At Connecticut Children’s, Sen. Murphy eyes a ‘bolder’ mental health reform bill to address crisis

With an eye toward developing the “next generation” of federal mental health reform legislation, Sen. Chris Murphy met with the leadership of Connecticut Children’s Medical Center Friday morning to discuss the ongoing crisis in children’s psychiatric care and brainstorm solutions.

“We’re at the tip of the iceberg and we need to acknowledge this at a national level,” Dr. Juan Salazar, the hospital’s physician-in-chief and chair of pediatrics, told Murphy, assembled around a table with other hospital directors at the hospital’s Hartford offices.

Encountering an 8-year-old who has attempted suicide is “beyond my ability to understand,” Salazar added, and yet, it “happens almost daily.”

In 2016, President Barack Obama signed the Mental Health Reform Act, co-authored by Murphy, a Connecticut Democrat, and Sen. Bill Cassidy, a Louisiana Republican, into law. The law expanded federal resources for addressing mental health issues and bolstered community treatment services. Six years later, Murphy is hoping to “be a little bit bolder” with a revised mental health bill, including by focusing on children’s mental health and potentially tackling reimbursement issues.

“We’re not adapting,” Murphy said. “We’re seeing this increase in children’s mental health cases, but the system isn’t adapting fast enough to this new reality and I hope this legislation will force that adaption.”

Addressing children’s mental health care has emerged as a priority for state and federal lawmakers in recent months. In Connecticut, Children’s reached a crisis point last fall, as its emergency department was deluged with children seeking urgent behavioral health care. More recently, behavioral health experts, doctors and community providers have stressed to state lawmakers that staffing shortages, reimbursement rate disparities and lack of throughput — the ability to move patients through the flow of medical services — remain critical issues.

“The system was under-resourced before the pandemic, and this has just surfaced all the gaps that existed,” said Howard Sovronsky, the chief behavioral health officer at Children’s. “The [intensive outpatient programs] were insufficiently resourced to begin with — there weren’t enough slots. Now, the need has quadrupled.”

Allison Matthews-Wilson, the director of care coordination for Children’s, told Murphy that her teams work in the emergency department to move children through various levels of care. But often the required level of care cannot be obtained, forcing the hospital to patch together solutions.

“We create bandaids and wrap these kids in less-than services,” she said. “We try to make up for it with some of the safety nets that the state of Connecticut has — emergency mobile psychiatric services, bringing in the pediatrician — but the reality is, is that if services were available, they would require a higher level of care.”

At the same time, hospital leaders said, high volumes of children continue to arrive at the emergency department with acute behavioral health needs. Some children have symptoms that have worsened over the course of the pandemic; others had no prior mental health history and are now in crisis. A similar dynamic also plays out in outpatient settings and pediatricians’ offices.

“We’re letting them go home with a higher level of symptoms than we’ve ever let them go home with before, because we know that there’s no other option for care,” Melissa Santos, the division chief of pediatric psychology of Children’s, said of outpatient care.

David Krol, a pediatrician and the medical director of the hospital’s Care Network, said that pediatricians are also struggling to contend with greater numbers of children presenting with behavioral health needs. Many pediatricians would be eager to embed behavioral health clinicians in their offices, he said, but often payment issues stand in the way, or there aren’t enough clinicians to fill those roles.

Murphy expressed support for bolstering care coordination, as well as an idea floated by Salazar to expand medical residencies in pediatrics to include an additional year focused on child psychiatry. Funding such a program, Salazar argued, would “train the next generation of pediatricians” and rapidly create a workforce equipped to handle children’s behavioral health needs.

“That’s one of the clear ideas that I’m going to send my team to work on,” Murphy said following the meeting.

Eliza Fawcett can be reached at elfawcett@courant.com.

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