Overburdened Children's Mental Health Professionals Feel COVID's Strain

Standing in her office, Gabriela Rodriguez points out thank you notes, and keepsakes from her time as a child psychologist. She says there are not near enough mental health professionals for children to meet current demand.

At her office located at Riley Children’s Hospital, the waitlist is months long.

Rodriguez says during the pandemic, more children are seeking mental health services. But with waitlists, help is delayed at a crucial moment.

“It's really challenging because we know that the sooner that we can get help, the better,” Rodriguez said. “So any time that's spent waiting is, I think, wasted time, unfortunately.”

Finding help was problematic even before the COVID-19 pandemic. Looking at 2018 projections, a federal agency reported that one in 10 children in America has a serious emotional disturbance. Only half of them will receive treatment.

COVID has put even more stress on children — like dealing with virtual school, mask mandates and the fear of losing loved ones. Now, families facing both acute and long-standing problems struggle to find treatment.

“So the number of residents, five years ago was six for the state,” Dr. Michael DeMotte, program director for the IU Health Psychiatry Residency, said. “And now we’re at 24, certainly some positive growth in that regard.”

But it's unlikely the increase will have an impact soon. It'll be years before these new residents fully enter the workforce, and adolescent and child psychiatrists require two extra years of school.

Psychiatrists also tend to be older than other types of doctors — and they’re leaving the field at a faster rate than we can train them. One study projects that in 2024, approximately 2,600 psychiatrists will retire and there will only be 1,800 new ones to replace them.

DeMotte said young doctors can be quickly overwhelmed by the demand.

“For a resident, doing inpatient work, depending on where they're at in training, they may be limited to eight or 10 patients,” DeMotte said. “Whereas, upon graduation, folks practicing are caring for twice that many on a daily basis.”

That demand has made it normal to see four to six-month waitlists in Indiana.

The American Academy for Adolescent and Child Psychiatry says there should be 47 child psychiatrists for every 100,000 children. Indiana has just 6 for every 100,000 children.

There’s another factor that can put mental health care out of reach for some families: psychiatrists choosing to forgo insurance. That forces patients to pay out-of-pocket, which can be prohibitively expensive.

The reasons for going this route are complicated, but it's often a doctor’s response to low reimbursement rates from insurers.

“Which then puts pressure on practices to see more patients more quickly,” IU Health psychiatrist Diane Reis said. “And in psychiatry, that's really challenging because so much of our work is built around relationships.”

By not taking insurance, providers can charge more and avoid squeezing patients into 15-minute appointments.

The increased demand goes beyond psychiatrists, as other mental health providers are also feeling the pandemic’s strain. Counselor Rebecca Peters, who runs a child and adolescent practice in Lafayette, Indiana, says she’s seen more problems because of the pandemic like acute stress and PTSD-like symptoms.

Peters said like all her colleagues, her wait is long, too.

“I will tell you, I hate returning phone calls,” Peters said. “Because I start with, ‘I do not have any new client appointments until August.’”

Some experts hope innovations like telemedicine will make it easier for people to get treated. And Rodriguez, the child psychologist, said she thinks legislators can make it easier by funding comprehensive services for children.

New federal funding created to address the COVID-19 pandemic will support community mental health centers. But some experts warn that the stressors of the pandemic will be felt for years — and the full impact is still unknown.

This story is the third part of a three-day series produced by Bridge Michigan and WFYI's Side Effects Public Media in collaboration with the Institute for Nonprofit News. The project was made possible by a grant from the Robert Wood Johnson Foundation with additional support from INN's Amplify News Project and the Solutions Journalism Network.

To read all the stories included in the project, click here.

Contact Side Effects reporter Carter Barrett at cbarrett@wfyi.org. Follow on Twitter: @carter_barrett.