From Cradle to Commencement: Public Health Perspectives on Pediatric Mental Health Care
3.28.2025
Common Pediatric Mental Health Disorders
Mental disorders among pediatric patients manifest as significant deviations from typical learning patterns, behaviors or emotional regulation, leading to distress and impairment in daily functioning.3 Various methods are employed to evaluate children’s mental well-being and identify these mental disorders. The Centers for Disease Control and Prevention utilizes surveys such as the National Survey of Children’s Health to assess positive indicators of children’s mental health and ascertain the prevalence of diagnosed mental disorders and the provision of treatment among pediatric patients.4 The surveys undeniably illustrate the severity of mental health disorders among the pediatric population, but such surveys rely on parental reports of positive indicators for such disorders in their children and diagnoses their children have received from a health care provider.5 This requirement suggests that there are likely many more pediatric patients suffering with mental health disorders who are going unreported, unrecognized and/or uncared for because of their parents’ refusal to acknowledge that they are struggling.6
Between 2016 and 2019, children aged 3 to 17 were estimated to have been diagnosed with the following disorders: attention-deficit/hyperactivity disorder: 9.8% (approximately 6 million); anxiety: 9.4% (approximately 5.8 million); behavior disorders: 8.9% (approximately 5.5 million); and depression 4.4% (approximately 2.7 million).7 As for college students, a 2018 National College Health Assessment survey of 88,000 college students conducted by the American College Health Association found that approximately 60% of students experienced overwhelming anxiety.8 More recently, in the spring of 2022, a similar survey of 54,000 undergraduate students by the same body indicated that 77% of college students were experiencing moderate to serious psychological distress.9 Moreover, though the COVID-19 pandemic is beyond the scope of this article, studies suggest that pediatric mental health has deteriorated even further following the pandemic in 2022.10
Barriers to Pediatric Mental Health Care
Policymakers have been keenly aware of the high levels of unmet mental health care needs for pediatric patients and the importance of increasing the availability of mental health care services dating back to the surgeon general’s report on mental health in 1999.11 Nevertheless, there has been little guidance on improving pediatric mental health care accessibility since few studies have explicitly examined barriers to such care.12 This is likely because barriers to obtaining pediatric mental health care, apart from structural barriers, are not well understood.13
Despite uncertainty surrounding barriers to pediatric mental health care, “conceptual frameworks in the general health services literature suggest that identifiable barriers to care exist.”14 Accordingly, two main categories of barriers to pediatric mental healthcare have been identified: structural and psychosocial barriers.
Structural Barriers
More than any other area of health care, the mental health field is “plagued by disparities in the availability of and access to its services.”15 Pediatric patients across the nation are suffering, and there is no one available to help them. If a provider is found who can help, patients are often faced with long waiting lists to be seen, while their symptoms escalate and their mental health deteriorates. When it is finally their turn to receive the care they need, pediatric patients are often turned away due to lack of insurance or inadequate insurance policies that refuse to pay for mental health services. These structural barriers that have been erected in opposition to an entire generation’s quest for a healthy mind and body have largely contributed to the declaration of a national emergency in pediatric mental health care.16
Provider Scarcity
Accessing pediatric mental health care services has been a challenge for at least the last decade. As the rates of behavioral disorders and other mental health disorders among pediatric patients rise, and public awareness increases, the disparity between service demanded and availability has become staggering.17 In 2022, the American Academy of Child and Adolescent Psychiatry released updated maps indicating the child and adolescent psychiatrist workforce, illustrating a severe national shortage.18 The maps depict the ratio of child and adolescent psychiatrists per 100,000 children aged birth to 17 by county, along with the average age of these psychiatrists per state. In total across the nation, there were 10,597 child and adolescent psychiatrists and 74,077,738 children under the age of 18.19 “Ratios of [child and adolescent psychiatrists] per 100,000 children range by state from 4 to 65. . . [,]”20 while the number of psychiatrists per 100,000 children nationwide was, on average, a mere 14.21 This means that, on average, an abysmal 0.014% of children across the nation have access to a pediatric mental health care provider. Seventy percent of counties in the United States have none at all.22
With less than one-tenth of the necessary workforce available, the United States faces a drastic shortage in its pediatric mental health care workforce.23 This workforce shortage has serious implications on the lives of our nation’s youth. For example, “between 2015-16, suicide rates among adolescents were higher in areas with greater levels of workforce shortages, compared to areas without workforce shortages when other factors such as poverty were accounted for.”24 According to an original investigation led by Dr. Jennifer A. Hoffman, from 2015 to 2016, there were 5,034 youth suicides.25 The study “found that youth suicide rates in the U.S. are associated with county mental health professional workforce shortages, after adjusting for county demographic and socioeconomic characteristics. . . . Notably, [it] found that youth suicide rates increase as the degree of mental health professional workforce shortages increases.”26
Nearly 1 in 5 children have a mental, behavioral or emotional disorder, but only about 20% of these children receive the care they need.27 Shortages of mental health care providers “contribute to this unmet need, with geographic variation in workforce shortages across the [United States].”28 This structural barrier to pediatric mental health care is perhaps the largest obstacle to overcome – without access to a professional who is able to help and support them, children and adolescents are left feeling alone and uncared for. When there is no one for them to turn to in their time of need, all hope is lost, all optimism forgotten.
