One of the most disturbing outcomes of the COVID-19 pandemic has been an exacerbation of mental health problems among children and adolescents. This has been called a global youth mental health crisis. Numerous studies have documented that since the beginning of the pandemic, rates of anxiety and depression have soared among children and adolescents. This situation has been attributed to the loss of social support and peer interactions that resulted from school closures and isolation practices during the pandemic. Some have also claimed that the increasing use of social media by young people is responsible, although this is controversial and not all studies agree.
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Studies do show that more children are seeking mental healthcare than ever before, but finding care is difficult. Many families resort to taking their children to emergency departments when mental health crises arise because individual providers are hard to find. As three researchers from the Children’s Hospital of Philadelphia put it back in 2021, “What is true worldwide is that needed mental health services are largely unavailable and children are waiting for care.” Back then, the U.S. Surgeon General, Vivek H. Murthy, issued an advisory on youth mental health that included a call for action to “Ensure that every child has access to high-quality, affordable, and culturally competent mental health care.”
Health Insurers Impede Solutions to the Youth Mental Health Crisis
Although there are some signs that the situation improved as the pandemic’s worst restrictions eased and schools opened, studies continue to show alarming rates of serious mental illness among children and adolescents. Although there have been many efforts by federal, state, and local governments to deal with the youth mental health crisis, some say that the problem is so large it would overwhelm even a well-funded mental healthcare system. But one thing we know is not helping—the propensity of health insurance companies to continue to make it difficult for people with mental health problems to access care. There is a profound shortage of child and adolescent mental health practitioners, to begin with, but health insurance companies exacerbate this problem by maintaining what are called “narrow networks” of providers and mandating lengthy and difficult prior authorization procedures before agreeing to cover mental healthcare. Sometimes, patients and their families make call after call to providers their insurer lists as part of their network, only to find that most of them are either not accepting new patients or not actually part of the network at all. Insurers are slow to remove clinicians who are not actually on the network from the lists, frustrating patients in their search for a mental healthcare provider who can help them.
Mental Health Parity Remains Elusive
Although the 2008 federal Mental Health Parity and Addiction Equity Act supposedly mandated that health insurers make mental health care as accessible as other medical services, the law is often flouted. In September, President Biden announced a new rule aimed at strengthening the mental health parity law. According to the administration, “nearly 70 percent of children [with mental illness] cannot receive treatment.” A report by Reuters noted that the rule would help close gaps in mental healthcare by requiring health insurers “to evaluate which mental health providers’ services are covered by their plans, how much those providers are paid, as well as on how often they require or deny prior authorizations for coverage.” Already, however, industry groups have challenged the new rule, insisting it is not necessary and too expensive and that legal challenges are likely.
Those legal challenges can only mean that for many young people suffering from serious mental health issues accessing high-quality, evidence-based care will remain nearly impossible. Some people will be able to pay out-of-pocket to see mental health clinicians, but for many others, this cost is too high and they and their families will be forced to deal with the problems on their own. This is a tragic situation. In the U.S. the suicide rate among preteens has steadily increased from 2001 to 2022 according to a recent study. It is now the fifth leading cause of death among preteenage boys and girls. Even when the consequences of psychiatric illness are not so dire that they result in death, studies show that mental health challenges among young people lead to lower grades and chronic school absenteeism.
There are no easy solutions to the youth mental health crisis. Its causes are multiple. Still, health insurers must be held accountable for their part in making the situation much worse by evading all attempts to induce them to cover mental healthcare in ways that make it accessible. Narrow networks—actually “ghost networks” in many cases—are a serious abuse of insurers’ responsibilities to their clients. We hope that the legal challenges aimed at President Biden’s most recent attempt to achieve true mental health parity fail and that, ultimately, people who need mental healthcare will have a much clearer path to getting it.
