Kids’ Mental Health is in Crisis—Primary Care is the Solution

by Dr. Sterling N. Ransone, Jr., President, American Academy of Family Physicians

Primary care physicians agree: our children, adolescents, and our nation face a growing and undeniable behavioral health crisis.

Thankfully, one resource to address the most urgent situations in the crisis are coming. In July, the three-digit suicide prevention phone line, 9-8-8, will be available nationwide. This dialing code will connect callers to the National Suicide Prevention Line and, when needed, crisis response teams to the caller’s community.

However, the reality is that we need to support people, especially children, before they reach the point of crisis. A proven solution is in sight: Congress must pass legislation to better integrate behavioral health services into primary care settings. Behavioral health integration is an evidence-based solution that improves equitable access to behavioral health services. Behavioral health integration can also reduce costs for patients and the health care system.

As a family physician, I’ve seen firsthand how the need to better integrate behavioral health care and primary care has never been more urgent. More work must be done to eliminate barriers to behavioral health care, and family physicians are part of the solution.

We Can’t Do This Alone

Family physicians are well equipped to identify behavioral health needs early and provide appropriate care, which often includes collaboration with other behavioral health professionals. In other words, we can’t do this alone.

However, access to comprehensive behavioral health services is not equally distributed throughout the U.S., and roughly two-thirds of primary care physicians are unable to connect their patients to outpatient behavioral health services in a timely manner. The nation could benefit from Congress enacting policy that incorporates behavioral health into primary care for children and adults.

Policy Solutions Are in Sight

In my practice, I regularly treat children and adolescents. The statistics I’ve seen about children’s mental health are jarring. Childhood mental health concerns and suicide rose steadily between 2010 and 2020, and by 2018 suicide was the second leading cause of death for youth ages 10-24. The pandemic has only intensified this crisis, as well as the glaring mental health care gap in the U.S. Inequities from structural racism in mental health and the pressures of the public health emergency have disproportionately impacted children of color.

We’ve called on Congress to enact policies that improve access to mental health. This includes expansion and reauthorization of the Health Resources Services Administration’s Pediatric Mental Health Access programs in the Bipartisan Safer Communities Act, which will provide practices like mine with access to pediatric mental health specialists via telehealth.

Importantly, we know that this program works. A recent RAND study found that over 12 percent of children in states with programs funded under the Pediatric Mental Health Care Access Program had received behavioral health services while only 9.5 percent of children in states without such programs received these services. Programs funded by HRSA have also enabled doctors to spend more time screening, referring, or treating children’s mental health. Family physicians stand ready to advocate for legislative vehicles that support this program.

Similarly, the Improving Access to Behavioral Health Integration Act (S.4306) is bipartisan legislation that would expand an existing HRSA grant program to provide grants to primary care practices to support the integration of behavioral health and primary care services. These grants can help primary care practices make the initial investments in staffing and infrastructure that can often be a barrier to standing-up an integrated care model.

Medicaid is the single largest payer for mental health care—over 40 million children rely on Medicaid and CHIP for health care coverage. A new Medicaid demonstration program is needed to finance integrated behavioral health services and to improve care coordination between behavioral health, primary care and community settings like schools and libraries.

While resources for suicide prevention are forthcoming through 9-8-8, many states need more support to ensure the phones can be answered and crisis response teams are available to respond. The AAFP endorses the 988 Parity Assistance Act, which prioritizes care coordination by making investments into a pilot program to support crisis response teams that include physicians, counselors, EMTs, peer responders and other team members with the skills and background to support individuals, including adolescents, in crisis.

Addressing the mental health crisis for all patients and especially children is critically important to our personal and public health—Congress must act now to make meaningful change. After all, if we’re not advocating for whole-person health for our patients and their families, we’re falling short of our duty as physicians.

Dr. Sterling N. Ransone, Jr. is a family physician and president of the American Academy of Family Physicians.