A sweeping children’s mental health bill providing everything from broader insurance coverage to loan forgiveness for mental health workers to trauma-informed training for teachers passed the State House of Representatives by a 149-0 vote on Wednesday.
This is the first of three bills focused on children’s mental health to pass in the State House this session. The bill includes provisions that affect every aspect of the mental health system, from state agencies to insurance companies, local school districts, physicians and mental health providers.
State Rep. Liz Linehan, D-Cheshire, co-chair of the children’s committee and one of the bill’s authors, said that the bill was the result of bipartisan collaboration in both chambers of the legislature. She said the legislation is a complement to Senate Bill 2, a bill focused on child mental health and early childhood education that passed through the senate on Friday.
“When we’re talking about children’s mental health it’s not about what we’re spending, it’s about what we are investing,” said Linehan. “If we can help these kids – or I should say when we help these kids – before those high acuity moments in their lives, then we’re actually saving money down the line, because it costs more to help someone who is in crisis than it is to really begin to help them when they are just entering having trouble.”
The budget includes $35 million, according to House Speaker Matt Ritter, D-Harford, to cover the cost of the programs in the bill over the next year. The bill also includes a number of requirements and costs for insurers that will likely be passed on to consumers.
Dr. Linda Mayes, professor of child psychology, pediatrics and psychology at Yale School of Medicine and director of the Yale Child Study Center, emphasized the value of addressing mental health needs at every stage.
“It would be so easy to take the simple point of view and say ‘We’re just going to fix the hospitals,’ ‘We’re going to fix just the [Emergency Department]’,” she said. “They’ve actually started to think about a continuum of care, which is critical in behavioral health.”
For Mayes, that continuum of care means supporting pediatricians and schools, which will alleviate the pressure on the emergency rooms. It also means providing outpatient services and intensive care services to support children at varying levels of mental health needs.
According to Mayes, the increased need for children’s mental health services existed before the pandemic. She said that in January 2020, the Child Study Center saw it’s highest rates of referral for patients ever, with children seeking treatment for conditions that included anxiety, depression, eating disorders and suicidal ideations. She said that when the pandemic hit, the center started to see an increase in the severity of the cases, as well as more children who were coming in with behavioral health concerns at a younger age.
Jody Terranova, a pediatrician at Connecticut Children’s Hospital and president-elect for the Connecticut chapter of the American Academy of Pediatrics, said that doctors at the hospital were seeing a larger number of children come into the emergency room in crisis because their mental health issues haven’t been addressed. She said that children who arrived in crisis were waiting weeks in the emergency room to be admitted.
“We see ten, twenty, thirty kids waiting in the emergency room for one week, two week, three weeks for a bed, which is ridiculous,” she said. “But then we need all the levels of care to be funded and provided and accessible so that people don’t have to wait until they’re in a crisis point to actually get help, which is where the system has kind of gotten to.”
“Abandoning their posts”
Many of the bill’s provisions are designed to recruit and retain more behavioral health specialists — including psychologists, social workers, school counselors and nurses. These include an extension of temporary permits for people with a masters degree in social work, a grant to help potential social workers afford preparation for the social work licensure exam, a scholarship program to help cover the cost of licensing fees, a loan forgiveness program for mental health providers and a grant program to incentivize hiring child psychiatrists. The bill will provide grants to local school boards, operators of summer programs and colleges and universities to hire specialists in child mental health.
State Rep. William Petit, R-Plainfield, ranking member on the Public Health Committee, said that attracting more mental health care workers would be the biggest challenge that the state would have to deal with, and one that would take five to ten years to accomplish.
Steve Wanczyk-Karp, executive director of the National Association of Social Work, has said that licensure fees for social workers in Connecticut are some of the highest in the country. He is asking the legislature to change the licensure from an annual to a bi-annual renewal while keeping fees the same. According to Wancyzk-Karp, Connecticut is one of six states with annual licensure renewal, which costs $195 per year.
Diane Michaelsen, Director of Field Education and M.S.W. Admissions at Southern Connecticut State University, told CT Examiner that the provisions in the bill would help stabilize a field that has seen a high attrition rate. According to Michaelsen, about 600,000 social workers have left the field since the end of last year. She said social workers had burned out from trying to take on more work than they could handle, and from the emotional toll of their job.
“The need continues to grow for social services, but the people that are meant to deliver them are abandoning their posts,” said Michaelsen.
Michaelsen said she thought the social work exam was an important part of becoming licensed, and said she was concerned about the provision in the bill allowing for master’s in social work to continue using a temporary permit for a year even if they had failed the exam.
“For a long time, social work didn’t have any oversight or any way of demonstrating what we were doing,” said Michaelsen. “And so I think that to have a license that follows two years of clinical work and a hundred extra hours of supervision is a good thing.”
