Townsend, a mother to four children who lives in this small Mississippi Delta town, needed immediate help. To get counseling, she called a nearby community mental health clinic that is funded by the state. The clinic informed her that they have a waiting list of at most six months. Even if the girl was accepted, the clinic would only allow her to see her once per month. Townsend stated that she didn’t believe one visit per month was enough. “She was suicidal.” Mississippi has few options for children with severe mental illness. To receive mental health support or services, they must travel to psychiatric facilities, which are often located far from their homes. Townsend and her daughter were blessed. Townsend was enrolled at a non-profit parenting program where she could get help. The group linked her to a therapist who could help her daughter through home visits. Townsend stated that her daughter now seeks out the therapist and anticipates her visits. Mississippi remains at the bottom of the national rankings for youth with emotional or mental problems, nearly a decade after it was sued by Southern Poverty Law Center. Despite attempts by the state to expand and increase funding, many children in Mississippi’s most remote areas still don’t have access to vital mental health services. According to a 2017 national report, Mississippi’s youth suffering from major depression (roughly 13,000) don’t receive any professional help. Although the state attempted to tackle the problem by providing mental health services to children with more severe mental and emotional problems, it has also tried to divert funds from psychiatric facilities to community-based services. However, these efforts are often hindered by a lack funding. The Department of Mental Health in the state has reduced hundreds of staff, cut some services and closed many programs, including one that offered community-based mental healthcare services to youth at risk. Mississippi’s efforts to reach more children are hampered not only by its limited resources but also because 44 percent of the state’s children live in rural areas. Experts agree that it is more difficult to connect children to mental health services because of the state’s scattered population. “That is why these families are saying, ‘I called the mental healthcare center. Joy Hogge is the executive director of Families as Allies, a Jackson-based non-profit. Poor outcomes can result for children and teens in Mississippi. Mississippi is already struggling with multiple issues that affect children’s well-being. Untreated mental or emotional issues can lead to youth being incarcerated, having difficulty in school and a higher rate of dropout and suspension, as well as more likely to commit suicide. Children who aren’t treated for mental illness have more access to health care than adults, and they are more likely to be poor and unemployed. Teri Brister is the director of information support for the Washington-based National Alliance on Mental Illness. She said that she has not seen any state create a strong, statewide system to provide children’s mental health care. However, Mississippi’s system is particularly troubling. Brister stated, “I don’t know if anyone is as disjointed than we are.” Brister speaks from personal experience. Brister worked for more than 20 years in the Mississippi community healthcare system before joining NAMI. Related: Online resource for rural schools to fill mental health gaps for students Mississippi’s 14 Community Health Centers are spread throughout the state. The centers are accredited by the state Department of Mental Health. However, each center is run by its own board and offers different services. Theresa Parsons is the director of Region IV’s children’s services. Region IV serves five north Mississippi counties. She said that therapists are sent to Region IV every day to visit schools. The program is still unable to reach rural residents. Are we meeting all of the needs? Parsons stated that he couldn’t claim we meet all the needs. Parsons stated that transportation is a significant problem in rural regions of Region IV. Parsons said that her case managers drive as far as 30 miles to pick up people and transport them to the medical appointments. This is not their primary job and increases their already overloaded caseloads. Parson stated that “a lot of times our case managers must step in and assist with things.” “It’s a lot.” Finding staff members can be challenging. Parsons still had a few positions available for August 1 starting date as of May. The state supports mobile crisis response teams. These teams are often composed of one therapist, two support specialists and can quickly respond to children and adults in mental health crises. The response teams responded to 23,168 calls and made 15,668 face-to–face visits in fiscal 2017. The state has gradually increased the number of wraparound programs that can provide long-term mental healthcare to children since FY 2014. These programs served approximately 1,700 children in FY 17. They create a team consisting of adults who meet each 30 days in the community of a child to develop a support plan. This plan could include referrals to community mental health services. Mississippi Youth Programs Around the Clock, (MYPAC) is another program that assists children with serious emotional disturbances. This program is administered by various non-profits that receive financial support from the state. It provides ongoing individual therapy and family therapy as well as connections to other community members like counselors, teachers, and neighbors who can offer support. MYPAC provides services at home, unlike other programs. Patrick McLaughlin is the assistant director of