HARTFORD -- Building on momentum generated by the Newtown shootings, advocates for mental health services hope to make strides next year on multiple fronts, including strengthening services in schools and improving coverage and access for privately insured patients.
"I think one thing that is abundantly clear is that the delivery of mental health services here in Connecticut and beyond Connecticut is pretty poor," said Scott Jackson, chairman of the state's Sandy Hook Advisory Commission. "And the resources necessary to improve it are pretty great. There's no simple fix for this."
Last spring, the legislature allocated $27 million over the next two years to an array of new and existing programs, many of which are already underway or soon will be.
These include training school officials to oversee the "climate" of the school and how to identify kids with mental health issues and get them help; new community treatment teams in four cities for adults; and the establishment soon of a consultation service for pediatricians seeking expert advice on treating children with mental or emotional issues.
"I was frankly very pleased with the amount that [the legislature] addressed in a very short time," said Patricia Rehmer, commissioner of the state's Department of Mental Health and Addiction Services. "It gave us quite a large amount of money. We've been really good about getting this stuff rolled out and up and running."
The legislation passed earlier this year represents the first step in creating a comprehensive framework of care for children out of a system that is now "fragmented and doesn't address the whole child," said Elaine Zimmerman, executive director of the Connecticut Commission on Children.
Zimmerman said that the aim is to provide care that is "seamless and customer-friendly" so that even if parents are "ashamed, shy and lost," they are able to find a way to get help for a child. The weakest link in the legislation is in the schools, she said.
"We have to increase the personnel in the school and that is a next step," said Zimmerman. "We really do need to create the behavioral, social, emotional response in the school house that is not yet in place."
The heightened concern about mental health issues, meanwhile, has led to greater demands, experts say.
The requests for training in how to identify and find services for children who have been traumatized are way up, according to Bob Franks, vice president of the Connecticut Child Health & Development Institute. In the time since the Newtown shootings, Franks said that the agency would normally have expected to train about 300 pediatricians and school nurses. Instead, it trained five times that number, or almost 1,500.
"I'm seeing just greater awareness, greater focus to address mental health issues than I've ever seen before," said Dr. Henry Schwartz, psychiatrist in chief at Hartford Hospital's Institute of Living and a member of the Sandy Hook Advisory Commission. "I'm both encouraged and cautious. You know, these kinds of things tend to come in waves. It would be a shame if this is a wave that will just diminish, but I'm hopeful that it won't."
Progress in 2013
Peter Gerardi, who oversees school climate for the Killingly schools, said that he was more confident in his ability to identify and get help for students with mental health issues because of training mandated by the legislature last spring.
Gerardi was part of the first wave of school climate officers to get the training earlier this month. "We talked about depression, anxiety, eating disorders, attention deficit and disruptive behavior, substance abuse," Gerardi said. "We learned about signs and symptoms, the risk factors in those areas, how to identify it and get some help. ... It's not medical first aid, but mental health first aid."
That program was part of a training program approved by the legislature last spring. In addition, the legislation requires training for mental health care providers, pediatricians, child care providers and school resource officers.
The legislation drew high praise from the National Alliance on Mental Illness, which earmarked it as model legislation for other states.
Sita Diehl, director of state policy and advocacy for the National Alliance, said, "We think training really helps people who work with children on a daily basis stop trouble before it erupts. Certainly, one of the best things that any state can do is invest in early intervention. ... We know from experience that the sooner you address a mental health problem, the easier it is to address."
New laws also require better coordination among mental health agencies, schools and emergency mobile psychiatric services. This fall, the number of calls for the emergency mobile team was up 22 percent in the three-month period from July to September.
It's not clear whether that increase is the direct result of the new law, but Tim Marshall, clinical manager for the state Department of Children and Families, said that after Newtown almost every district reviewed safety plans, and school officials have a heightened awareness of the need for crisis intervention services.
