In a time when concerns are rising about the social and emotional health of youth, there are not enough child psychiatrists to provide services.
A little over a year ago, 16-year-old Isabel Molina was a sophomore in high school. Still learning about herself as a young woman, Isabel sent explicit photos of herself to a boy in her class, who then shared them with their other classmates. Isabel decided the only way to cope was to take an excess of Tylenol.
She took the pills, went to school and started telling her friends goodbye.
When a friend noticed something was wrong, she told the school counselor.
Isabel told the counselor what she did, and an ambulance rushed her to the hospital.
After the Tylenol was out of her system, the hospital transferred Isabel to a mental health facility where they prescribed her psychotropic medicine.
Isabel then moved in with her mother, Stephanie Roberts, in Bloomington-Normal.
"She was vocal about her feelings up until the end,” Roberts said. “So she would come to me and tell me, 'Mom, I'm in a bad place. I feel like I'm going to hurt myself.’ So she went back into the hospital in February of this year."
Isabel was weaned off her initial medication and placed on another, only for the same to happen over and over again. A few weeks or months would pass with Isabel doing okay, and then another near two week stay in the hospital.
On her fourth hospital stay, doctors took Isabel off her anti-depressants and put her on two different mood stabilizers.
"When we picked her up, you could tell this isn't working for her, and we knew it wasn't working for her. She was either crying hysterically over the littlest things, or she was very angry,” Roberts said. “There was not an in between spot."
Roberts tried getting in contact with her daughter’s psychiatrist in Bloomington-Normal to fix what was wrong with Isabel’s medication, but found out the psychiatrist was no longer practicing and there would be no replacement.
They referred back to Isabel’s pediatrician, who referred the teen to a psychiatrist in Peoria. Roberts and Isabel would have to wait to hear from the doctor for an appointment.
A Lack Of Local Psychiatrists
McLean County Center for Human Services (CHS) Executive Director Tom Barr said struggles to find a child psychiatrist is common throughout all of McLean County.
"That's a real challenge in McLean County, particularly for youth, because there aren't any child psychiatrists in McLean County practicing at this point in time," Barr said.
CHS has one psychiatrist and two advanced practice nurses on staff who can prescribe medication to youth age 12 and older. But, that is only a small slice of their full caseload, which is mainly focused on adult care.
Barr said CHS prioritizes services to individuals with the greatest need and the fewest resources in McLean County. To qualify as a client, they have to be on Medicaid.
A lot of times, they refer those in need to alternate providers.
"Oftentimes it's out of the community. And that's one of the great challenges at this point in time is the proximity to where the youth live and trying to provide services that, particularly when looking at the population that we serve who may not have the financial resources to travel a great distance,” Barr said. “Oftentimes the youth may end up being unserved or being seen by a pediatrician, or another primary care physician."
Barr said one out of 20 people will have a severe and persistent mental illness that requires ongoing counseling and psychiatric care. That number stays consistent, he said, regardless of age group.
He said local statistics don’t exist because often times when someone sees the lack of resources in the county, they stop looking for help.
Similar to CHS, the Center for Youth and Family Solutions has two specialty programs providing mental health services to the community.
One program, the Family Support Program, is application based and restricted to youths who utilized services already in the community without success. Currently, there are 15 youths in that program.
Clients also had to first go through the center’s other program, Screening Assessment and Support Services, or SASS.
SASS assists youths with mental illness for three to six months with therapy, counseling, and possible medication prescription.
Stephanie Barisch is the center’s regional clinical supervisor. She said SASS screens around 630 youths annually in McLean County, and roughly 430 of those kids go to counseling at the center.
So how does it work for scheduling outpatient counseling services?
"That sometimes is the tricky piece,” Barisch said. “Wait lists tend to go up in the school year because the need tends to increase during the school year."
Barish said the wait list now is about three to four weeks, but if a client has a greater need or potential risk, they can work them in faster if necessary.
But to qualify for SASS, the client, again, has to be on Medicaid.
So what happens when the center can’t help a youth in need of mental health services? They are referred to CHS to go through the similar dance.
The same thing happened to Stephanie Roberts and Isabel.
Life On The Wait List
After waiting two weeks for that call back on the referral to a Peoria psychiatrist, Isabel wasn’t doing well. She called her mom to pick her up from school early that day.
"And she sat, and she was fine at home,” Roberts said. “And she did like two hours of homework, and during that time I called the pediatrician's office again and was like, 'These meds aren't working. She's unable to function.' And they said, you know, 'We gave the referral.'"
