Fund Children’s Mental Health, Our Future Depends on It
Madeline Wozniak MD, Julianne Edwards MD
I asked my 13-year-old patient in the emergency department if she ever had thoughts of hurting herself.
“Yeah, lots,” Ada responded. “Every room I go into, there are new possibilities of different ways to kill myself. In this room I have already thought of three different ways.”
This is a common story that pediatricians hear. One in 10 Washington tenth graders reports making a suicide attempt. Nearly four children die from suicide each week in Washington state. But this patient is not a faceless statistic.
This is a child’s life. This is a family permanently changed.
The COVID-19 pandemic has very real physical impacts. Unfortunately, it has also had very real emotional consequences for Washington’s youth. Almost every aspect of children’s lives has been disrupted by COVID-19. Kids worry about family members who are at increased risk of contracting the deadly virus or the new financial burdens their families face due to employment. Teens who are missing important educational opportunities and social milestones wonder about their futures.
These emotional consequences have created a second pandemic for Washington’s youth. Our emergency departments (ED) are full of kids in serious trouble. Nationwide, the proportion of ED visits for teenagers with suicidal ideation have increased by nearly 44% compared to 2019. In September 2020, over half of teenagers reported thoughts of suicide or self-harm more than half of the time or nearly every day of the previous two weeks. Consequently, suicide attempts among children have increased in 2020 compared to 2019.
We had a problem addressing kids’ mental health issues even before COVID-19 hit. Prior to the pandemic, Washington ranked 43rd in the nation in youth access to mental health care. Youth and their families are trying but losing in a broken system. Wait times to see a mental health provider often exceed one month. In King County, fewer than half of the mental health providers accept Medicaid coverage even though over half of Washington’s youth have Apple Health, our state’s Medicaid program.
Why? Apple Health currently reimburses at $67 per hour, less than half of the $150/hour Medicare pay rate for counseling, making it difficult for mental health providers to provide services to Washington’s youth. In 2016 only 8% of children covered by Apple Health received mental health service of any kind, despite nearly 20% of children being diagnosed with a behavioral health disorder.
Without access to mental health care through insurance, many youth rely on schools for their mental health care. School closures have left these students without the services they need. In 2014, 13.2% of adolescents nationwide received mental health services from a school setting. Among all adolescents who used any mental health services between 2012 and 2015, 57% received some services through school. Furthermore, the teenagers most likely to receive services exclusively from school settings were those in racial and ethnic minority groups, with lower family income, or with public health insurance.
Structural inequities in the scaffolding of the U.S. healthcare system worsen mental health outcomes and access for youths of color. Nearly half of all children on Medicaid are people of color. The suicide rate for kids under the age of 13 is approximately two times higher for black youths than for whites.
Without access to preventive care, children enter the health system in crisis. We meet kids like Ada when they come to the ED actively suicidal, or in our hospitals after they have attempted suicide and require intensive medical monitoring. We cannot help but wonder how these children’s lives would have been different if they had access to preventive services. It is a reality that our current system is killing children.
Importantly, with smart policymaking, our state can address the ongoing mental health epidemic among Washington’s youth that the pandemic is aggravating. This is a very real opportunity to save children’s lives.
Disaster-response psychology postulates that rates of depression will only increase in the coming months. With the increasing COVID-19 prevalence throughout the state, now is the time to act.
Bring Apple Health for Kid’s counseling rates in line with Medicare’s. Allow mental health providers to give comprehensive, compassionate care to Washington’s youth in a timely manner. Equip primary care providers to support children and families before they are in crisis. Empower children to live healthy lives and decrease use of expensive emergency care.
Prevent youth suicides. Fund pediatric mental health.
Affiliation: Drs. Wozniak and Edwards are resident physicians at the University of Washington School of Medicine and members of the Washington Chapter of the American Academy of Pediatrics. The views and opinions expressed are their own. Twitter: @maddywoz @julieedwardsmd1
