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MC3 Consulting Psychiatrists in the Media

Q & A: Dr. Sheila Marcus on Pediatric Mental Health

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  • Alyssa Wealty |

  • Apr 28, 2022
Photo of Dr. Sheila Marcus

This Q&A is an excerpt from the Second Wave Michigan article by Estelle Slootmaker titled “Special report: COVID-19’s silver linings for mental health care in Michigan”

This interview has been edited for length and clarity.

Q: Why is it important that we focus mental health efforts on children and teens?

A: We are beginning to discover what was a substantial problem in the state of Michigan before the pandemic has become a tsunami of need during and following the pandemic. About 20% of children and adolescents will have some sort of mental health issue, depression, anxiety, ADHD, autism, trauma, OCD, and a whole host of issues. That has increased during the pandemic. The data now is something like 40% of adolescents report mood and anxiety symptoms during and following the pandemic.

In places where there exist child-mental-health-trained or child psychiatrists, the wait times are anywhere between four and six months. The vast majority of the counties in the state of Michigan don’t have any trained children’s psychiatrists. So there’s no wait time because there’s no line to wait in. In those cases, generally, children are being cared for by pediatricians, family medicine physicians, or nurse practitioners.

Q: What kinds of mental health challenges does MC3 help pregnant women and new mothers overcome?

A: The most common complication of pregnancy is postpartum or pregnancy-related depression. The postpartum period is often a time when women who have bipolar illness have their first episodes. The other big issue in pregnancy and postpartum is trauma. So many women are victimized during their pregnancies. In the case of women with domestic violence histories, there often are uses of substances including marijuana and alcohol, sometimes opiates.

We’re very mindful that when we’re caring for pregnant moms, we also have to care for the babies, even during the pregnancy. If we have a victimized, traumatized, substance-abusing, depressed mom, simply treating the mom’s disorders will be insufficient. You have to make sure that mom and baby get into infant mental health services to give mom the skills that she needs to form a healthy attachment relationship to the infant. We sometimes call this ‘the dance of early childhood,’ moms looking at babies, babies looking back at moms, and falling in love with one another.

Q: What role can primary care providers play in meeting the mental health needs of these women and their infants?

A: Many obstetricians are doing a screening for depression, anxiety, and trauma during pregnancy. They’re more likely than anybody to pick up on signs and symptoms of some of these disorders. They may have followed the mom in other pregnancies and have a sense of whether there have been other issues. In family medicine [practices], doctors are following moms during pregnancy and postpartum as well as their children. They’re really connected to the family, sometimes for many generations.

Q: How is MC3 engaging these PCPs?

A: Our role is to support and scaffold the primary care docs in caring for the children that are already in their panels for primary care. After they’ve called us once or twice, they realize that we’re here to support them and here to validate that the work that they’re doing is incredibly difficult — not chastising them for not being able to do things that they weren’t trained to do.

We also do “brown bags,” clinical case consultations, where a group gets together and presents a case or two to discuss cases over lunch. We have a variety of recorded modules available to practitioners on a whole host of topics like depression, anxiety, eating disorders, LGBTQ issues, and suicide. We’ve begun a specific suicide prevention and safety planning [module], which we’re delivering to 60 or 70 practitioners several times a year. Since COVID, there are now billing codes that allow them to bill for consultations, report writing, tests, or multidisciplinary meetings that happened on the same day as a [patient] visit.

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MC3 in the Media

Whitmer Hosts Mental Health Roundtable in Pontiac

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  • Alyssa Wealty |

  • Apr 25, 2022
Photo of Gov. Gretchen Whitmer meeting with others at round table discussion about mental health

The following is a press release originally published on the Michigan.gov website. It features a mention of Gov. Whitmer’s proposal to fund a $5 million on-demand help of school-based clinicians initiative via the MC3 program.


LANSING, Mich. — Today, Governor Gretchen Whitmer sat down with students, parents, educators, and mental health professionals at Pontiac High School to advocate for additional mental health investments in schools at the beginning of Student Appreciation Week. The governor’s fiscal year 2023 School Aid Fund budget recommendation would invest $361 million for school-based mental health services, including hiring and retaining mental health professionals and opening 40 new clinics for students across the state.