Insurance Insufficiency
It is no secret that medical care is expensive. “The financial cost of children’s mental health care is a commonly cited impediment for U.S. families. With many U.S. families struggling to be financially self-sufficient, obtaining the necessary care [is often not] affordable.”29 Poverty in and of itself can be a barrier to pediatric mental health care, and it would be inappropriate to not acknowledge that that barrier exists.30 However, this section will focus on the insufficiency of the health insurance market and of health insurance providers.
Following the adoption of the Patient Protection and Affordable Care Act in 2010, the health insurance industry was meant to be transformed and the cost of health insurance coverage for individuals who qualified was to be reduced.31 The ACA “expanded Medicaid eligibility, created health insurance exchanges, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage due to preexisting conditions.”32 The ACA also guaranteed access to mental health services in individual, small-group, and Medicaid expansion plans by requiring coverage of 10 essential health benefits, including mental health care.33
Though the ACA improved access to mental health care in the first 10 years after its adoption, gaps in coverage remain. Likely exacerbated by the COVID-19 pandemic, which caused many Americans to lose health insurance through their employment, 8% of U.S. citizens do not have health insurance.34 “Furthermore, because there may be health care coverage gaps, simply having health insurance does not necessarily make pediatric mental health care affordable for all families.”35 In the wake of the Trump administration, progress toward increasing health insurance coverage has halted as it relaxed regulations on non-ACA compliant insurance plans that could refuse mental health care.36
Moreover, although the ACA mandated mental health coverage for individual and small-group plans, large-group plans remain exempt from this requirement, and the enforcement of coverage parity varies by state.37 Concerns have been raised in studies regarding the adequacy of mental health provider networks, with approximately 113 million individuals living in areas facing shortages of mental health providers.38 A 2017 report by Milliman, a group specializing in supplements and specialty research, revealed that reimbursement rates for mental health and substance use disorder treatment providers under private insurance plans were significantly lower compared to reimbursement rates for other medical providers, relative to Medicare rates.39 When insurance plans fail to provide adequate reimbursement to providers, many opt out of participating in the plans’ networks. 40 Consequently, individuals seeking help may struggle to find an in-network provider and are often forced to seek treatment out-of-network, leading to increased expenses.41 The financial burden often forces many to forgo treatment altogether and face the consequences without necessary support.42
While strides have been made in the past decade to improve access to pediatric mental health care, the landscape of pediatric mental health care remains marred by significant challenges in terms of insurance coverage and affordability. Addressing these challenges will require concerted efforts from policymakers to ensure that all children have access to the mental health services they need without facing undue financial burdens. Echoing the pleas of the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry and the Children’s Hospital Association in their declaration of a national state of emergency in children’s mental health, policies must be implemented that relieve the financial burden related to pediatric mental health care on patients and their families.43
Psychosocial Barriers
A major distinction between disorders of the mind and disorders of the body, and the ability to receive care for such disorders, lies in the negative connotations surrounding mental health and mental health care. Because the symptoms of a mental health disorder do not often manifest as physical ailments, patients with mental health disorders are often believed to be exaggerating what they are experiencing or making it up entirely. Pediatric patients especially are viewed as seeking attention when complaining of mental health issues. The disorders discussed thus far in this article are typically considered “normal” behaviors of children and adolescents or are associated with just “growing up.” These negative perceptions surrounding mental health disorders inhibit pediatric patients’ ability to receive help when it is most needed. Additionally, when pediatric patients are fortunate enough to have people in their lives recognize and acknowledge that they truly need help, there is a stigma attached to their efforts to seek care that impedes such efforts and causes inadequate funding for and provision of mental health care.
