Child mental health service imperiled
Funding lapses in December
Appearing in the Times Record June 28, 2012
BY DARREN FISHELL
Times Record Staff
Dr. Andrea Loeffler learned a lot in medical school, but not how to counsel children and adolescents grappling with serious mental health issues.
The Martin’s Point Healthcare pediatrician has practiced medicine in the Mid-coast region for 13 years. During that time, she’s learned that the job often makes her the first medical professional to deal with children experiencing psychological crises.
“The truth is that the bulk of childhood adolescent and mental problems land on our doorsteps first,” Loeffler said.
For the last three years, she’s had a reliable place to turn when faced with new and challenging questions about her patients’ mental health. Through the Child Psychiatry Access Program (CPAP), Loeffler has been able to get answers to her patients’ mental health questions within 45 minutes or make referrals for patients with mental health issues beyond her expertise.
Dr. Janice Wnek, with Midcoast Pediatrics, said the service is the next best thing to having a full-time child psychiatrist on staff.
While full-time staff isn’t always possible, neither is CPAP. Continued funding for the program, based out of Spring Harbor Hospital in Westbrook, is uncertain, and time is running short. For the first three years, a grant from the Maine Access Health foundation funded the program. This year, a donation from Cape Elizabeth residents Judy and Al Glickman supported the program. But after December, the well runs dry.
The program, which first formed in 2009 to help Brunswick- and Bath-area pediatricians handle their patients’ mental health needs, now serves 34 physicians at nine medical practices in Brunswick, Westbrook, Yarmouth, Boothbay Harbor and Norway.
With three part-time staff members and an annual operating cost of around $110,000, the program advised in the cases of approximately 1,200 children with mental health problems in its three-and-a half years.
The program’s goal is to expand children’s access to mental health services, but that doesn’t always mean referring more patients to psychiatrists.
Don Berube, CPAP’s clinical care coordinator and a Fort Kent native, said that finding a child psychiatrist in some areas of the state, including his hometown, can be difficult.
But Mid-coast doctors in the program have found that even having a child psychiatrist in the area doesn’t always help.
The idea of making a referral sometimes hits parents the wrong way.
“When I say I’d like to bring in a psychiatrist, there’s a wall that goes up,” Loeffler said.
With training through CPAP, Loeffler said she’s able to, in some cases, take on mental health cases herself. In other cases, she said, as the family doctor, she has been in the best position to get a child the help they need.
“Even if we’re not the direct managers, we’re where the trust lies,” Loeffler said. “It takes a lot of talking to get people to go to other sources, and it’s important to get that guidance.”
Estimates from the U.S. Surgeon General’s Office indicate that 8 percent to 13 percent of Maine’s youth population suffers from an emotional or mental health disorder, and that three-fourths of those children do not receive treatment.
When it comes to identifying those children with mental health needs, Berube said that primary care pediatricians and nurse practitioners prove most effective.
“I would say that every call we get from primary care physicians and nurse practitioners is worth it and not just some trivial thing,” Berube said.
Part of the program’s effort to increase access to mental health services for children is to better train doctors to identify and handle mental health issues so that, going forward, doctors can handle more cases and referrals directly.
Leoffler said that she has referred to CPAP less as she confronts and responds to mental health issues in her practice.
“Any advice could help me for the next 15 patients,” she said.
In addition to case-by-case calls, CPAP provides some training for doctors on topics related to child psychiatry.
On Tuesday, 16 medical professionals gathered in Brunswick for a quarterly “Lunch and Learn” talk by Dr. Sandra Fritsch on treating and identifying suicidal patients.
According to a study by the national Centers for Disease Control (CDC), 11.4 percent of high school students in Maine made serious suicide attempts during 2011.
One Brunswick pediatrician on Monday cited handling three recent cases of patients who made unsuccessful suicide attempts.
In cases when mental health problems reach an extreme, Berube said, the end result can be a trip to the emergency room.
In not catching signs of those problems earlier, Berube said, “the risks to the parent or the child are huge.”
According to Fritsch, a campaign to find a sustainable source of money for the program is under way, with an eye turned first toward the state.
Twenty-three states offer similar psychiatry consultation programs. In eight of those, the programs are funded by the government and available to physicians statewide.
While the program leaders are focused on preservation, they also hope to expand the program’s reach.
Fritsch said that advocacy efforts, reaching out to legislators in areas such as Brunswick, where pediatricians belong to the program, are just beginning as the program looks ahead to funding that ends in December.
With an austere economic outlook, Fritsch said she knows that could be a tough sell.
THE CHILD PSYCHIATRY ACCESS PROGRAM
(CPAP) is a partner of the nonprofit Community Counseling Center, which provides mental health counseling at 85 Baribeau Drive, Brunswick. That program is part of an effort called “The Children’s Initiative,” which aims to counsel children and families who have been exposed to violence or other trauma. That program can be reached at 373-9417 or online at commcc.org.