Across the country, more children than ever are struggling with mental illness. 20% live with a diagnosable mental illness and 10% have a significant impairment. Twice as many adolescents and young adults have had major depressive episodes in the past 10 years, and suicide is now the norm second leading cause of death for Americans ages 15-19. To make matters worse, more than 33% of toddlers, teenagers, and young adults in Michigan with mental health problems do not have access to health care.
In 2012, Dr. Sheila Marcus and her colleagues from Michigan medicine launched a program to combat this mental health epidemic: Michigan collaborative childcare (MC3). MC3 helps primary care providers (PCPs) improve the mental health of their young patients by providing same-day telephone consultations, scheduling telepsychiatric sessions with patients, connecting families to local mental health resources, and providing educational opportunities for PCPs to develop their expertise in Diagnosis and expand treatment. In addition, MC3 has expanded its reach to women who suffer from mental illness during pregnancy and after childbirth.
MC3 not only draws on, but works with, the Michigan Medicine’s Psychiatry Department as well Michigan State University College of Medicinewho offers group case counseling and educational programs, and the Michigan Department of Health and Human Services (MDHHS). Since its launch in 2012, MC3 has enrolled approximately 3,500 PCPs and conducted approximately 18,000 consultations.
Marcus, a clinical professor at the University of Michigan (UM) and director of child and adolescent psychiatry at Michigan Medicine, says MC3 aims to improve access to mental health care and improve the “competence and confidence” of PCPs.
“I realized that mental health care for children, young adults, and women in the state of Michigan was getting worse,” says Marcus. “… MC3 is designed to bring the mental health expertise of major academic centers to the community. The aim is to provide diagnostic clarification to clinicians who are genuinely confused by what to see and unsure of what to call it – and to improve evidence-based treatments, including counseling on psychopharmaceutical drugs and psychotherapy. “
For example, Marcus notes that pediatricians mistakenly diagnose children who have experienced trauma as bipolar illness or ADHD. When these pediatricians consult an MC3 psychiatrist, they will be able to make better diagnoses.
DR. Sheila Marcus.
“We offer access to people who would otherwise not have access,” says Marcus. “We see high trauma rates in the populations we care for, high rates of suicidality – patients who have been admitted to the hospital and come out of the hospital, or patients who have some degree of suicidality. When they went to the emergency room, they weren’t heavy enough to be admitted. So come back to the PCP office. “
“I was overwhelmed.”
One of these PCPs, Dr. Lia Gaggino, practiced as a pediatrician with Bronson Rambling Road Pediatrics – Oshtemo for 33 years. She joined the MC3 program when Marcus, whom she did not know at the time, recruited her through Facebook in 2012.
“By the time I was exercising, we were essentially learning how to deal with ADHD, which I think pediatricians are very good at. I’ve always had an interest in mental health, so I took psychopharmacology classes, attended a lot of conferences, read a lot, and worked with some other pediatricians who were really talented, “says Gaggino.” When Dr. Marcus described MC3 could be a support , I was able to speak to a child psychiatrist that same day [of a patient’s visit], I was overwhelmed. Even if she had said: ‘We can be back with you in two weeks’, I would have been thrilled, because before MC3 I had to do everything without a psychiatrist. “
Gaggino’s withdrawal from active practice brought her to her role at MC3, where she now advises, trains, and recruits pediatricians, general practitioners, and obstetricians from Michigan.
“Mental health is more of a concern for children than ever. Both the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have declared a mental crisis, “says Gaggino.” Behavioral health concerns account for well over a third of patient visits. … For most paediatricians this is an everyday occurrence. “
Gaggino says these patient visits show that too many children are living with anxiety, depression, and thoughts of suicide. Parents can bring children because they have chronic abdominal pain, chronic headache, or insomnia. If physical causes are ruled out, your doctor can quickly see an MC3 psychiatrist and get advice on the same day.
“We find that most of the time PCPs don’t know what to call things,” says Marcus. “Children with trauma are often misdiagnosed as having bipolar disease or ADHD. We’re trying to correct some of it. “
A phone call with a child psychiatrist will help clarify the diagnosis and get the child on the move with the right medication and treatment plan. This plan could include a telepsychiatric visit to one of MC3’s behavioral counselors, referral to a local mental health counseling center, or simply further follow-up care at the PCP. MC3 also advises over 75 school-based health centers and offers educational programs for PCPs as well as schools.
“The MC3 behavioral health consultants are all regionally dispersed and know very well what resources are available in the home community,” says Marcus.
Psychological help for the youngest among us
With funds from the MDHHS Healthy mothers, healthy babies Initiative, MC3 has expanded its reach to the Michigan perinatal providers who care for new mothers in the weeks immediately before and after the birth. Dr. Maria Muzik, who heads UM’s psychiatry Zero to flourish Mental health programs for women and infants, shared their findings in a September 2019 State of Health Series Story on new mothers and mood disorders.
DR. Maria Muzik.
“These are natural points where mothers are seen by medical professionals,” Muzik said. “We know this is a time when women are prone to mental health problems and that pre-existing illnesses are made worse by hormonal changes, sleep deprivation and birth trauma.”
MC3 gives pregnant women identified at risk of mental health problems brief interventions and access to virtual counseling and care coordination on the same day from remote behavioral health counselors. In some cases, MC3 sets up telepsychiatric consultations with psychiatrists that focus on the perinatal period. When mothers have access to mental health services, infants and children will continue to be better prepared for better mental health.
Through COVID and beyond
Has COVID-19 hits the mental health of the Michigandans particularly hard, especially in families who have lost their jobs or found themselves food insecure. And long-term mental health prospects are not exactly favorable for both rural and urban dwellers. MC3 has offered virtual care for years before the pandemic outbreak and is a shining example of how mental health care can be expanded to meet this growing need.
“There is no question that there is an ‘increase after the increase’ during COVID,” says Marcus. “There are increased rates of suicidality, especially among teenagers. There are increased rates of trauma. When you think of families being quarantined along with their aggressor, that’s a big problem. There are problems with children with special needs, such as autism and developmental disorders. “Conditions whose primary treatment has been interrupted.”
Because of MC3, Michigan communities that lack mental health services or a practicing psychiatrist have an alternative. The organizers hope that as this model of care grows in recognition, health systems and payers will increase funding to expand it – and reduce reliance on grants.
Gaggino says MC3 made her a better clinician and “completely changed” her prescribing habits.
“You do your best, but you can do better if you have help,” she says. “MC3 is really brilliant at adding to that support.”
As a freelance writer and editor, Estelle Slootmaker is happiest to write about social justice, wellness, and the arts. She is the editor of development news at Fast growing media and chairs The Tree Amigos, Wyoming City Tree Commissioner. Her greatest achievement is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.
Dr. Sheila Marcus photos by Doug Coombe. Dr. Maria Muzik Photo courtesy of Maria Muzik.