Figuring Out Mental Health Care For Teens In Crisis

Got tweens/teens? We’re trying a new advice column here at Alpha Mom to address your questions for the older-kid crowd. We hope you enjoy! And if you have a question to submit, hit me up at alphamomteens[at]gmail[dot]com.

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I received a long, detailed, and pretty heartbreaking request from a fellow mom dealing with two teens with varying mental health issues. Because I am not a professional (and I don’t even play one on the Internet), I cut this down to remove specifics and address the overarching question. She asks:

The question in short form is this… how does a parent go about identifying and selecting appropriate professional mental help for a teenager? (Side note: And why, dear God WHY, is it so freaking hard?)

I am astonished and dismayed at the level of difficulty it is to find quality help. It’s been expensive, frustrating and time consuming. We’ve tried our family doctor, family counseling (both church and secular), peer counseling, marriage counseling, inpatient care, family meetings, etc., etc. Part of the issue is that we live in a rural community with a low population density and high percentage of people with significant issues. The system is overwhelmed, resources are depleted and community ignorance/resistance is rampant.

I know mental health is not a one size fits all kind of thing but how do you make your way through this confusing world?

As anyone who’s been reading me through the years knows, this is a topic near and dear to my heart. A huge part of the answer is already part of your question: The system is overwhelmed, resources are depleted and community ignorance/resistance is rampant. There is a nationwide shortage of mental health providers for children and adolescents (the linked article is from California, but similar articles can be found about every state in the nation). The reasons are complicated—the pay tends to be crummy, insurance companies often don’t want to pay for needed services, state-funded facilities are being closed all over the nation (leaving available/affordable inpatient care at an all-time low), parents who lose a young person to mental illness are arguably more likely to sue providers than when an adult loses the battle, and this is just a very demanding field and not for the faint of heart, etc. There are not enough psychiatrists and psychologists willing to treat minors, not enough facilities, not enough community support. There’s just not enough, period.

That’s the bad news. And you already knew it, so I hope it’s not too awful to hear it again. For whatever it’s worth, I’m sorry.

Here’s the good news: I believe that we are (very slowly) experiencing enough pushback on this lack of services that change is happening. Insurance companies are changing their policies (our HMO provides unlimited counseling with no copay; I guess they finally figured out that’s cheaper than paying for a crisis); schools are receiving increasing training in spotting and supporting families with mental health issues; community agencies are working together to provide resources to families in need (here in Georgia we have something called the Local Interagency Planning Team, where a bunch of different agencies come together and brainstorm support/solutions for community families); some providers in big cities are offering phone/Skype services to families who aren’t local (the Marcus Autism Center in Atlanta comes to mind). Help exists. It’s just a matter of persevering.

So let’s get to the meat of it. You asked: How do you make your way through this confusing world?

Philosophically: You keep going, telling yourself that you are your child’s best advocate and you’ll keep searching for help until you get it. Pragmatically: You work your way up the food chain in every possible direction.

When your child first has an issue, it makes sense to start with their pediatrician and ask for a referral to an appropriate mental health specialist. Ask around, too, to get some recommendations or feedback. This may end up being your first roadblock; in a small or underserved area, you may discover that, for example, there’s only one psychiatrist who sees minors, and maybe they’re not taking new patients or the wait time is months. If that happens, call your insurance company. Explain that your child needs help now and the only covered option doesn’t have a reasonable wait time (or is actually unavailable). They may be able to get you in sooner by calling the office directly, or they may approve an out-of-network provider if you can prove that’s the only reasonable option. Insurance companies have case managers whose only job is to help people in situations where they don’t have reasonable access to the care they need, so don’t feel like you’re being difficult or asking for the moon. Their job is to help you.

When it comes to therapy, you already know there are a ton of options. Psychologist, LCSW, MCSW, “counselor”—there’s lots of different paths to ending up as a talk therapist. Personally, in the case of a serious issue, I’m biased towards psychologists and psychiatrists (but that doesn’t mean there aren’t social workers and clergy and other people who also happen to be really good at their jobs). There’s lots of considerations here: finding someone who specializes in whatever you need, actually getting in to see them, and whether or not they click with your child. I can’t even tell you for sure how many therapists my child had over the years—many of them perfectly capable, I’m sure—who were just not able to reach her in a way that made for progress. And it’s not like you can always figure this out beforehand, either. You just have to make your best guess, try someone for a while, and see how it goes. Keep going until you find someone you trust whom your child likes and trusts. But if you’ve been down this road (sounds like you have) a bunch already, start with phone calls and ask for a meeting interview for you to explain the history and feel out the provider before bringing your child in for an appointment. (I made over 30 phone calls and did five interviews before my daughter started with her current therapist. I not only laid all her issues on the table, I explained her propensity to chew through therapists and looked to see how potential providers reacted to that. It was a huge amount of work and time but they’ve now been together for years and she’s made huge strides. Worth it!)

So you start with the child’s doctor for a referral and look for appropriate specialists. At the same time, gather community support and find your proverbial oxygen mask for yourself. I recommend:
1) Individual therapy for parent(s) dealing with a troubled child.
2) Consult the child’s school (guidance counselor, psychologist, or social worker) about community options in your area like the LIPT I mentioned earlier.
3) Al-Anon was developed as support for the families of problem drinkers, but the philosophy and model can be useful to any family dealing with a member who is out of control (even in a non-addiction sort of way).
4) NAMI (National Alliance on Mental Illness) provides resources, discussion boards, a HelpLine, and local support groups. You may discover (as we did) that your area either doesn’t have a group or claims to have one but it’s been disbanded, but even the online information/connections can be useful.

I wish I could wave a wand and make it easier, faster, and more affordable. I can’t. You’re right that it’s hard, soul-sucking, and expensive. But… that’s parenting, right? If you keep going, keep advocating for your child, hopefully you will find what makes things better for all of you. I think my teen would agree that for about three years, it felt like we were all in hell. We tried a lot of different avenues for help, and some of them—I’m not going to lie—were mistakes. I’ll tell you the same thing I tell her: I always did the best I could with the information and resources I had at the time. My heart was always in the right place, even if my decisions weren’t always the optimal ones. We learn and do better as we move on. Life isn’t perfect now, but it’s much better. She’s better. We’re better. And (as I’m sure you know) progress has been a zig-zag, never linear, and things will be less better again and we’ll deal with it until it’s more better. Perhaps most frustrating, some of that time was spent with perfectly reasonable and useful supports available and my child fighting it all tooth and nail, because it turns out that you cannot force someone to get better if they’re not ready.

So you do what you can do. And you hang on by your fingernails until you feel like you can’t do it anymore… and then you keep doing it. I promise you can do this, and you are not alone.

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Don’t forget that you can submit your own question to alphamomteens[at]gmail[dot]com.