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March 29, 2005
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| Public school social worker Ann McInerney says there's a six-month wait for mentally ill children to get into her day treatment program (MPR photo/Dan Olson) |
St. Paul, Minn. — The shootings at Red Lake last week were committed by a 16-year-old who was on the radar screen. Mental health professionals had reportedly diagnosed Jeff Weise's problems and prescribed actions. Why the actions didn't work remains a mystery. The incident illustrates the complexities of treating depression and other mental illnesses.
The biggest complexity experts say is making the system work. In l989 Minnesota lawmakers passed the Children's Mental Health Act. The goal was early screening and prompt intervention for all children.
Twelve years later, in 2001, the state commissioned the Citizens League to see evaluate the legislation's results.
The Citizens League panel returned a report saying the state's goals remain, "utterly unfulfilled."
Minneapolis child and adolescent psychiatrist Dr. Will Dikel, the president of the Minnesota Psychiatric Society, says his experience mirrors federal studies which show most young people are not getting the mental health help they need. "The continuing tragedy in childrens' mental health care is the needless suffering, school failure, anti social behavior, family disruption that results from 4 out of 5 children and adolescents who have psychiatric disorders never receiving treatment," Dikel says.
The personal costs are staggering. Suicide is the 2nd leading cause of death for children 10 years old and up.
The personal cost measured in time is months even years of waiting to get help. Six months is how long children have to wait to be helped by Ann McInerney, president of the Minnesota chapter of the National Association of Social Workers. She's a social worker in an urban school district.
McInerney leads a day treatment program for 15 mentally ill students. She says there are at least that many young people waiting in line for her help.
Minnesota ranks high in graduation rates and test scores. But we rank low compared to other states, McInerney says, in the number of counselors, social workers, psychologists and psychiatrists working in schools to help young people. "We don't have high rates of that at all. I think that if we asked any of the student support staff in schools they would say they are overworked, that they have a lot of kids with a lot of needs," she says.
If there were more money it could be used to hire people like Bob Gooddale. He's doing the kind of early detection and intervention that experts say saves lives and money.
Gooddale works in public middle schools in a western Twin Cities' suburb. He relies on his own observations and those of his colleagues to find young people who may be angry because of bullying or sad because of family breakup or having other problem. "I get folks that work in the lunchroom that say, 'Have you noticed this kid, he's kind of eating by himself , you might want to just see how he's doing'" he says.
Gooddale counsels young people in groups or individually. If the problem is beyond his training he can try find the young person more specialized help. "With resources being tighter it can feel overwhelming at times in terms of trying to address all the needs of all the students," he says.
Services for helping young people with their mental health problems are lacking, says state Sen. Linda Berglin, Democrat, Minneapolis, because health care companies have not made the issue a priority compared to treating heart disease. "If we had people waiting six months to get a heart stent put in they'd make sure they took care of that issue," she says.
Advocates say Minnesota laws give people who need mental health care some clout. But few people know about the laws, and they are seldom used.
In a nutshell the laws mandate that health care companies hire enough people to supply mental health care to customers including young people in a reasonable time and within a reasonable distance.
Berglin says the Minnesota Department of Health could refuse to re-license health care companies that don't abide by the law. "If people feel they are not getting what they should under the law they can complain to the Department of Health. The Department of Health will investigate and tell the HMO you have to do something about this," she says.
But almost no one is filing any complaints. There are only five this year, the state health department says, and there were only 20 last year, and almost none were complaints about access to mental health care.
Medica's Glenn Andis says Minnesota's mental health care system needs improvement, and he says health care companies like his would offer more care if there were hundreds of complaints.
Minnetonka-based Medica is Minnesota's largest health maintenance organization. Andis is senior vice president of government programs at Medica. He's a psychologist with 20 years of mental health practice.
Andis says people don't seek mental health care and thus don't complain about lack of services for a range of reasons. "Stigma, lack of resources, lack of education, lack of awareness, defensiveness, people don't want to admit they have a problem," he says.
Advocates assert another reason the state's mental health care system is broken is practitioners can't earn enough. That explains why there's a shortage of child psychiatrists, psychologists and social workers. The pay is poor, they argue, because employers are pressuring health care companies like Medica to keep a lid on rising costs.
Glenn Andis says the pressure is a factor in explaining why mental health care services are not more widely available. "Employers are very concerned about simply being able to provide insurance because they can't afford to do so, so any increase in cost is of great concern. Do we have employers who are specifically saying, 'No don't pay these particular providers more?' No we don't have that," he says.
Andis says health care companies are part of a voluntary program that is looking for ways to improve mental health care delivery. However, so far only about 1/2 the state's counties are covered by the effort.
Social worker Ann McInerney says parents and other adults must play a bigger role in young peoples' mental health.
She says adults need to spend more time controlling and explaining the messages our culture is sending to children.
McInerney says children she works with increasingly see violence in movies and video games as a realistic way of dealing with life. She says media coverage of real life incidents like the Red Lake shootings is affecting children, and adults need to take time to explain the event. "The more that we blow it off, the more that we pretend that it's not affecting them, the more the kids will accept it as normal, 'This is probably how life goes and how society is set up,' And I don't think that's fair for our children to think that that's how life should be."
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