Summer services in the Bellingham and Nooksack Valley school districts included something new this year: mental health therapy.
Thanks to $40,000 from the United Way of Whatcom County Impact Fund, Compass Health implemented a series of one-on-one and group therapy sessions at school sites that were also open for food distribution and summer school programs.
As of Aug. 12, the program had held over 190 group therapy sessions, said Shannon Webb, clinical program manager for Compass Whatcom’s child and family team.
Weekly age-appropriate sessions addressed topics like grief and loss, stress and anger management, social skills and LGBTQ issues. Individual students could attend multiple groups, in person or through telehealth, Webb said.
Compass obtained more than 50 telehealth devices with another United Way grant during the 2021-22 school year, and this summer redistributed the devices to children who needed them.
Supporting each other
The program was particularly effective in helping students bond over shared issues.
“It’s been amazing to witness the support that the attendees provide to each other, and the friendships that they’re able to organically develop,” said Webb, who facilitated several group sessions herself.
Groups attracted more and more students, sometimes doubling attendance numbers in just weeks, Webb added.
The summer sessions supplement academic-year support from Compass. Just two districts used their services in 2020-21. This expanded to five last year, and will add the Lynden and Mount Baker districts this year, providing full coverage of the county public schools.
Last year, Compass received more than 600 referrals for services and served around 1,700 children, according to a recent press release.
Compass is also working with additional United Way grants to help the lowest-income families access therapy, including gas cards for families struggling to get kids to in-person appointments, Webb said.
Students over the age of 13 do not require parental consent in Washington to seek outpatient mental health services.
Filling the gaps
Support from providers such as Compass fills some gaps in the existing school counseling services.
In the Bellingham School District, 14 elementary schools are served by one counselor each. Two are available at each middle school, with four at the three main high schools and another at Options High. In addition, three prevention/intervention specialists serve the four high schools.
Although this counselor/student ratio is better than the state average, many of these counselors are not licensed mental health providers, meaning they can’t provide regular therapy sessions or prescribe medication.
Chris Cochran, mental health coordinator for the district, said that collaborations with various community health providers including Unity Care NW and Sea Mar have been ongoing for years. Unity Care currently operates a child therapy program for Carl Cozier and Roosevelt elementary schools.
The Compass summer program not only provided students with services in times when they might not otherwise have had it, but also avoids the need for a fresh intake process once school starts, Cochran said. This saves families the sometimes time-consuming burden of referral paperwork and scheduling, which can delay the start of treatment.
Compass services are available only to students who use Medicaid coverage, Cochran said. “If someone has Regence or Premera or Kaiser, that’s not something that Compass can bill,” he said. “We’re looking at ways we can work with other community mental health agencies to either bill private insurance, or to contract in other ways, maybe using interns.”
Many other families find services outside the district on their own, and the district can work with a family to help them search for a private insurance-based provider.
Space is also at a premium in many school facilities, but Cochran said the district works diligently to find spaces where therapy can take place on campus and to provide a place for telehealth sessions with off-campus providers. In some cases, school employees have volunteered to give up their offices so a session has a place to happen.
Despite the progress made by providers like Compass Health, large gaps still exist in appropriately accommodating every student who needs help.
John Dunne is the mental health representative for the board of the Northwest Medical Society, an organization that serves a large region including Whatcom, Skagit and San Juan counties.
He meets monthly with childhood mental health workers in Whatcom, and spent 42 years as a child and adolescent psychiatrist before retiring in 2019. Asked to give a grade on the overall state of youth mental health resources in Whatcom, he was frank.
“Maybe a D minus,” he said. “The system is overstretched everywhere.”
Although enthusiastic about the progress that providers like Compass are making, Dunne said there is still a significant shortage of mental health personnel locally and nationally, at a time when more people than ever are seeking help.
The reason for a shortage of psychiatrists is multifaceted, but began in the 1990s, Dunne said, when Congress cut tuition support for a number of medical specialty trainings. As a result, some graduating medical students emerged with loan burdens of $300,000 or more.
Since nonsurgical medical specialties like family medicine, internal medicine, family practice and psychiatry pay far less than other specialties, Dunne said, many medical students are reluctant to enter these fields.
“If you want to do reasonably well financially, and pay off these massive debts, don’t go into psychiatry,” Dunne said. “That’s the message here. So, what’s happened is that some of the training programs have closed, simply because they couldn’t get enough trainees.”
