By Jennifer Fiorillo
Mental Health
Jennifer Fiorillo
With the start of the legislative session on Feb. 7, I carefully considered how I wanted to frame our discussion and narrative to our delegation this year. I thought hard about some of the most pressing challenges that community-based mental health providers are facing, and the barriers to delivering the most accessible, responsive and supportive treatment to those we serve.
This year is not unlike any other year since 2020. Despite the many helpful bills that have been passed and recent funding to support mental health and substance use services over the last four years, I came to the stark realization that the situation will likely get worse before it gets better.
There are a number of challenges that are impacting how safety net organizations are able to meet the increasing and evolving need and demand for services. An upside is that people feel comfortable with the idea of seeking services, which is progress as we continue to work toward normalizing mental health as a vital component of one’s overall health.
What’s concerning is the complexity of behavioral health issues that are coming through the doors – especially what we are seeing in children and adolescents. A report issued by the Centers for Disease Control and Prevention from the 2021 Youth Risk and Behavior Survey shows that nearly one in three teen girls seriously considered suicide in 2021, an increase of 60 percent from a decade before. Social isolation, academic disruption, illness and job loss of parents throughout the pandemic has had lasting impact. Younger children are displaying higher levels of aggression and require more intensive intervention and services to manage their needs.
Adults are reporting symptoms of depression or anxiety almost three times more than in 2019. According to a study published in the JAMA Health Forum in 2023, the use of mental health services increased by 40 percent among adults with commercial insurance. One out of eight US adults now takes an antidepressant.
The mental health system is unable to accommodate these increasing and more complex needs at a time when there has been an unprecedented shortage in clinical staff to provide vital services. It has become increasingly difficult for community-based organizations to recruit and retain qualified clinical staff and pay them a competitive wage. Despite newly passed bills to support the development of a diverse clinical workforce in past legislative sessions, there are still periods when there is a mass exodus of therapists. This only disrupts care and causes burnout in the clinicians who take on larger caseloads.
There are often wait lists and limited openings across many levels of care for children and adolescents. Office and school-based outpatient services are seeing high-acuity cases, requiring more than the level of care can provide.
The family needs to be supported as well as the child or adolescent receiving treatment, especially after an emergency room visit or hospitalization. Appropriate step downs from the hospital or emergency room to more intermediate levels of care, such as intensive outpatient services or in-home psychiatric services for children and adolescents, have become more challenging to place.
Placement becomes even more difficult when there aren’t clinicians to fill vacant positions in these programs. It is a precarious combination when agencies are presented with these high-risk cases and there aren’t enough available resources to put them in an appropriate level of care.
The mental health crisis is alive and well, and the ability of providers to deliver the most responsive care has been compromised for more than three years now because of these challenges. It’s not likely that this situation will change any time soon as more people feel comfortable with accessing care and community-based providers are not able to meet the need. Something has to give.
Jennifer Fiorillo, MBA, MPH is the president and CEO of Bridges Healthcare in Milford, and may be reached at Jfiorillo@bridgesmilford.org.