The growing mental health crisis affecting our children and families has reached a breaking point. As a child and adolescent psychiatrist, I know well the current mental health crisis is dire and demands immediate attention. And I worry we are not moving fast enough to help those in need.
The number of kids and teens aged 3 to 17 diagnosed with depression or anxiety spiked by 30% from 2016 to 2020, and behavioral problems grew by 21%, according to a study published by the Journal of American Medicine. This was the concerning trend even before the COVID pandemic. In all, a quarter of kids and teens today have a mental, emotional, or behavioral disorder. And 80% go untreated.
It is of little surprise that our modern society is struggling to address mental health issues. We are still using a mental health care model developed decades ago. Imagine if we all still drove around in Henry Ford’s first Model Ts. This is the sad equivalent of what we are doing with our mental health care today.
It is past time for us to think differently about the problems plaguing mental health care for children and families.
Fixing the problem requires the use of technology. Telemedicine services – combining ultramodern technology platforms, health privacy-compliant software, and widening availability of high-speed internet – should be used widely. Youth in rural areas are twice as likely to experience depression and suicidal thoughts compared to those in urban areas, and yet two-thirds of rural and suburban counties do not have psychiatrists. Technology – specifically telemedicine – will help fill gaps by maximizing the efficiency of our system’s limited capacity. Not only does it help with access, but it affords the opportunity for more targeted and personalized interventions. Telehealth is not just equivalent to in-person care – it can be better.
Fixing the problem requires early intervention. We need to invest in prevention services to manage issues before they escalate to emergency care. Developing coaching programs for less severe mental and behavioral health issues can help give kids and teens tools, action plans, and skills to become resilient to challenges – rather than waiting for a full-on crisis that more deeply strains families and system resources. The best way to help families access these resources is through their primary care providers, who are on the front lines.
Fixing the problem requires care coordination and an appreciation for the ecosystem kids and teens rely on. We must develop more state and regional networks of pediatric mental health teams composed of child and adolescent psychiatrists, licensed mental health professionals, and care coordinators who connect dots. This allows overwhelmed pediatricians, teachers and counselors, and others involved in kids’ daily lives to work collaboratively with a central coordinator for a family. Therapy and psychiatry are helpful, but mental health interventions are less effective if a family is suffering from food insecurity or another unnoticed social determinant. Care coordination will help.
Fixing the problem requires acknowledgment that mental health care, like health care broadly, is plagued with disparities. Only 13% of diverse racial and ethnic backgrounds receive mental health services, compared to 31% of white children and youth. Additionally, 85% of children and youth in the child welfare system who need mental health services do not receive them. Acknowledgment of disparities, and thoughtful policies to address them, will help.
Fixing the problem requires putting mental health on equal footing as physical health. Today, a behavioral health visit for a child is ten times more likely to be out-of-network than a primary care office visit. Also, services for mental health may receive different government reimbursement depending on the care setting. Those needing the most help often get the least. Mental health should have the same rules as other conditions, and providers should be able to seek authorization for care considered medically necessary – regardless of the setting. Rethinking and updating coverage policies will help.
Fixing the problem requires us to reconsider our overly aggressive drug-prescribing habits. Over a 10-year period, young ADHD patients prescribed at least one medication nearly doubled, and those given multiple medications jumped by nearly a quarter. And the percentage of young patients on drug therapies for ADHD while also receiving medicines for other mental health conditions spiked from 26% to 41%. Much of this may be related to the lack of non-medication options, so a skills-oriented approach or more measured combination of skills and medications is crucial to address the mental health crisis.
May was Mental Health Awareness Month. It reminds us to take care of ourselves and each other – and to consider that our nation’s mental health crisis demands an innovative approach grounded in technology, early intervention, care coordination, resilience, and equality. Other foundational improvements, such as addressing the systemic short supply of mental health care providers, are important but will take upwards of a generation. With time of the essence for so many children and families in crisis, bending the existing system to work better for us immediately should be our priority.
Monika Roots is a psychiatrist and health care executive.
