Dayton Children's seeking approval to build a new five-story outpatient center

Investigation: Options growing to treat children’s mental health, but gaps still exist

There will soon be more options for children in a mental health crisis to get hospital care after Dayton Children’s Hospital completes its new inpatient wing as part of an ongoing expansion of its mental health services for kids.

But while the hospital is taking big steps, the Dayton Daily News found more work needs to be done to meet growing demand and fill long-standing gaps in mental health care for children in this region.

Catching up? Read more about Dayton Children’s plans

• Dayton Children’s to add mental health wing

• Kettering Health moving some adolescent behavioral services to Dayton Children’s

Whether or not children get adequate mental health care can impact the rest of their lives, affecting not only their quality of life but also thousands of dollars in health care spending.

“We know that starting early with children and families holds great promise for improving health outcomes,” said Amy Rohling McGee, president of the Health Policy Institute of Ohio, which just published a series of policy recommendations to improve children’s health.

The number of teens with depression in Ohio has been rising for years. There’s a lack of long-term residential mental health treatment for local youth. And it can be hard for parents to know where to go for help and hard to get insurance to cover care.

Officials also cite the need for more preventative care that helps children build healthy social skills and get screened to get help early if needed.

Dayton Children’s expansion

Dayton Children’s Hospital is planning to open its first mental health inpatient beds in July 2019. It will have 24 beds for children who need to be admitted for crisis care and patients will stay about four days on average, said Dr. Greg Ramey, executive director for the Center for Pediatric Mental Health Resources at Dayton Children’s.

When children came to the hospital with a mental health crisis, they used to come to the emergency room but now children go to a newly opened crisis intake center staffed by trained mental health professionals.

The intake center will work with the new inpatient mental health unit when it opens so children who need to be admitted can stay at the hospital.

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After Dayton Children’s opens its inpatient unit, Kettering Health Network will close its mental health inpatient unit for children. Kettering Health has the only inpatient beds for children who need mental health care in the Dayton area. Premier’s Upper Valley Medical Center in Troy closed two years ago.

For now, Kettering Health has 22 beds in double rooms but often can’t use all the beds if they are treating children who need a room by themselves. If a child has a medical condition like epilepsy or a heart condition, they also can’t stay there because Kettering Health doesn’t have pediatric specialists at the hospital.

Dr. Greg Ramey, pediatric psychologist and the executive director for the Center for Pediatric Mental Health Resources at Dayton Children’s Hospital.
Photo: Staff Writer

When Dayton Children’s opens its unit it will help solve these problems by opening more beds and by letting children get mental health care close to home even if they have other medical needs beyond mental health. It will also let Kettering Health expand adult services.

But Ramey said there are limits to how much a hospital can address the mental health needs of local children.

Rates of anxiety, depression and self harm are rising for youth in the area and Ramey said resources need to be dedicated to help children early before things escalate to an emergency hospital stay.

“A lot of professionals, myself included, do not think inpatient care is the panacea for these problems,” Ramey said.

Screening and prevention

More can be done at schools to teach healthy social and emotional skills, said McGee.

While there are schools that have adopted evidence-based programs to teach behavioral skills, the Health Policy Institute of Ohio has recommended a statewide approach to bringing programs that work to schools.

Schools now screen for health issues like scoliosis and whether children need glasses, but McGee said the institute also recommends universal screening for depression, substance abuse and adverse childhood experiences, so officials know early which children need counseling or other mental health services.

Pediatricians or school health centers could provide the screenings, looking for flags like symptoms of depression or “adverse childhood experiences,” which can range from witnessing violence, having a family member go to jail to being neglected.

Paula Cosby will start at ADAMHS this week as the director of external relations. CONTRIBUTED
Photo: Staff Writer

Montgomery County Alcohol, Drug Addiction & Mental Health Service is looking at ways to fill gaps for prevention and early intervention services, said Paula Cosby, spokeswoman for the agency.

She said they are working on more access to intensive home-based treatment, and this year started a program to help schools provide services and meet new mandates, like for more school-based opioid prevention. The agency also wants to expand which schools provide screening for mental health needs.

“I think schools do a really good job of screening for vision and those kind of things but we’re certainly advocating that there would be an additional screening that would address mental health issues,” Cosby said.

Gaps in resources

Montgomery County Juvenile Court Judge Anthony Capizzi said through his work in LIFE Court, his treatment court specialized for minors with mental health conditions, he’s seen the gaps in mental health resources.

There aren’t local places for teens who need longer-term intensive mental health care at a residential facility, so if they have to stay more than a few days for care they have to go outside the community.

Capizzi said he’s not aware of any local mental health peer groups for children, which could provide support. There’s a gap in medication education for families of children he works with in court, who need help understanding the multiple prescriptions their children are taking.

Judge Anthony Capizzi in his courtroom. He has spent 13 years on the bench in the Montgomery County Juvenile Court. CONTRIBUTED
Photo: Staff Writer

“Each one of those kids are on multiple medications normally. We find that the parents have not been properly educated on what they are for, what they are supposed to solve and how to even adequately manage the distribution of those medications,” Capizzi said.

There also needs to be a better transition model for children to smoothly maintain services when they become adults.

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“I lose all those juvenile services I’ve been able to supply this child once they turn 18,” Capizzi said. “That transition has always been problematic. They normally have to switch providers, switch therapists. And with the mentally ill, that in itself is a challenge.”

There can also be significant bureaucratic barriers to getting care paid for, Capizzi said. He said he can typically get children with Medicaid into counseling in a couple of weeks if not sooner. 

“But for the working poor, the working middle class, I have a very hard time with mental health counseling because I have to jump through too many hoops,” Capizzi said.

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