Perceptions About Mental Health Disorders
Negative perceptions about mental health disorders erect a near-impenetrable barrier to receiving care, especially for pediatric patients. Adult patients possess a level of autonomy and a trust that pediatric patients do not, influencing the ability for pediatric patients to receive care. When parents disregard mental health symptoms as normal behaviors of a child, or as something that will pass with age, pediatric patients internalize these feelings and never seek the care they need. They do not possess the skills to reason with their parents or financial ability to seek help without parental supervision.
Despite the availability of well-established diagnostic tools for pediatric mental health disorders for over 20 years, parents and teachers are often unable to recognize the signs and symptoms of mental health problems in children.44 In the surgeon general’s 1999 national report on mental health, most children with mental health disorders – even those with well-recognized disorders like ADHD – were found not to have received treatment.45 Recognition of pediatric mental health needs often depends on the awareness of important adults in the lives of these children, like parents and teachers, but most are unable to identify the children’s need for mental health services.46
The inability to identify pediatric mental health disorders may, in part, be due to parent and adult denial of the severity of the disorders. In the National Stigma Study – Children, the first nationally representative study of public response to child mental health problems, 1,393 adults were surveyed regarding their ability to identify pediatric mental health disorders by using vignettes consistent with diagnoses of ADHD and depression.47 While respondents were able to differentiate “daily troubles” from mental health problems, it was found that the respondents were less likely to see disorders like ADHD as serious, as a mental illness or as needing treatment.48 Moreover, a substantial group who correctly identified each disorder rejected its mental illness label (ADHD 19.1%, depression 12.8%).49
One of the most challenging issues children and adolescents face involves parents who ignore, minimize or deny their child’s experience of mental health issues. When parents “refuse to recognize the pain that their children are going through, this can have dire consequences.”50 Parents who fail to recognize that their child is suffering, or who do not prioritize mental health, may downplay their son or daughter’s struggles, suggesting that the issues are merely physical, such as requiring more rest, food or engaging in physical activities. Such perceptions from parents can leave the child or teen feeling isolated and can erode trust within the family.51
Despite some awareness that their child’s behavior may be unusual, parents often do not define the problem as related to a mental health disorder that could benefit from diagnosis and treatment.52 Even if parents are able to recognize that their child is suffering with mental health issues specifically, they might “delay seeking care for their adolescent as they may think or hope the symptoms will go away on their own, be in denial, or think that mental illness cannot happen to their adolescent.”53 Additionally, concerns about stigma related to mental health disorders, the use of medicines and the cost of treatment or problems getting help have kept parents from seeking care on behalf of their child.54 Addressing these complex issues required not only increased awareness and education but also a shift in societal attitudes toward pediatric mental health, ensuring that all children and adolescents have access to the care they need for their well-being and future success.