“Last year, I made largest education investment in Michigan history and delivered resources to hire over 560 mental health professionals, including nurses, social workers, and psychologists,” said Governor Whitmer. “In my budget for the next school year, I’m proposing another historic investment in on-campus mental health supports for our kids. We can and must work together to expand access to mental health care to help our kids thrive in and out of the classroom. My budget includes the highest per-student investment in Michigan history – I look forward to making that investment reality. Let’s get it done.”

Governor Whitmer’s Proposed Mental Health Investment

The fiscal year 2023 School Aid Fund Executive Recommendation includes $361 million for school-based mental health services. Today’s visit highlights the increased need for school-based mental health services and the Governor’s proposed response. Governor Whitmer’s proposed budget includes:  

  • $150 million to offer training for teachers in partnership with TRAILS.
  • $25 million to give every school free access to quality mental health screeners.
  • $120 million to hire more school-based mental health professionals.
  • $50 million to continue to strengthen school-based mental health supports to ensure school nurses and social workers are part of a bigger effort and not isolated resources.
  • $11 million to open school-based health centers in regions with limited access to care.
  • $5 million to provide on-demand help for school-based clinicians responding to unique cases in partnership with the Michigan Child Collaborative Care at the University of Michigan.

School-based health centers, also known as child and adolescent health centers, are housed in school buildings and staffed by clinicians. There are over 100 sites across Michigan, serving more than 200,000 students annually in communities where families lack access to medical services. Governor Whitmer proposes adding 40 more sites.

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MC3 in the Media

How can Michigan address its dire shortage of mental health professionals?

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  • Alyssa Wealty |

  • Apr 14, 2022
Photo of Michelle Schulte, the maternal infant child health division director of the Inter-Tribal Council of Michigan

The following article was written by Estelle Slootmaker and originally published by Second Wave Michigan. It mentions the MC3 program in reference to MC3’s collaboration with the Inter-Tribal Council of Michigan to improve mental health outcomes for members of Michigan’s tribal communities.


This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Even as mental health issues have risen worldwide, Michigan has fallen behind on having enough health professionals to address that trend. According to National Alliance on Mental Illness (NAMI) data, there were 421,000 Michiganders who did not receive needed mental health care in 2021, but only 38.4% cited cost as the reason. A Kaiser Family Foundation analysis illustrates one of the other key reasons people aren’t getting the care they need. That study finds that more than four million Michiganders live in communities with a shortage of mental health professionals, ranking fifth worst in the nation, behind Texas, California, Alaska, and Missouri.

“There’s a systemic shortage. We don’t have enough providers to meet the needs of the population. The shortage has progressively gotten worse over the last five or 10 years. And we’re feeling the impact even more due to COVID,” says Timothy Michling, research associate in health affairs at the Citizens Research Council of Michigan and author of a report entitled “Michigan Falls Short on Mental Health Services.” “When we look at projections going forward, we see the gap between demand and supply of providers widening. If we don’t address the issue now, it’s only going to get worse in the future.”

According to Michling, this shortage spans the mental health professions, from direct caregivers to master’s-level therapists to social workers to psychiatrists to psychologists. Many Michigan counties have no psychiatrists, particularly for children and adolescents.

“Mental health underpins our wellness as a society. We see much worse outcomes in a variety of health conditions when you have an untreated mental health disorder. This affects our economy and our society at large,” Michling says. “Students are not able to do as well in school if they have an undiagnosed or untreated mental health condition. And that follows children into adulthood. It affects their career readiness. It affects our rates of homelessness, our rates of unemployment and workforce participation.”

Filling the void for tribal communities

Effects of the mental health professional shortage vary by geographic region in Michigan. Six Upper Peninsula counties and nine Lower Peninsula counties have no psychiatrists, and three UP counties and seven Lower Peninsula counties have neither psychiatrists or psychologists. Michelle Schulte, maternal infant child health division director for the Inter-Tribal Council of Michigan (ITCMI), works with Northern Michigan tribal communities located in some of these areas of need.

