The pandemic's long shadow over the mental health of Minnesotans — especially youth

Concerns are growing about burnout; caregivers are reducing hours or leaving the field entirely. And while telehealth has made it much easier for many patients to access mental health care — sometimes in just a day or two, and particularly across rural areas — broad adoption could be making it harder for providers to staff in-person treatment.

Patients with serious and persistent mental illness are having "a very difficult time finding a place to go" as the supply of such specialized care providers hasn't kept up with the growing need, said Steve Girardeau, a psychologist and legislative co-chair of the Minnesota Psychological Association. Long-standing access problems for kids and patients seeking a provider of color likely persisted or worsened during the pandemic, says William Robiner, a psychologist and researcher at the University of Minnesota.

Nearly 89% of the state's mental health workforce is white, compared with 78% of the population, according to the Health Department.

"The concept of 'shortages' is a slippery one — there isn't a statewide or even a regional number of providers that is 'right' or that would indicate that the market is in balance," said Teri Fritsma, the lead health care workforce analyst at the Minnesota Department of Health. "All that being said, for many years we have been aware of serious imbalances in the numbers of providers we need compared to the number we have."

Insurers have seen increased demand for mental health services over the last several years driven by easier access through telehealth, reductions in stigma, growing awareness and a greater overall need among patients, says the Minnesota Council of Health Plans, a trade group for the state's non-profit health insurers.

 

This month, UnitedHealth Group — the Minnetonka-based health care giant that operates UnitedHealthcare, one of the nation's largest insurers — said it's seeing increases across the country, with the percentage of people accessing behavioral care over the last year growing by double-digits.

 

Minnesota health care providers say patients should keep seeking care, because they're employing new strategies in response to the demand, but they point to obvious signs of systemic stress.

 

This spring, nearly 7,000 children were on waiting lists for services across 21 nonprofit clinics surveyed by the Minnesota Association of Community Mental Health Providers.

 

PrairieCare says only six counties in Minnesota have pediatric psychiatric hospital beds, and staffing those beds has become even more challenging. Like the U.S., the state has a shortage of child and adolescent psychiatrists, said Todd Archbold, chief executive of the Brooklyn Park-based medical group.

 

Between January and April, pediatricians across nine clinics at Children's Minnesota made nearly 500 referrals for therapy — a significant increase, they say, over previous years.

 

Across all ages, referrals through mid-June to outpatient mental health from primary care clinics at M Health Fairview were up 15% over last year. The health system has launched services to help connect patients to outpatient therapies and programs that often have delayed appointments and start dates.

 

Among kids, Fairview has seen a huge increase in mental health needs, said Bobbi Jo Krieg, an outpatient therapist who works with pediatric patients at the health system.

 

"The world basically ran a giant experiment [during the pandemic] that would not be ethical to run — and we're seeing the outcomes of that," Krieg said. "You're seeing young people move through developmental milestones without the support they would have had. And you're also seeing teens who decreased their in-person socialization and increased social media consumption as a substitution — and there's plenty of studies out there to show that that increases anxiety and depression."

 

Even before COVID-19, more kids were coming to primary care with mental health issues, but the frequency and severity of problems since 2020 has intensified, said Dr. Eileen Crespo, president of the Minnesota chapter of the American Academy of Pediatrics.

 

Doctors are trying to provide kids in the clinic with stop-gap measures to help — suggesting mindfulness exercises, for example, when appropriate — because it can be such a long wait for therapy appointments, Crespo said. There's also a push at many clinics that pre-dates the pandemic to provide collaborative care, where mental health providers are embedded in primary care offices and offer near-term help with little or no waiting.

 

Pediatricians, she said, were not surprised by the U.S. surgeon general's report this May warning about the dangers of social media for youth mental health.

 

"We have just never had the volume of patients, who are all symptomatic at the same time, like we are seeing right now," said Crespo, who practices at Hennepin Healthcare in Minneapolis.

A Star Tribune survey of more than 20 mental health providers in June found that some therapists were offering appointments for adults within just a week or two. The waits at other providers were significantly longer — up to eight months at one health system.

 

It's difficult to generalize about wait times because they vary by age, severity of illness and services needed, but kids usually wait about seven times longer than adults because there are fewer providers with pediatric expertise, said Erin Pash, the chief executive at Mendota Heights-based Ellie Mental Health. Before the pandemic, the waiting list for mental health services at Minneapolis-based Washburn Center typically included fewer than 200 children, but it recently has had at least 500, said Craig Warren, the center's chief executive.

 

Options Family & Behavior Services announced this month it will close day treatment programs for both adults and teens because it's become too difficult to hire staff.

 

Wage requirements are rising much faster than insurance reimbursements, said Brian Sammon, chief executive at the Burnsville-based agency. And some therapists prefer the work-from-home flexibility with virtual visits, which leaves fewer staff for in-person work at his company's group therapy programs, Sammon said.

 

"We have people lined up out the door," he said. "We have a waiting list — and not enough staff to serve them."

During the pandemic, socialization decreased and isolation increased across the population, pushing most people down on a continuum that stretches from good mental health to severe mental illness, said Lew Zeidner, the vice president for mental health and addiction services at M Health Fairview. Meanwhile, a significant number of mental health caregivers reduced hours, stopped taking patients using health insurance or got out of the field altogether.