These 10 steps would go a long way toward shoring up the services our teens desperately need
Robert Ferguson is Director of Government Grants and Policy for Pittsburgh’s Jewish Healthcare Foundation.
Adolescence is often a rocky journey as boys and girls make the difficult transition from childhood to adulthood. The transition, emotionally, socially and physically, can be painful.
For U.S. teens, the journey seems unusually challenging, and it is too often unsuccessful — particularly in comparison to youth in similar countries. U.S. teens have higher rates of depression, substance use, anxiety, obesity, diabetes, sexually transmitted disease, injury and death. In the United States, suicide is now the second-leading cause of death among adolescents, and more than a third of Allegheny County teens reported intentionally hurting themselves in the past year.
And, right now, in America, these problems could be exacerbated by the fear of violence in the very school settings where teens go to become competent, responsible and successful adults.
The saddest part of this story, the climax of an unsuccessful adolescence, is the inability to get mental-health services when needed. Whether one is a concerned parent seeking help for a teenager who shows signs of depression, anxiety or drug and alcohol misuse, or a frantic relative trying to prevent a young person from injuring themselves or others — like the grandmother in Seattle who discovered her grandson’s alarming journal — support is often absent.
Families may wait for 10 hours or more to get a teen evaluated during a crisis, only to be told that there are no hospital beds available unless they travel to a distant city. They may wade through directories of support services that aren’t current, only to find no outpatient-services openings, no immediate support services or no insurance coverage when openings occur. The teen may drop out of school or get expelled while the family pleads for help.
We have not invested in the mental health of our teens. The data provide evidence. We have a leaky, broken safety net because we have not provided enough services, trained enough therapists and support staff, or built enough centers to help teens and families cope. Because of this, we jeopardize the future of our nation. Troubled youth who get no help cannot be expected to excel as parents, workers or responsible citizens. As a society, we can pay now or pay later — in a hundred ways.
Therefore, we plead with our legislators to pay now, to provide a powerful safety net to guide our youth to stable adulthood. It is a bipartisan, societal imperative. Let’s get the job done.
Here is an agenda woven from two years of conversations among state and county leaders, mental-health and substance-use providers, social-service representatives, family and patient advocates, educators, health-plan representatives, nonprofit leaders and researchers. There’s urgency; it’s time to deliver.
1. Increase loan reimbursements and payment rates for psychiatrists and other behavioral-health professionals. Many private behavioral-health practitioners no longer accept insurance, since salaries in behavioral health care are well below similar positions in other types of health care. This issue is especially acute for child and adolescent psychiatry. There are severe shortages in 85 percent of the states, including Pennsylvania. While psychiatrists and other behavioral-health professionals are now part of a loan-repayment program in the state, we need to increase the opportunities for loan repayment.
2. Create certificate programs and reimbursement for Family Support Partners and Youth Peer Support Partners. The Pennsylvania Medicaid program funds Certified Peer Specialists with lived mental-health recovery experience who work with adults with serious mental illness. We commend efforts to expand this program to serve youth with serious emotional or mental illness and to create certification programs and reimbursement for Family Support Partners who help parents advocate for their children.
3. Require school nurses, counselors and other personnel to be trained in behavioral health. We need to create a community that recognizes signs of distress in our teens, and can help them get back on track. One good avenue is Youth Mental Health First Aid, which is designed to train school personnel, teachers, families, youth, employers and other community members how to assist someone experiencing a mental-health crisis.
4. Advocate for commercial and public resources to increase the full continuum of services, including step-down treatment. We need everything from out-of-home services to community-based services. This means increasing resources for everything from crisis-response services to inpatient psychiatric beds to community care and ongoing supports; from creative pre-crisis and safety-net services to informal networks of family caregivers and teens. It also means removing barriers to care, like the exclusion that prohibits use of federal financing for care in behavioral-health residential treatment facilities with more than 16 beds.
5. Create a mental-health-bed registry in Pennsylvania. Identifying available psychiatric beds across the state would help simplify referrals and reduce bottlenecks at emergency rooms.
6. Advocate for commercial insurance coverage, including coverage for behavioral-health crisis and follow-up service. Resolve Crisis Network services are publicly funded and available to everyone. Support from commercial health plans would create greater capacity for crisis services and get help to teens and families more quickly.
7. Create new methods for paying behavioral-health providers based on outcomes rather than individual, discrete services. Health plans and providers, in both the private and public sectors, should design payment methods that allow them to deliver services that matter to families before, during and after a behavioral-health crisis.
8. Update the regulations on behavioral-health providers. We encourage families, teens and advocacy groups to help review the regulations for services. A unified licensing and credentialing system for providers and closing the disconnects between services for mental health and alcohol and other drugs also could relieve significant regulatory burdens on providers.
9. Fund the provision of evidence-based behavioral-health services by creating a system for training providers on evidence-based services, financing the services and measuring the outcomes. Although evidence-based services exist for adolescents, such as trauma-focused cognitive behavioral therapy, they are not always provided in practice. Families also often do not know whether the service being provided is based on the best available evidence as to what works and what doesn’t work.
10. Demand transparent strategies for ensuring the quality of behavioral-health services and use validated surveys for measuring satisfaction, functioning and recovery. Families need to be able to identify what services are most essential, effective, affordable, compassionate and accessible. While a method exists to measure consumer satisfaction in the publicly funded behavioral-health system, this information should be available much more quickly. Private health plans must implement a similar method to measure and report consumer satisfaction and quality.
We will salute the legislators, health systems and public officials who advance and support these policy imperatives. We will reassure families, youth, advocacy groups and committed professionals that you understand the urgency of this situation and that you have responded to a crisis with the bipartisan intensity it deserves. Make Pennsylvania the gold standard for adolescent mental-health services and guarantee a healthy and responsible next generation.