Lawmakers to tackle kids’ mental health ‘crisis’

Push for reforms prioritized for next legislative session

With the pandemic taking a massive toll on children’s mental health, Connecticut lawmakers are already beginning to plan what reforms may best target what experts have called a crisis.

Over the last several weeks, legislators have hosted forums with behavioral health professionals, state agencies and child experts to discuss what is happening and where improvements need to be made in the state.

Connecticut emergency departments saw an overwhelming number of children seek psychiatric care as the toll of the pandemic fell on the state’s youngest residents last year and as students headed back to in-person classes this school year.

Legislative leaders say mental health services will be one of the substantive issues during the 2022 session, which begins in February. Next year’s session is only three months, however, and lawmakers will have to move quickly to get important bills through the General Assembly.

“I think you’re going to see it be a major focus,” said House Speaker Matthew Ritter, D-Hartford, who recently convened a forum on the issue. “It’s a problem. It was a problem before COVID, and obviously, things got exacerbated since then.”

Scaling up workforce development

Some of the legislative efforts this session may focus on funding — directing more money toward staffing and incentives to work in the mental health industry.

“There are a real lack of people in that space. So that’s something we have to think about – how do you incentivize people to move to Connecticut and practice in that space?” said Ritter. “That’s probably a combination of loans or one-time payments. It’s like recruiting; you have to recruit people to come to Connecticut to do this.”

Lawmakers are also exploring whether to use out-of-state providers. Some providers in the mental health field must be licensed in Connecticut to practice here. Legislators are considering waiving certain licensure requirements to enable providers from Massachusetts, New York or other states to conduct telemedicine appointments with Connecticut residents.

The co-chairs of the Children’s Committee, Rep. Liz Linehan, D-Cheshire, and Sen. Saud Anwar, D-South Windsor, said workforce development is also one of the top priorities heading into the 2022 session.

They are considering legislation that would increase the number of training programs for social workers and psychiatrists, looking at intermediate and longterm plans to ensure psychiatrists are paid fairly and considering how to improve reimbursement rates.

Linehan wants to build on a bill introduced in 2021 that would provide tax incentives to psychiatrists to buy a house in Connecticut by including doctors and nurse practitioners who “have prescribing abilities in the mental health field all around the country.” The program’s incentives would include a rebate on the income taxes they pay while working in Connecticut and a grant from the state for a down payment to buy a home if they stay in the state for 10 years after graduating medical school.

Linehan and Anwar have also had conversations about other legislation that could enhance mental health care coordination at pediatrician offices.

“So another thing that I really think is going to be hugely important and that we can scale up very quickly … is to beef up our access mental health program,” she added.

Access Mental Health is a referral program pediatricians can use if they are presented with a child showing mental health symptoms that they do not feel they have the specialty to handle. The pediatrician can then call Access Mental Health to speak to a psychiatrist and get a referral for that child.

Linehan’s top priority is to strengthen Access Mental Health by budgeting for an “immediate infusion of funds” to help double the number of psychiatrists on call for the program.

“The family can receive three telehealth visits with that psychiatrist if they desire and be covered by insurance and, if not, at least for the time being until we’re out of this pandemic, hopefully the state can cover those three telehealth visits for each family,” Linehan said.

Another substantial problem is that many pediatrician offices are not looped into a child’s mental health care coordination strategy, which is why some children who leave the emergency department or an outpatient facility do not get the proper follow-up care they need, Anwar said.

“What’s happening right now is that people have a way of just getting into the system, for management, through the crisis interventions that are there, if they know about it, and the pediatricians may not be in that loop,” he said. “I want to make sure that the rest of that coordination can happen from their office so that these patients are not lost to follow up at the various levels.”

Preventing hospitalization

The Connecticut Hospital Association has been in ongoing conversations with legislators about immediate and long-term measures to address the children’s mental health crisis in the state.

Carl Schiessl, director of regulatory advocacy at the CHA, said one way the state could immediately address the issue is by assessing how quickly facilities can expand capacity by adding more inpatient beds and staff to “increase both inpatient and intermediate levels of care, even if it’s just for the short term.”

“That would be a great potential immediate or short term measure that the state itself could take to expand capacity to provide the needed care as an option to having patients sitting in an emergency department waiting for an inpatient admission to one of these intermediate levels of care,” he said. “That’s one way the state can use its revenue, whether it’s their own or derived from federal sources, and we know there’s a lot of federal money coming in.”

But addressing children’s mental health care needs does not stop at emergency care. CHA and legislators are looking at measures that would expand outpatient services in communities and resources in schools to help prevent the need for a visit to the emergency department or so that they can continue receiving the proper level of care once they are discharged.

“When the emergency is over, where do you go? You hear the phrase ‘stuck kids in emergency departments,’ and what that means is the hospital addressed the emergent medical condition. That’s not hospital level, but it’s still care,” Schiessl said, adding that one of the things the state needs to do “on the back end” is to create incentives to expand access to intensive outpatient programs, partial hospitalization and other types of outpatient behavioral health services like group therapy, individual therapy and home care.

“Because if we have a safe place to discharge a child, and get them the right care in the right place at the right time, that again will relieve the crisis of too many children in our emergency departments,” he said.

For the 2022 session, legislators are also exploring funneling more resources to schools.

“It’s not just [health care] facilities. Everyone thinks we just need to add beds. But as you peel back the layers, it’s much more complicated than that,” Ritter said. “It’s the workforce, and it’s also trying to keep people from those beds. It’s so much more expensive. And so that might be hiring people and subsidizing school districts to have more counselors and providers on hand, so situations don’t escalate.”