Gaps in mental health care pose a challenge for children needing treatment

A 17-year-old arrived at UNC Hospitals needing mental health care.

After being admitted to the Emergency Room, the teenager waited for eight days, said Jack Naftel, vice chair for clinical affairs and child and adolescent services at UNC-Chapel Hill.

“Our hospitals are always full,” Naftel said.

Naftel said there were 11 children and adolescents waiting for mental health care in the emergency room at UNC Hospitals. That included a 16-year-old who waited six days, and a 10-year-old and 8-year-old who each waited four days.

There were 23 mental health patients in the hospital on Oct. 20, which Naftel said was “about average for us.”

The Orange County Health Department is working on a report on child access to mental health care in the county to identify and address the severity of the gaps in care. The health department is halfway through compiling information, and will likely release the report in late November or early December.

“Part of what we’re doing is really trying to get a grasp of what’s going on in our county,” said Rebecca Crawford, director of finance and administration for the Orange County Health Department.

Mental health patients comprise about 10 percent of Emergency Department patients, according to the 2015 Orange County Community Health Assessment.

Naftel said many psychiatric patients face long waits for treatment and remain in the hospital for too much time, because there are very few in-patient treatment options available in Orange County.

While children can see a therapist for basic treatment, Naftel said options are limited for mental health treatment that is a step down from the hospital.

“The whole issue is really state-driven, because you’ve got a failing mental health system,” Naftel said.

Naftel said the problem can be traced back to mental health reform in 2001.

In that year, North Carolina passed the Mental Health Reform Act to save money and improve efficiency by reducing funding and making treatment more community based.

But Naftel said it is hard to find the right level of care for children, especially when that child needs in-patient care.

“The resources are not as available as they should be,” Naftel said

Suicide killed 62 people in Orange County between 2011 and 2015, according to the North Carolina Department of Health and Human Services. During that timeframe, suicide was the second leading cause of death in people ages 20-39 with 19 deaths, and the sixth leading cause of death for people 0-19 years old, with two deaths, according to the North Carolina Department of Health and Human Services.

About 90 percent of people who die from suicide have a mental illness, according the National Alliance on Mental Illness.

Karla Siu, therapist and clinical director for El Futuro, said available treatment is expensive. And the language barrier can be an issue for parents seeking treatment for their children.

The stigma behind mental illness can contribute to the problem, Siu said.

“My sense is that individuals struggle with mental health are often blamed for their illness, so they should not ‘need’ as much care,” Siu said in an email. “There is emphasis on short-term treatment, and little understanding about how chronic mental illness can be at time for some individuals.”

Naftel saw the impact of stigma in reaction to the problem. He said while there has been outrage over the lack of care, the response would be stronger if physical illness faced that deficit in treatment.

“I don’t think the public would tolerate if people were coming into emergency rooms and couldn’t get the medical treatment they needed… I think the public would be outraged with that,” Naftel said.


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