By the third week in September, families across New Jersey were reaching a breaking point. Parents struggled to get their kids back into the school routine after a year of largely unstructured remote learning, while children resisted — scared of getting COVID-19 and burdened by the loss of loved ones and time with friends.

Daily calls to a state children’s health network peaked at 559 early that week, one-third higher than the volume at that point in 2020, according to data provided by the New Jersey Department of Children and Families (DCF).

The system’s mobile response unit, which visits families in crisis at home, was dispatched 150 times one day in mid-September, and nearly hit that daily peak again the following week, the data shows — a 20% increase over last year’s volume. More than 1,000 children were referred for services over two weeks, the most in months.

“Getting adjusted to something as simple as waking up on time and taking the bus after not having to have done it for a year can be a struggle, and that transition can be further hindered and complicated by feelings of stress, anxiety, and fear,” DCF Commissioner Christine Norbut Beyer said.

The state has taken steps to identify children who are struggling and to help families find appropriate support services. But mental health providers warn there is already a capacity crunch within New Jersey’s community-based network of caregivers — the nonprofit and private practices to which clients are referred — leaving some families to wait weeks before they can access care.

‘We ask that parents be aware of the signs — maybe it’s uncharacteristic changes in mood, or increased and prolonged patterns of fighting or lying, or maybe it’s children not enjoying the activities that they once enjoyed.’

Norbut Beyer said Wednesday that the DCF system does have the resources to help more residents and urged parents to monitor their children closely. “We ask that parents be aware of the signs — maybe it’s uncharacteristic changes in mood, or increased and prolonged patterns of fighting or lying, or maybe it’s not enjoying the activities that they once enjoyed,” she said. “Don’t be afraid to ask your children what’s wrong and normalize asking for help when they need it.”

Struggling with transition back to school

To ease that process, state officials unveiled on Wednesday a new youth mental health portal on the state’s COVID-19 website to serve as a one-stop behavioral health resource that contains relevant hotline numbers and links to other services, tailored for specific audiences.

“Children and families are really struggling with anxiety and the transition back to school,” said Louis Schwarcz, CEO of The Bridge, which provides behavioral health services to families and individuals in Essex and Union counties. “It’s been a really, really difficult year for all of us.”

Norbut Beyer also urged parents whose children have been suffering for a prolonged period to call the Children’s System of Care, a network of providers that specializes in behavioral health and services for individuals with disabilities — and open to all families regardless of income. The system, run by PerformCare NJ, can dispatch mobile units to help families in crisis, support children through school-based programs, and refer individuals to community-based outpatient services for ongoing treatment.

Although Gov. Phil Murphy tried, unsuccessfully, to cut back state funding for school-based services last year, on Wednesday he touted this year’s investment of $100 million to expand care under the children’s system to better meet the growing need. In September, more than 15,000 families were having care managed through the system, at least 1,000 more than the previous year, DCF said.

Despite this increased demand for services, the state’s children’s system is still able to help more families, officials said. Thanks to the new funding, “our provider network of youth behavioral health services has the resources, the skill, and the capacity to help youth and their families when it’s needed,” Norbut Beyer said Wednesday.

Wait lists for outpatient, individual care

Behavioral health experts praised New Jersey’s Children’s System of Care but warned that capacity remains a challenge for the community-based providers who accept referrals from this state program. While DCF’s system — which also serves as an early-intervention initiative to identify health problems — may have the resources to conduct additional family assessments, it could take these families weeks to get outpatient care.

“I have a lot of concerns about people getting counseling when and where they need it,” said Carolyn Beauchamp, president and CEO of the Mental Health Association of New Jersey. Group programs are more widely available, she said, but individual sessions are hard to find.

‘The reality is, it’s hard to find a therapist now because of the numbers of people who are struggling and in pain.’

Schwarcz said The Bridge is busier than usual. “We’re seeing a multitude of calls to our mental health hotline, more than ever,” he said, adding that most organizations have a wait list to access care. “The outpatient services are stretched,” Schwarcz continued. “The reality is, it’s hard to find a therapist now because of the numbers of people who are struggling and in pain.”

DCF spokesperson Nicole Brossoie said that PerformCare includes more than 175 providers that offer a variety of services and hire professionals based on the needs of each agency and the community it serves. Wait times depend on the type of treatment, she said, and while the mobile emergency unit can be sent on demand, home-based services “can take time to coordinate” based on location and provider capacity.

Unequal access

Access to care is not necessarily equal, experts also noted. Dr. Gary Rosenberg, a child psychiatrist and assistant professor at Robert Wood Johnson Medical School in New Brunswick, said youngsters with more severe needs may get treatment more quickly while children with less urgent issues sometimes struggle to access care. “There may be a lot of services available in the state,” he said, “but clearly there can be a difficulty in getting access to treatment.”

To boost capacity, Rosenberg urges the state to expand an existing program that pairs pediatricians with psychiatrists — who are in short supply in New Jersey and nationwide — who can advise them by telephone when they encounter behavioral health needs. “I think that’s an important component,” he said. “Any primary care physician should have access to this program.”

Some providers said telehealth can also help them reach additional patients. Schwarcz called it a “huge breakthrough” for some consumers and said it was a highly popular option at The Bridge. But he is concerned payments now available for these remote services will dry up as the pandemic recedes. “Less people are canceling (appointments) and more people are participating in care” under telehealth, he said. “A lot of our clients don’t want to go back to face-to-face.”

But Beauchamp said she is concerned that telehealth is less effective for mental health care and worried about the impact it is having on the workforce. With online and telephone-based counseling services exploding nationwide, she said these companies are luring counselors and other clinicians away from community-based providers with promises of better pay and other benefits, like working at home. “A significant number of clinicians are going for that,” she said.

School-based programs are also critical in identifying and assisting children with mental health needs, experts agreed, and several praised the Murphy administration for protecting the in-school programs that were initially proposed for a budget cut last year. On Tuesday, Murphy signed a bill that requires schools to conduct regular mental health screenings and appropriates $1 million to launch the initiative.

While the pandemic has triggered anxiety and depression for many New Jerseyans — including some mental health providers — Schwarcz said there is a silver lining in the fact that more people are talking about these issues, reducing the stigma somewhat. “We’re all in the same fishbowl. And that’s true in schools too,” he said. “We’re all struggling now. We need to continue to make it OK for people to ask for help.”

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