Nemours eyes mental health
Children’s hospital to integrate services with primary care to prevent depression from going untreated
After a nationwide increase in mental illness and suicide attempts, Nemours Children’s Health plans to improve access to mental health treatment by integrating it with primary care, an approach backed up by research.
At the moment, Nemours Children’s primary care pediatricians screen patients for mental health issues but refer them to another provider for treatment. Many kids never go to that follow-up appointment: Almost two-thirds of Florida youth with a major depression diagnosis don’t get treated, according to a 2021 analysis by Mental Health America.
Mental Health America ranks Florida 48th in the U.S. in terms of access to mental health care.
“There are many barriers that exist to children receiving mental health care: availability, location, reimbursement, stigma, and a host of other social determinants of mental health,” said Dr. Thomas Lacy, Central Florida division chief of Nemours Children’s Primary Care.
Using a $150,000 seed grant from TD Bank, the Nemours Children’s Health Integrated Behavioral Health Initiative will staff eight licensed mental health counselors at about 15 of its primary care pediatrician offices in Central Florida, allowing for same-day treatment at the location that a child is evaluated.
Counselors will also use telemedicine to serve the not-for-profit health system’s approximately 74,000 Central Florida pediatric patients during the one-year pilot program, Lacy said. The system’s Delaware primary care offices will also receive some of the funding.
The ultimate goal is to intervene before a child’s mental illness can escalate to dangerous behavior such as drug use or suicide, he added.
“That’s what we lose sleep over, is losing the child who commits suicide. If you’ve been a pediatrician long enough, you’ve had
that happen in your practice, probably,” said Lacy.
The stress and isolation of the pandemic have escalated the already rising numbers of children with mental health crises in the U.S., according to a Sept. 2021 analysis published by the Assistant Secretary for Planning and Evaluation, the principal advisor to the Secretary of the U.S. Department of Health and Human Services.
Nemours Children’s Hospital Florida saw 52 patients for intentional self-injury or suicidal ideation from January 2020 through September 2021, spokesperson Margot Winick said.
AdventHealth for Children, which also recently announced plans to establish a new youth mental health program, hospitalized over 300 children following a suicide attempt or other intentional self-injury from September 2019 to 2021. This was a roughly 75% increase over previous years.
Other places in the country have been integrating mental health care into primary care for several years. Nemours’ Delaware Valley primary care offices have already started employing psychologists part-time.
“It’s the wave of the future,” Lacy said.
However, Central Florida has had to change Delaware’s model. Instead of psychologists, masterslevel licensed mental health counselors will staff Nemours’ primary care offices in Central Florida because this will be more sustainable, Lacy said.
“In Florida, we’re not going to be able to have a sustainable process that has a psychologist in every pediatric office. I would love that but it’s not going to happen, honestly,” he said. “Our state, unfortunately, has terrible funding for this type of work.”
Florida was the lowestranked state in terms of mental health care and treatment spending per capita as of 2019-20, according to the third interim report of the Twentieth Statewide Grand Jury, released by the Florida Attorney General’s Office in December 2020.
“Deficiencies in funding, leadership and services related to mental health care tend to turn up everywhere like bad pennies,” the report read.
In contrast, leaders from several organizations that provide mental health treatment were complimentary of Gov. Ron DeSantis’ 202122 budget for mental health and substance abuse when it was released in June 2021, according to a press release from DeSantis’ office.
“Governor and First Lady DeSantis have been strong advocates for our programs to support Floridians’ mental wellbeing since the start of this administration,” said Department of Children and Families Secretary Shevaun Harris.
The total budget includes a $20 million increase for school mental health initiatives for a total of $120 million. There is also $5.5 million to continue Youth Mental Health Awareness and Assistance Training in schools.
DeSantis has previously vowed to improve the state’s mental health services in his administration, as has first lady Casey DeSantis.
Yet Rep. Anna Eskamani (D-Orlando) said she thinks the state legislature should do more.
She emphasized the utility of telehealth, peer-topeer support programs, and reform of Florida’s current mental health care system; right now, responsibilities are spread throughout various state agencies and private mental health organizations, making coordination of mental health services difficult.
“Ultimately all of these efforts will cost money, but if the Florida Legislature stopped engaging in corporate tax breaks, then we would be better able to make substantial investments in mental health funding, reaching these collective goals to positively impact people’s lives,” Eskamani said.