A March 2022 report on mental health care from the U.S. Senate Committee on Finance indicated more than 6,000 shortage areas across the country, with nearly 60% in rural areas.
Dunne, who is also on the Washington State Council of Child and Adolescent Psychiatry, said Washington has recognized the shortage of child psychiatry and child psychiatry trainees over the last decade or so, and has worked to increase that number.
Even so, Medicare and Medicaid reimbursement to mental health clinicians can be frustratingly low, explaining why many psychiatrists will not take insurance and accept only private pay. With therapy session rates often over $100 an hour, poorer families and individuals are often out of luck.
“Only a very rare person would accept Medicare or Medicaid patients,” he said. “If reimbursement was better, there might be more [providers] willing to see these patients who are trying to find services through state support.”
Cochran pointed out that many providers may not know what an insurance company will reimburse them for until it comes time to bill them. A percentage of that fee is also usually shaved off during the billing process.
Sadly, in the meantime the burden is passed along to those seeking help — if they can find it.
Serving the vulnerable
Dunne recently spoke to two psychiatrists involved with Bellingham’s Catholic Community Services, whose services for vulnerable populations serve hundreds of people each year. He said the two told him that the organization is having a tough time both attracting and retaining therapists.
Their CEO, Will Rice, told Dunne in an email that even if therapists are available, they cannot be assigned to patients without the help of a case coordinator — another understaffed part of the mental health services hierarchy.
At Whatcom’s Northwest Youth Services, unhoused and struggling youth ages 13 to 24 can receive a variety of mental health services. These include substance-abuse counseling, which is commonly needed, as well as one-on-one counseling sessions and community-based group therapies like animal therapy or healing groups.
For a nonprofit that regularly serves 600 to 700 clients a year, executive director Jason McGill said the one counselor they currently have is obviously not enough. The organization is about to start the hiring process for two more counselors.
“We need a robust clinical team,” he said. “And clinical doesn’t necessarily mean just that traditional, status quo model of having that one-on-one sit down with a counselor or therapist. It’s a holistic approach.”
Youths aged 13 to 17 are served at NWYS’s Positive Adolescent Development (PAD) shelter. While NWYS funding comes from a combination of county, state and federal funding, McGill said they are pushing the Whatcom County Council to consider future funding increases.
“We need investments to really meet the needs of the young people that we serve, so we can prevent them from entering into that ‘chronic homelessness’ category,” he said. “And we can do that. There’s a lot of young people that come with mental health barriers.”
McGill sees that level of investment happening eventually, but not soon.
“I’m not confident that it’s going to happen within the next five years,” he said. “But I am confident that, eventually, we will get there as a society in fully understanding that this isn’t going to go away. We can’t just keep allocating funding that is just putting band-aids on stuff. If we’re going to actually change this, then we have to invest as a community in these services.”
A bed desert
By far, the most critical shortage in current adolescent mental health care is for in-patient services. In much of Western Washington, those services are virtually nonexistent.
There are no in-patient beds for non-life-threatening, underage mental health patients in Whatcom, Skagit or San Juan counties, Dunne noted. The nearest are in a behavioral health clinic in Snohomish County’s Smokey Point.
The next nearest in-patient program for youth mental health is Seattle Children’s Hospital, with a psychiatric facility that boasts quality care but just 42 beds. It’s now common, Dunne said, for providers to tell parents to take their children to the hospital’s emergency room and wait as long as it takes for a bed to open up, as children in the ER are prioritized for bed space.
“You don’t just call up somebody and say, ‘hey, I’d like you to admit this kid’,” he said. “It just doesn’t work that way.”
Of course, the main objective of child psychiatrists and counselors is to provide early or preventative treatment, avoiding the need for crisis services in the first place.
In Seattle, several schools have opened in-school health clinics through provider partnerships, providing mental health services among other routine care. A Peace Health clinic at Sedro-Woolley High School uses this model.
“The idea is to work with people long before they ever get into crisis,” Dunne said. “You want to take the appendix out before it bursts, not afterwards.”
“This is a long-term problem,” Dunne said. “There are no short-term solutions. It’s going to take years to dig out of and it’s going to take money, unfortunately, which the state and private insurers may not be willing to come up with.”
— Reported by Matt Benoit
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