Is our health care system prepared for a pediatric mental health crisis?

May 31st, 2019

The rapidly increasing rates of depression, suicide, and other behavioral health problems among young people in the U.S. signal a growing mental health crisis. From 2007 to 2016, the suicide rate among young people increased by 56 percent, according to the Centers for Disease Control and Prevention. Analyses of insurance claims also show rapid growth in the number of claims for major depressive disorder for patients age 22 and younger, from 15 percent of all depression claims in 2007 to 22 percent in 2017. Rates of anxiety and eating disorders have also increased among younger people over the past decade.

Is our health care system adequately prepared to treat more behavioral health problems in younger people? So far, the answer is no. Amid the growing need for mental health treatment, mental health care remains inaccessible for many people who need it, particularly low-income people.

Take Massachusetts, for example. Although Massachusetts has more mental health care providers per capita than any other state, only about half accept Medicaid or even private insurance, making it extremely difficult to find affordable care. According to a survey of Massachusetts residents by the Blue Cross Blue Shield of Massachusetts Foundation, more than half of respondents who sought mental health or addiction treatment had difficulty getting care, and 39 percent went without treatment.

“Mental health care has become, in large measure, a private-pay business that operates outside the insurance system,” wrote journalist Liz Kowalzyk in The Boston Globe.

Psychiatrists in particular are less likely to accept insurance, compared to physicians in other specialties, according to a 2014 study in JAMA Psychiatry. Only about 55 percent of psychiatrists accepted private insurance, compared to 89 percent of other doctors, and just 43 percent of psychiatrists accepted Medicaid, compared to 73 percent of other physicians.

However, even when mental health care providers accept insurance, insurers are finding ways not to cover needed services. According to an investigation in Bloomberg News, insurers are skirting around the Mental Health Parity law by “padding their directories” with clinicians who are no longer in network, requesting “piles of paperwork” before approving treatment, and giving smaller reimbursements to mental health clinicians than to other clinicians for the same services. Insurers have been able to get away with this in part because the law is ambiguous in setting parity rules, and because enforcement efforts by government agencies are meager and disjointed.

To put it simply, when it comes to mental health, “we have a lousy system of care,” said Dr. Wun Jung Kim, a child psychiatrist and professor at Rutgers University, in USA Today.