How does the US child mental health system differ from Canada's?
August 29, 2017 11:38 AM   Subscribe

How does the US child mental health system differ from Canada's?

I have a child with special needs, including mental health needs. We are in Canada, specifically BC. Over the years, we've had a few practitioners who have moved here from the US. They tell me that the supports available here are few and far between and that so many of the supports they had in the US are not here.

For example, there is no longer term in-patient treatment for children here in BC.

I don't have time during appointments to get into details. It sounds like maybe there are youth support workers and trauma support counsellors, perhaps?

I was just wondering if anyone knew the difference. With the shortage of child mental health professionals here in BC, I imagine there will be more practitioners coming from the US. Some of them have told me that they have struggled in asking for supports for my child, as they are trying to understand what is available here. So, if I had some understanding, I think I could do a better job. I've worked with at least four mental health practitioners from the US now and it is a bit of a slog to work with them to get up to speed. (I am also very curious about what is available in the US.) Thanks.
posted by shockpoppet to Health & Fitness (17 answers total)
 
Mental health resources vary widely between different states, counties, and towns.
posted by The Underpants Monster at 11:55 AM on August 29, 2017 [3 favorites]


From what someone sent me and said I could post:
"So you mentioned not having inpatient psych treatment for children in BC... here's what I was told when I asked my son's therapist what would happen if we had to take him to the ER. He said they would evaluate my son and if he needed to be admitted, they'd look for a bed for him. In the state. Somewhere. So we're in Cleveland, and that bed could be in Cincinnati or Athens, 4 hours south. Or there might not be a bed and I guess we'd be on our own? That wasn't really covered.

Then there's paying. Acute inpatient psychiatric care would be covered under our private insurance, same as our other health care, but residential treatment is not really covered by any private insurance. (Probably there's long term care insurance for children but I can't think who would buy it, since it's so unlikely one would need it.) Some states have a Medicaid waiver, which means that the child is covered by Medicaid even if the parents don't qualify for it (Medicaid is single-payer insurance for poor ppl; the waiver is for parents' income.) But our state doesn't have that. So we'd just be screwed, I guess. We'd have to run up infinite bills and declare bankruptcy, who knows. I do have friends in our state who will just be paying their local childrens' hospital a tiny bit at a time, forever, in order to cover their son's stays. "
posted by shockpoppet at 11:57 AM on August 29, 2017


I can't speak to what's available in the U.S., but if you're dealing with practitioners trying to understand what's available in BC, I'd highly recommend that they reach out to the Provincial Health Services Authority (PHSA), which has oversight of both BC Children's Hospital and BC Mental Health & Substance Use Services. PHSA is in the best position to advise as to what mental health resources are available for children and adolescents, and can usually liaise between the mental health services that fall under the Ministry of Health and the social services for special needs kids that may fall under the Ministry of Children and Family Development. More information is available at www.phsa.ca/our-services.

If a practitioner is contacting PHSA, they can actually bill for a telephone consultation through the RACE (Rapid Access to Consultative Expertise) service, where Child and Adolescent Psychiatry is listed as one of the specialties available. More information can be found on the service's website at www.raceconnect.ca.

They may also want to contact the Mental Health and Substance Use office in whatever health authority is local to where you are (Vancouver Coastal, Fraser Health, Island Health, Interior Health, or Northern Health).

As you may know, we also have a new Ministry of Mental Health and Addictions. Practitioners can contact this Ministry or the Ministry of Health (which still has a Mental Health and Substance Use office) for more information, or reach out to the College of Physicians and Surgeons of BC for guidance.

(Sorry that this isn't U.S. information, but hopefully it might be of some help.)
posted by haruspicina at 12:17 PM on August 29, 2017 [2 favorites]


Thanks, Haruspicina. We and they are aware of all those services. But what I mean is that they're saying they want to order/write up supports that we don't have here. These practitioners are from major US cities. (But you've provided some great resources for people learning the system - thanks.)
posted by shockpoppet at 12:25 PM on August 29, 2017


What supports are they trying to get written? That might help others that follow figure out what differences they are seeing and being frustrated by. Is it related to education planning and supports? for example or referrals to inpatient treatment. Inpatient treatment is lacking for all people but I know at least a child arriving at an er would be found a bed or referred to BC children's hospital program.
posted by kanata at 1:59 PM on August 29, 2017


Kanata, I don't know where you live, but that is not a typical experience here in Vancouver.

