Advocates say youth mental health services still in crisis

Rebecca Almeida spent three hours on a recent school day searching for her 14-year-old daughter. Suffering from several behavioral health challenges, Almeida's daughter lost her temper while at school in West Warwick and fled without anyone noticing. Hours later, after Almeida had filed a missing person's report, the teen was found at a friend's house. Almeida says the incident is just the latest evidence that her daughter, who qualifies for Medicaid, isn't receiving the care she needs. Now the youngster is one of 10 children named as plaintiffs in a federal lawsuit filed by American Civil Liberties Union of Rhode Island Inc. and other advocacy groups accusing the state of denying Medicaid-eligible youths their right to appropriate mental health care. Also on the list of plaintiffs are three of Almeida's other children. Behavioral health advocates say the class action lawsuit filed in U.S. District Court in Rhode Island on Nov. 13 highlights the desperate need for more behavioral and mental health services for adolescents in Rhode Island, demand for which has only increased since the COVID-19 pandemic. Named as defendants are the R.I. Executive Office of Health and Human Services and R.I. Department of Children, Youth and Families, both of which said they would not comment on pending litigation. The lawsuit demands that the two state agencies "promptly arrange" in-home and community-based behavioral health care options for the plaintiffs and enact policies and programs to help about 20,000 Medicaid-eligible children in the state who may qualify under the class action lawsuit. In Almeida's situation, her 14-year-old daughter has been in and out of the hospital several times for behavioral health issues. Doctors have repeatedly recommended that she receive more in-home services, but they haven't been available. Instead, the teen has spent hundreds of days both in hospitals and residential treatment centers. At the same time, Almeida has a 13-year-old daughter with similar experiences. Most recently, she was discharged from the hospital in early December without any recommended home or community-based services in place, and Almeida is still searching for the care her daughter needs. "My daughter needs instant services," she said. For years, advocates have been pushing for action in the area of child mental health, including increasing state funding and raising Medicaid reimbursement rates. In 2022, groups representing Rhode Island pediatricians and psychiatrists declared a "state of emergency" as rates of depression, anxiety and trauma skyrocketed among children, as did suicide rates. The situation hasn't improved, observers say. Kristine Sullivan, legal director at Disability Rights Rhode Island, a Warwick-based nonprofit that joined the ACLU and Children's Rights Inc., says the state is experiencing a shortage of providers in the area of adolescent mental health caused by a lack of interest in entering the field, the need for training and low pay rates. Indeed, Beth Bixby, CEO of the West Warwick nonprofit Tides Family Services Inc., says the state has been struggling with labor shortages and increased need since before 2019, and it has intensified since the pandemic. Tides provides families with intensive, community and home-based counseling services that help avoid placing children in expensive and restrictive settings, but the organization has had to start a waiting list for the first time in its 40-year history. It also cut some services completely during the pandemic. "That was a huge issue," Bixby said, noting that medical professionals say the longer a child is in a residential program, their physical and mental health can deteriorate further. Tides' decision to take over day-to-day management of the troubled St. Mary's Home for Children in May has placed extra pressure on the agency. Still, Tides continues to provide support for about 500 youths daily, and has been able to accept 60 more patients recently because of a focus on staff recruitment and training, Bixby says. Tides partnered with local universities to offer internships and then hired 13 of the 18 interns. Tides also started mobile crisis response services in 2020 - the first in the state - to provide short-term, in-person support intended to prevent future crisis situations. Other Rhode Island agencies have started similar programs. Along with more mobile services, the lawsuit wants the state to provide two other resources: intensive care coordination, which is case management and planning led by a team and meant to manage care across multiple systems; and intensive in-home behavioral services, which are individual therapy interventions provided in homes and other community settings that are consistent and meant to improve behavior and prevent out-of-home placements. Sullivan says the state has promised to provide more of these services - as opposed to inpatient treatment - for years. Instead, the state spent $45 million on a 16-bed residential treatment center for adolescent girls in Exeter that is expected to open in 2026, she says. EOHHS and DCYF have until mid-January to respond to the lawsuit. Meanwhile, Almeida is continuing to search for services for her four children who are part of the lawsuit and who, combined, have spent thousands of days in hospitals. She's frustrated by the lack of progress in getting her children treatment. "You're just on this massive merry-go-round," Almeida said.