Stigmatization of Mental Health Care
Mental health stigma “refers to the labeling and devaluing of a person based on negative beliefs, attitudes, and perceptions about mental health issues that results in status loss, discrimination, or stereotyping.”55 The detrimental impact of stigma on individuals dealing with mental health disorders is evident in the labeling and stereotyping they often face, especially related to seeking or receiving help. Rather than receiving understanding and support, pediatric patients with ADHD and other behavioral disorders are unfairly characterized as impulsive or wild; those with anxiety may be labelled as a coward or as uptight; and those with depression might be called antisocial or told to simply “snap out of it.”56 Such stigmatization not only perpetuates misunderstanding but also discourages individuals from seeking the help they need. “Deeply embedded in societal norms, stigma is a multifaceted issue permeating every level of [mental health care], leading to delayed treatment, increased morbidity, and a diminished quality of life for patients.”57
Stigma toward those seeking mental health care arises from misconceptions about mental health patients, social prejudice and stereotyping, and misinformation about the mental health field.58 Misconceptions about mental health patients often result in these patients being perceived inaccurately as dangerous, unpredictable or responsible for their condition.59 Furthermore, social prejudice and stereotyping can “foster a culture of fear, rejection, and discrimination” against mental health patients.60 Finally, misinformation can “hinder public understanding and acceptance of mental illness, exacerbating stigma while negatively influencing policy and legislation, leading to inadequate funding and support for mental health services.”61 A large contributor in reinforcing these stigmas is the media. Media platforms often portray inaccurate stereotypes about people with mental health disorders, sensationalize situations through unwarranted references to mental health disorders and may even use demeaning or hostile language when referring to those with mental health disorders.62 Many people get their information solely from the media, and when misinformation about mental health is amplified in television, movies and other forms of entertainment, viewers encounter a confirmation bias that only enforces their unfounded belief that mental health disorders are abnormal.
The profound impact of prejudice and discrimination on mental health patients surpasses the challenges posed by the disorders themselves. Stigma marginalizes mental health patients and leaves them feeling alone and vulnerable. Stigma in and of itself is distressing, can exacerbate the mental health disorders patients suffer from and can contribute to low self-esteem.63 This may cause patients to not seek treatment, withdraw from society, to cope by abusing alcohol and drugs or, in more serious cases, to suicide. 64
Stigma not only affects individuals’ well-being but also has broader societal implications, leading to discrimination in various aspects of life. School-age children are often “bullied, excluded from social groups, or become a victim of violence.”65 For families, the stigma can cause shame and isolation, making the pursuit of vital care and resources even more difficult for patients.66 “For society at large, stigma can result in the misallocation of resources, with mental health services often being underfunded and overlooked.”67
Stigma is a notorious and pervasive factor in shaping the level – and use – of resources available for individual and communal mental health needs. It causes community and health decision-makers to view individuals with mental health disorders unfavorably, leading to hesitancy in allocating resources toward mental health care.68 Moreover, stigma results in discrimination in the delivery of services for physical ailments and mental illness, as well as reduced utilization of diagnostic procedures for physical conditions.69 Interestingly, stigma has been found to contribute to burnout and demoralization among health care professionals, thereby diminishing the quality and delivery of care.70 The stigmatization of mental health disorders also creates distrust in the provider-patient relationship. Patients begin to distrust mental health care providers, “complicating matters to establishing trustful and therapeutic relationships, which are essential for effective care.”71
Mental health patients often are reluctant to receive care to begin with or avoid it altogether. The stigmatization of mental health disorders only serves to perpetuate feelings of inferiority and inadequacy and ensure that the mental health care field is underfunded, underutilized and undervalued. To ensure that individuals receive the care and support they need to lead fulfilling and healthy lives, overcoming mental health stigma is not just necessary, it is essential.
Dismantling the Barriers
The seriousness of pediatric mental health disorders and the effect they have on the health of the nation’s youth is not an unrecognized idea. In fact, advocates of mental health care have called on the nation’s policymakers to enact change since at least the turn of the century.72 Nevertheless, barriers to pediatric mental health care have been erected that permeate the health care system.
