The mental health crisis affecting American youth requires health care reforms

The statistics are grim. The average waiting time for initial assessment, ongoing therapy and medical services is longer for children than for adults. While an adult can usually wait 12.7 weeks for therapy, a child may be delayed by more than 15 weeks.

Meanwhile, ideas of suicide among young people have been growing steadily since 2009; suicide is the second leading cause of death in children between the ages of 10 and 14. The mental health of young Americans has been deteriorating for years, but the COVID-19 pandemic has exacerbated the crisis. Millions of children have suffered from social exclusion caused by school closures and the loss of loved ones due to the disease, which worsens the gap between the demand and supply of mental health services.

The most difficult visual problem in the care of the mental health of children and adolescents is the lack of stationary beds. One Monday in March, there were 503 adults and 247 children waiting for beds in psychiatric facilities in Massachusetts. More beds in psychiatric facilities would mean that vulnerable children would not have to spend another night in the emergency department.

But extra beds will not be at the root of the problem unless the number of people entering the behavioral health of children and adolescents – including but not limited to psychiatrists, nurses, counselors, social workers and psychologists – is commensurate with the ever-increasing number of children in need of care.

Although hospitals are struggling to hire doctors and practitioners, more and more are leaving. For every 10 outpatient clinicians admitted to mental health clinics, 13 outpatients leave. Caring for children in outpatient clinics is crucial: meeting their mental health needs early can prevent them from having to stay on board later.

The main reasons for leaving suppliers are low wages and benefits for increased workload. Adolescent mental health care includes whole care systems, starting with the child and extending to their school, family, teacher, therapist and community.

“Because our culture doesn’t value mental health care and cost recovery is set up in a way that reflects our culture, we look at people who burn and leave,” said Dr. Patricia Ibeziaco of Boston Children’s Hospital. The failure of insurers to adequately assess outpatient mental health services forces clinicians to either leave the field or work privately, making them less accessible.

Another concern for psychiatrists in Boston is that insurance companies that have the ultimate power to allow different models of child care are not well aware of children’s mental health needs.

As cumbersome as the authorization of a routine medical procedure may be, it is much more difficult to prove the importance of different behavioral care methods such as intensive outpatient therapy, virtual group therapy or dialectical behavioral therapists for insurance companies.

Mental health, especially in children, has been ignored for centuries as the stigma against mental illness has grown. Now that politicians are catching up, they would also do well to keep in mind that colored children and LGBTQ people are suffering at an even higher rate and that the number of colored mental health providers is also not growing fast enough.

There is progress on Beacon Hill, but it may not be enough and it is certainly not fast enough.

The legislature has invested some money in the federal program to promote COVID’s mental health, and last year the Massachusetts Senate passed its ABC 2.0 Mental Health Act. The law puts more teeth in the requirement for mental health and primary care providers to be reimbursed at the same rates for the same service; removes the requirements for prior authorization for acute treatment; and obliges mental health insurance coverage to be equal to insurance coverage for other medical conditions. The House of Representatives urgently needs to address this legislation.

Then there is the Thrive Act, school-based behavioral health legislation that requires public schools to require age-appropriate physical and mental health education for all students. This is also yet to be approved by the Chamber.

Finally, there is pressure from Gov. Charlie Baker to improve access to health care – the bill requires providers and insurers to increase primary care and behavioral health spending by 30 percent over the next three years.

All proposals have some overlapping policies. But any legislation stemming from the various plans presented to Beacon Hill would be an improvement over a health care system that has left too many children in crisis.


The editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.

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