Roberts called the hospital and doctor's office where they referred Isabel, but the doctor had not yet looked at the referral. Another long wait list.
It was nearly a month since the hospital placed Isabel on mood stabilizers and released her.
Roberts started Googling psychiatrists in Bloomington-Normal.
Roberts said every office she called said they had no openings and told her she could not take Isabel off her meds without consultation.
Isabel had private insurance, so she did not qualify for services at CHS and the Center for Youth and Family Solutions.
There are youth psychiatrists who see clients with private insurance, but that is not their primary clientele. And those who do see youth patients have long wait lists. That’s a problem for those experiencing crisis.
Other organizations have to make up for the deficit.
OSF’s Resource Link is one of those programs. It works as a consulting link between psychiatrists and pediatricians to advise a diagnosis and prescribe mental health medication for youths in need.
Kelly Barnes works as Resource Link’s care coordinator for the eastern region of Illinois, including McLean County.
One of Resource Link’s services is facilitating a phone conversation with a certified psychiatrist. Their job is helping the pediatrician care for a client with mental illness.
"Because with pediatric meds, you know, there's a lot of black box warnings,” Barnes said. “There are doctors out there that are not comfortable prescribing psychotropic medication to children. Which is completely fine, and we understand that. It's out of their realm of expertise."
Barnes said when a doctor feels uncomfortable taking the responsibility of prescribing those meds Resource Link, again, refers the youth out of the county and they go on another wait list.
That’s exactly what Stephanie Roberts said happened to Isabel when she was referred to Peoria.
"One day, I don't know. I guess it just got too much and she just decided that it was her time,” Roberts said. “But I feel like, why is there not more psychiatrists in this town? I mean, apparently there is a need because all of them here are full. Why was Isabel not red flagged? A 16-year-old in and out for depression, and then just told to kind of just wait."
Three months after Isabel killed herself, Roberts is still waiting to hear from the Peoria psychiatrist to see if Isabel would ever get an appointment.
Providing In The Deficit
The problem isn’t only wait lists. These wait lists wouldn’t be so long if there were more youth psychiatrists in the area.
Barisch with the Center for Youth and Family Solutions said the county is experiencing a deficit.
“There is absolutely a lack of pediatric psychiatrists in McLean County,” she said. “Our SASS program contractually obligates me to have a psychiatric resource available for the youth in our SASS program."
The center utilizes one telepsychiatrist for their entire client list. That means clients talk with a doctor based in New Jersey through a video chat.
But, the center only has four hours of that psychiatrist’s time a week. One initial meeting with a psychiatrist lasts an hour, to give some perspective.
Barisch said she has had to contract a psychiatrist from out of the county for the last 15 years.
"This is the only resource I have been able to find. And I run a crisis program for youth who are in psychiatric crisis,” Barisch said. “So we have no one to refer these kids to when we're done. We're referring back to pediatricians or referring back to family care. We're referring to areas outside of McLean County where families are having to travel to Springfield or having to travel to Champaign if they're lucky to find a psychiatrist if their pediatrician isn't comfortable."
Again, the center serves youths in the SASS program for a maximum of six months, which gets them only a handful of tele psychiatrist appointments before they need to be transferred somewhere else. Back onto the wait list.
Stories like Isabel’s are all over. Bloomington resident Kevin McCuen told GLT another young girl in Bloomington-Normal is facing the same battle with finding local treatment.
After frequent spouts of depression, she also experienced losing her psychiatrist earlier this year.
McCuen said this left the 14-year-old with no one to refill her medication.
“With no one to go talk to, she also can't get medication because you're supposed to be talking with somebody to get that provided medication," he said.
With limited means of transportation under the care of a single mom, transferring to a psychiatrist out of the county wasn’t an option.
McCuen said the family is still waiting to hear about a local resource.
"There's people who say, 'Well I see these offices all the time.' There are. But they don't see children, children being under 18,” McCuen said. “So that's kind of where a lot of people, the misconception around here is that there are doctors and stuff, but they don't see children."
He said these children are lacking consistency in a time that they need it most. Without a local resource for mentally ill youths in the county, the only option they have is to fend for themselves.
Isabel’s mom knows that firsthand.
"My goal is I don't want anyone else to feel this way,” Roberts said.
She said every path they turned for help led to more and more waiting when time was the one thing Isabel did not have.
Tom Barr of the Center for Human Services said a lack of state funding, and the fact becoming a child psychiatrist is hard and unpopular for young professionals, means the situation that trapped Isabel is not likely to change any time soon.
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