Stigma Reduction
The stigma surrounding mental health disorders and mental health care is perhaps the most difficult barrier to pediatric mental health care to dismantle, as it is essentially inherent in American culture and “[d]eeply embedded in societal norms. . . .”73 Reducing the stigma surrounding mental health is not a novel idea. In fact, in recent years “antistigma programming” has been implemented in various countries “to promote greater social equity for people with mental illnesses.”74 Scientific literature indicates that stigma is the result of a linear qualification of those with mental health disorders as “different,” and thus deserving of ostracization and marginalization:
First, people must distinguish and label a particular human difference . . . resulting in culturally derived categories that are used to differentiate people into groups. Second, labelled differences must be linked to a set of undesirable characteristics thus forming a negative cultural stereotype . . . that is summarily applied to every member of the group. Third, those who are so labelled and stereotyped are seen as fundamentally different from the dominant group . . . . Fourth, stigmatized groups are socially devalued and systematically disadvantaged . . . . Finally, stigmatization is entirely contingent on access to social and economic power, as only powerful groups can fully disapprove and marginalize others.75
Accordingly, approaches to stigma reduction must be “multi-faceted to address the many mechanisms that can lead to disadvantaged outcomes, and multilevel, to address stigma perpetuated at the individual and social-structural levels.”76
The first step in reducing the stigma surrounding mental health is to educate all persons and communities. This will necessarily involve providing accurate information about mental health disorders, including signs, symptoms and treatment options.77 Using correct terminology is also important to separate the person from their diagnosis.78 When speaking about a mental health disorder, separate the person from their diagnosis. For example, you do not want to call those with anxiety “high strung.” Instead, you want to say, “That person has an anxiety disorder.” “This simple shift demonstrates that a person is so much more than a diagnosis.”79 Moreover, research shows that having contact with someone who has a diagnosed mental health disorder is highly effective in reducing stigma.80 Interpersonal contact strategies have been linked to changes in overall behavior as well as long-term attitudinal changes.81 “Evidence suggests that fostering interactions with persons with mental illness may have an even greater impact on attitudinal changes than educational or protest strategies.”82 Notably, when compared to educational strategies, contact strategies have proven more effective in reducing stigma with adults, whereas educational strategies have proven more effective with children.83 With the goal of reducing stigma surrounding pediatric mental health, this distinction is imperative. Children need to be educated on the disorders their peers suffer from so as to foster communication and friendship rather than ostracization. On the other hand, adults need to have more interpersonal contact with children and adolescents who suffer from mental health disorders so they can have first-hand understanding that mental health disorders are not just “normal parts of growing up” and that these children and adolescents are not just “faking it” but rather that they are suffering daily with serious problems.
In contrast to personal and social stigma, where education and contact strategies are superior in their efforts to reducing stigma, advocacy activities are important in reducing systemic stigma. According to the World Health Organization, advocacy is a means of raising awareness about the importance of mental health disorders and mental health care and ensuring that mental health is on government agendas.84 “Advocacy employs numerous techniques including awareness-raising, dissemination of information, education, training, mutual help, counselling, mediating, defending, and denouncing.”85 In a first effort to achieve this objective, WHO established World Mental Health Day in 1992 to increase global awareness of mental health issues and support efforts that advocate for mental well-being.86 Then, in 2001, WHO implemented a significant advocacy initiative by placing mental health on the agenda of the 54th World Health Assembly, resulting in an agreement between 132 ministers of health that budgets for mental health care needed to be increased to relieve the financial burden placed on individuals in search of mental health services.87 Furthermore, advocacy groups like the National Alliance on Mental Illness engage in federal advocacy on policy issues with Congress and the executive branch by taking a nonpartisan approach to advocate on a wide range of policy issues.88 Most recently, in 2023, the National Alliance on Mental Illness urged Congress to continue their commitment to mental health by focusing on four key areas: (1) reimagining crisis response; (2) improving youth mental health; (3) advancing research; and (4) increasing access to care.89 Advocacy organizations are imperative in bringing mental health issues to the attention of the nation’s policymakers and are key to enacting real change.
Addressing the pervasive stigma surrounding mental health disorders and mental health care is a complex endeavor, deeply embedded within societal norms and cultural attitudes. Through coordinated action at various levels, progress can be made toward a more inclusive and supportive environment for pediatric mental health. This inclusivity and support are how the nation will finally be able to dismantle the stigma barrier to pediatric mental health care. It is imperative that American citizens and policymakers work together to ensure our nation’s children and adolescents feel supported so that they may receive the care they deserve.
