The mental health crisis afflicting young Americans calls for health care reforms

The statistics are sad. Average wait times for initial assessment, ongoing therapy, and medication services are all longer for children than for adults. While an adult can typically wait 12.7 weeks for therapy, a child can be delayed by more than 15 weeks.

Meanwhile, suicidal ideation in young people has been steadily increasing 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 deteriorated for years, but the COVID-19 pandemic has significantly worsened the crisis. Millions of children have suffered from the social isolation caused by school closures and the loss of loved ones to illness, widening the gap between supply and demand for mental health services.

The most visually striking problem within mental health care for children and adolescents is the lack of hospital beds. On a Monday in March, there were 503 adults and 247 children awaiting bed in psychiatric facilities across Massachusetts. More beds in psychiatric facilities would mean vulnerable children won’t have to spend another retired night in an emergency room.

But rollaway beds won’t get to the root of the problem unless the number of people entering children’s and adolescent behavioral health – including but not limited to psychiatrists, nurses, counselors, social workers and psychologists – matches the ever-increasing number of children in need of care.

Even as hospitals struggle to recruit doctors and practitioners, others are leaving. For every 10 outpatient doctors who go into mental health clinics, 13 outpatient doctors leave. Serving children in clinics is key – meeting their mental health needs early can prevent them from having to endure boarding later.

The main reason suppliers leave are low wages and the benefits of increased workload. Adolescent mental health care involves entire systems of care, starting with the child and extending to his school, family, teacher, therapist and community.

“Because our culture doesn’t value mental health care and reimbursements are set up in a way that reflects our culture, we’re looking at people running out of steam,” said Dr. Patricia Ibeziako of Boston Children’s. Hospital. Insurers’ inability to properly evaluate outpatient mental health services prompts doctors to leave the field or work privately, making them less accessible.

Another concern of Boston psychiatrists is that insurance companies, which have the ultimate power to authorize different models of child care, are not very well versed in children’s mental health needs.

As cumbersome as the authorization for a routine medical procedure is, it is much more complicated to demonstrate 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 due to the stigma against mental illness. Now that politicians are catching up, they would also do well to consider that children of color and LGBTQ youth suffer at even higher rates and that the number of black mental health service providers is also not growing fast enough.

There has been progress on Beacon Hill, but that may not be enough and they certainly aren’t fast enough.

The legislature invested money from the federal COVID stimulus program into mental health, and last year the Massachusetts Senate passed its Mental Health ABC Act 2.0. The act places more teeth on the requirement that mental health and primary care providers be reimbursed at the same rates for the same service; eliminates prior authorization requirements for acute treatment; and requires insurance coverage for mental health care to be the same as insurance coverage for other medical conditions. The House of Representatives should urgently adopt this legislation.

Then there’s the Thrive Act, school behavioral health legislation that requires public schools to require all students to have age-appropriate physical and mental health education. This too is awaiting approval in the Chamber.

Finally, there’s Governor Charlie Baker’s push to improve access to health care: This bill requires providers and insurers to increase spending on primary care and behavioral health by 30 percent over the next three years.

All proposals have some overlapping policies. But any legislation that emerges from the various plans launched on Beacon Hill would be an improvement on a health 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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