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June 17, 2024 11:34 am

Local News

Poor access to mental health care leaves Georgia children who need a psychiatrist in the lurch

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Ellen Eldridge, GPB News

When Layken Edenfield was little, her moods would switch quickly, her mother, Teresa Edenfield remembers. 

“One minute she’d be happy and laughing, and the next minute she’d be crying her eyes out,” Edenfield said. “She was really hypersensitive about certain things around, or really terrified.” 

A decade ago, 3-year-old Layken and her two younger, maternal siblings joined Teresa, her husband, and their four biological children in rural Darien, about 20 miles from Savannah. The childrens’ birth mother struggled with mental illness and substance use disorder, which Edenfield thinks puts Layken, now 13, and her siblings at a higher risk for developing the mental health condition she now has.

Lakyen’s moodiness as a toddler shifted to behavioral symptoms by elementary school, Edenfield said. Teachers and family members caught Layken lying and stealing. They knew something wasn’t right with the young girl, but they couldn’t put their finger on what was wrong. 

By middle school, the principal called and said she must be picked up immediately after school because there weren’t enough people to watch Layken, who was having severe emotional outbursts.

Sometimes they were violent.

At home, Layken threatened to beat her sister Madison in the head with a baseball bat while she slept. Edenfield took Madison into her bedroom, and locked the door at night. 

“I would actually put something in front of my door so if she did try to come in, because she figured out how to get in my room if the door was locked, I would know if I could hear somebody coming in,” she said, her voice cracking. “It was scary, I’m not going to lie.” 

The situation reached crisis levels when Layken made threatening comments about a specific student. The school called Edenfield, requesting she pick her Layken up for an involuntary psychiatric hold for evaluation by a doctor in a behavioral health crisis intervention center, usually within 48 hours.

In the state of Georgia, there exists a legal document called a 1013 form. The purpose of the 1013 form is to initiate transportation to an “emergency receiving facility” and is completed by an authorized licensed clinician.

The facility must agree to receive the client (i.e., they have an available and appropriate bed for the client).

It was the first step, of a long journey, to getting Layken the comprehensive care she needs.

Shortage of staff, lack of crisis care availability. 

As mental health conditions rise among children, public schools like Layken’s are sometimes the first and best option for early intervention — especially in Georgia, where health care shortages are worsening and broadband access is not widespread.

Pediatricians can offer some support for children’s mental health, but their scope is limited. Layken’s pediatrician prescribed 100 milligrams of Zoloft (sertraline) after a basic psychological exam, but later suggested adding a mood stabilizer and one-on-one psychotherapy — services she couldn’t provide.

“That was out of her wheelhouse,” Edenfield said. “We needed a psychiatrist.”

Outside of schools and primary care, many families find mental health services hard to come by and challenging to afford. According to the Rural Health Information Hub, 151 of the state’s 159 counties struggle with a shortage of mental health providers. The National Alliance on Mental Illness (NAMI) also reported that nearly 5 million people in Georgia live in a community that does not have enough mental health professionals.

These disparities are prevalent in marginalized communities and with access to specialized services for more severe mental health conditions.

The Georgia Council for Child and Adolescent Psychiatrists has 240 psychiatrist members statewide, most of whom practice in the metro Atlanta area, and few of whom accept Medicaid. Children can wait up to six to eight months to book an appointment with an adolescent behavioral health specialist, according to the Kids Count Data Center

Roland Behm, who serves on the board for the Georgia chapter of the American Foundation for Suicide Prevention, said the state needs to work on expanding access to Medicaid so that more families have an opportunity for preventative care.

“We need to have that crisis care, no doubt,” he said. “But we need to be able to provide care at early stages so maybe that crisis care isn’t necessary because that crisis care is expensive. It’s difficult to find. We need to be doing more and better.”

Searching for help 

Layken’s school’s recommendation and Edenfield’s agreeable decision to hospitalize her in a behavioral health crisis facility didn’t solve the family’s problems. They still needed to find — and pay for — care.

Layken Edenfield on the first day of school in August 2023.
Layken Edenfield on the first day of school in August 2023. Credit: Contributed

They headed to the hospital in Savannah, the nearest city, but had to turn around after finding out the hospital didn’t have an available bed. 

As they looked for alternatives, the Edenfield family struggled to manage Layken’s symptoms, which were worsening.