Behavioral Health Integration
In addition to addressing individual mindset, institutional changes in the health care field are essential to dismantling barriers to pediatric mental health care. In an effort to revolutionize mental health care and make the necessary institutional changes to the field, the CDC advocates for behavioral health integration.90
[Behaviorial health integration] is an approach to delivering mental health care that makes it easier for primary care providers to include mental and behavioral health screening, treatment, and specialty care into their practice. It can take different forms, but BHI always involves collaborations between primary care providers and specialized care providers for mental health.91
“By bringing medical and behavioral health services together within primary . . . care settings, the integrated care team is better able to meet both the mental and physical health needs of the patient.”92 Accordingly, implementing behavioral health integration in the health care field has been shown to enhance outcomes for children and adolescents, increase efficiency and coordination in care delivery, increase treatment rates, reduce parental stress and enhance consumer satisfaction.93
The two most widely utilized models of behavioral health integration are the Primary Care Behavioral Health Model and the Collaborative Care Model.94 In contrast to the Collaborative Care Model, which is based on an adult chronic care management approach, the Primary Care Behavioral Health Model focuses on care across the lifespan (i.e., pediatric, adult and older adult populations).95 As such, it is the primary care model that should be utilized to improve pediatric mental health care and remove any barriers to care. This model implements comprehensive prevention and early identification strategies, along with providing targeted treatment for behavioral health conditions, suboptimal health behaviors that worsen physical health issues and chronic health conditions.96 Importantly, the primary care model has proven to decrease patient distress, decrease depressive and anxiety symptoms among patients with such disorders, reduce suicidal ideations and ensure continued access to mental health care services following the COVID-19 pandemic.97
The Primary Care Behavioral Health Model in pediatric primary care provides population-level care to more children, removes barriers to obtaining care, increases access to treatment and reduces the cost of mental health care services.98 By embedding behavioral health integration services in primary care settings, the primary care model mitigates the impact of provider scarcity by using existing health care infrastructure, eliminating the need for patients to seek out a specialized mental health care provider. Furthermore, by advocating for comprehensive, all-inclusive health care programs, the Primary Care Behavioral Health Model works to reduce stigma by normalizing mental health services and fostering a supportive and inclusive environment for pediatric mental health patients. This model of behavioral health integration may just be the key to dismantling both structural and psychosocial barriers to pediatric mental health care.
American Rescue Plan Act
The health care field is not the only institutional level at which changes must be made to dismantle the barriers to pediatric mental health care. In fact, “[l]iterature has shown that the school environment and teachers play a significant role in meeting children’s mental health needs.”99 By fostering a proactive and supportive environment within educational institutions, we can empower the nation’s youth to navigate the challenges of mental health rather than shy away from them, ultimately promoting a healthier and more resilient generation.
Following the declaration of a national emergency in children’s mental health by the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry and the Children’s Hospital Association in 2021, and in response to the increase in mental health needs in the wake of the COVID-19 pandemic, former President Biden passed the American Rescue Plan Act in March 2021, which included a budget of $170 billion for school funding, and many schools used the funding to hire mental health care workers, including psychologists.100
Furthermore, in his first state of the union address in 2022, Biden emphasized the importance of ensuring that every student has access to mental health care when they need it.101 In this address, Biden also committed himself to “doubling the number of school-based mental health professionals.”102 He promised that
the Department of Education would continue to support states, school districts, colleges and universities, in using relief funds . . . invested by the American Rescue Plan . . . to address the mental health needs of students, including by training, recruiting, and retaining more school- and college and university-based mental health professionals.103
In dedicating millions of dollars to youth mental health, the American Rescue Plan set the ball in motion for policymakers to dismantle the barriers to pediatric mental health care, and Biden intended to build on this investment. In his 2023 budget, Biden proposed “to make historic investments in youth mental health services, including more than $70 million in infant and early childhood mental health programs.”104
Despite promises of increased funding and access to mental health care in educational institutions, there is still work that needs to be done if the nation wants to witness true change in pediatric mental health care. As such, the Office of Elementary and Secondary Education advocates for use of American Rescue Plan funds to “increase access to mental health services, improve mental health systems, and reduce the negative attitudes, stigma, bias, and discrimination that [is] associated with mental health.”105 By way of dismantling the structural barriers to care, the office urged school districts to use the funds to create a positive and accessible process for students to seek help, including increasing mental health resources and support on school campuses and awareness of those resources and services.106 It further urged districts to ensure there was sufficient access to mental health care services for their students and that such services were equitable, welcoming and inclusive.107 To reduce psychosocial barriers to care, the office advocated for use of American Rescue Plan funds to improve communication and transparency about mental health support systems within the wider school community. The Office of Elementary and Secondary Education hoped these funds would be used to “meaningfully engage families and students and establish two-way communication between schools, mental health programs, and families to improve access to and awareness of available mental health resources.”108 Such openness and awareness is essential to reducing the stigma surrounding mental health disorders and mental healthcare.
