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Mental Health Services More Challenging For Children

by Christine Stuart | Oct 17, 2012 1:11pm
(4) Comments | Commenting has expired
Posted to: Town News, Hartford, Health Care

Christine Stuart file photo A panel of health care advocates heard what they already knew Wednesday: that getting access to appropriate mental health and substance abuse prevention programs is no easy task in spite of state and federal parity laws.

Healthcare Advocate Vicki Veltri who chaired the panel of experts at Wednesday’s public hearing said her office sees more cases related to denials of mental health and substance abuse services than any other clinical area.

Perhaps some of the most difficult cases are related to children.

Cathy Morelli, who has a 14 year old daughter with multiple mental illnesses including cutting and an eating disorder, said her insurance carrier Anthem denied her daughter 13 times this year within a five month period of time.

Morelli said the denials were issued “personally” to her daughter, who was hospitalized several times after suicide attempts.

One denial letter from Anthem, which Morelli read into the record, said “you have recently been in a psychiatric hospital for about one month due to behavior problems and trying to hurt yourself. You have had these problems for a long time. You had to go into the medical hospital for a few days and now the medical hospital wants you back in the psychiatric program. You have not been getting better in a significant way for at least the last 30 days. There’s no plan to do anything different. It does not seem likely doing the same thing will help you get better. You need treatment that will likely help you get better.”

“Interestingly Anthem only paid for one day of the 30 days that they speak about in this letter,” Morelli said. “What they fail to mention is that she had a suicide attempt while in-patient at this psychiatric hospital, but in spite of that Anthem still maintained their denial of coverage for her stay there.”

Jody Rowell, a mental health parity advocate in the Office of the Healthcare Advocate, thanked Morelli for her testimony.

“We recognize the human damage that is sometimes done when care is not available or denied,” Rowell said. “I wish I could tell you that you are one in a million as far as being in this position. You’re not and that’s supposed to make you feel better, but it doesn’t.”

In-home services weren’t appropriate for Morelli’s daughter who needed more intensive hospital care, but there are other children which benefit from learning coping strategies in the home.

Dr. Laura Saunders, a child psychologist at the Institute of Living, said there are absolutely no private insurance plans in the state that cover in-home psychiatric services. She said the only carrier that covers it is the state’s Medicaid program called HUSKY.
The only thing she can recommend as a provider is a higher level of care than is medically necessary for a child.

“If you have commercial insurance, we have to automatically divert someone to get voluntary services,“ Saunders said. “The lack of access is very, very unfair to these families with commercial insurance.”

In order to access in-home services families have to get a referral from the Department of Children and Families Voluntary Services division.

She said the in-home service is an absolutely unique service developed by Yale University about 16 years ago. The method is called Intensive In-Home Child and Adolescent Psychiatry Service or IICAPS, and it was recently replicated in New York state.

Veltri wondered if anyone has approached the insurance carriers and asked them to cover this service. No one attending the hearing at the Legislative Office Building could say whether there has been a conversation with carriers to talk about the benefits of the service.

“If someone hasn’t then I think we need to do that,” Veltri said.

She said it’s a more cost effective service delivery model than constant hospitalizations or in-patient psychiatric care for children.

Kevin Galvin, founding chair of Small Business for a Healthy Connecticut, said his health care advocacy wasn’t born out of the Patient and Affordable Care Act, but his experience with his daughters eating disorder.

At the age of 15 one of his daughters was diagnosed with an eating disorder. Although she is better now, Galvin recalled a time when she was constantly in the hospital and near death on at least two occasions.

“I firmly believe that if our insurer would have listened and responded to upwards of a dozen ED experts, and hospitalized my daughter for more than the 28 day normal cycle of hospitalizations that ED suffers get, I would have a far healthier child now,” Galvin said.

But in spite of the insurance companies denials, Galvin was able to win some of the denials on appeal. He also had an unfair advantage. His wife is a certified psychiatrist and pediatrician with working knowledge of eating disorders.

“We has inside clinical knowledge. We had a great network of professionals. We had the best insurance you could get and my daughter almost died,” Galvin said.

