Access to Children’s Mental Health Care

Access to children’s mental health care is one of the most important things that we can offer to children and their families, and yet the majority of children around the United States do not have access to the care that they need. This can have devastating consequences, including dropping out of school, unemployment, entering the juvenile or criminal justice system, developing further mental illness such as PTSD and depression, childhood obesity, substance abuse. and even suicide. Loss of life due to suicide is the second leading cause of death for individuals ages 10 to 24.

What’s preventing proper access?

Studies show that a significant percentage of parents reported a barrier to mental health services for their children. The types of barriers included those related to structural constraints, perceptions of mental health, perceptions of services, and parenting difficulties.

There are four main categories that influence whether children and adolescents get the mental healthcare that they need. These are individual, social, relationship, and systemic/structural factors.

Individual factors

• Lack of knowledge of when and where to seek help for mental illness
• A preference to cope with problems alone
• A lack of commitment to the process due to emotional and motivational factors, including failure or reluctance to attend appointments and failure to commit to treatment
• Perceived autonomy, or whether it was their own choice to seek help versus the choice of a parent or adult
• Preference for informal support from family and friends rather than formal support
• Ability to talk about difficulties
• Negative past experiences with seeking help

Social factors

• Negative stigma in the community and from friends and family
• Fear of public embarrassment due to the negative stigma

Relationship with MHP

• Perceived confidentiality
• Perceived traits of professional (respectful, non-judgmental attitude, etc.)
• Ability to trust a stranger
• The similarity between child/adolescent and professional – (gender, ethnicity or race, religion)

Systemic/Structural factors

• High costs and poverty restrict access to mental health care
• Poor accessibility of professional help (difficulty making an appointment, staffs’ attitudes towards child/adolescent)
• Lack of technology – desire to communicate distress and attend treatment via digital/virtual tools instead of in-person services
• Limited availability of mental health help
• Excessive waiting times for mental health help
• Lack of time, interference with other activities, and transportation difficulties
• Lack of affordable health care coverage

How to improve access to children’s mental health care

The Centers for Disease Control and Prevention (CDC) offers three ways to improve access to children’s mental health care. They are:

1. Support innovative solutions that improve access to mental health care:
   • Partnerships between primary medical care practices and mental health care specialists can make mental health services more accessible for some families
   • Early identification, accurate diagnosis, and effective treatment of mental health.
   • Early identification can be provided by parents, teachers, primary care providers, mental health professionals, school staff, and school administrators. 

2. Understand gaps in the workforce:
   • Scientists from the CDC found that less than half of emergency departments had any policies in place to care for children with mental health and social concerns
   • There are not enough pediatricians, family medicine physicians, psychiatrists, psychologists, and licensed social workers per state, as can be seen on this nationwide map.

3. Create solutions for rural areas:
   • Creating School-Based Health Centers (SBHC) and offering more telemedicine services can help increase accessibility for children in rural areas

The current Biden-Harris administration is also offering ways to improve access to children’s mental health care.

1. Increased coverage for children − Medicaid and the Children’s Health Insurance Program (CHIP) serve as sources of coverage for children, covering around 39 million children nationwide.

2. Improving the quality of care − Supporting state reporting to ensure that children and adolescents are receiving the quality of care that they deserve. All measures on the Medicaid and CHIP Child Core Set will become mandatory for states to report starting in 2024.

3. Investing in Community-based Youth Mental Health and Substance Use Care − The Department of Health and Human Services (HHS) has invested approximately $190 million in supporting initiatives to advance access to behavioral health services for youth.

4. Increasing School-Based Behavioral Health Supports − The American Rescue Plan contributed $30 million for Project AWARE, a grant program for state and tribal education agencies to improve the mental health of children in school. Project AWARE funds school-based activities to increase awareness of mental health issues among children and provides training for school staff to identify and respond to mental health issues, and connects youth to mental health services.

5. Laying the Groundwork for Future Improvements in Youth Mental Health and Substance Use Prevention and Treatment − President Biden’s budget calls for increased funding to address mental health and substance use. The administration claims that these additional resources would be used to support youth with mental health needs, support the children’s caregivers and families, partner mental health providers with law enforcement, expand suicide awareness and prevention measures, and support increased hiring of school-based health professionals.

Overall

Accessibility to mental health care is nowhere near where it needs to be. We need to improve accessibility to these services to prevent the children of today from becoming the discouraged and disheartened adults of tomorrow.