Conclusion
Amid a national emergency in pediatric mental health care, children and adolescents are left feeling alone and out of options.109 Their struggles are often overlooked or underestimated, and the mental health care system continues to fail them. With less than one-tenth of the necessary workforce available, the United States faces a drastic shortage in its pediatric mental health care personnel.110 Moreover, even when there are providers available to help, insufficiency in the insurance market undermines any attempt to seek treatment. Gaps in health care coverage, despite the efforts of the ACA, mean that merely having health insurance does not necessarily mean that pediatric mental health care is affordable for all those who need it. 111
Perhaps most devastating are the negative perceptions about mental health disorders and mental health care that inundates American culture. Negative connotations surrounding mental health disorders and the inability for pediatric patients to effectively advocate for themselves manifest in the inability for children and adolescents to be taken seriously. Instead, symptoms of mental health disorders are seen as “normal” behaviors of childhood, and those suffering are often told to simply “grow up.” Additionally, the stigmatization of the disorders and of mental health care ostracizes children and adolescents who are suffering. Stigma marginalizes mental health patients and leaves them feeling alone and vulnerable.112 It creates disparity in the allocation and use of resources, distrust in the mental health care system and diminished quality of care.113 With the shame, despair and hopelessness pediatric mental health care patients face, both systemically and culturally, it is no wonder that in the last decade, suicide became the second leading cause of death among children and adolescents aged 10 to 24.114
Children are burdened with mental health disorders from cradle to commencement, and they are often left feeling as though the only way to escape their suffering is to end their life. This tragedy cannot continue. Echoing the sentiments of Dr. David Satcher, the 1999 surgeon general, “[w]e have allowed stigma and a now unwarranted sense of hopelessness about the opportunities for recovery from mental [health disorders] to erect these barriers. It is time to take them down.”115
Mikayla Kolahifar is a 3L at the Maurice A. Deane School of Law at Hofstra University, where she is a Dean’s Scholar. Mikayla focuses on health law and bioethics and will graduate with her J.D. in May. Prior to law school, Mikayla obtained her bachelor’s degree in biology from Stony Brook University. This article appears in a forthcoming issue of the Health Law Journal, the publication of the Health Law Section. For more information, please visit NYSBA.ORG/HEALTH_LAW_SECTION.
Endnotes
1 See Alexandra Schumm, The Escalating Children’s Mental Health Crisis and a Path Toward Solutions, Chartis, Mar. 10, 2023, https://www.chartis.com/insights/escalating-childrens-mental-health-crisis-and-path-toward-solutions [https://perma.cc/C8QG-PG8S].
2 Steven Berkowitz & The Conservation US, The Youth Mental Crisis Worsens Amid a Shortage of Professional Help Providers, Sci. Am. (Aug. 18, 2023), https://www.scientificamerican.com/article/the-youth-mental-health-crisis-worsens-amid-a-shortage-of-professional-help-providers [https://perma.cc/RZH6-XAPV].
3 Data and Statistics on Children’s Mental Health, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/childrensmentalhealth/data.html [https://perma.cc/M9QC-E63E] (last visited Feb. 7, 2024).
4 Id.
5 Id.
6 See Jyothsna S. Bhat, When Parents Deny Their Kids’ Mental Health Struggles, Psych. Today, May 26, 2022, https://www.psychologytoday.com/us/blog/the-psychology-the-south-asian-diaspora/202205/when-parents-deny-their-kids-mental-health [https://perma.cc/D5J8-99BG].
7 Data and Statistics on Children’s Mental Health, supra note 3.
8 Gabriel X.D. Tan et al., Prevalence of Anxiety in College and University Students: An Umbrella Review, 14 J. Affective Disorders Reps., 2023, at 1.
