In the weeks since the Newtown school massacre by mentally disturbed shooter Adam Lanza, mental health care in America has come under renewed scrutiny.
For decades, public investment in mental health care has dwindled. In the past few years alone, federal and state support has plummeted by billions of dollars, leaving many people with limited treatment options or none at all. Even the mental health coverage provided by private insurers is often insufficient. In its most recent report, the National Alliance on Mental Illness gave North Carolina and the United States as a whole a D grade for its delivery of mental health services. Not one state earned an A and just a handful got a B.
Meanwhile, 10 to 15 percent of all American children at every point on the socioeconomic spectrum suffer from a significant mental disorder. In many cases, helpful treatments do exist. But less than 25 percent of children will ever access those services. Of those, even fewer will be treated effectively.
The costs in terms of health care, under-performance in the classroom and sheer human suffering are extraordinary. In the worst instances, mass killers like Lanza emerge.
Though lack of funding is getting a lot of attention, there is another crucial obstacle to effective mental health care for children and young adults: a badly fragmented delivery system in which schools, social workers, health care providers, government agencies and community partners often work in silos.
Thats where an ambitious new project led by Duke Medicine strives to make a difference. Just three weeks before Lanzas horrific attack in Connecticut, the Charlotte-based Duke Endowment awarded a four-year, $1.6 million grant to fund the Integrated Pediatric Mental Health Care Collaboration in Durham.
Designed to aid children in Durhams public schools, the initiative aims to identify gaps in mental health care delivery, strengthen coordination among existing providers, train health care providers and educators to identify mental health problems early and study the impact of innovative new models for improving mental health care.
We have a lot of systems of care in Durham that have been developed by smart, caring people, says Dr. Helen Egger, who is leading the project as chief of the Division of Child and Family Mental Health and Developmental Neuroscience at Duke University Medical Center. Some of those systems are working and some of them arent.
Right now, for example, a student might be sent to an emergency department for evaluation if a fight at school indicates psychiatric problems. Sometimes that student will be admitted to the hospital and treated. But after their discharge, underpaid, swamped case workers cant monitor their status carefully. Educators dont talk with health care providers about that students subsequent behavior. And no one is consistently connecting the dots among these groups. Theres a good chance the student will ultimately have another episode and go back to the emergency department, starting the process all over again.
Egger imagines a scenario in which the school reaches out immediately, via videoconferencing technology, to an on-call psychiatrist who can address the situation and eliminate the ER visit. Meanwhile, a case coordinator with a more balanced and focused workload ensures that families, doctors, teachers and social workers can rally quickly to support the student.
The first step involves greater collaboration among the many groups with a stake in mental health care and Egger is bringing more than 20 partners to the table for this project, ranging from the Durham Board of Education to several state agencies to a half-dozen departments within Duke Medicine.
The complexity of the project is high the list of collaborators in Eggers funding proposal alone covers one-and-half pages but so are the stakes. In the end, Egger hopes it results in a sustainable, replicable, affordable model that communities can put to work nationally and swiftly. If we dont invest in this now, she says, it costs us greatly as a society.
Christopher Gergen is a founder of Bull City Forward, Queen City Forward, and HUB Raleigh. Stephen Martin is a director at the nonprofit Center for Creative Leadership.
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