“The shortage of mental health professionals is impacting people in our communities in a very bad way,” Schulte says. “We have long waiting lists … People who have needs can’t get in. In our rural areas, especially the UP, many people have to travel two to four hours to get the kind of care that they need. Some tribal communities have a limited contract with a local psychiatrist or psychologist that comes in maybe once a month and sees everybody on that same day. If you miss your appointment or can’t make it on that day, you’re stuck.”

Schulte and her ITCMI colleagues have collaborated with a wide range of partners to create projects and programs that shore up the lack of mental health services, especially for children and young families. MIchigan Medicine’s Michigan Child Collaborative Care program provides mental health services via telehealth. The Michigan Public Health Institute and Michigan Association for Infant Mental Health programs train early childhood teachers to address children’s mental health in Head Start programs and tribal schools, and to equip designated child behavior specialists from within the community to support families. 

“We’re seeing children who have a high influx of behaviors that our early childhood providers have never had to deal with before or feel ill-equipped to deal with,” Schulte says. “A child may have disruptions at home, … may not have slept well, may not have been bathed, or may feel run down. How do we address it in a way that the child gets what they need, as far as nurturing attention or care?”

ITCMI social media campaigns enlist aunts, uncles, and grandparents to play traditional cultural roles in raising children within extended families. An ITCMI focus group with tribal elders explored Anishinaabe words for resiliency, producing rich definitions that strengthen that concept in community. 

“Our goal is to support healthy development and resiliency in children,” Schulte says. 

NAMI Michigan a first responder for many

Kevin Fischer, executive director of NAMI’s Michigan chapter, agrees that the state is experiencing a dire shortage of mental health professionals. That may be one reason that NAMI affiliates across the country have seen requests for help increase between 80% and 100% over the last year. The nature of the calls for help has changed, as well. More people are calling with an urgent need for services. NAMI’s education and support programs also are seeing huge increases in enrollment.

“People are calling to get a better understanding of what’s going on, what a mental health diagnosis means,” Fischer says. “For example, they ask, ‘What is schizophrenia? What does bipolar mean?’ They may have a family member and want to better understand how they can help them.”

NAMI Michigan’s peer-support volunteers help the nonprofit meet this increasing need. These peers have lived experience of mental illness. That experience may be helpful to a person initially diagnosed with a mental illness, who may feel uncomfortable talking to friends or family members about it.

“They really want to talk to somebody who’s walked in their shoes already, to get an understanding of what their recovery process would look like,” Fischer says. “Peer supports have become tremendously valuable.”

Fischer notes that unless more mental health professionals enter the field, Michigan communities will be ill prepared for increasing demand for mental health services. For example, from 1999 to 2019, suicide rates have increased in the general population by 35%. Other groups have seen even more severe increases. Among Black male adolescents, suicide attempts increased by nearly 80% between 1991 and 2019.

“We’re seeing another significant uptick in needs for mental health services among young people because of social distancing and closing the schools,” Fischer says. “There’s a significant increase in mild to moderate mental illness — depression, anxiety, some self-harm like cutting. Across the board, there’s been a significant increase.”

More strategies for increasing the ranks

Fischer notes that the surge in telehealth usage has helped address the shortage of mental health professionals, especially when COVID-19 limited face-to-face health care visits. While virtual video calls are not the answer for every person living with mental illness, the modality has had surprising success. Another strategy that could help relieve the shortage is better equipping primary care providers to offer mental health services.

“We’re in this age now where we’re talking about integrated health care. Our primary care physicians really should be our first responders for behavioral health care,” Fischer says. “They are able to diagnose and prescribe medication for people who are experiencing mild to moderate mental health diagnoses, or refer them to a psychiatrist or psychologist if they think something more serious is going on, like schizophrenia or bipolar disorder. But that’s not the norm.”

