Mental health treatment in America has a lot of room for improvement. In particular, depression is underdiagnosed and subtracted.
The American Academy of Pediatrics took a big step in February to address a deficiency – the early identification of depression in adolescents. The group asked that every child be found for depression every year, starting at the age of 12.
You may catch more children who are symptomatic and catch them earlier. However, once you have a diagnosis in your hand – then what?
Then teens and their parents will face a new problem: getting treatment. Finding a provider who takes your insurance, who has availability, who is not too far away, who has after-school hours and whom your kid clicks with is no easy task.
Kate — a Washington state mother who, like other parents in this column, insisted on being identified by first name only to protect their families’ privacy — was grateful that her family’s primary-care provider prescribed antidepressants when her 16-year-old daughter asked for help.
She also knew that her child, who was diagnosed with severe depression and suicidal ideation, should see a specialist. In her town, there were two adolescent psychiatrists who took private insurance; however, they had waiting lists of 10 and 12 months.
A Chicago mother had trouble finding a therapist who took Medicaid for her child who was depressed and cutting herself.
“We spent a lot of time working with random therapists who allowed us to pay out of pocket,” she wrote in an email. “These people were good, but none were psychiatrists, [so they] couldn’t prescribe meds.”
Becky in Connecticut adds another layer to the challenge: “Trying to choose a therapist from a website that gives minimal info, looking for ‘teens,’ ‘depression,’ and ‘LGBTQ’ in the list of specialties and hoping that’s enough to make a good match.”
These examples represent a too-common story line, which was substantiated by a 2017 study. Harvard researchers called 601 pediatricians and 312 child psychiatrists in five cities, posing as parents of a 12-year-old child with depression.
Appointments were scheduled with 40 percent of the pediatricians and 17 percent of the child psychiatrists. Long wait times were the good outcomes. Most psychiatry practices were not accepting new patients or had incorrectly listed phone numbers.
“Mental-health care is not highly valued,” says Paul Gionfriddo, president and CEO of Mental Health America, a patient advocacy group. Psychiatrists are paid less than most other specialists, and psychologists’ rates have fallen in the past two decades.
Many therapists have social work degrees; they are reimbursed at even lower rates than psychiatrists and psychologists. (These comparisons come from Medicare data, which private insurers often use as bench marks to set their own rates.) “We don’t pay enough to providers, so there’s not enough providers around,” Gionfriddo says.
His group’s latest report, The State of Mental Health in America, says that 63 percent of youth with major depression do not receive any mental-health treatment.
The reports states: “That means that 6 out of 10 young people who have depression and who are most at risk of suicidal thoughts, difficulty in school and difficulty in relationships with others do not get the treatment needed to support them.”
There are other impediments to getting from diagnosis to treatment. Parents may not want to believe their child is depressed. Teens themselves don’t always want to take the recommended steps.
Radovic and Gionfriddo say that having teens engage with other teens can be very helpful, such as in group therapy sessions. Radovic has also developed a website, SOVA (Supporting Our Valued Adolescents), that is a moderated online chat forum for teens with depression and/or anxiety.
“Teens who have been through treatment, they want to help others,” Radovic says. Her team is now studying outcomes, including such questions as “Does interacting on the site get kids into treatment sooner?”
Radovic says she would like people to know that it’s normal to resist help for anxiety and depression. Resources and social support can be valuable, she says. “Don’t be scared to ask, ‘Might this be a problem?’ It’s better to be wrong than to be too late.”