There Is a Youth Mental Health Crisis and Health Insurers Aren’t Helping

A version of this post also appeared here.

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 increasing use of social media by young people is responsible, although this is controversial and not all studies agree.

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. A harrowing piece published in  ProPublica in September told the story of a man named Ravi who tried for months to get an appointment with a mental health clinician from his health insurer’s network of providers.

“Ravi didn’t know it,” the story explained, “but he, like millions of Americans, was trapped in a ‘ghost network.’ As some of those people have discovered, the providers listed in an insurer’s network have either retired or died. Many other providers have stopped accepting insurance — often because  the companies made it excessively difficult for them to do so. Some just aren’t taking new patients. Insurers are often slow to remove them from directories, if they do so at all. It adds up to a bait and switch by insurance companies that leads customers to believe there are more options for care than actually exist.”

Mental Health Parity Remains Elusive

Ravi never found a therapist or psychiatrist to help him and ultimately died from his mental illness. While this story is dramatic, it illustrates a major problem that people face when trying to access mental healthcare. 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% 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 with serious mental health issues accessing high-quality, evidence-based care will remain nearly impossible. Some people will be able to resort to paying 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. And 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, stories like that of Ravi are far less frequent.