“Saving lives by the end of the summer”
The bill also augments the intensive services available for children in crisis. It develops a pilot program in Waterbury that will create a partial hospitalization program and an intensive outpatient program for teenagers. Linehan said the program will be launched at the end of the summer and will be able to serve up to 144 children struggling with mental health problems.
Linehan said that Waterbury was chosen because there was a “service drought” of intensive outpatient programs in the city, because it was a central location and because Wheeler Clinic, which will run the program, has the ability to expand quickly and inexpensively in the city.
“This intensive outpatient program will literally have the ability to start saving lives by the end of the summer,” said Linehan.
The bill also establishes a grant program to help parents who can’t afford mental health care for their children and provides respite care for parents who have children with mental health struggles.
“[We] gave more money to a respite program to give those parents some much-needed time off,” said Linehan, who cried when speaking about the difficulties of parenting a child struggling with mental illness.
Within the school setting, the bill creates the position of regional trauma coordinator who will create a program to train teachers, administration, staff and coaches in trauma-informed practices.
Michaelsen said that while she believed it was important for teachers to be able to recognize when a child hadn’t eaten or needed a place to sleep, she also believed it was a lot to ask of teachers to address things like trauma in students. Terranova also acknowledged that it was a lot to ask of the teachers, but pointed out that these were the people who were present in the children’s day-to-day life.
Both the American Federation of Teachers and the Connecticut Education Association, the major teachers unions in the state, testified in support of the bill. In testimony, CEA President Kate Dias and AFT Divisional Vice President Mary Yordon both highlighted the need for more mental health staff in the schools.
“With anxiety, depression, self-harm and dysregulated behavior increasing among young people there is a great need to rethink and reconfigure services to those who serve children and the services themselves,” Yordon wrote in her testimony. “With the rates of anxiety and depression skyrocketing due to the pandemic, the need for additional mental health support has never been higher.”
Another provision requires the state to develop a model for a peer-to-peer support program for middle and high schoolers.
Linehan said that evidence-based peer-to-peer support programs were available for school districts to purchase independently, but were costly. This model, which would provide a program to the school districts for free, would cost the state a total of $150,000 to develop.
“It is actually a program that is a significant cost saving to school districts while helping kids,” said Linehan.
Truancy is also addressed in the bill, which requires students who have missed more than a certain number of school days to be evaluated by a mental health specialist and that school districts take into account mental and behavioral health when they make policies about truancy.
State Rep. Kathleen McCarty, R-Waterford, said she was grateful for the attention to truancy, and that she was in support of the bill as a whole.
“This is a real crisis with our school students. They need these services. We’ve been talking for years about restorative practices and helping our students, and I believe this bill addresses many of those issues,” she said.
“Where can we send these kids?”
The bill contains multiple expansions to insurance coverage for mental health services, including requiring insurers to cover intensive evidence-based treatments and acute inpatient psychiatric services. Prior authorization from the insurance companies will not be required for children to be admitted to acute psychiatric services.
It also requires the coverage of two mental health wellness exams for a student. State Rep. Tammy Nuccio, R-Tolland, said this addressed a long-standing problem in that insurance companies would not cover services unless there was a clear diagnosis, putting pressure on physicians to diagnose something that may not be clear.
“We’re asking the insurance companies to bear this cost, which we actually think is in their interest. Getting a child before the right kind of practitioner early on, having an early intervention even before there is a diagnosis will lead to better outcomes and less acuity down the road,” said State Rep. Jonathan Steinberg, D-Westport.
The bill provides three free follow-up consultations for children who are prescribed medication for mental health issues.
“Sometimes they’ll get discharged and then we’re asked to continue to refill their meds, but then they’re just getting medication and no other therapeutic service, and it’s really a disservice for the kids,” explained Terranova.
Terranova said she believed that requiring insurance providers to cover intensive psychiatric care would help with the general lack of these services in the state.
“That’s a barrier to begin with … where can we send these kids? There’s often such a shortage of either programs or providers. And I think part of that is because of the lack of appropriate reimbursement,” she said.
The bill also requires the Office of Health Strategy to study insurance reimbursement rates for mental health services and how private insurers are reimbursing for mental health in comparison to the state insurance.
State Rep. Kimberly Fiorello, R-Greenwich, was critical of the bill, but ultimately voted in favor. Fiorello said she felt that while the legislation was well-intentioned, it was overly broad and she expressed concern that there was not enough data being collected to measure the success of the programs.
“What I am wishing for, is some real data to really dig into the problems, the specific problems, and then the bill to try to solve it,” said Fiorello.
The bill does include provisions that will collect data on the various programs, and Petit said it would be important to follow the programs in the bill as time progressed.
“I think some of these things may work well, some may work reasonably and some may not work at all, so we need to revisit the issue,” he said.
Linehan said the bill was the result of having heard the struggles that parents are having in confronting their child’s mental health issues.
“This bill is real. It makes real change. It is transformative,” she said. “It will make a difference in so many lives.”