In 2020, the CDC released research that uncovered troublesome trends in mental health of American children, including rising utilization levels for acute mental health care services among pediatric patients. To learn more about these trends, healthcare analytics company Clarify Health examined insurance claims from more than 20 million children ages 1-19 years old annually across the last six years.
Clarify’s report, released Monday, found that among other things mental health inpatient hospital admissions increased by 61% among U.S. children from 2016-21. To address these concerning trends, the report recommended more school and community-based mental health screenings for children, as well as better mental health coverage and access among state-sponsored health plans.
The research showed that the largest increases in inpatient mental health admissions were among adolescents aged 12-15. From 2016-21, inpatient admissions for mental health conditions increased by 84% among girls and 83% among boys ages 12–15 years old. Notably, the report showed that mental health inpatient admission levels for girls ages 12-15 were more than 2.5 times higher than admission rates for boys in the same age group in 2021.
“Related research suggests adolescent girls may experience worse mental and behavioral health due to earlier development, given a greater response to stressors (such as school or the pandemic), and due to differences in peer networks — including in response to increased use of social media,” said Niall Brennan Clarify’s chief analytics and privacy officer.
In addition to rising levels of mental-health related inpatient admissions, the report showed that emergency department visits increased by 20% among pediatric patients.
However, it found that in-person office and outpatient pediatric mental health services utilization increased by only 5% during 2016-21. This finding may reflect a lack of supply of office and outpatient mental health providers, according to Brennan. He pointed out that these professions have been historically poorly covered by insurance plans, so physicians specializing in mental and behavioral health are relatively uncompensated compared to other clinical specialties.
The report examined data representing children covered by Medicaid and commercial insurance plans, finding significant disparities in mental health utilization between the two populations. For example, mental health-related inpatient admissions increased by 103% among commercially insured children, but only 40% among children enrolled in Medicaid. But when it came to mental health emergency department visits, the rate increased by 10% among the commercially insured children and 20% among Medicaid-covered children.
“Care provided through the emergency department is often treated as a last resort for urgent and acute care patients, including many who are covered through Medicaid and unable to access timely office and outpatient care,” Brennan said. “We found that this appears to be occurring among pediatric patients with mental and behavioral health conditions.”
In order to minimize these insurance coverage disparities among pediatric mental health patients, state-sponsored health plans need more equitable reimbursement for and access to mental health providers, Brennan argued. Compliance with mental health parity laws requiring comparable coverage between mental and physical health services is another important step to address such disparities, he said.
The report also recommended that the U.S. increase mental and behavioral health screenings for children to identify signs of mental health conditions and offer appropriate interventions. The U.S. Preventive Services Task Force recommends universal screening for major depressive disorder in adolescents ages 12-18, with the guidance noting that screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up, Brennan pointed out.
“Despite recommendations for universal screenings for many prevalent pediatric mental and behavioral health conditions, screening rates remain far below 100%,” he said. “Efforts to increase universal screening rates could incorporate many approaches — including increasing pediatric healthcare providers’ awareness of their importance, use of financial incentives or quality reporting to promote screenings, and engaging with school- and community-based programs.”
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