A 14-year-old with large brown eyes and tightly cropped hair told me a few weeks ago that voices were telling him to kill people. A day before the Sandy Hook school massacre, he threatened to light his house on fire and stab everyone in the family, according to his mother. This boy — whom I'll call Trevor — is a severe case, presenting the early, violent symptoms of schizophrenia at an age when the illness often begins to emerge. Untreated, his condition poses a serious danger to himself and those around him.
I am an outpatient therapist, working primarily with children and adolescents from disadvantaged backgrounds. Trevor is on Medicaid, yet cuts to Medicaid funding in recent years, here in North Carolina and throughout the country, mean that children like him slip through the cracks. In the best scenarios, cuts to reimbursement rates result in shortened therapy sessions and restrictions on the number of visits clients are allotted; in the worst, practices that serve the poor are going under.
Trevor's coverage provides for mental health care, but most psychiatrists in his area do not accept it because of the low reimbursement rates. Those offices that do have two- to three-month waiting lists. Trevor needs psychiatric care and cannot wait months to get it. Last October, when my concern about Trevor first began to escalate, I made a dozen calls and finally managed to get him in to see a psychiatrist near his home. The doctor, according to Trevor's mother, spent 15 minutes with the boy. He diagnosed Trevor with obsessive compulsive disorder, prescribed no medication and suggested that Trevor continue to see me weekly. From what I know of Trevor, 15 minutes is insufficient to gather the information necessary for a diagnosis.
Trevor's statements to me in December — referred to as homicidal ideation — demanded, both legally and ethically, that I send him to an emergency room. In North Carolina, as in many states, there aren't enough hospital beds to accommodate mentally ill individuals in crisis. Physical maladies and injuries take precedence, and those with mental-health issues often do not get out of a waiting room. Trevor spent five hours at the emergency room, then was sent home with instructions to call the hospital's adolescent mental health team the following day; his mother was unable to reach a member of that team when she called, she told me.