Youth mental health advocates renew calls for action

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More than 130 national and state children's groups are asking the Biden administration to do more to address youth mental health, including by issuing an emergency declaration on the issue—the latest amplification of the seriousness of the youth mental health crisis.

The groups made the request in a letter to President Joe Biden on Thursday. The letter came a year after child and adolescent psychiatrists, 's hospitals and pediatricians declared their own state of emergency over the dramatic uptick in children's concerns and months after Surgeon General Vivek Murthy issued his own advisory pertaining to the youth crisis.

Congress and the administration have taken some actions to specifically address the behavioral health needs of children and adolescents, but the groups want them to do more.

The 2022 gun safety law included $80 million to support pediatric mental health care teams, and several congressional committees still hope to pass additional bipartisan legislation this year.

And this week the U.S. Preventive Services Task Force issued recommendations that children 12 and older be screened for depression and children 8 and older be screened for anxiety.

Those recommendations mean that under the 2010 health care law, most private insurance plans must cover these screenings as a preventative service.

Still, children's health experts say these are just one piece of the puzzle.

"The pandemic for children's mental health has not subsided. I think sounding the alarm was the first step," said Warren Y.K. Ng, president of the American Academy of Child and Adolescent Psychiatry. "We are going to need some new skills, but we're also going to need the foundation to sustain it."

Both American Academy of Pediatrics President Moira Szilagyi and Paul King, chair of the board of the Children's Hospital Association, said their organizations had held recent summits at which adolescent mental health was a top issue.

Szilagyi said that, on average, one-third of visits to pediatricians are related to mental health but that that has changed.

"I think most pediatricians now would say it's in the 45 to 55 percent range depending on where they work. It has taken over our practices and it is telling us the children in America are not doing well," she said.

Amy Wimpey Knight, president of Children's Hospital Association, said a universal worry is how to expand the mental health workforce, an issue that Congress has also identified in hearings and draft legislation.

"A lot of the legislation that we're supporting specifically focuses on making sure there's enough workforce across the continuum," she said. "I think the reimbursement rates are really challenging for people to train in this field and then stay in the field for a long period of time."

Experts say that if Congress adds a mental health section to the expected end-of-year spending package, it will need to include language specifically targeting youth.

"There's been a lot of fantastic mental health legislation this year, but by the time it gets to a state, the likelihood of it getting to a child is slim to none," Knight said. "We really actually need some specific funding directed at this workforce, infrastructure, telehealth [and] screening."

Lee Ann Savio Beers, a pediatrics professor and medical director for Community Health and Advocacy at Children's National Hospital, said providers also need financial incentives and payment to support additional services, such as mental health.

"It truly can take hours for a physician or psychiatrist to do care coordination for a patient," she said, adding that a colleague recently said they could spend two minutes freezing a wart off a child's foot and be paid more than days of care coordination for insurance for a family with mental concerns.

Appropriate , she said, "would pay for these additional things because all these bodies are not paid for through our existing billing and payment systems and hospitals and clinics are very stretched right now."

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