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Boston's new mental health czar lays out his goals – The Boston Globe

In June, Dr. Kevin Simon became Boston’s chief behavioral health officer — a role new to the city and possibly unique to Boston. Mayor Michelle Wu and Dr. Bisola Ojikutu, executive director of the Boston Public Health Commission, appointed Simon, a child psychiatrist with Boston Children’s Hospital, to develop a city-wide strategy to address behavioral health issues, especially among youth.
The Globe’s Felice J. Freyer recently caught up with Simon to find out more about his background and goals. This is an edited version of their conversation.
Felice Freyer: Tell me about your background. What drew you into psychiatry?
Kevin Simon: I’m originally from Brooklyn, N.Y. My parents are Haitian. My dad, Deacon Mauclair Simon, was the first Black deacon of the Roman Catholic Archdiocese of New York.
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Very early on, I would see my dad counseling people experiencing a wide range of challenges, be it immigration, be it spiritual in nature, mental health in nature. And he has a certain disposition that just is calm. Outside of being a deacon, he was a public school teacher for 25 years in New York, then after that he became a social worker.
While I was in medical school, the rotations and courses that most intrigued me — because they require you to think most holistically about people — were psychology and sociology. Then clinically it was psychiatry, because you can make a significant impact for people and a significant impact for families.
And so I came to learn, the vast majority of psychiatric illnesses — schizophrenia, depression, bipolar, substance use disorders ― actually begin in early or middle adolescence. If you want to be as preventive as possible, you’ve got to start seeing kids. And then when you see kids, you find there’s a strong comorbidity of mental health, substance use, and juvenile justice involvement.
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So I did a child psychiatry fellowship at Boston Children’s Hospital.
The work that my dad was doing in terms of helping people in their lowest state, I find that that’s what I do as a child psychiatrist and addiction specialist.
The people who are most vulnerable in society — that’s where I wanted to be.
Q: Why are kids having such a hard time today?
A: There’s evidence that the rise in anxiety, rise in depression, rise in emergency room visits, were increasing pre-2020.
Now the pandemic happened. There was a two-year period where children were isolated, told not to come in person. If you increase isolation, that is going to increase anxiety, that’s going to increase things like depression.
Then if we think about a youth that had neurodevelopmental conditions, who at one time had maybe 10 hours of organized structured behavioral engagement — you took that away. And not away for like a day, but away for months at a time.
If we think about other subsets of youths — Latino, Black youth, minority youths — who’s getting hit worse from COVID? In June of 2021 nationally there have been more than 140,000 youths who had lost a caregiver to COVID. Now you compound that with — we actually don’t know when this is going to end.
All that just exacerbated the problems that predated the pandemic.
Q: What are the biggest issues that you’re going to try to address?
A: One is access. Access to providers — therapists, counselors, psychiatrists, child psychiatrists.
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I hear from the provider side, “Hey, it’s difficult to retain providers.” I hear from the parent and patient side, “I can’t get my son into a clinic.” “I can’t get my daughter help — it is a more than eight-month waitlist.”
Access is a problem. Simultaneously, stigma is a problem. There are subsets of populations that will not engage with a mental health clinician. I can speak from my ethnic culture of being a Haitian American. There’s hesitancy about: “Who is a mental health provider? Why would I want to talk with one of them?”
So part of my role is also being a communicator about how therapy is healthy and normal. And showing that yes, somebody who looks like you, thinks like you, has been doing this kind of work.
Also, workforce development. We in essence have two systems — the shadow out-of-pocket system [providers who don’t accept insurance] and the MassHealth, Medicaid system. Unfortunately, a fair number of behavioral health providers exist in the shadow system, because the remuneration for services is not there.
Q: How can the city help with access to mental health care?
A: There is already a model where a clinician or a child psychiatrist serves as a consultant to primary care providers — the Massachusetts Child Psychiatry Access Program or McPAP.
Potentially, the McPAP model could be piloted within community health centers and schools. That’s one way access can be widened.
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The city can also advocate for different reimbursement fees, and to make the billing process a little bit simpler so that providers could see more patients.
Additionally, in trying to address mental and behavioral health concerns, the mayor and Dr. Ojikutu had thought about the development of a center for behavioral health and wellness, where we could have people under one roof all together trying to better address the challenges that we see.
There is an Office of Recovery Services that focuses on substance use. There is Homeless Services; a large subset of people that are homeless have mental illness. There’s the Children and Family Bureau. How do you take a step back to say, “Oh, wait a minute, there’s actually connections here and we could work together”?
There’s a subset of youth that have experienced increasing homelessness over the pandemic period. Those youth go to school, right? You start to see that we’re actually all connected — housing, food insecurity, economic security, education, the lived environment. We have to be thinking holistically.
Q: What do you think will be different in Boston as a result of you being in this role?
A: I hope we can think about prevention, to create safe spaces for youth to gather, like East Boston’s Zumix — where youth 8 to 18 learn how to host a podcast, play musical instruments, and feel comfortable making mistakes. It doesn’t identify as a place for therapy, but I would call it a very therapeutic place. There are not enough of those places around. We could promote that kind of environment.
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The challenges related to mental and behavioral health are clearly more than just one person, one mayor, mayoral office, or the Boston Public Health Commission, can solve. It really is all hands on deck.
We’re all connected to somebody that has a behavioral health challenge. There’s no way to say it’s not important to you.
Resources:
If you or a family member is experiencing a mental health or substance use disorder crisis, the Massachusetts Emergency Services Program/Mobile Crisis Intervention is available 24 hours a day, seven days a week, 365 days a year. Call toll-free at 1 (877) 382-1609.
Massachusetts also now has a direct three-digit phone line to trained National Suicide Prevention Lifeline call takers. If you or a loved one is in emotional distress or having suicidal thoughts, dial 988 anytime from anywhere.
The Boston Public Health Commission offers a list of residential and outpatient services here, including services delivered in multiple languages.
More resources are available at the website of the Massachusetts Department of Mental Health. https://www.mass.gov/guides/finding-mental-health-support-in-massachusetts
Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.
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