Comment: Kids face daunting gap for behavioral health services

The U.S. needs five times as many child psychiatrists and schools need more counselors.

By Lisa Jarvis / Bloomberg Opinion

Between falling test scores and rising rates of mental illness, U.S. kids are not alright. Covid is an easy villain, but signs of strain were showing up well before this virus took hold: Anxiety among children was up 27 percent and depression 24 percent between 2016 and 2019, according to data from the National Survey of Children’s Health. Global, national and city-level studies show the pandemic exacerbated an already worrisome trend.

The U.S. Preventative Services Task Force — affiliated with the U.S. Surgeon General’s office — recently took a needed first step in addressing the issue by recommending that all children 8 and older be screened for anxiety. That’s a crucial advance, but to truly help kids, sufficient resources and support need to live on the other side of any diagnoses.

Some level of anxiety is good for us; it’s the reason we study for that big exam, or flee a situation that feels unsafe. But some kids reach a point where their anxiety starts to be in charge, says Jacqueline Sperling, program director of the McLean Anxiety Mastery Program at McLean Hospital, which is affiliated with Harvard Medical School.

That can manifest in different ways, from phobias to physical symptoms or behavioral outbursts. Parents might assume their child will grow out of it. But anxiety shouldn’t be brushed off as a phase. It can interrupt kids’ social, familial and academic lives, and untreated anxiety can lead to other diagnoses, like depression, eating disorders and substance abuse.

In an ideal world, any child that is struggling with anxiety would be referred for treatment. The catch, of course, is that even as the rates of mental illness have gone up, the number of mental health clinicians has not. In 2019, the American Academy of Child and Adolescent Psychiatry found that the country needs 47 child psychiatrists for every 100,000 kids, yet only has 9.75 per 100,000.

That’s a big reason that parents who try to find support for their child often encounter a long waiting list. The pandemic only drove up demand; in a survey conducted last year by Ann & Robert H. Lurie Children’s Hospital of Chicago, 18 percent of parents said they couldn’t find a mental or behavioral health care provider for their child. Some didn’t know how to find the right person, while others said the wait was too long or the provider was too expensive.

Pediatricians’ offices, a natural site for connecting families to help, are also struggling. Between 2017 and 2018, researchers surveyed more than 1,400 practices that care for children to gauge how many could recommend or provide evidence-backed care — meaning treatments known to help — to children with behavioral health disorders. Nearly all of them, whether treating kids in a large, urban health care network or a rural individual practice, reported some level of challenge.

Meanwhile, schools, a critical venue for struggling kids, also face a dire shortfall in resources. An analysis of federal data by Education Week found that nearly 40 percent of school districts lacked a school psychologist in the first year of the pandemic. Some 44 percent of schools surveyed by EdWeek said their students did not have adequate access to school-based mental health professionals.

A few changes could make the available resources, however thinly stretched, more accessible to more families.

One obvious measure would be to improve insurance coverage for children’s mental health services. A recent report by RAND assessing mental health services in New York City found that a significant barrier to accessing mental health care was the lack of providers who accept Medicaid or even private insurance.

Another fix would be to make telehealth a permanent fixture in behavioral health services. The pandemic opened the door to virtual visits, but their future needs solidifying; along with making them more widely available and reimbursable. The telehealth option is especially important for teenagers who, having grown up in a digital world, might be more comfortable with that medium.

Telehealth can also make it easier for parents to connect with their children’s providers. “Their involvement in the care of the kid is so critical to having a successful outcome,” says Warren Ng, president of the American Academy of Child and Adolescent Psychiatry. “When we’re not working collaboratively with parents and kids, we’re missing half the solution.” And on a practical level, virtual visits mean that parents don’t have to miss work to drive a child to an in-person appointment.

Hopefully larger, structural change is coming, too. The field of child and adolescent psychiatry is exploring the most effective ways to recruit more people. And President Joe Biden’s administration last spring made a landmark commitment to improving mental health care in the country, a move that included funds intended to double the number of school-based mental health professionals.

All of these efforts will make a dent. But the most critical component will be to ensure that commitment to mental health doesn’t waver once the memory of the pandemic recedes.

After all, many past efforts to implement evidence-backed behavioral health programs at schools have not had long-term support, says Colleen Cicchetti, Executive Director of the Center for Childhood Resilience, which is housed at the Lurie Children’s Hospital of Chicago. Many programs have been funded by piecemeal grants; when the money runs out, kids and educators lose resources they had come to rely on. Principals have been clear with Cicchetti that “unless you’re creating something sustainable … please don’t even bother coming.”

Parents, doctors, schools, all can play a role in helping stem the child mental-health crisis. Identifying the kids that need help is an important step. Now comes the much harder work of building a sustainable infrastructure that will ensure today’s anxiety for kids doesn’t grow into deeper, lifelong struggles for adults.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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