“It was to the point that we were having to call the police,” Edenfield said. “She was attacking her sister and her brother and, you know, yelling and fighting and screaming. ”With help from the school, Layken was eventually admitted at St. Simons By the Sea, a behavioral health center for emergency mental health care and stabilization for teens and adults that took Medicaid.  

“She was in there for a week,” Edenfield said. “The very next day they called me and diagnosed her with bipolar I.” 

Edenfield didn’t know what that meant, but they had a diagnosis.  Still, they needed a child and adolescent psychiatrist to prescribe and manage Layken’s medication — one who also accepted Medicaid.

Unaffordable care 

Layken eventually connected with a psychiatrist in Brunswick through Gateway, one of the state’s 22 community service boards (CSB), local agencies that provide mental health services to families on Medicaid or with no insurance. 

Funded through the Georgia Department of Behavioral Health and Developmental Disabilities, CSB services are high in demand and have limited availability. 

“Our CSBs are challenged to find social workers and clinicians and direct care professionals [to work for them],” said Department of Behavioral Health and Developmental Disabilities Commissioner Kevin Tanner, who added that state mental health care salaries should be increased by about 40%.

“That’s why so many of our providers that we have in the state of Georgia are private pay only and do not take Medicaid or even health insurance,” Tanner said. “That has to change, and we have to increase our rates.”

In private practices, the funding of mental health care is also an issue. Many therapists and psychiatrists won’t accept private health insurance or Medicaid, citing arduous paperwork and low reimbursement rates from providers. 

Psychiatric assessments can cost as much as $200 or more out of pocket, and that doesn’t include therapy or medication management. Cost was the deciding factor for 45.4% of adults in Georgia who did not receive mental health care they needed, according to NAMI. 

In the past two years, state lawmakers have attempted to improve access to affordable mental health care through legislation including passing the Mental Health Parity Act, but Georgia is still ranked at the bottom of the U.S., at 49th, according to Mental Health America.

Early Intervention

To improve the mental health care system, advocates say the state will need to take a multi-faceted approach, especially when it comes to children. Nearly 1 in 4 Georgia children ages 3 to 17 years old have one or more emotional, behavioral, or developmental conditions, according to data collected in 2021 from the Annie E. Casey Foundation.

Recognizing families’ reliance on school-based services for early intervention, Gov. Brian Kemp dedicated $50 million in his recent budget to hire school psychologists to work in schools.

While the recommended ratio is one psychologist for every 500 students, Georgia currently has one school psychologist for every 6,390 students. Kemp also increased funding for the state Apex program, which links schools with community-based mental health services, from $634,554 in 2021 to $8,294,554 in 2024.

The Apex program places children in tiers depending on the level of support they need. The top of the pyramid are the 3% of children like Layken with the highest needs. But everyone in the school can benefit from support like workshops on coping strategies and suicide prevention training, said Dimple Desai, a senior policy analyst with Voices for Georgia’s Children, an advocacy group.

During the 2022-23 school year, 735 schools engaged with the Apex program, representing 15,894 individual students statewide.

Looking forward

Back in Darien, Layken continues to work with her care team — the same psychiatrist at Gateway, the school counselor in Darien and, in emergencies, a visit to in-patient care, her mother said.

After a manic phase in September and an episode in October, Layken returned to school for two weeks. But just before the holidays, Layken had another episode and was admitted to St. Simon’s By the Sea for four days. Her doctors changed her medication after adding psychosis to her bipolar 1 diagnosis.  

“So far [Medicaid coverage] has paid for everything. Thankfully!” said Edenfield in an email. “I’m afraid to even think about how it would be if we couldn’t afford her medication. Very scary.”

Most children dealing with stress and emotional difficulties don’t need medication or ongoing therapy, said Kathryn Allen, a therapist who works with children and adolescents in Atlanta.

Though your kids may not struggle with serious mental illnesses, they probably do need to talk, she said, which means more than just asking, “How was school?”

“But, really, like, ‘how is everything socially at school?’” Allen suggested. “‘Is there anyone that you know is hurting your feelings? Are there any bullies? Is there anyone, you know, kind of making fun of you and telling you that you’re less than?’”

Ideally, someone who interacts with young people will have some mental health care training and has an eye out for certain behaviors that call for further assessment.

“Then they shouldn’t get left, you know, kind of lost within the cracks,” Allen said.

This story comes to the Augusta-Richmond Herald through a reporting partnership with GPB News, a non-profit newsroom covering the state of Georgia.