Parent shares frustrations over access to mental health care - WQOW TV: Eau Claire, WI NEWS18 News, Weather, and Sports

Parent shares frustrations over access to mental health care

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Eau Claire (WQOW)- If you're feeling sick you may head to your doctor's office or maybe a walk-in clinic, even the emergency room. It's relatively easy to get the care we need when it comes to our physical health, but what about mental health?

Research shows that 50-percent of lifetime mental illness cases begin by age 14. That's why many mental health care providers advocate for early intervention. In fact, they've begun partnering with school districts in an attempt to connect families with treatment options.
But, despite those efforts a growing number of local kids are not able to access mental health services.

Stephanie Henning was encouraged by the changes she'd begun to see in her daughter, Jessica. But now, after weeks without therapy her mother worries old behaviors are beginning to emerge. "She was making so much progress and some stranger up and decides she doesn't need services," says Stephanie. Jessica had been in a day treatment program until her mother says the family's HMO decided they would no longer pay for services. "I was upset," recalls Stephanie, "She wasn't ready yet, and everybody knew she wasn't ready."

Without the help of an insurance company the cost of a day treatment program, or school based counseling is too expensive for many families to afford. 

HMO's or health maintenance organizations contract with doctors, hospitals and other health care providers to create a network of participating providers.

"If they have one particular HMO nearly 8 or 9 out of 10 are not getting the services," says Dr. Tom Johnston, Director of Marriage and Family Health Services in Eau Claire.

HMO's have the power to decide which agency a child can receive care from, or if they qualify for care at all. In the past those decisions were made solely by the state's Department of Health and Human Services. "In the last two years that decision was shifted to the HMO's," explains Dr. Johnston. "Some professionals in the community feel that there is somewhat of a conflict of interest there"

"For instance, if a family is on Badger Care and has a Group Health HMO the only provider they can see is Omne Clinic," explains Jessica Modjeski, a social worker with the Eau Claire school district. "Unfortunately that happens pretty often."

The Eau Claire school district does not currently partner with Omne Clinic to provide services in its schools, which means those families have to seek out care on their own time. "The waiting list to get in to Omne Clinic is maybe very long and it's through no fault of their own," says Modjeski. "There is just a high need in our community and we don't have enough providers."

Dr. Tom Johnston says certain HMO's have opened the door to care only to cut that funding off once a child shows progress. "I'll give you an example," says Dr. Johnston. "We'll make a fictitious name. Patricia. Sexually abused child. Just began talking about her trauma and what happened to her. Just began to establish enough trust and because she showed a little improvement and was talking about it, they asked for her to be discharged and she's not ready to be discharged. The county social worker is supportive of her being in the program, the physician is supportive of her being in the program, to finish her work and the school wants her to finish. There's nobody that does not want her to finish, but the funding source was denied."

"Many HMO's work very freely and are very open to helping the children but this is not something that's across the board right now," adds Dr. Johnston.

After many phone calls and lots of paperwork Jessica's family was able to switch their HMO. As of March 1st the cost of her treatment will be covered. "It had my family doctors on it that I've gone to all my life and that all my kids have gone to and that's how we chose our HMO to begin with," explains Stephanie. "But I think you've got to do more research to find out exactly what they're willing to cover, what they're not." 

Cost of care, availability and transportation are very real road blocks but they are not the only barriers to care. Perhaps one of the biggest things preventing families from seeking out mental health services is something you can't see at all.

"It's not a sign of weakness to ask for help and it's not a sign of a bad parent to have a child who has mental health disorders," says Modjeski.

Dr. Johnston believes there is still somewhat of a stigma surrounding mental health care.  "Sometimes we'll have people from one community who are driving to another community that we serve to receive their services so people don't see their car in the parking lot." But adds, "I think things are beginning to head in the right direction." 

Click here for Kids in Need: Barriers to Care Part 1.

You can find more information about mental illness here.

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