It is estimated that 20 percent of pediatric primary care visits are now due to mental health concerns. In my role as president of the Washington Chapter of the American Academy of Pediatrics, I travel to all corners of our state — and the story is the same: Pediatricians are struggling to find help for children and adolescents’ mental health needs. One in five children experience mental health disorders in a given year, yet 80 percent of those children do not receive the care they need. Instances of suicide attempts or suicidal ideation in youth doubled from 2008 to 2015. In 2014, mood disorders became the most common reason children were hospitalized, surpassing other childhood conditions, like diabetes or flare-ups of asthma.
Why so many youth are struggling with mental health issues is a difficult question to answer. I believe many factors are at play, including: increased use of electronic and social media, social isolation, increased performance pressure, a proliferation of divisive news (and associated feelings of powerlessness), greater financial burdens on parents, and the experience of living in poverty. Greater research is needed to understand what challenges are contributing to kids’ increased mental health needs.
Our state, unfortunately, is ill-equipped to handle this growing epidemic, and our kids are paying the price. Washington is 34th in the nation in kids’ access to mental health care. Untreated mental health disorders in childhood hinder a child’s social, emotional and academic growth. If we don’t identify and treat these problems early, they can worsen and ultimately require costlier, more complex care. In fact, a majority of adults who struggle with mental health needs first experienced such difficulties by age 14.
Why are so many kids unable to get help? For one thing, we have a workforce shortage. There simply are not enough mental health care providers to take care of all of the kids who need help. That is a problem that we can fix with long-term strategies — loan repayment programs for mental health professionals willing to dedicate themselves to serve kids on Medicaid for periods of time provide one example of how we might chip away at the problem — but it will take time to develop a sufficiently trained workforce.
More immediately, we need to help families overcome barriers to getting care and reach kids where they are, in schools and in primary care clinics, when they first need help, not when they are in crisis and have to turn to hospitals and emergency departments.
Some primary care clinics have taken a step in the right direction by pairing mental health counselors with doctors, an integrated approach that can help the whole child in one place with a trusted team. Unfortunately, primary care clinics are rarely able to afford integrated behavioral health. The reason why? Reimbursement for counseling on Apple Health for Kids — Washington’s Medicaid program — is abysmally low, amounting to about half of what Medicare pays for a counseling visit, and about half of our state’s children and adolescents are insured on Medicaid. (A 30-minute appointment on Apple Health for Kids pays $37.34; the same 30-minute appointment for an adult insured on Medicare pays $63.79.)
This low rate also makes it difficult for children who are on Apple Health for Kids to find a therapist in the community who will accept their insurance. Kids typically wait weeks or months to get an appointment, critical time when their condition may worsen and they may be struggling at home and school.
Our state’s Medicaid agency and legislative staff estimate that an additional $15 million in state funds, which would activate an additional $19 million from the federal government, would allow Washington to increase the counseling rates on Apple Health for Kids to Medicare rates. (That $15 million would represent about 0.03% of the total state budget.) We know that counseling access will not increase for kids without Medicare parity since current rates are so low.
Our children need our help. As Nelson Mandela once said, “The true character of society is revealed in how it treats its children.” Washington must adequately fund reimbursement for mental health care. For less than $1.50 per month for each child on Apple Health for Kids, we could make meaningful progress in youth access to mental health care now and their ability to learn and thrive for the rest of their lives. We urge our state legislators to address the crisis in kids’ mental health with a solution to increase access now and prevent more needless deterioration of kids’ health.
