No time to wait: ending the youth mental health crisis

Content warning: This article discusses suicide. If you or someone you know needs help, please call or text the National Suicide & Crisis Lifeline at 988.

Years before the coronavirus pandemic began, another national health crisis was roiling. Children and teens were showing up in greater numbers in emergency rooms in mental health crises. Depression and anxiety were rising. More kids were reporting suicidal thoughts and rates of suicide had been climbing. The U.S. Surgeon General issued an emergency advisory in 2021 about the growing youth mental health crisis, as did several other major medical associations, calling on the American people to act. The message was clear: the pandemic had only exacerbated kids' existing mental health problems. It was also clear that youth of different racial, ethnic, gender identity and socioeconomic groups were experiencing this crisis in ways that were, and still are, often inequitable.

Numbers tell the story of a deepening crisis

The statistics are staggering. Take, for example, numbers tracked by the Blue Cross Blue Shield Health Index. The Index monitors the prevalence of 390 different diseases and conditions to identify which most affect Americans’ overall health. It’s powered by insurance claims data from more than 40 million BCBS commercially insured members. In 2021, the top condition impacting the nation's teens' overall health was depression. Anxiety was the sixth. BCBS claims data also reveals that in 2017, 1 in 10 kids ages 12 and up had been diagnosed with anxiety. By 2021, that number was 1 in 5. In 2021, more than 1 in 10 teens had been diagnosed with depression. Those numbers only tell a story about kids seen by a health care professional. Many more have likely gone undiagnosed.

Numbers like those may overwhelm and make a crisis feel abstract. However, the real numbers of children they represent likely means that most of us probably know or care about a young person dealing with mental health issues.

We’re not waiting to implement solutions

That’s why Blue Cross and Blue Shield companies haven't been waiting to address this crisis in youth mental health. BCBS companies have been taking action in communities across the country, partnering with health care providers and working with policymakers to break down barriers to better health. Here’s where we’re focusing our efforts:

Making mental health care more accessible

It’s well known that the nation faces a shortage of child psychiatrists and psychologists. While educational institutions, policymakers and health care organizations work to fill the pipeline with new students, other kinds of providers and services are providing critical access to care.

• Blue Cross & Blue Shield of Rhode Island covers a coaching service provided by Braver, a mental health provider that pairs each pediatric patient with a trained coach. Coaches work with children at home or wherever they need every week to address anxiety and OCD. Child psychologists and psychiatrists are available, and group therapy rounds out the treatment. It’s a “force multiplier” for doctors who supervise the work.

• Horizon BCBS of NJ offers members ages 13 to 25 access to a text-based mental health coaching service that emphasizes culturally concordant care. The health plan has also partnered with a virtual treatment program for eating disorders, to offer in-network access for patients ages 6 to 24. Eating disorder specialists are among those in short supply, so the virtual program expands access in unprecedented ways.

Promoting integrated mental and physical health care

Physical and mental health are intertwined. Treating them that way can improve access to mental health care.

• Blue Cross Blue Shield of Michigan now has 213 primary care practices that use BCBS Michigan’s Collaborative Care model. BCBS Michigan provides incentives, training and ongoing support to practices that include psychiatric consultants and dedicated care managers who support pediatricians, family medicine physicians and internists. The upside is that patients may not need to be referred to a specialist for behavioral health concerns—specialists who may have long wait lists or be located far from a patient’s home—and can receive care faster.
• The American Academy of Pediatrics has partnered with BlueCare Tennessee to offer Behavioral health care training for pediatricians. Empowering pediatricians to treat less complex pediatric mental health conditions right in their practices can get kids the help they need faster and ease parent concerns about access to specialists.

Empowering schools to meet the growing need

Kids spend a huge portion of their week in school. Teachers and staff may be among the first to identify a mental health concern and able to assist. Many will need support and training to take on these responsibilities. Blue Cross and Blue Shield companies are providing that support community by community, responding to individual school and school district preferences.

• Blue Cross and Blue Shield of Kansas City is providing Mental Health First Aid training to school staff, most recently to Pembroke Hill School. The training helps school staff respond not only to a crisis but create a supportive, stigma-free learning environment.
• The Independence Blue Cross Foundation is funding a multi-year pilot to provide access to mental health care for every student at Girard College. Girard College is an independent, five-day-a-week boarding school in Philadelphia, serving hundreds of students in first through twelfth grades from families with limited financial resources. More than 80 percent of the student population identifies as African American. This pilot integrates school support with telehealth services provided by the renowned Children’s Hospital of Philadelphia.

These represent just a few of the initiatives underway to address our nation’s youth mental health crisis. The overarching theme is about finding ways to provide kids the help they need right now, whether it’s in a doctor’s office, in school or at home. We have more work to do. And we’re not waiting.