"Any time a situation rises to a level that [the student] needs to be separated from the classroom or even from the building, rather than just automatically ... calling the police or an ambulance or sending the kid home," Marshall said, school officials are calling the emergency mobile psychiatric team.
Legislators also earmarked an additional $3.5 million in each of the next two years to expand cognitive behavioral therapy programs at psychiatric clinics for children who have experienced trauma.
And $3.6 million will be invested in the next two years on a program that will enable pediatricians to consult with a psychiatrist or social worker for assistance in how to identify children with mental or emotional issues and how to help or refer them for services. The program is expected to start in February or March.
Sen. Dante Bartolomeo, D-Meriden, said the goal is to set up a more coordinated, accessible system of mental health care for children across about a half-dozen state agencies. This will allow parents to more easily get care for their children, she said.
"People said this isn't going to stop an Adam Lanza," said Bartolomeo, referring to the shooter at the Sandy Hook school. "But my hope is that if a system like this were in place when he was a young infant, a toddler or young child, somewhere there would have been a framework for him to be identified, to get the help he needed."
The legislation includes a requirement that DCF complete a comprehensive plan to address children's mental, emotional and behavioral health needs by October 2014. It also requires the agency to coordinate home visitation programs that offer services to families with young children, as well as to launch an educational campaign about children's mental and emotional health issues.
An Agenda for 2014
Legislators and experts say much is left to be done, although exactly where they focus might depend on recommendations from two panels: the Sandy Hook Advisory Commission and the legislature's bipartisan Task Force to Study the Provision of Behavioral Health Services for Young Adults.
The advisory commission has issued an interim report, but as Jackson, the chairman said, "It didn't touch mental health. We knew that that would be the biggest intractable area."
He said that two areas were of particular concern -- the rural swaths in Connecticut with few mental health providers and the tendency for young adults to run into problems getting services.
"At the exact moment in time when individuals are most likely to have a psychotic break, also happens to be the exact moment in time, when they are in transition from the youth side of the house to adult side of the house," said Jackson. "They can certainly fall through the cracks."
It's unlikely that the commission's final report will be ready by February, Jackson said, but the commission might deliver any legislative recommendations it has ready by then to the General Assembly.
The bipartisan task force, meanwhile, has a wide range of areas to address -- from the shortage of providers qualified to treat adolescents and young adults to looking at behavioral programs for preschoolers and reducing the stigma associated with mental illness so that more people seek treatment.
"It's an enormous agenda," said Dan O'Connor, co-chairman of the task force. He said that the 20-member task force so far has broad consensus on a few items, including the belief that better mental health care for 16- to 25-year-olds depends on better mental health care for young children.
"You've got to recognize vulnerable children and families early in life," said O'Connor. "If you want to reduce adult mental health disorders, you have to fund a robust pediatric system."
Rep. Diana Urban, D-North Stonington, said she was especially interested in expanding school-based health centers. Children and their families are more likely to get mental health care through a school-based health center because it's convenient and there appears to be less stigma involved, Urban said.
"This is a place we're going to hammer," Urban said of her plan to emphasize school-based health centers in the legislative session that begins next year. "We want to bring it to scale."
Schwartz, of Hartford Hospital, said he would also like to see a focus on ensuring that people who rely on their insurance to pay for mental health care have the coverage they need. It's a complaint that was talked about widely during last year's legislative session -- the state-funded mental health system for poor people often provides far more comprehensive care than is covered by private insurance companies.
Those people who rely on insurance "are often blocked from receiving care through managed care practices that deny care often on the basis of the care not meeting the 'medically necessary" standard," Schwartz said.
Schwartz said he would like to see the system changed so that the onus is on insurance companies to prove that care is not medically necessary, rather than on patients who must show that it is.
"I have to employ five full-time master-prepared nurses to do battle with insurance companies who deny care," Schwartz said. "I'm not going to tell you what that costs -- that's a lot of money." ___