In 2020, the CDC released research which revealed troubling trends in the mental health of American children, including increasing rates of use of acute mental care services among pediatric patients. To learn more about these trends, the healthcare analytics company Clarify health handles insurance claims from more than 20 million children ages 1 to 19 annually over the past six years.
Children’s ED visits, mental health hospital admissions rise steadily
Clarify reportpublished Monday found that, among other things, mental health hospitalizations increased 61 percent among U.S. children from 2016-21. To address these alarming trends, the report recommends more mental health screenings of children in school and in the community, as well as better mental health coverage and access among state-sponsored health plans.
The study showed that the biggest increase in mental health hospitalizations was among adolescents aged 12-15. From 2016-21, mental hospital admissions increased by 84% among girls and 83% among boys aged 12-15. Notably, the report showed that mental health hospital admission rates for girls aged 12-15 were more than 2.5 times higher than admission rates for boys in the same age group in 2021 .
“Related research suggests that adolescent girls may experience poorer mental and behavioral health because of earlier development, greater responsiveness to stressors (such as school or a pandemic), and differences in peer networks—including in response to the increased use of social media,” said Niall Brennan, Clarify’s chief analytics and privacy officer.
In addition to rising rates of mental health-related hospitalizations, the report shows that emergency department visits have increased by 20 percent among pediatric patients.
However, it found that the use of in-person and outpatient pediatric mental health services increased by only 5% from 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 historically been poorly covered by insurance plans, so doctors specializing in mental and behavioral health are relatively undercompensated compared to other clinical specialties.
The report examined data representing children covered by Medicaid and commercial insurance plans, finding significant differences in mental health use between the two populations. For example, mental health-related hospital admissions increased 103% among commercially insured children, but only 40% among children enrolled in Medicaid. But when it comes to emergency room visits for mental health, the rate increased 10 percent among children with commercial insurance and 20 percent among children covered by Medicaid.
“Care provided through the emergency department is often treated as a last resort for urgent and acute care patients, including many who are covered by Medicaid and do not have access to timely office and outpatient care,” Brennan said. “We found that this appears to be the case among pediatric patients with mental and behavioral disorders.”
To minimize these disparities in insurance coverage among pediatric mental health patients, state-sponsored health plans need fairer reimbursement and access to mental health providers, Brennan argued. Adhering to mental health equity laws requiring comparable coverage between mental and physical health services is another important step in addressing such disparities, he said.
The report also recommends that the U.S. increase mental and behavioral health screenings of children to identify signs of mental illness and offer appropriate interventions. US Preventive Services Task Force recommends universal screening for major depressive disorder in adolescents ages 12-18, with guidance noting that screening must be implemented with adequate systems to ensure accurate diagnosis, effective treatment and appropriate follow-up, Brennan said.
“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 can involve many approaches—including raising awareness among pediatric health care providers of their importance, using financial incentives or quality reporting to promote screenings, and engaging with school and community-based programs .”
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