Youth Mental Health: The Unintended Costs of Care

Our kids are in crisis. It's so dire that the U.S. Surgeon General Vivek Murthy issued a rare public health advisory about our national youth mental health crisis. A 2021 General Advisory report found that one in three high school students and half of female students reported persistent feelings of sadness or hopelessness – an overall increase of 40% from 2009.?

Pediatricians, parents and educators—the people who are closest to youth—are also sounding the alarm. Representing more than 77,000 physicians and 200 children’s hospitals, the American Academy of Pediatrics issued an urgent warning declaring the mental health crisis among children so dire that it has become a national emergency. Parents and educators report that they are equally alarmed. 91% of parents are worried about their childrens’ mental health. And, both parents and educators ranked “Mental and Emotional Health” as the biggest challenge facing middle and high school-aged kids today2. The majority of educators ranked it #1—higher than school safety, cyber-bullying, physical health and wellbeing, social media addiction3. The Pew Research Center just published an article illustrating that four-in-ten U.S. parents with children younger than 18 are extremely or very worried that their children might struggle with anxiety or depression at some point.

Clearly both experts and families are concerned. But, access to mental health services is very limited. There’s a shortage of mental health professionals and, even if a family can find a provider, the cost of care prevents many of them from getting the help they so desperately need. Our system has failed our kids. How can we help?

A Collaborative Approach: Health Plans

Mental health care is a tough business - not only emotionally but financially. A typical therapy session runs between 45-minutes to an hour. While there are large variances based on location and speciality, the reimbursement rate for a therapy session is often the same, if not lower, than a 20-minute office visit with an Advanced Practice Provider.?

While it can be enticing to double down on higher reimbursement channels such as cash-pay only models or contracting directly with employers, this creates even more inequities in care. At Daybreak Health, we are committed to providing affordable and accessible care to all children which requires close partnership with insurance —commercial and Medicaid. This means negotiating our fee-for-service rates with commercial plans while also pursuing programmatic partnerships. It means being smart about contract prioritization of Medicaid Managed Care Organizations to maximize our impact based on population coverage. It means building out revenue cycle management tools while simultaneously fostering a pipeline of in-network insurance patients to justify the cost. And, it means staying firmly committed to our mission of creating equal access to youth mental health care.?

Enabling our Frontlines: Schools

School districts are also prioritizing mental health as a top investment area and using innovative funding sources to cost-effectively launch and sustain these programs. Billions of dollars of funding on a state and federal level have been allocated for youth mental health services, including ESSER and Medicaid. Oftentimes, district leaders are launching programs with temporary funds and then transitioning to general funds to ensure the long-term viability of the program. When asked which funds were being used, school districts responded that State grants and Medicaid top the list (51%) followed closely by Federal grants and general funds (50%)4.??

Looking ahead, there are some interesting trends in where school districts are planning to invest most heavily in student mental health services:

1. Virtual Mental Health Services to allow for more flexibility, speed to care, the opportunity to serve more students, and increased access to more diverse clinicians.?
2. Mental Health Screening to enable early identification and intervention for problems like anxiety, mood disorders, stressors, and trauma that impact students’ day-to-day activities, which in turn lets school teams proactively and efficiently target their efforts.
3. Mental Health Education to not only destigmatize mental health challenges, but help parents and other adults recognize and address problems early.

Creating an Ecosystem of Care

With cost being one of the largest barriers to accessing youth mental health care, it is going to require systemic collaboration to help solve this massive issue facing our kids. Families, educators, pediatricians, insurers, government, and employers must act now and work together to put a youth mental health infrastructure in place to serve more kids in an equitable and affordable way. Together, we can solve the most defining problem of an entire generation.

Learn how Daybreak has partnered with 850 schools, representing over 30 districts, to reach ~650K students with school-based mental health services.?

Article written by: Amanda Weaver, VP Clinical & Health Plan Operations, Daybreak Health

1 The State of Youth Mental Health & Our Schools Report, Daybreak Health, 2022

2 Ibid.

3 Ibid.

4Ibid.