Kids mental health programs in CT are running out of money and at risk of shutting down

Stamford Advocate – Monday, December 16, 2024
By Alex Putterman

Over the next six months, Connecticut lawmakers will reveal the extent to which children’s mental health remains a priority for the state.

Several of Connecticut’s most innovative efforts to help kids in crisis have survived over recent years largely on funds from the federal American Rescue Plan Act. Now, with that money spent, providers say the programs can only continue if the state steps up with permanent funding.

“If the legislature doesn’t replace the ARPA dollars, then probably what is one of the nation’s most recognized and well-designed crisis systems will collapse,” Gary Steck, CEO of Wellmore Behavioral Health in Waterbury, said in a recent interview. “There’s no nice way to say it.”

Christina Ghio, the state’s acting child advocate, offers the same assessment.

“Without funding, (key initiatives) would not continue to operate,” she said.

Among the programs that previously relied on ARPA money and will now require additional state funding:

• Four urgent crisis centers — in New Haven, Waterbury, Hartford and New London — that offer a softer alternative to the emergency room for kids in mental health crisis
• Crisis stabilization beds in Hartford for children with mental health needs requiring overnight care
• A 24-hour mobile crisis intervention service providing in-person response for kids in crisis, which previously ran from 6 a.m. to 10 p.m. but had its hours extended in 2023 using federal funds

Whether these programs are funded, and at what level, will be up to Gov. Ned Lamont and the state legislature, who will negotiate a budget during the legislative session that begins Jan. 8 and ends in early June.

Jodi Hill-Lilly, commissioner of Connecticut’s Department of Children and Families, was noncommittal when asked whether the state would replace the lapsed ARPA money. In a statement, Hill-Lilly said the agency’s budget “is still being developed” and that officials “continue to collaborate with our community partners to determine if there is a gap in funding and if one exists, how to successfully support them and mitigate the deficiency.”

Discussion of how to fund children’s mental health programs comes as youth suicides increase both nationally and in Connecticut. As some advocates see it, maintaining a strong continuum of care could be a matter of life and death.

“It’s a very good service system. It’s one of the best in the country,” said Jeff Vanderploeg, president of the Child Health and Development Institute of Connecticut. “And when you have something that’s good, you can’t let it wither on the vine.”

‘Life-saving care’

Dr. Laine Taylor, chief medical officer at The Village for Families and Children in Hartford, tells of a recent patient who told her school guidance counselor she was having thoughts of suicide.

The guidance counselor quickly called the student’s mother, who brought her to the urgent crisis center at The Village. There, Taylor talked the girl through her sense of isolation and loneliness, worsened by too much time spent on social media. She also worked with the girl’s mother, who blamed herself for her daughter’s struggles.

The patient left the urgent crisis center with a better understanding of her depression and a greater willingness to seek help. Her mother left with less guilt over what her daughter was going through.

“That’s the kind of work that we get to do,” Taylor said. “It’s not just like, ‘Go home or go to the hospital.’ It’s really being able to have those in-the-moment supportive conversations to help them gain some hope.”

Connecticut’s urgent crisis centers launched last year, as an option for children who need immediate attention but don’t necessarily require treatment in the emergency room. Today, providers say the number of patients there has steadily increased as word has spread in their communities and that outcomes have been encouraging.

“The volume is growing and continues to grow,” Steck said. “This is life-saving care, and we are very pleased with the early results.”

Taylor said The Village has also seen strong results from its crisis stabilization unit, which offers robust overnight care beyond what patients would find in most emergency departments.

Whereas the urgent crisis centers and stabilization beds are brand new in recent years, the mobile crisis hotline has existed for years. As of 2023, however, the service is available 24 hours a day so that kids experiencing a crisis in the middle of the night don’t have to wait for morning to seek help.

Vanderploeg said he’s proud of the work Connecticut has done over nearly 20 years to build “one of the best crisis service arrays in the nation.” Rolling back the mobile crisis hours, he said, would undermine that progress.

“The overnight hours for youth mobile crisis have become, really, an expectation at the national level,” he said. “Preserving that after-hours, overnight response capacity is really important.”
What’s next

Each of the past two years, providers have worried the state would fail to fund these programs, and each of the past two years legislators have come through in the final days of the session with money to ensure they continue.

This time, though, the ARPA funds are gone, meaning support for the urgent crisis centers, stabilization beds and 24-hour mobile crisis service will have to come directly from the state budget.

Hill-Lily, the DCF commissioner, noted that the state has created Medicaid codes for urgent crisis centers and stabilization units, which can also bill private insurers. Providers, however, say they typically receive very little money from private insurance and that Medicaid rates are far too low to pay for the level of care required.

As for the 24-hour mobile crisis response, Hill-Lily said data shows calls “typically fell within evenings until midnight and the Saturday and Sunday early mornings.” State officials, she said, “continue to look for alternative ways to support/fund or reimagine what our mobile crisis system will look like.”

Some states have paid for expanded crisis services through surcharges on cell phone plans, but Connecticut lawmakers have not chosen to pursue that option.

Most advocates and providers say they’re not sure what to expect during the coming legislative session. They continue to hear from lawmakers that children’s mental health is a priority, but with the state budget expected to be tight, it’s difficult to be sure what will happen.

“Somebody has a press conference about 40 kids in the emergency department or another suicide, but then nobody cares about it at budget time,” said Sarah Eagan, executive director of the non-profit Center for Children’s Advocacy.

Taylor, from the Village, is a bit more confident. She says the Village is working with the state on a “blended” funding model for the urgent crisis centers, in which some money would come from a grant and the rest from insurance coverage and believes the crisis stabilization beds will be funded as well.

“I think that the state is invested in continuing both of those particular programs,” she said. “There’s a lot of energy still around making sure this really works, and there’s been so much investment by the state already that I can’t foresee it not working out.”

Rep. Tammy Exum, a West Hartford Democrat who’s been one of the legislature’s top advocates for children’s behavioral health, said she can’t predict what will happen during the budget talks but that she thinks children’s behavioral health remains a priority for her colleagues.

Preserving the urgent crisis centers could be a particular focus, Exum said.

“I know it’s early, but we have found great effectiveness around the urgent crisis centers,” Exum said. “That would be a priority to continue if we cannot keep everything that we want to keep and have to pick and choose.”

In the worst-case scenario for providers, in which the urgent crisis centers and stabilization beds close and the mobile crisis hotline’s hours return to what they were previously, the result would likely be greater strain on emergency rooms, which are often already over-packed with children waiting for the care they need.

Ghio, the acting child advocate, knows what happens when kids check into the emergency room and what happens when they visit the new urgent crisis centers. In most cases, she says, there’s little question which is better.

“The UCCs provide a much speedier and more focused approach in a child- and family-friendly environment,” Ghio said. “It would be a tremendous loss for children and families for them to go away.”

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