Why Aren’t We Doing More to Help Children?

The kids aren’t alright.

People with mental health challenges face an overwhelmed and under-resourced health care system. Those issues are worse for young people in need of care.

A recent report issued by the Centers for Disease Control and Prevention (CDC) found 44% of high school students said they experienced “persistent feelings of sadness or hopelessness” during the pandemic, with girls and LGBTQ+ youth reporting the highest levels of poor mental health and suicide attempts.

A study published in Pediatrics Nov. 14, “Trends in Suicidal Ideation-related Emergency Department Visits for Youth in Illinois: 2016-2021,” found that emergency department visits in Illinois for children experiencing suicidal ideation spiked in 2019 and another surge followed during the pandemic.

“Rapidly rising hospital use may reflect worsening mental illness and continued difficulty in accessing low-cost, high-quality outpatient mental health services,” the researchers concluded.

A crippling workforce shortage, abysmal reimbursement rates, absence of integrated care and poorly coordinated care all make it harder to address our youth mental health crisis in a meaningful way.

In late October, The Washington Post reported, “In the state of Maryland, there are roughly 1,040 licensed psychiatric beds for adults in general and private hospitals and another 240 for children and teens. The majority are almost always full. As a result, patients rushed to the emergency room often spend days or even weeks waiting for beds to open up in psychiatric hospitals and wards. The younger the patients are, and the more severe their cases, the fewer beds there are, and the longer they often wait.”

Improving access to care will require much more than increasing the number of beds available for young people, said Jeff Richardson, chief operating officer at Sheppard Pratt, a world-class private facility based in Towson, Md., and a National Council for Mental Wellbeing member.

Providing care for young people must begin much sooner, he said, with better preventative services and improvements in crisis care to prevent hospitalizations. Because more young people are being diagnosed with autism, for instance, the need for greater access to specialized treatments will grow.

“We need better systems of care and more coordinated care so young people have access to the resources they need, whether that’s in the pediatrician’s office or in school,” Richardson said.

Dr. Joe Parks, medical director at the National Council and co-chair of our Medical Director Institute, also said meaningful care for young people must begin sooner and that passage of the Bipartisan Safer Communities Act provides valuable resources to offer that care in schools and elsewhere.

“Kids don’t suddenly have suicidal ideation overnight,” Dr. Parks said. “Rather, it’s the result of problems that build over time, so we need to focus on those problems upstream, long before a young person reaches a moment of crisis.”

In addition to the Bipartisan Safer Communities Act, more federal efforts are in the works to fill some of the remaining gaps. In the House, lawmakers advanced a package that reauthorizes resources for mental health care and introduces mental health reforms, according to a Nov. 21 story in the National Journal. It would remove a waiver requirement physicians must meet to prescribe buprenorphine and provide grants to states to help ensure mental health parity is enforced.

The Senate Finance Committee has drafted language to address telehealth services, youth mental health and workforce development. It also has what it calls “draft legislation” to standardize Medicare payments for mobile crisis-response teams, create a bundled payment in Medicare for crisis services and support state initiatives to enhance crisis services under Medicaid. That’s significant because about half of all children in the United States have Medicaid insurance, which pays only 60 percent of Medicare rates on average, a group of physicians wrote in the Boston Globe recently.

“Access to care for young people with a mental health challenge was bad before the pandemic,” Richardson said. “It only got worse during the pandemic, and we need to make changes so the system can help communities address the mental health crisis.”

Passage of the Bipartisan Safer Communities Act was a big, bold start, but more work remains to improve access and ensure that the kids can be alright again.

What barriers do you think are the most problematic? Tell us what they are and what you would do to help people overcome them and get the care they need.