Access Problems with Pediatric Mental Healthcare Raise Ethical Worries
There is a “national emergency for children and adolescent mental health,” according to the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association.1
A growing body of evidence suggests there is a surge in demand for pediatric mental healthcare. Mental health insurance claims roughly doubled for teens in March and April 2020 compared to those same months in 2019, according to a white paper from FAIR Health, a New York City-based nonprofit that collects data on privately billed health insurance claims.2
Concurrently, there are problems with accessing needed mental healthcare. Only half of parents who tried to obtain mental healthcare for their children succeeded in doing so during the COVID-19 pandemic, according to a survey conducted in September 2021 by DotCom Therapy, a pediatric teletherapy provider.3
“Pediatric mental health is a human rights issue,” says Mary A. Ott, MD, MA, professor of pediatrics in the Indiana University School of Medicine and adjunct professor of philosophy at IUPUI in Indianapolis.
The UN Committee on the Rights of the Child has defined access to the best attainable health, including mental health, as a basic human right. “This means that we, in the U.S., by failing to provide adequate access to pediatric mental health services, are failing to meet our children’s basic human right to mental healthcare,” Ott laments.
Broad structural and social factors influence pediatric mental health. “However, many of the approaches focus on the individual child — pathologizing the child, rather than considering the interaction of the child and the environment,” Ott notes.
Assurances of confidentiality can expand adolescent access and engagement in care, but other barriers remain. One example is the 21st Century Cures Act, which requires providers to give patients or their legal representatives access to electronic health records. While mental health notes often are exempt, much pediatric mental health is provided through pediatricians and is integrated into general medical care.
Another ethical concern is the shortage in mental healthcare disproportionately affects children from minority groups, children who are low-income, and children in rural areas.4,5 “This reinforces and worsens health inequities in access to mental health services, and, by extension, outcomes. There are marked racial and ethnic inequities in diagnosis, and, by extension, access to treatment,” Ott says.
For example, a Black male adolescent is more likely to be diagnosed with conduct disorder than a white adolescent with the same presentation.6 To counter all these issues, extra funding for expansion, training, and innovation in pediatric mental healthcare is needed. Collaborative care models in primary care settings and school-based settings can bring services to children and adolescents in need.
There also is a need to consult adolescents and underserved communities, says Ott, “to make sure that we have the perspectives of youth and the communities where they live.”
- American Academy of Pediatrics. AAP-AACAP-CHA declaration of a national emergency in child and adolescent mental health. Oct. 19, 2021.
- FAIR Health. The impact of COVID-19 on pediatric mental health: A study of private healthcare claims. March 2, 2021.
- DotCom Therapy. New independent survey reveals that only 50% of parents who tried to access mental health resources for a child during the pandemic were able to. Nov. 17, 2021.
- Hodgkinson S, Godoy L, Beers LS, Lewin A. Improving mental health access for low-income children and families in the primary care setting. Pediatrics 2017;139:e20151175.
- Morales DA, Barksdale CL, Beckel-Mitchener AC. A call to action to address rural mental health disparities. J Clin Transl Sci 2020;4:463-467.
- Fadus MC, Ginsburg KR, Sobowale K, et al. Unconscious bias and the diagnosis of disruptive behavior disorders and ADHD in African American and Hispanic youth. Acad Psychiatry 2020;44:95-102.
Mental health insurance claims roughly doubled for teens in March and April 2020 compared to those same months in 2019. However, only half of parents who tried to obtain mental healthcare for their children succeeded in doing so during the COVID-19 pandemic.
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