“It did take us several weeks just to get an appointment, and then the appointment was like six weeks later,” said Sarah Lewis, of Troy, whose seven-year-old daughter was diagnosed with ADHD.
• MENTAL HEALTH MATTERS: More from this project
Mental health care is not just about knowing when to ask for help, the Dayton Daily News found in our ongoing series looking at what youth are facing when it comes to their mental health.
In talking to local parents, getting their child in front of the right health care provider can be a lengthy, arduous process, often worsened if poor community conditions add to the youth’s mental health struggles in addition to limiting availability of help.
For Lewis, who just needed an appointment for her daughter, it took months just to get the diagnosis she needed for an accommodation plan at her daughter’s school.
“It was about a three- or four-month process just to get an initial appointment,” Lewis said.
‘You’re constantly following up’
Navigating the mental health care system, as well as getting an approved accommodations plan for her daughter, was not an easy process, Lewis said. The school her daughter was in first noticed that she may have ADHD, so they started with their primary care doctor.
The first place their primary care doctor tried to connect Lewis’ family wasn’t able to take on her daughter as a patient, so they went to another provider. For the second provider, his office said he wasn’t taking any more patients, but they were able to connect with the doctor directly, who helped get them in, Lewis said.
In between trying to connect with a mental health care provider who could assess and diagnose her daughter, it was stressful not knowing where to turn or if the process would even work out, she said.
“You kind of feel helpless,” Lewis said. “You’re constantly following up.”
At one point, they were looking at providers in Dayton before they ended up with their current doctor. Even with the doctor being in Miami County and closer than Dayton, it still became a challenge to work in the appointments with their work schedules.
“It’s a lot of work,” Lewis said. If she didn’t have flexible job, it would have been difficult to pull off, she said.
Mental health professional shortage areas
Nearly 123 million Americans live in areas deemed to be a mental health professional shortage area, according to the Health Resources and Services Administration (HRSA), a federal agency that falls under the U.S. Department of Health and Human Services.
Designations are used to identify areas experiencing a shortage of health professionals, according to KFF, a nonprofit for health policy research. In Ohio, about 4.8 million people live in an area with a shortage of mental health professional with about 30.4% of the need being met, KFF says.
To be designated as a shortage area, federal regulations compare the number of health professionals relative to the population with consideration of high need. For mental health, the population to provider ratio must be at least 30,000 residents to per one practitioner, or 20,000-to-1 if there are unusually high needs in the community, KFF says.
Ohio has 137 facilities with a mental health care shortage, KFF says, and Ohio would need about 230 additional practitioners to get the designation removed.
Community, economic challenges
Community member focus groups conducted by the Health Policy Institute of Ohio in 2023 highlighted challenges that get in the way of coping with mental health conditions, as well as in the way of seeking help.
Coping challenges included:
- Lack of access to basic needs such as housing, well-paying jobs, and safe areas to live, work and play
- Unsafe living conditions, such as violence and shootings in neighborhoods and parks
- Lack of awareness of resources and difficulty navigating community resources and health systems
Challenges to seeking help included:
- Lack of transportation to follow-up appointments and other services
- Feeling overwhelmed, feelings of hopelessness, thoughts of suicidal ideation
- High turnover and lack of staff lead to long wait times for behavioral health services
Economic disadvantage varies widely from one local school district to the next, the assessment says, from a low of 2.1% in Oakwood schools to a high of 99.9% in Trotwood-Madison and Northridge. In Dayton schools, 93.1% of students were economically disadvantaged in 2021-2022.
There were 7,650 Montgomery County K-12 students enrolled in Medicaid who had a diagnosed behavioral health condition in 2021-2022, which was about 25% of Medicaid-enrolled students, according to the Health Policy Institute of Ohio, which compiled a 2023 behavioral health equity roadmap assessment for Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS).
Dayton, Trotwood-Madison, Jefferson, Northridge and Mad River schools have the highest percentages of students who are economically disadvantaged and chronically absent. Students in these districts may need extra support to succeed and be healthy, the assessment says.
Overall, 46% of Montgomery County K-12 traditional public school district students were enrolled in Medicaid in the 2021-2022 school year, a total of 29,065 students. Data for children not enrolled in Medicaid was not available.
Insurers’ member services offering help
To help patients find care, health care navigators for large health care networks and support services through insurance providers are finding ways to help people work through the system.
“Just as health care has become increasingly high quality, it has become more complex,” said Stephanie Stitt, director of behavioral health for CareSource Ohio.
CareSource’s Member Services team can help its members find care, Stitt said.
“A particularly challenging area can be behavioral health, especially when a family is in crisis. CareSource can connect members with special resources that can help, like OhioRISE, a unique program in Ohio that can help eligible families coordinate their care in particularly challenging situations,” Stitt said.
LifeServices, for members 14 and up, can help Ohio members with transportation, job training, housing and other resources that help advance their overall wellbeing, she said.
Patients in rural areas can also seek out virtual or online resources.
Navigating the system
For children not in a crisis, Dayton Children’s recommends starting with the child’s pediatrician for recommendations.
“More and more now, pediatricians have therapists actually located in their office,” said Dr. Kelly Blankenship, the division chief of psychiatry at Dayton Children’s Hospital.
Parents can also turn to Dayton Children’s Mental Health Resource Connection, which is open Monday through Friday from 9 a.m. to 5 p.m. at 937-641-4780 or online at childrensdayton.org/getconnected.
Anybody, including parents and providers, can call the Mental Health Resource Connection to speak with a social worker who can help them find care, Blankenship said. They will give families a couple different options of numbers to call to get the child into things like therapy and psychiatry.
“Another place that we tell families to look at is schools. There are quite a few schools that actually have therapists embedded,” Blankenship said.
Even just the school counselor meeting with them until they can get in to see a therapist is another option for families, she said.
To avoid falling through the cracks with the referral process between doctors, parents can also call the places their doctor referred them to in order to make sure they received the referral and can take them on.
If the therapist or other type of mental health provider is not able to see the child soon, the parent can go back to the pediatrician for a referral somewhere else, or they can reach out the Mental Health Resource Connection for other options, Blankenship said.
Prevention can also help parents connect with their children before a mental issue worsens.
“Prevention is so important in making sure parents are talking to their kids,” Blankenship said, directing parents to Dayton Children’s On Our sleeves program, which offers free access to supportive materials to open dialogue and boost mental health.
“Parents will get those conversation starters that really promote parents starting to talk to their kids about all kinds of things, but also about their mental health, so that if the child does start to exhibit any kind of symptoms, you get there in the beginning instead of when the child is in crisis,” Blankenship said.
For more information, visit childrensdayton.org/onoursleeves.