community-based services for Youth Villages in Mississippi. He said that the purpose of the services was to give tools, skills and resources to the family so they can function without us. McLaughlin stated that MYPAC can “help build them up.” However, despite the promises of MYPAC’s model McLaughlin acknowledged there are still challenges, particularly in rural areas. A family may not have the means to travel to a psychiatric or medical appointment if they don’t own a car. McLaughlin stated that this can increase the isolation people feel when dealing with mental health problems. McLaughlin stated, “A lot families we have… They are seeking this support and help.” Nonprofits and schools in rural Mississippi have attempted to fill the gap in mental health services. They offer free services or train teachers on suicide prevention. It has been difficult to build a mental health workforce. As of 2015, the majority of Mississippi’s counties and particularly its rural ones, did not have psychiatrists or psychologists. Many of these rural areas were also without pediatricians. These are the professionals parents often turn to when they have concerns about their child’s mental health. Wait lists can get long for families who do eventually find a provider. Mississippi has one of the highest rates of mental health insurance in the country, with nearly 15 percent of its children not having coverage. According to providers, it can be difficult and taxing for staff to travel to rural areas to meet with families. Similar: Students of color are less likely to seek out mental health counseling. Experts agree that more support should be provided in schools where children spend most of their time, especially in rural areas. However, the number of Mississippi school psychologists has decreased by 20% between 2005 and 2010. There were less than 400 school, counseling, and clinical psychologists in Mississippi in 2017. Most of them worked in the Jackson area in southern Mississippi. They also served as border counselors between Mississippi and Tennessee. Many students who seek out school counselors for help with mental health issues may find their counselors too overwhelmed by paperwork and other aspects of the job to offer support. Michelle Cresap is a school counselor from Rankin County. She has been responsible for coordinating testing and enrollment. Cresap stated that not all schools support their school counselors. Cresap said that not all schools support their school counselors. She is also the president of the Mississippi School Counseling Association. Cresap works with students in grades 9-12. She offers individual counseling and connects students with outside counselors when needed. Cresap estimates that she spends 80 percent of her time face-to-face working with students. This is what allows her be a support to kids. She said, “If I get a hold on that child, then I can help that kid.” Families as Allies found that many parents were unaware of the state’s mental-health services. This was based on a 2016 and 2017 statewide survey as well as a series a town hall meetings with Mississippi residents. Even those who were aware of the services often couldn’t afford them or could not get them. Some parents reported that they called 911 in an attempt to help their child with mental health issues. Mississippi continues to rely on institutions for treatment of children with mental disorders and depression, despite a 2010 lawsuit. According to a 2015 study, nearly half of the state’s funding to children’s mental healthcare went to private and public institutions. The report found that inpatient psychiatric hospital admissions for youth increased 22 percent between FY 2010- FY 2014. The SPLC sued Mississippi for failing to provide treatment and screening services that children who are eligible under Medicaid were entitled to. The state’s overall spending on mental health services for Medicaid children has decreased in the years following the lawsuit. (Mississippi lawmakers chose to not expand Medicaid in 2013, foregoing insurance for more 300,000 residents, including children, and instead chose to ignore the rest of the country. Officials can still point to some progress. The Mississippi legislature has allocated $16.1 million over the past five years to improve community-based mental healthcare services. The state has increased programs serving children with severe mental health problems by using these funds. A suicide prevention outreach program, a program to help young adults aged 15-30 who have had their first episode with psychosis, as well as a program that assists youth and young adults with severe emotional disturbance transition into adult mental health services and prepares them for independent living. According to Adam Moore (director of communications at the Mississippi Department of Mental Health), the Department of Mental Health will take $10 million from its budget to support institutions in the next fiscal year to improve community practices and reduce dependence on institutional care. The majority of the money will be used to expand crisis services at the state’s 14 Community Mental Health Centers. The state also had 50 beds closed in its two youth institutions. Similar: Schools that have more black students are less likely than others to direct students to mental health services. Experts warn that the state’s new funds might not be sufficient to cover current gaps. More than 2 million Mississippians live in areas that the federal government calls “mental health care shortfall areas.” These areas are home to as many as 30,000. Ron Manderscheid is the executive director of National Association for Rural Mental Health. He said that the shortages are worse for youth. Rural