They just keep telling me that supports available in the US are not available here. They've said there are programs for stabilization and not just assessment, in-home supports, youth support workers, behaviour consultation, behaviour intervention, psychiatrists, counsellors, trauma supports, ongoing domestic violence programs, etc, but they said that it's even more than that. But I don't know what it is they mean.
posted by shockpoppet at 5:00 PM on August 29, 2017


I agree with kanata that more details about what they're trying to arrange may be helpful (but I get that's exactly what you're trying to find out here, if the practitioners you're talking to are being vague about it). I hope some helpful Americans chime in!

While I can confirm that BC Children's Hospital does provide stabilization services and one-month inpatient treatment with a post-discharge care team, it could well be that BC's regulations for involuntary treatment of mature minors may be much more limiting than a US-trained physician may be accustomed to.

I assume they're likewise aware of the local CYMH offices, which are meant to include case management and consultation, child and family counselling, referrals to private psychiatrists (insured by MSP), and access to child and youth support workers, as well as access to partnered programs like the Children Who Witness Abuse counselling program through VictimLinkBC under the Ministry of Justice. While the CYMH services are likely in line with the free and low-cost services offered through hospitals and social services in the U.S., it could well be the practitioners you're speaking to are used to a much wider range of private youth residential and outpatient psychiatric treatment programs and the private professionals available "in-network" through private insurers.

We have our share of private adult mental health facilities in BC (Edgewood, etc.), and some for youth with addictions and behaviour issues, but it's true that both our licensing regulations in BC and the regulations around what must and can't be billed to MSP limit the feasibility of some of the U.S. service models here.
posted by haruspicina at 5:52 PM on August 29, 2017


The supports your doctors are describing are pretty amazing, and are definitely not universal across the US. I treat adults, not kids (but some adolescents) and none of the three East Coast states where I've practiced have anything near like "in-home supports, youth support workers, etc." My experience matches what the person who contacted you privately describes: if a person is acutely mentally ill, the hospital can get an emergency order to keep them in the ER for 24-72 hours (depending on jurisdiction) while the social workers/case managers run a bed search for a bed, somewhere, anywhere in the state. This might be several hours away from home. For adults, this requires a judge's order because you're taking away legal capacity, but for kids it's probably easier since they don't have legal capacity to begin with.

Depending where you are, non-acute services are extremely hard to come by in the US. One of the great things about Obamacare is that it made mental health an Essential Health Benefit which made parity actually enforceable, rather than Clinton and Bush era legislation that was like "This would be nice to have, yeah?" Even so, implementation has been spotty. The only place I practiced that had any kind of non-acute services for psychiatric stabilization was New York City, which had plenty of self-pay therapists. Other places have had psychiatrists, but child psychiatrists specifically are few and far between, and in my limited interaction with that world as a student, my sense is that home services were not common.
posted by basalganglia at 6:03 PM on August 29, 2017 [1 favorite]


Hmm.. I know that they don't keep them long term at BC Hospital but that's because hospitalization isn't healing in the long run. I'm on Vancouver Island and when I had mental health issues as a teen I was referred by my GP to the Ministry of Mental Health Childrens version (don't remember the name). There I was offered weekly counseling, a case worker who handled all information and supported my parent. A psychiatrist to do med support and there was also support for behaviours or abuse offered as well. At the time I didn't admit to abuse so didn't take that option. They helped me understand my illness and would have worked with the school councilor so they could understand that me missing days was medical.

I have noticed over the years that those supports (for adults as they used to be there as well) have dropped a lot in quality and availability due to the rising overdose epidemic and the shortage of doctors willing to work in Canada. But they seem to be moving forward to a more theraputic outlook as they've realized that mental health is not getting treated as there is no time to help with creating independence and managing illnesses, and supporting family members as people are dying so quickly.

