Saturday, February 21, 2009

Nebraska and Wyoming share a trait: lack of children's mental health care services

The daily newspaper was invented for this.

On Feb. 1, the Omaha World-Herald published a long article, "Safe Haven kids finally got right help." The article, by staff writers Matthew Hansen and Karyn Spencer, was based on interviews and research into 10,000 pages of documents released to the paper by the Nebraska Department of Health and Human Services. It takes time and patience it took to read that many pages of bureaucratese. It takes skill to translate that into an article that is heart-breaking. Read it at, and then read Judith Warner's column in the New York Times that alerted me to the OWH piece. Go to

I've written several posts about the weird happenings surrounding Nebraska's "Safe Haven" law. Parents, at their wit's end with kids (mostly teens) who had mental health and behavior problems, abandoned them to Nebraska's authorities. One mother drove her child to Nebraska all the way from Georgia.

Nebraska is Wyoming's neighbor to the east. Both states reflect the fact that there is a severe shortage of mental health care practitioners and facilities in the nation's rural areas. Here's a paragraph from Warner's column:

In 1990, the Council on Graduate Medical Education estimated that by 2000, the United States would need 30,000 child psychiatrists; there are now 7,000. Many rural areas have no child psychiatrists or psychologists at all. Often, pediatricians end up providing mental health care, but they aren’t trained for it and often aren’t reimbursed for it by health insurance. The American Academy of Child and Adolescent Psychiatry is currently working with the American Academy of Pediatrics to try to formalize ways to collaborate on caring for children with mental health needs, but models for such joint care are scarce. And doctors have no financial incentives to talk to one another on the phone.

Many rural areas have no child psychiatrists or psychologists at all. Wyoming, with its 97,000 square miles of mostly "rural," doesn't have a single child psychiatrist. Psychologists? Yes, in the state's cities of Cheyenne and Casper, maybe a few others. There are licensed therapists who can provide counseling and possibly point harried parents in the right direction. There are non-profits such as UPLIFT and its outreach specialists who can do the same thing. (Note: I'm an UPLIFT board member). But when you are a parent faced with a mentally ill child, you need lots of guidance and professional help. Your child will likely need medication -- you need an M.D. for that.

Why do I care about this? My daughter just spent 2008 in a residential treatment facility. My wife and I are involved in our communities and know our way around mental health care and twelve-step programs. We have health insurance, but knew it wouldn't come close to covering the costs.

When it comes to long-term care for your own child, we often felt the way this mother described it to the OWH reporters:

Theresa Thomason, an Omaha native who lives in Oklahoma, said she had been struggling to get her adopted foster child into a residential program for his psychiatric problems.

She called an elected official and said she was taking her son to Nebraska unless someone helped her. A barrage of phone calls, e-mails and faxes followed. Her son was admitted within days.

"Why on God's green earth does it take all that to get help?" she asked.

Good question, Theresa.

More about some of the possible answers in future posts.

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