The BDN Opinion section operates independently and does not set news policies or contribute to reporting or editing articles elsewhere in the newspaper or on bangordailynews.com.
Lindsey Tweed is the immediate past president of the Maine Council of Child and Adolescent Psychiatry.
Many congratulations and thanks to Callie Ferguson for her excellent article on Maine’s struggles to help troubled youth and their families; they are not getting the help they need, and this article does a great public service to shine a light on their often hidden (e.g., in emergency departments) and painful plights.
The article states that “Many of those adolescents do not suffer from classic psychiatric disorders but have chronic, aggressive behavioral issues…” This statement is not inaccurate, but we desperately need to improve the situation to which it alludes: classic psychiatric disorders versus behavioral issues.
The article vividly describes Timmy, Harry, and Michelle Richardson’s daughter. These youth had diagnoses of ADHD, anxiety, depression and unspecified mood disorder, and all suffered from emotion dysregulation, explosive outbursts and resulting aggression. Their mental health issues contributed greatly to their lack of success in school; they came to feel like “nobodies.” Timmy and Harry started cannabis by middle school and were into “hard drugs” (with a suspected fentanyl overdose) by late adolescence.
It is undeniably, but very unfortunately, true that elements of the children’s mental health system have avoided treating youth with these problems, often labeling them as “behavioral” (a term whose definition I cannot find in any textbook or journal article and whose function seems to be to avoid treating challenging youth). But this avoidance is waning. We are beginning to bring these problems (and these youth and families) under the tent of classic psychiatric diagnoses where they have always belonged. These disorders are always biopsychosocial — the Bangor Daily News article very rightly points toward the roles of child abuse and neglect and poverty — and they need comprehensive biopsychosocial treatment.
It is certainly true these problems can be longstanding. Chronic, though, may imply a poor prognosis; we can, in fact, effectively treat most of these youth.
I was accurately quoted in the article as saying that emergency departments are the new detention. Maine’s Division of Juvenile Services has stopped criminalizing youth mental illness — that is awesome. But now, when a parent or teacher has an acute concern for public safety and an immediate need for a locked door and security guard, there is only one place to go: the emergency department.
Maine’s executive branch currently distributes funding and responsibility for these youth across the departments of Correction and Health and Human Services (one of fewer than 10 states, according to the article, to do so). This is a structural recipe for cost shifting and responsibility dumping. Let us bring Division of Juvenile Services and the youth and families it serves into DHHS and the children’s mental health system where they belong.
