We need more mental health resources to tackle anxiety in children – California Health Report

Photo by Jatuporn-Tansirimas/iStock.

As the pandemic continues, creating what could be another wave of infections, it’s time to stop and reflect on the mental health crisis we face today, especially among our children. I am the state volunteer coordinator for the Selective Mutism Association, a parent and former school nurse, and see the urgent need to make mental health services more accessible to children and their families.

In 2013, my son Ram spontaneously developed a condition called Selective Mutism, a childhood anxiety disorder. Children with this disorder lose the ability to speak in certain social situations. In my son’s case, he stopped talking to anyone outside of our home when he was 3 years old. I didn’t realize there was a problem until the preschool teacher told me he wasn’t speaking at school anymore. As a mother and children’s rights advocate, I diligently researched treatment options and discovered that he needed cognitive behavioral therapy. After three months of searching for a therapist taking on new patients, I finally found an experienced psychologist with knowledge of child development who understood selective mutism. My husband and I felt so relieved…until we found out she didn’t take insurance.

It turns out that this scenario is common. Health insurance — whether private or through California’s Medi-Cal program — does not pay what many psychologists charge for their services. Ram’s psychologist charges $200 an hour. Still, a typical insurance reimbursement rate for psychotherapy in California is around $85 per session. Many therapists refuse insurance because rates like these do not cover the cost of care. This leaves many families unable to afford mental health care for their children, even if they have insurance.

In my family’s case, we paid for Ram’s therapy out of pocket and then filed a claim with our insurance company to try and get reimbursed. Much to our frustration, our insurance did not reimburse any of the costs. We had a high-deductible plan that required us to spend $12,000 before the care was reimbursed.

While this is manageable for my family, I shudder to think what this situation would mean for low income families or single parent households. Still, it was a tough trip for our family. I put my career on hold so I could provide full-time support to Ram and teach his school staff how to support him as well.

Thankfully, Ram is now fully recovered and a confident speaker. He even spoke on a panel with me about selective mutism in 2019, which made me so proud.

Unfortunately, many families who have a child with selective mutism cannot access the resources that were vital to us. Not only do many California families deal with the stress and worry of caring for a child with a mental health disorder, but they also have to pay a high price to get their child treated. Many don’t have the resources to pay out of pocket, let alone try to navigate the system, and they don’t have the ability to take time off work. Those who speak a language other than English or do not have health insurance may face even more obstacles.

Not being able to afford mental health services can impact whether a child overcomes selective mutism, anxiety, or other mental health issues. In my work at the state level, I hear from many parents who struggle to find psychotherapy for their children that is covered by health insurance. It’s also a common topic of discussion on Facebook support groups, where parents go for advice on how to navigate the complicated insurance system. We need policy changes that improve mental health treatment coverage so that our children can regain their mental health and thrive.

School mental health programs are one way to help provide care for children with anxiety and other disorders. As a former school nurse, I have seen many students deal with social and separation anxiety as a result of online learning and the pandemic. The transition to in-person learning at the start of the 2021-2022 school year was very difficult for the children in the schools where I worked. My office was constantly occupied by students complaining of nausea, stomachaches and headaches – symptoms commonly associated with anxiety.. I assessed each child, noted when children were making recurring visits for the same symptoms, and called their parents with advice on how to ease their child’s anxiety about returning to school.

Fortunately, the children are incredibly resilient, and by October the number of anxiety-related medical visits had decreased at the schools assigned to me. It was a team approach; parents, teachers, nursing colleagues, administrators and staff members have all worked with the common goal of helping students transition into a regular school routine. However, I know that some of the students I worked with would have benefited from additional therapeutic support. Yet many families lacked the means or insurance coverage to pay for therapy outside of school.

The need for better and more affordable access to pediatric mental health care is urgent. A recent study by the US Department of Health and Human Services found that between 2016 and 2020, the number of children aged 3 to 17 with anxiety and depression increased by 29% and 27% respectively. These rates have likely increased further since then, given the well-documented crisis in youth mental health in the wake of the pandemic. The study highlights the critical need to support the mental and emotional well-being of parents and caregivers.

The Health Resources and Services Administration, which conducted this study, offers recommendations for expanding access to children’s mental health services. These include training child psychiatrists and psychologists to modify treatment plans based on a child’s developmental stage and investing in growing the mental health workforce. These recommendations, if implemented, could make a huge difference in improving the mental well-being of children. However, they do not address the issue of insurance coverage and reimbursement, an issue that I believe must be at the heart of efforts to improve our mental health system.

While we wait for changes at the political level, I encourage parents to continue to advocate for their children and learn how to support their mental health. Platforms such as Selective Mutism Association and Child Mind Institute, for example, offer free webinars and educational resources. The Selective Mutism Association also has a directory of mental health professionals searchable by geographic area. No matter the challenge, a parent’s love, support and advocacy can go a long way in helping a child heal.

Lola Ravid is a registered nurse and freelance writer passionate about child advocacy, children’s mental health, and parent education.

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