As more children need mental health help, fewer providers are available

Monadnock Ledger-Transcript
Published: 11/15/2022 1:31:57 PM

Fifth of a series on mental health and children.

The inability to find therapists and psychiatrists for children in the Monadnock region has created what one pediatrician calls a “vicious cycle.” 

Dr. Greg Kriebel, a pediatrician at Monadnock Community Hospital in Peterborough, said access to mental health support is by far the biggest problem for children experiencing anxiety and depression. Kriebel explained the pandemic created a “perfect storm” of more need and fewer providers who have left the profession or gone to virtual-only meetings.

For patients who come to him with anxiety, Kriebel said most need a therapist and not medication. 

“In my first 10 years, I probably prescribed antidepressants and anti-anxiety medication maybe a dozen times,” he said. “Pre-COVID, that number had changed to a couple of people a week, and now I’d say it has increased to a patient a day.”

Kriebel said a lack of therapists and counselors has made pediatricians a “de facto psychiatry group.”

“This isn’t our area of expertise,” he said. “We’re [prescribing medication] because if we don’t, no one will.”

Kriebel said finding a child psychiatrist outside of a major medical center is nearly impossible in the state, and that for those covered by state insurance, smaller providers sometimes don’t accept it..

“Unfortunately, all I can do sometimes is Google providers and make a lot of phone calls,” he said. “Parents are struggling, and some of them don’t have the wherewithal to pick up the phone.” 

According to the National Alliance on Mental Illness (NAMI), one in six youth ages six to 17 experiences a mental health disorder each year in New Hampshire and 15,000 children aged 12 to 17 have depression. In 2021, according to NAMI, 56.6 percent of youth age 12 to 17 who have depression did not receive any care in 2021.  

In the Granite State, barriers to mental health access and support for children, along with the funding to pay providers competitive salaries, is having “cataclysmic” consequences for the delivery of mental health services, said Emily Read Daniels, a counselor specializing in trauma incident stress management in the Monadnock region.

“There are a lot of different pieces that are barriers, and they add up to cataclysmic fallout in terms of support for mental health in our state,” Read Daniels said. “For one, we have a massive lack of psychiatric services and we’re not attracting people to health care systems.”

Read Daniels resigned from her position as a counselor at ConVal five years ago and is now engaged in trauma-informed school consultancy work. One of her concerns, given the shortage of counselors available for children in New Hampshire, is the process of becoming a licensed mental health counselor (LMHC). 

“The State of New Hampshire has one of the most-rigorous and ridiculous licensure processes I’m aware of,” Read Daniels said. “I have my master’s degree in school counseling as well as post-graduate certifications and training in therapy. But if I wanted to be a LMHC, I’d have to go back to graduate school again and get a whole other degree.”

Read Daniels explained that pursuing an LMHC requires spending years working in community mental health, where incomes are low, in order to complete the number of internship hours needed.

Licensure in the state is overseen by the Office of Professional Licensure and Certification (OPLC). The OPLC, which was established by state law, sets the standards and oversees licensing for a number of positions in the health and technical professions. Dr. Amy Alletzhauser, who has been on the mental health board for the OPLC, disagrees with Read Daniel’s sentiment regarding licensure, saying the licensing process and requirements are not overly prohibitive.

“We hold people accountable to today’s standards,” she said, adding that there is plenty of access for people to become licensed. “Some people don’t want to go back for various certifications such as ethics. [But] we have to be accountable for today’s practices.”

Kriebel agreed that licensing should be regulated, but said, “On the flip side, the state should be doing everything they can to get people licensed as quickly as possible.” 

Read Daniels said another issue with access to mental health services involves the way funding is structured. Public health networks that fund nonprofits, she explained, have three-year cycles of funding.

“What happens is that in order to keep that funding, organizations must demonstrate outcomes, and that is not a good expectation,” she said. 

Read Daniels believes telling organizations that they’re going to be funded for a minimum of seven to 10 years would provide more of a safety net.

“A lack of consistent funding is a big driver of chaos,” she said.

Another way to meet mental health challenges and needs, according to Susan Stearns, director of NAMI New Hampshire, would be to increase Medicaid rates and create more flexibility for out-of-state practitioners.

“We now have an interstate compact that would allow people licensed in other states to work here, but there's still work needed in the actual licensing to make that happen,” she said.  Another improvement, she added, would include tuition reimbursement for providers.

“That could be one of those things that help us have the best people who want to work and live here in New Hampshire and stay and  support our system,” she said.

Kriebel believes the lack of access is a flaw in the health care system.

“It’s not a moneymaker,” he said. “The good thing about mental health is that people don’t need a referral from a doctor for a provider, but they do need to be able to find one.” 


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