As a pediatrician making the rounds in the intensive care unit, I rely on the numbers to tell the story of my patient’s condition. A girl is here, and her blood pressure numbers are low. Her medication dosage: high. Spontaneous movements? Zero. How many pills did she take? 90. How many weeks since her last psychiatric hospitalization? Two. How old is she? 12.
These numbers don’t just tell one patient’s story, they illustrate a broader emergency. Today in Washington state, our children face a mental-health crisis. Rates of depression, anxiety and other mental-health conditions have skyrocketed. Over the last 20 years, rates of adolescent suicide have increased by 50%, making suicide the second leading cause of death in teenagers. In children under age 14, the rates of suicide have nearly tripled. My young patient in the ICU could be one of those numbers.
Picture a classroom of 25 bright, vibrant 9th graders. Five of them will have a mental-health diagnosis such as depression, anxiety or PTSD. These diagnoses can be treated with effective, evidence-based therapies including counseling and medication. Like all diseases, they are easier to treat when caught early. Yet four of those five children will not receive adequate treatment. Two of them will receive no treatment at all.
Across the state, it has become routine and frequent for pediatricians to care for suicidal children. Every day, pediatricians feel helpless as children wait for hours in emergency rooms for more appropriate care to keep them safe and help them recover. I see the numbers on my ICU patient’s ventilator, after desperation led her to actions that cannot be taken back. And I see numbers on depression-screening surveys, ranking severity one through three, for children who seek help from me in the clinic when things are just starting to get bad. But in our state, a different set of numbers may be the most important of all: insurance reimbursement numbers.
Increasingly, it is standard of care for pediatricians and family physicians to screen all adolescents for depression to catch problems early. The trouble is, we can catch problems early but can’t get kids help quickly, especially kids on Apple Health, our state’s Medicaid program, which insures half of Washington children.
Apple Health for Kids reimburses mental-health providers less than half of what Medicare pays for the same service for aging adults, and just a third of typical private-insurance payments. Apple Health does not cover the cost to provide care, limiting the number of providers who see Medicaid patients, which blocks access to treatment for the neediest children.
Washington state has recently taken meaningful steps to improve mental-health care for adults, but our care for children lags far behind. In fact, Washington ranks 43rd in the nation in terms of access to mental-health treatment for kids.
After my patients receive a diagnosis and treatment recommendations, they wait several months to see a therapist and even longer if they need to see a psychiatrist. Many parents are stymied by the barriers of multiple phone calls, long wait times, insurance approvals and far away mental-health clinics. Pediatricians become the primary prescribers of psychiatric medication, a role we don’t receive much training in. Many children go untreated or undertreated, and their disease continues to worsen. Too many end up in the emergency room or ICU.
Washington needs to change the numbers for our children. We know from past mental-health parity laws that increased reimbursement rates lead to more children and adolescents accessing treatment.
I urge lawmakers to treat this situation like the crisis it is: improve access now by increasing reimbursement rates for Medicaid to equal Medicare rates for mental-health treatment. This will expand the number of providers who accept Medicaid and allow those providers who already see some Medicaid patients to see more.
Half of all adults with mental-health issues experience their first symptoms by age 14; 75% have symptoms by age 24. But today’s struggling children do not have to become tomorrow’s struggling adults. Early intervention with accessible, evidence-based treatment can change these numbers for our children. Mental-health treatment is necessary. It is lifesaving. And our children deserve it.