Children's mental health and the pandemic

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03/23/2022 10:06

Subject: Children's mental health and the pandemic

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Anonymous

A feature in the Washington Post magazine delves into the question of children's mental health in the pandemic. I think it's really interesting and cuts through the "the pandemic destroyed every child's mental health" vs "the kids are all fine! If your kids have problems it's because you're a bad parent!" binary. Our family's own experience is that our daughter definitely has a genetic predisposition to anxiety, but the isolation most certainly made it worse, and pandemic restrictions make it very difficult to treat when the treatment involves exposure to social situations. The reality is our mental health system is terrible, was terrible during the pandemic and now the system is even more stressed and children with mental illness are struggling more. While I'm so glad my child doesn't have to wear a mask anymore, ending mask mandates will not solve this problem and it hasn't cured my child's illness. I think stopping school closures was so much more important. But more than that, we need investment in mental health care in a way we have never done before, not during the pandemic or before the pandemic. I really like the idea of giving better training to PCPs, school counselors, teachers and also training parents, that's such an important piece.

Contracting with big and profitable companies like Cigna, Aetna and Blue Cross Blue Shield shouldn’t amount to charity work. Yet economic realities make it so. Nationwide, insurance payment rates for primary care physicians (who consistently rank among the lowest paid doctors) are almost 24 percent higher than for mental health practitioners — including psychiatrists. In 11 states, that gap widened to more than 50 percent, a report from the Bowman Family Foundation noted in 2019.

That discrepancy points not only to the historical devaluing of psychiatry as a discipline, it also sheds light on a major problem with the relative status of different kinds of interventions. In the health-care world, where values are defined by insurance company reimbursement rates, talk — the essential component of thoughtful medication management, therapy or counseling, and, for that matter, any successful form of healing — has long been compensated at rates that trail far behind those that insurers pay for medical procedures. “Our system is set up so that I get paid more to see a child and do an asthma breathing test than I do to spend an hour with the family of a child who might be thinking about hurting themselves,” noted Chung of the American Academy of Pediatrics.

That dollars-and-cents reality plays an enormous role not only in who gets care, but in who can afford to provide it, and how. Mental health parity laws adopted over the past 26 years were supposed to directly address this issue. But the insurance industry has been almost diabolically adept at skirting those laws; as one of the largest contributors to PACs, political parties and candidates, they’re not likely to face real pressure to change anytime soon. Another seemingly obvious big fix for the supply-chain issues plaguing children’s mental health care — tuition reimbursement incentive programs for medical students who choose to specialize in child psychiatry and are willing to commit to working with underserved populations (a definition that really ought to include all families that can’t afford to shell out hundreds of dollars for every out-of-pocket visit) — has never worked in the past. And even if those programs were to be expanded and improved, they’d take so long to show results that they’d do nothing for the children who are struggling right now.

Fortunately, families don’t have to wait. Over the past decade, a growing number of frustrated practitioners and researchers have taken matters into their own hands, creating and often collaborating on low-cost solutions that work around the current system. At base, they all center on creating a new mental health workforce, which means training the people who are already on the ground day-to-day with kids — primary care providers, school nurses and counselors, teachers, and, yes, parents — in elemental forms of mental health care.

https://www.washingtonpost.com/magazine/2022/03/21/childrens-mental-health-crisis-politicization/?itid=hp_health-science