I am wondering if these doctors coming from the american system are finding themselves stimied by waiting lines, what can be funded by MSP, etc. Our system is not ideal but maybe they are not used to the idea that as doctors they can't just refer when they want and the test is done quickly. My old GP wasn't allowed to just place me in the psych ward when I was suicidal. I had to go through the ER. There are many flaws in the system but over all the existing ministries and social support system should be there to provide it when needed. Have you connected with a local CMHA association? They can help provide support or point out your options as well as usually have an advocate who can help you navigate the ministries.
posted by kanata at 6:42 PM on August 29, 2017


For example, I had an American locum that had to be told by the receptionist gently that me having classic signs of carpal tunnel didn't mean it went diagnosis>surgery... but that there were extra steps that had to be taken (testing, different options tried) before MSP would approve it. It can be infuriating so you have my sympathies if that is happening because it does seemed a bit flawed that my doctor had to justify and send information back and forth to MSP over a couple of months to prove I had tried everything and needed a certain medication. I've had experiences with other doctors who won't spend the time to do that so it could be that as well. They resent the extra work it takes to get a test or medication or referral paid for and thus, think we don't have those supports here.
posted by kanata at 6:49 PM on August 29, 2017 [1 favorite]


but that there were extra steps that had to be taken (testing, different options tried) before MSP would approve it.

That's true of many insurance companies in the USA, as well. Doctors can appeal and write letters of medical necessity, but It's not always successful.
posted by The Underpants Monster at 7:17 PM on August 29, 2017 [1 favorite]


Ok. My impression of the us system (mostly from TV and ask me) is that there are no wait times and everyone can refer themselves to specialists any time they want if they can afford it without needing a gp but going to the doctor bankrupted people. Apologies to the OP as that rules out any ideas I have about what these doctors are talking about.
posted by kanata at 8:29 PM on August 29, 2017 [1 favorite]


Thanks. It isn't just doctors. Counsellors and therapists are saying there are way more supports in the US. I wonder if some of it can be from non-profits and foundations in the US?
posted by shockpoppet at 9:20 PM on August 29, 2017


It varies dramatically from county to county or town to town (in-school support above what is required by federal law) and it varies from health plan to health plan (e.g. availability of covered pediatric psychiatrists).
posted by zippy at 11:45 PM on August 29, 2017 [1 favorite]


I hear you on not having time but if you could narrow down the exact type of supports they are looking for, the hive mind might know what that looks like up here.

I have family in the medical field on both sides of the border and sometimes it's true that what's available in the US is more, if you have the right insurance and/or means. (As a direct example, my sister was able to use a drug off-label for an issue (not mental health-related) I also had, and I was not (both experiences were in-hospital). Our long-term results were the same, although at the time I was just angry about it.)

However sometimes we've had family members who are doctors come up during health crises and they have been flipping out that XYZ is not available and it turns out it is, it's just engaged differently or at a different point in the process.

It can also be demographics. I don't know where you are in BC but what's available in say, the interior, is not going to be anything like supports available in smaller US centres. This is especially true if you have west coast Americans coming up to west coast Canada since all of Canada is roughly the population of California. So if you have a need for highly specialized treatment you might only be able to get it in like Toronto and Vancouver, as opposed to LA/San Diego/SF or whatever.
posted by warriorqueen at 10:43 AM on August 30, 2017


Counsellors and therapists are saying there are way more supports in the US.

There are, in theory, lots of those supports in the US. In practice, very few people's insurance covers them, and they're almost nonexistent outside of major population centers.

What services health-care professionals believe are available in the US are very different from what patients have found available.
posted by ErisLordFreedom at 10:44 AM on August 30, 2017


Counsellors and therapists are saying there are way more supports in the US.

Just to give one example of how "it's complex," when I needed to find a pediatric psychiatrist in my health plan, there were three serving my large urban built up area of approx 500k people, all thirty minutes and several cities away.
posted by zippy at 1:08 PM on August 30, 2017


« Older Smart card for Windows Login - 10 years later   |   Luteinizing Hormone 13 on 1.7-8.6 Way elevated.... Newer »
This thread is closed to new comments.