Mental health professionals seek federal aid for Oregon youth

Oregon youth mental health professionals are frustrated.

At a roundtable discussion Thursday, Aug. 11, health care providers and representatives from a tribal health agency and Portland Public Schools expressed frustration that public and private health insurance plans have left many youth untreated.

They called for expanding the school mental health workforce and overhauling outdated regulations that restrict facilities and care providers. They also said the federal government should hold insurers accountable for denying behavioral health care to children.

The roundtable was convened at Oregon Health & Science University’s Southwest Portland campus by US Senator Ron Wyden of Oregon. He was joined by Chiquita Brooks-LaSure, director of the federal Centers for Medicare and Medicaid Services, as well as parents and students to discuss youth mental health care as they begin the new school year.

Wyden said children in Oregon are “sounding the alarm loud and clear” that more mental health support is needed.

The other participants agreed.

A 2020 survey of about a third of Oregon students by the Oregon Health Authority and the Oregon Department of Education found that nearly half felt sad or hopeless for more than two weeks. And a report published this week by Annie E. Casey Foundationfound that the number of Oregon children struggling with mental health problems rose from 11% in 2016 to 16% in 2020, a 40% increase.

Wyden said the pandemic has exacerbated Oregon’s children’s mental health crisis. “It was a problem before the pandemic and it’s mushrooming,” he said.

Wyden, Brooks-LaSure and health care providers agreed that schools need more counselors and therapists. They said Medicaid should provide greater access to mental health care.

In Oregon, about two out of five children are insured through Medicaid, the federal program that covers low-income families. Nationally, nearly half of children receive free coverage from Medicaid and the Children’s Health Insurance Program, or CHIP.

Expanding the workforce

In 2019, the state appropriated more than $1 billion for the Student Success Act of 2019, which helped pay for mental health care in schools. In addition, Oregon received millions from the America’s Emergency Relief Plan during the pandemic, with directives that some of it be used for staffing and mental health programs.

But the money hasn’t solved the problems, according to Colt Gill, director of the Oregon Department of Education.

“The Student Success Act gave us money for more counselors,” Gill said at a November meeting of the Oregon Senate Education Committee. “We can’t find them.”

One mother said during the discussion that her son had been on the waiting list to be seen by a school counselor for six months.

Brooks-LaSure said her agency is accepting public comment on a policy that would increase the number of mental health providers in schools, giving counselors more flexibility in who they treat and their focus. As an example, they could treat students and veterans, or they could work in schools but also offer family counseling. This would bring in professionals who are not currently working in schools. The audience can send comments until the end of August.

Rep. Lisa Reynolds, D-Portland and a pediatrician, said about 30 percent of her patients are on Medicaid. Some wait weeks or months to see a therapist because of the shortage of mental health professionals.

Reynolds said more doctors need to be trained in mental health care and that payments to social workers, counselors and therapists need to increase. Although Oregon regulations require equal payments for physical and mental health care, therapists are generally paid less than those who provide physical care. The increase in payments will increase the number of specialists, she said. “We need to compensate mental health care providers the same way we do physical health care providers,” she said.

Randy Kamphaus, director of the new Ballmer Institute for Child Behavioral Health at the University of Oregon in Portland, which offers training programs to students interested in the field, added that interns should be paid while they learn. The institute’s first graduating class of 200 students will intern in Portland Public Schools in the fall of 2023, Kamphaus said. They will begin by screening students to identify those at risk or susceptible to mental health problems.

Outdated regulations hinder progress

Many of the health care providers on the panel expressed frustration with Medicaid policies that limit care.

Laura Platero, executive director of the Indian Health Council of Northwest Portland, said a restriction that allows providers to seek reimbursement only when care is provided in a facility is particularly restrictive. She told Brooks-LaSure that Medicaid should be expanded to tribal practices, such as the Canoe Healing Program for Native American youth. The curriculum incorporates tribal traditions and practices to strengthen children’s ties to their culture and to combat suicide and substance abuse.

She said her agency struggles to help children with their mental health.

“We’ve had a hard time finding inpatient treatment for youth, and when we do, we have to wait or it’s too expensive,” she said.

Robin Henderson, CEO of Providence Behavioral Health, said he runs the only child psychiatric unit in the state and that there is often a waiting list. She said administrators face the biggest problem with reimbursement from private insurers. All Oregon insurers are required to include the clinic in their network, but she said many are not.

“We need regulators to hold insurers accountable,” she said.

She criticized some insurers’ requirement for prior authorization before authorizing treatment. Very often they deny coverage, she said.

“I can’t tell you how many times I’ve heard, ‘well, this is a behavioral health issue,'” Henderson said. She urged Wyden to continue pushing for insurance reforms in Congress.

Money approved for school counselors

Wyden said an “overwhelming call for help” from students pushed the recent Safer Communities Act over the finish line. The law, which includes $1 billion for school counselors over five years, was included in a gun safety bill that Congress passed in June.

Oregon student Trace Terrell, a student at La Pine High School, testified in favor of the measure before the US Senate Finance Committee, which Wyden chairs. Terrell said about 80 percent of his peers who were referred for counseling had never heard of a counselor.

Wyden said Thursday that Terrell’s testimony had a profound impact on the committee that played a major role in writing the gun safety bill.

Wyden said more help is coming. He indicated that Congress is likely to pass a “major bipartisan package” to help states add youth mental health professionals.

By Alex Baumhardt of Press Partner Oregon Metropolitan Chronicle

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