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My experience with public school

girl studyingThroughout my public school years I always struggled with teachers, school counselors, and just about everybody in administration. When I began school, I started having problems immediately. No one there believed that I had mental illnesses. I did get a 504 plan starting in the 3rd grade. It consisted of bathroom breaks or breaks in general without questions, but my teacher didn’t follow my accommodations at all. I had the same accommodations on my 504 plan each year and each year the school did not follow it. I was given a pass to go to guidance and the school nurse whenever I needed. Multiple times when I would go to the nurse, she would tell me I was faking and send me back to class.

One incident happened where I was having a severe panic attack.  I went to my guidance counselor because I needed someone immediately but she was no help. As I was walking in, she was ready to walk out. She saw I was in distress so she sat me down to talk – or so I thought. I sat down, then she said she didn’t have time to talk because she had lunch duty.  She handed me a piece of chocolate and left me in her office alone. I started really freaking out because I didn’t know what to do. I was not allowed to call my mom because the school didn’t want me to go home when I had a panic attack. I was scared and felt I couldn’t trust anyone. When she came back, she looked at me with a nasty look and asked me why I was still in her office. I couldn’t even talk because of how bad I was panicking.

I was diagnosed with depression right before I started junior high, along with the anxiety I already had. My teachers constantly picked on me for falling asleep in class even though it was my medication making me tired. I had one teacher yell at me and tell me I should go take my meds in front of my entire class. I was extremely embarrassed.

I was always a quiet kid but I started getting mouthy with my teachers because they treated me with no respect whatsoever. They would threaten to take things from me, send me to the office and, in some cases, they would give me detention or an in-school suspension. My teachers still didn’t follow my 504 plan.

My high school years were the worst of all. I tried a new school that eventually didn’t work out due to my mental illnesses. I went back to my old school. After years of fighting with the school, I finally got an Individualized Education Program (IEP). Even with an IEP, the school still did not do what they agreed to do for me. I stopped going because I was having a really hard time.

I got diagnosed with agoraphobia shortly after that. My psychiatrist filled out a home/hospital form, which is a doctor’s order that lets a student be educated at home. During this time, the school sent cops to my house, filed a CHINS on me and called the Department of Children and Families. After being out for two school years, I went back for a short time to see if they would help me get back on track. The only thing they did was put me in a “quiet” room which was really the printer/fax machine/microwave/coffee maker/student file room.  Teachers constantly were in and out to get stuff or do something and would always tried to converse with me while I would try to work.

Finally, after doing all I could do to get the school to help me and listen, I couldn’t take it anymore. I decided to leave public school altogether and get my GED. Being out of school relieved a lot of stress and anxiety from my life.

I wanted this blog to end with a happy ending, like most of them. But my story isn’t over yet.   I have big plans for my future and I won’t let anything hold me back.

G.G, a 16 year old youth, is our guest blogger.  G.G. enjoys music, the arts and has completed the intern program at Youth MOVE Massachusetts.

Child psychiatrists or unicorns, which one is harder to find?

Unicorn Pooh, Flickr, CCWhen the local mental health clinic abruptly closed last September, Cheryl knew she would have a tough time finding a new psychiatrist to treat her son.  Her 15 year old son is complicated, to start with.  He has several diagnoses, has uncommon reactions to medications and has had frequent ups and downs.  Shortly after she began searching, Cheryl realized the truth:  child psychiatrists with openings are nearly impossible to find.

The clinic closed with no warning and Cheryl didn’t have time to get a referral, make a plan or even grab her son’s records.  She scrambled just to stay afloat. She called every clinic and practice that her insurance covered.  Then she called the ones it didn’t cover.  She googled, she pored over lists and once, upon finding a number for the old psychiatrist, called it only to find it was the doctor’s home number.  That didn’t work either.  The old psychiatrist didn’t have a private practice and couldn’t prescribe through the now-closed clinic’s system any more.

It’s more than 6 months later and Cheryl is still looking for a psychiatrist.  Her son’s pediatrician has been reluctantly prescribing the same medications he was on last September when the clinic closed.  If anything changes – a new reaction, a new crisis – the pediatrician doesn’t think he has the expertise that Cheryl’s son needs.

For Cheryl and many other parents, child psychiatrists are scarcer than unicorns.  In popular culture unicorns are making a small comeback, appearing on t-shirts, in movies and songs.  In the real world they remain a myth.  The term unicorn has come to mean “any fabulous beast which many desire to find and possess, but which proves to be enormously elusive.”  You see the parallel to child psychiatrists, right?

The statistics back Cheryl’s experience up.  In 2014, a study published in the American Psychiatric Association journal Psychiatric Services showed that the average waiting time in major U.S. metropolitan areas to see a child psychiatrist was 25 days for a first visit. Investigators for the study tried to get an appointment with 360 outpatient psychiatrists in Boston, Houston or Chicago and found that after two calls, despite having insurance or saying they would be willing to pay out of pocket, appointments were nailed down with only about 25 percent of the doctors. According to the American Academy of Child and Adolescent Psychiatry, there are approximately 8,300 practicing child and adolescent psychiatrists in the United States — and over 15 million youths in need of one.

Besides the scarcity, there are other barriers.  Some psychiatrists aren’t taking new patients.  Others are leaving the field to pursue other interests.  Many others don’t take insurance of any kind whatsoever.  One mother called me several years ago to tell me she was trying to find a child psychiatrist for her teenage son.  She got a solid referral and was filled with hope.  When she called the doctor’s office she was told that he worked off a retainer system similar to an attorney.  You paid several thousand dollars up front and he billed against it.  When that was gone, you negotiated the method to pay once again.  She was shocked and called to ask if this was standard practice.

When child psychiatrists work at clinics, hospitals and medical groups, their services are available to anyone who has insurance accepted by that group, which often includes most health plans.  But many clinics have a policy in place which creates an additional obstacle.  Only children and teens who receive outpatient therapy at that clinic or medical group can access the services of the psychiatrist.  The thinking is that this will ensure that there is more coordination between the therapist and psychiatrist.  While some parents like this model, others report that the coordination simply doesn’t happen. And for children and teens who get therapy at an outside location, this policy limits the number of child psychiatrists available to help them.

Most pediatric medical specialists, such as pediatric cardiologists or pediatric endocrinologists, get paid a higher rate by insurance companies because they have the extra training and education needed to work with children and teens.  Unfortunately, this is not true for child psychiatrists.  The get paid the same rate as general psychiatrists.  Most child psychiatrists  go to college for four years to get an undergraduate degree, followed by four years of medical school, then four years of general psychiatry and finally a two-year fellowship in child psychiatry. A college freshman aspiring to be a child psychiatrist is looking at 14 years of training.  Their reimbursement doesn’t match that.

Parents value psychiatrists because they are highly trained and have greater breadth of experience at the end of those 14 years. When a child has uncommon reactions to medications, like Cheryl’s son does, a child psychiatrist can parse out whether the new symptom is the illness getting worse or a medication side effect.  They listen to parents talk about their child’s behavior and are great at figuring out how to prioritize this over that in the treatment plan.  They ask smart questions and are great observers.

With the passage of health care reform, our children get their yearly well child visits for free.  Their annual flu shots are not only free but you can often get them right away at a local pharmacy, a “minute clinic” or other options in your community.  None of this is true for mental health care by a psychiatrist.  Costs are high, waits are long and the search is filled with dead ends.  I think it might be easier for Cheryl to find a unicorn.  If she does, maybe she can trade it for a child psychiatrist for her son.