Solutions to better mental health services may be years away

Is there any hope for better mental health services for Fresno County's children?

Yes and no.

There could be locally trained children's psychiatrists in the next few years to reduce the doctor shortage. But it's doubtful they will be practicing in a psychiatric hospital in Fresno.

Donna Taylor, the county's head of behavioral health, hasn't given up hope for a children's psychiatric hospital. The reopening of a county crisis center for adults last month offers a sliver of hope, she said, but realistically it's a long shot.

When the county closed the center for budget reasons three years ago, mentally ill adults flooded hospital emergency rooms and many were referred to Community Behavioral Health Center, an adult psychiatric hospital in Fresno. If the number of adults there was reduced, she said, maybe there would be room for children.

The door isn't shut on discussions with the county, said Dawan Utecht, CEO of the Behavioral Health Center. But a children's unit would have to be self-supporting, she said.

That would be hard to guarantee, Taylor said. Children hospitalized by the county would be on Medi-Cal, the state-federal insurance for low-income families. Medi-Cal reimbursements are notoriously inadequate to cover operating costs, Taylor said.

A much surer bet: Fresno is expected to start training child psychiatrists next year in a residency program that health professionals have been trying to bring here for years -- and one they say is crucial to reducing the doctor shortage for children with mental illnesses.

The University of California at San Francisco-Fresno Medical Education Program received a $1.5 million, five-year state grant to train child/adolescent psychiatrists. And Fresno County agreed to provide $150,000 toward faculty salaries for the psychiatry fellowship for the first year. The county should be able to cover the faculty costs for the entire five years, Taylor said.

Two fellows will be trained each year in the two-year fellowship program, which is scheduled to be accredited by a national organization in July 2013, said Dr. Karen Kraus, director of child and adolescent psychiatry at UCSF-Fresno. Kraus helped spearhead the years-long drive for the fellowship program.

The training program won't immediately solve the child psychiatrist shortage in Fresno County, where four psychiatrists see most of the children with private insurance. But it should add doctors in years to come, Kraus said.

"Fellows or trainees tend to stay in the area where they are trained," she said. And the faculty who train the fellows also attract other professionals to a community, she said.

But, she said, it will take time for fellows to graduate and -- it's hoped -- set up private practices to see children with private insurance.

In the meantime, Kraus said parents can talk with their children's pediatricians and sometimes the pediatrician may be able to help.

Schools also have psychologists and counselors who can provide some services to children and guidance to parents, Kraus said. And the National Alliance on Mental Illness office in Fresno offers support groups and training programs for parents.