Q&A: Dr. Kristi Kleinschmit, Associate Professor of Psychiatry at the U of U School of Medicine, on the mental health crisis facing children and youth in Utah

KRISTI KLEINSCHMIT, MD

 

Kristi Kleinschmit provides clinical services for children and adolescents at the University of Utah Huntsman Mental Health Institute. She is a consulting psychiatrist to primary care providers across the state of Utah through the CALL-UP psychiatric consultation line

She acts as Vice Chair of Education for the Huntsman Mental Health Institute (HMHI)/University of Utah Department of Psychiatry, and is the training program director for the Triple Board and Child Psychiatry Training Programs. She has been working with the Department of Educational Psychiatry to advance the state’s school-based mental health programs. 

 

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State of Reform: What is the current state of youth and children’s mental health in Utah? How does the situation compare to other states?

Kristi Kleinschmit:It’s not an unknown fact that there is a youth mental health crisis within the country. Utah as well is suffering from really high rates of youth mental health conditions. One unique thing about Utah, unfortunately, [is that] suicide is the leading cause of death in youth in Utah ages 10 to 24. Most places in the country, suicide is the second leading cause of death, which is also very unfortunate, but in Utah [suicide] has risen in the last 5 years to become the largest cause of death with our youth. We also have a lot of concern about our preschool aged and young mental health issues in Utah.

There was a report that came out a few years ago that showed there’s just woefully inadequate access and service lines for infants and preschoolers and young children who are struggling with mental health concerns. Utah does have quite a high rate of postpartum depression with our mothers and certainly there are a lot of repercussions for that with attachment and bonding and future mental health concerns for youth growing up with a mom who is depressed and not getting the care that she needs.

There are a number of other states like us, but [Utah has] this large urban center that has inadequate but some access to child psychiatric services. Then we have these large, vast rural areas that really just have limited to no access to therapists or psychiatrists or other types of prescribers for mental health conditions. It’s really difficult for patients and families to access therapy.”

SOR: What are the specific needs in the state and how can federal and state policies support services for young people?

KK:One of the best things that came out of COVID was this wide rollout of telehealth services, and previously there was a lot of regulation and stipulation regarding who can get reimbursed for telehealth… you had to be rural and had to have certain bandwidth. At the end of the day, we want the communication to be safe, but in general, [telehealth] has been a game changer for access to mental health care.

[The] ongoing support [we’ve seen in Utah] for equal reimbursement for telehealth services for mental health conditions is amazing because then you can be in rural Utah and you can see a psychiatrist at the University of Utah and you do get that equal access that folks in the urban areas can have.

Or you can be sick and still see a therapist. It really has just helped to sort of level the access field for folks that previously would have had to drive like 3 to 4 hours to go and see a clinician. Making sure that reimbursement for [telehealth] remains robust and supported.

Certainly one of the things that can lead to mental health conditions is adverse childhood events. Supporting families to have housing, access to food so there’s not food insecurity, and access to health insurance [is necessary]. We often think about making sure kids have access to health insurance so they can get help. That’s very important, but also their parents need to have access to health insurance because if they cannot get help for their physical or mental health conditions, that leads to a lot of adverse childhood events.

Having a parent with an untreated mental health condition is one of those. Being poor and being unable to afford housing, if you have physical health or mental health conditions that aren’t being treated, that sort of leads to that cascade. So another way is just to help families get out of poverty [and] make sure people are getting the mental and medical health that they need.”

SOR: What programs does the University of Utah have in place to address the issues of family mental health?

KK:[In addition to programs like HMHI’s crisis line and Mobile Crisis Outreach Teams], we have a program called the CALL-UP Psychiatric Consultation Line. This is a telephone number that pediatricians and family practice doctors and nurse practitioners, anyone doing primary care in the state of Utah can call. They can reach to talk with a child psychiatrist, Monday through Friday, 12 to 4:30 pm.

The purpose of that is really to help bring access to child psychiatry to all parts of Utah. If you’re in the middle of nowhere and you’re seeing a patient when you have a question about mental health concerns, you can call this line and ask me and there’s a variety of other doctors that work on the line. You can ask us for our case guidance and we can give you in real time, help for that.

Then we’re also providing resources to clinicians as well. That’s a service called CALL-UP just for primary care clinicians in Utah. We also have at the University of Utah a number of clinical programs, outpatient programs, inpatient programs, [and] something called day treatment programs.

We’re not unique in that but [day treatment] is this really nice intermediate level of care [where] kids come Monday through Friday, 8am to 4pm and get therapy. They do some school, they have groups, they talk to a psychiatrist and it lasts like 4 to 6 weeks and over the course of time we really try to get kids ready to go back to school and function kind of back in their families as well.”

SOR: What are the merits of school-based mental health services in Utah and what areas need to improve?

KK:We have this Utah School Mental Health Collaborative and this is a partnership. We received funding from Cambia Health as well as HMHI and we are partnering with the College of Education’s School of Psychology program at the University of Utah to expand these school mental health services. [The program is] a huge benefit for students and families because we can go where they’re at. Instead of having the access concerns, kids go to school, and so if you can go and see them at their school that just takes a huge barrier away. We’ve managed with our grant funding to add a case manager to the role which has been such a needed addition because she’ll go do home visits if we’re having a hard time getting hold of parents to get consent for services.

She can do education about what types of services that we are able to provide. [Case management] can decrease even a little bit of the stigma. If it just becomes part of what we do with schools, it’s not all that stigmatizing to have to go see the school nurse [or] go and meet with the school counselor, the school psychologist. If you interweave a school mental health program effectively in your school, then now all of a sudden hopefully we’re stamping out stigma that way…

Some of the barriers are just [that] it’s hard to roll out a universal screening program for a school and each school district approaches things a little bit differently and [making sure that] you’re having the time and the interest and the expertise to be able to roll that out is something we’re hoping to help with. We do have a school mental health taskforce that works with a lot of interested stakeholders across the state which has been great.

Other barriers or areas for improvement [are having access to] clinicians. There’s just never enough therapists, school counselors, school psychologists, school social workers, psychiatrists. All of those needed services are all underserved and so figuring out [workforce shortages] is a challenge everywhere. But I think especially in Utah. How do we interest people in going into mental health care as a career? And then how do we sort of also interest them in wanting to go and practice in the rural parts of Utah.”

SOR: How are recent reforms to address workforce shortages impacting behavioral health care? 

KK:The state of Utah has been really supportive with initiatives and funding for increasing training spots, especially for psychiatry and psychiatric nurse practitioners. The funding that we got from the Huntsman Foundation to create the HMHI has really spearheaded this idea of the university and the HMHI becoming this training hub for all sorts of mental health careers.

We are actively working with the College of Nursing to come up with additional training opportunities for the PMHNP students. We already have some cooperation with the PA school and the hope is that we give what some of our faculty provides, just the psychiatry didactic portion that everybody gets. If we get people excited about psychiatry with how we teach them or the training opportunities, we can increase people’s interest in doing that.”

This interview was edited for clarity and length.