The message was well received by the health care advocates on the panel, who will be looking at finding solutions to some of these problems in the future.

“The bottom line is, we have to stand up as a state and pledge to take this on,” said Veltri. “We need to break down the silos in our public and private systems.”

Today’s public hearing was just the first of many Veltri hopes to hold across the state. After receiving more public input she will put together a report with stakeholders to break down some of the barriers to services.

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(4) Comments

posted by: Parent Advocate | October 18, 2012  11:46am

My adult son, who has been fully disabled due to severe, chronic mental illness since the age of 18, is able to live independently in the community because he receives Medicaid-covered Assertive Community Treatment services through a DMHAS-contracted Community Mental Health non-profit provider (which has been flat-funded by the state for four - five? - years, and is bleeding out as a result, having cut staff to the bone, now having to reduce services to clients who desperately need and depend on them - how is this “preserving the safety-net”?).

The ACT program covers intensive, wrap-around services that include case management, medication management and assistance with daily living skills. Prior to ACT program services, my 30-year-old son had never been able to live on his own, and endured many high-cost, acute-care hospitalizations, when his psychosis became so bad that he required hospitalization for his own, and others, safety.

Private insurance will cover these crisis hospitalizations, and, rarely, maybe, if you’re lucky - if you and the clinicians fight like hell - a period of short-term (also very expensive), medically-necessary residential treatment, but they will not cover the comprehensive community-based treatment that allows my son and many, many others like him, to stay out of the hospital and have a life.

Every time that my son’s illness worsens to a level of severe mania and delusions, his brain is further damaged, and each time the damage is more likely to be permanent. ACT services give him a chance to break this terrible, frightening progression of increasing and potentially permanent disability. But our private (many for-profit) insurance companies refuse to support these demonstrably successful, cost-effective, community-based support programs that preserve the lives and dignity of thousands of people in our state.

And we let them get away with it. What’s wrong with this picture? What’s wrong with us?

posted by: Victoria Veltri | October 18, 2012  7:19pm

Dear Parent Advocate -

Thank you for sharing your story.  Please let me know if our office can be of help.  1-866-466-4446.

posted by: lkulmann | October 22, 2012  8:34am

The easiest solution for Children with Mental Healthcare issues is to pay the providers what they need to run a viable business. Pediatric Mental healthcare workers on an outpatient basis are out there, but the State reimbursement rate is minimal. Ask any doctor. I have. The Healthcare Advocate needs to advocate a higher reimbursement rate from DSS to private providers. That will NEVER happen because OHA is a State agency. Vicki Veltri is a State Employee and to advocate higher reimbursement rates would be like biting the hand that feeds her. It won’t happen through this or any State Agency as it is presently run.

posted by: Psychkills | October 29, 2012  9:52am

Psychiatry’s “treatments” often don’t work. Even the industry quacks will admit to that; however, all logic stops there. They will then continue to preach compliance with the same ineffective course of action despite the fact that, the evidence from the past 50 years has shown that the treatments have actually worsened long-term outcomes. There is an epidemic of psychiatric disability. How can this be, if the treatments are so much better that they were in the past? You are better off having a “psychotic” episode in Nigeria than in the U.S. Why? Because third-world countries have better recovery rates for so-called “schizophrenia” or “bipolar” than the United States and other industrialized nations that keep their psychiatric patients “maintained” on the drugs. In the United States, one “psychotic” episode will almost always land you in psychiatric wasteland for the rest of your life. It is psychiatry itself that created the “chronicity” in so-called “mental illness”.

One definition of “insanity”: Doing the same thing over and over while expecting different results…

But psychiatric professionals and their chemically lobotomized customer fan-base will say you have to keep trying “treatment” anyway. Without doing anything different, you are condemned to being stuck in the same so-called “mental illness” mire you are currently in. Because in all honesty, wellness requires faith in one’s ability to heal, and if you go looking for that from an external source, you can be damn certain that your misplaced faith will be bottled and sold back to you for a high price.