Sunday, January 25, 2009

The Monthly Access Report: How Hard Is It to Get Your Child Into Treatment?

Mamacate was back with another comment today-  I really should get her to post on this blog more regularly, as she has much good insight into the current "non-system" based on what sounds like much hard experience:
I feel like we have immense resources compared to the average family dealing with this--financial flexibility to pay out of pocket for assessments, graduate-level education that makes it difficult for the school to intimidate us, jobs that are flexible enough to allow for us to run off to appointments across the state and IEP meetings that last for hours, and the time and educational background to read and understand peer-reviewed research on these diagnoses (not to mention an academic account that allows me to pull full-text from most journals). How, if we're struggling like this with the resources we have, can it be for parents who have to punch a clock, or those for whom signing that $4,000 promissory for the first neuropsych would risk financial ruin? It can't really be this bad....can it?
The short answer is:  "Yes, it can."  We hear all of the time how hard it is for parents, busy with work and kids and all that that entails, can't get appointments, can't see the right specialists, and are not heard as they try to cope with their child's mental illness.  The Massachusetts Behavioral Health Partnership actually puts out numbers, fairly regularly, based on reports from the various agencies who contract to see Masshealth patients.  What do they say?

The report comes on a spreadsheet;  the first five pages are devoted to children and the next five pages are devoted to children.  In Worcester, the intake evaluations were listed as having a 4-5 week delay at all of the agencies, with another 4-6 week delay in getting into therapy and 6-8 weeks after that to get a psycho-pharmocology evaluation.  Things are a bit better at the one agency in Southbridge (1 week to intake, 1 week until therapy and 5 weeks for the psychiatrist)  Similarly, Fitchburg is difficult, but not as bad as Worcester.  The hard bit in the North and South of Worcester County is that there are very few agencies, so many of the people go into Worcester for services.  For adolescents, it looks the same.  Hard to be reassuring to a family when it is going to be 10-19 weeks before they are through the entire process.

Is this different?  Well, I happened to have saved (in my usual packrat style) the same report from January 2006.  At that time, the waits were 1-2 weeks for intake, 1-2 weeks for therapy and 5-6 weeks for psycho-pharmacology.  It would be interesting, but tedious, to do an agency by agency comparison, but it looks to me like we are seeing a system on the verge (or maybe over the verge) of being swamped.  We sort of expected this after we began screening children in the Commonwealth for mental illness, and I suspect it was not helped by the economic downturn, which has placed tremendous strain on mental health agencies throughout the Commonwealth.  Whatever the reason, the need for more workforce is clearly real, and services are hard to access.  High quality services are even harder to access.  

Mamacate is correct-  what is one do do on a single income with an inflexible job and limited transportation?  This will be the critical question as the Rosie D remedy rolls into the next phase.

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