Michling concurs. However, even though primary care physicians may have received mental health care training in medical school, many are not comfortable — or not willing — to tackle mental health issues during office visits. Additional options to address the shortage include policy changes that allow nurse practitioners to have a wider scope of practice, school loan forgiveness for college graduates entering behavioral health care fields, and better insurance reimbursement levels for behavioral health services.

“We also want to look at ways to incentivize people to stay in the field so we don’t have high rates of atrophy and people leaving the field for other professions. That requires research on why folks are leaving,” Michling says. “Recruitment efforts at the undergraduate or high school level could make a really clear talent pipeline and career trajectory for folks to get into various behavioral health careers. Beyond that, providing grants to help hospital emergency departments deal with psychiatric or other mental health emergencies, or supplemental training for physicians, nurses, and other emergency department personnel, could make them better equipped to deal with what we’re seeing.”

While finding ways to increase the ranks of mental health professionals is essential, Michling feels it is even more important to address the root causes of growing mental illness among Michiganders.

“Much in the way that we treat chronic disease, we want to focus our public health resources on strategies to deal with stress, improved nutrition, improved sleep, mitigating the community-level factors that we know can put people at greater risk for experiencing a mental health disorder,” Michling says. “That prevention piece, I think, is what’s really lost.”

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MC3 Consulting Psychiatrists in the Media

USPSTF (U.S. Preventive Services Task Force) recommends for the first time that kids 8 and older get screened for anxiety

  • No Comments |

  • Alyssa Wealty |

  • Apr 13, 2022
Photo of Dr. Joanna Quigley

MC3 Consulting Psychiatrist Dr. Joanna Quigley was interviewed for this MD Edge article. 

Link to the original article. 


[…]

Joanna Quigley, MD, clinical associate professor and associate medical director for child & adolescent services at the University of Michigan, Ann Arbor, said in an interview she was not surprised the USPSTF recommended screening for anxiety starting at age 8.

That’s when parents and providers see anxiety disorders begin to present or become more problematic, she said.

“It’s also acknowledging the importance of prevention,” she said. “The sooner we can identify these challenges for kids, the sooner we can intervene and have better outcomes for that child across their lifespan.”

Screening gets providers and families in the habit of thinking about these concerns when a child or adolescent comes in for another kind of visit, Dr. Quigley said. Chest pains in a well-child check, for example, may trigger thoughts to consider anxiety later if the child is brought in for a cardiac check for chest pains.

“It creates a culture of awareness that is important as well,” Dr. Quigley said. “I think part of what the task force is trying to do is saying that identifying anxiety can be a precursor to what could turn out to be related to depression or related to ADHD and factors we think about when we think about suicide risk as well.

“We’re seeing an increase in suicide in the younger age group as well, which is a huge concern, “ she noted.

Dr. Quigley said, if these recommendations are adopted after the comment period, pediatricians and family practice providers will likely be doing most of the screening for anxiety, but there may also be a role for the screening in pediatric subspecialty care, such as those treating children with chronic illness and in specialized mental health care.

She added: “This builds on the national conversation going on about the mental health crisis, declared a national emergency in the fall. This deserves attention in continuing the momentum.”

[…]

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MC3 Consulting Psychiatrists in the Media

Children as Young as 8 Should Be Screened for Anxiety, Experts Recommend

  • No Comments |

  • Alyssa Wealty |

  • Apr 12, 2022
Photo of Dr. Nasuh Malas

Dr. Nasuh Malas, an MC3 Consulting Psychiatrist, was quoted in a Wall Street Journal article.


[…]

All children should be screened for anxiety starting as young as 8 years old, government-backed experts recommended, providing fresh guidance as doctors and parents warn of a worsening mental-health crisis among young people in the pandemic’s wake.

[…]

“What the pandemic has done is, it exacerbated a pre-existing issue,” said Nasuh Malas, director of pediatric consultation and liaison psychiatry services at C.S. Mott Children’s Hospital in Ann Arbor, Mich., who isn’t on the task force. “These guidelines are a preliminary step to many, many steps that we need to take nationally as a community of people who are concerned about our youth.”

[…]

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