's grant. She said the additional resources will allow counselors to serve families, including older siblings also affected by a wide range of stressful situations ranging from a parent's job loss or divorce to neglect or domestic violence.

"Coming out of the pandemic, we're finding that kids have really experienced a lot of extra stress in their families, especially if their family does not have a lot of financial resources," Fitzsimons said.

Additional funding, she added, should push the program's overall capacity from 300 to 350.

Rest Haven, an organization first formed in the early 1900s to treat children with tuberculosis, sees the current pediatric mental health situation as dire enough to give the largest single grant in its history, allocating $1 million to San Diego Center for Children, which already runs extensive mental health care programs throughout the region.

Cass Kaminetz, Rest Haven's executive director, said that the Center for Children's proposal built on the organization's already expansive work serving kids in partnership with Rady. That history, she said, gave the board confidence.

"The idea was already there and a proven concept; they just needed a kick start to get it going, and I think that's something that really resonated with the board," Kaminetz said.

Plans include launching a new mental health access program, expansion of existing outpatient services and expansion of intensive services such as partial hospitalization and other "step down" services for kids who were recently treated in hospital units.

The grant is expected to expand capacity by about 1,450 youth per year.

Barón said the difficulty in expanding mental health care programs is not just down to funds. An acute workers shortage limits outreach efforts, though new programs will use "peer support specialists" and also master's degree-level graduates who need clinical experience to become licensed therapists as a way to expand quickly. A bill signed in 2020 allows for licensing of peer support workers, and Barón said that the access program will use the new legislation to expand care at the base.

"We need to do a better job of identifying what are some of the things that they can do, what is some of the prevention work that they can do, train them, and be able to supervise them to provide that level of care," Barón

said. "Not everybody needs to see a psychiatrist or a psychologist; we need to be able to do a better job of being able to really train this full continuum of providers and make sure there is a good match in terms of the level of care that's needed and received."

"The idea was already there and a proven concept but just needed a kick start to get it going,"

This story originally appeared in San Diego Union-Tribune.

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