areas often have no one who can offer mental health care to children. Nationally, up to 50% of youth are diagnosed with a mental disorder. This includes anxiety disorders and behavioral disorders. According to Mental Health America, 12 percent of young people aged 12-17 report having experienced at least one major depressive episode. This could include inability to concentrate or engaging in normal activities and thoughts about suicide. Children living in poverty have higher rates. The federal government could help the state in its efforts to improve mental health services. The President Donald Trump’s Omnibus Budget, which was signed earlier this year, provided funding increases to support mental programs. This included a $700m increase for a grant program that provides school mental health services and $5 million for programs for children in early childhood mental healthcare. Experts agree that this is a good place for a start. More access to mental health care early on is crucial to reducing the long-term effects of mental illness. Hogge, from Families as Allies, said that the earlier you intervene and support them, the better they will do. Telemedicine, which is a video-chat technology that allows for consultations and medical examinations, is another option. Mississippi was one of the first to adopt telemedicine for many services. The American Telemedicine Association gave Mississippi, along 14 other states, the highest grade for telemedicine in mental health in 2017. The state is still lacking in an essential element of telemedicine success, internet connectivity. Utah and Georgia have increased their focus on telemedicine to provide counselors and psychologists to children in rural areas. Tennessee passed legislation last year requiring that insurers cover school telehealth services. Texas passed legislation that required reimbursement for certain telehealth services provided by schools. McLaughlin, Youth Villages, said that the organization helped families participate in video chats when their family members are unable or unwilling to travel to a physical appointment. McLaughlin stated that if the family does not have access to the Internet or their cell coverage is poor, it could lead to them not being able “to get everything they need.” Manderscheid stated that the increased use of technology should be combined with an effort to train therapists, and other providers who are willing to settle in rural areas. He suggested that the state encourages rural students to pursue a career in behavioral health because they are more likely to return to rural areas to work. Oregon is one example of a state that has tried to train rural primary care doctors to care for children with mental disorders. Teachers need to be trained in the recognition of signs and symptoms of mental illness. Teri Brister, NAMI, stated that teachers need to be able to recognize signs of mental illness and take action. Labella Preston is a school-based therapist at LifeHelp, a community mental healthcare center. She said that she has seen children with depression not receive help because their teachers believe they are quiet or disengaged. Preston stated, “I try and get my teachers understand and look for all these signs.” “Not only children who are fighting,” Preston said. The nonprofit Delta Health Alliance, which is located in Sunflower County, Mississippi, has attempted to fill the gap left by Mississippi’s broken system. The parenting program that linked Jennifer Townsend’s child with a therapist was also run by the Delta Health Alliance.
The nonprofit, along with several other initiatives has invested money and resources in the Leland Medical Clinic. The clinic is a one-story brick building that sits in a residential area. Children can receive counseling, physical therapy and occupational therapy. The clinic has one patient room that can be used to speak to therapists and psychologists from other parts of the state. As part of the play therapy program, Erinisha Johnson’s room for play therapy allows children to paint, play in a pit or write in a journal. Johnson stated that Johnson will often see children who are creative and encourage them to share their ideas. Johnson sees children between 3 and 18 years old, including those with ADHD, Oppositional defiance Disorder, depression, anger management, or social anxiety. Many children have “irrational” thoughts and believe they are not as smart as their peers or that they are responsible for the bad things happening at home. A program is also offered by the Delta Health Alliance that connects parents to community resources. Constance Butler, a Leland resident met a liaison through the program via her son’s school. Carmeloe, 9 years old, had failed second grade in first grade. Dorothy Fowler, a liaison to LINKS, a DHA programme connecting children to services, visited the family’s home. Butler stated that her son wasn’t excited about school and didn’t want to do his homework. He also had trouble paying attention. Fowler told Butler immediately that this was not normal. Fowler referred Carmeloe to the clinic where he was diagnosed with Attention Deficit Disorder. Butler prescribed him medication, which Butler says has made him “a lot better.” She said that she could have used Google to gain insight into Carmeloe’s behavior. Butler stated that she has seen “progress.” Butler stated that Carmeloe is paying more attention and conversing better. However, Butler suggested that if more mental health services were available, including more information for parents and more resources to diagnose children, she could intervene before Carmeloe was so far behind in school. She said, “I could have caught that.” “I wish that I had known then what I know now.”