9 Jessica Bryant & Lyss Welding, College Students Mental Health Statistics, Best Colls., Feb. 15, 2023, https://www.bestcolleges.com/research/college-student-mental-health-statistics [https://perma.cc/95DN-N2RL].
10 Laura Kauhanen et al., A Systematic Review of the Mental Health Changes of Children and Young People Before and During the COVID-19 Pandemic, 32 Eur. Child & Adolescent Psychiatry 995, 995 (Aug. 12, 2022).
11 Owens et al., Barriers to Children’s Mental Health Services, 41 J. Am. Acad. Child & Adolescent Psychiatry 731, 731 (2022); see Dep’t Health & Hum. Servs., Mental Health: A Report of the Surgeon General (Howard H. Goldman et al., eds. 1999) [hereinafter Surgeon General’s 1999 Report].
12 Owens et al., supra note 11, at 731-32 (explaining that few studies have examined barriers to pediatric mental health care, and those that do tend to focus on accessibility of mental health services rather than on treatment retention).
13 Id. at 732.
14 Id.
15 David Satcher, Preface to Dep’t Health & Hum. Servs., Mental Health: A Report of the Surgeon General (Howard H. Goldman et al., eds. 1999).
16 See Declaration of a National Emergency in Child and Adolescent Mental Health, Am. Acad. Pediatrics, AAP-AACAP-CHA, https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health [https://perma.cc/4NTG-XYWE] (last visited Feb. 19, 2024) [hereinafter National Emergency Declaration].
17 Policy Statement on Behavioral Healthcare Workforce Shortage, Am. Acad. Child & Adolescent Psychiatry (Oct. 2023), https://www.aacap.org/AACAP/Policy_Statements/2023/Behavioral_Healthcare_Workforce_Shortage.aspx [https://perma.cc/5N3N-RB36].
18 See Workforce Map by State, Am. Acad. Child & Adolescent Psychiatry, https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx [https://perma.cc/6WSC-CALK] (last visited Feb. 19, 20214).
19 See id.
20 Severe Shortage of Child and Adolescent Psychiatrists Illustrated in AACAP Workforce Maps, Am. Acad. Child & Adolescent Psychiatry, May 4, 2022, https://www.aacap.org/aacap/zLatest_News/Severe_Shortage_Child_Adolescent_Psychiatrists_Illustrated_AACAP_Workforce_Maps.aspx [https://perma.cc/XK9G-NH9R].
21 See Workforce Map by State, supra note 18.
22 See Policy Statement on Behavioral Healthcare Workforce Shortage, supra note 17.
23 Id.
24 Id.
25 Jennifer A. Hoffman et al., Association of Youth Suicides and County-Level Mental Health Professional Shortage Areas in the US, 177 [J]AMA Pediatrics 71, 75 (2022).
26 Id.
27 Improving Access to Children’s Mental Health Care, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/childrensmentalhealth/access.html#ref [https://perma.cc/3546-NDFX] (last visited Jan. 22, 2024).
28 Hoffman et al., supra note 25, at 76.
29 Darisa M. Toure et al., Barriers to Pediatric Mental Healthcare Access: Qualitative Insights from Caregivers, 48 J. Soc. Serv. Rsch. 485 (2022).
30 See Toure et al., supra note 29.
31 Will Kenton, Affordable Care Act (ACA): What Is It? Key Features, and Updates, Investopedia, Sept. 23, 2022, https://www.investopedia.com/terms/a/affordable-care-act [https://perma.cc/S4FS-NFY6].
32 Id.
33 Jesse C. Baumgartner et al., The ACA at 10: How Has it Impacted Mental Health Care?, Commonwealth Fund, Apr. 3, 2020, https://www.commonwealthfund.org/blog/2020/aca-10-how-has-it-impacted-mental-health-care [https://perma.cc/38WS-H2HH].
34 Toure et al., supra note 29.
35 Id.
36 Id.
37 Id.
38 Id.
39 See Stephen P. Melek et al., Addiction and Mental Health vs. Physical Health: Analyzing Disparities in Network Use and Provider Reimbursement Rates, Milliman (2017), https://www.milliman.com/-/media/milliman/importedfiles/uploadedfiles/insight/2017/nqtldisparityanalysis.ashx [https://perma.cc/RA3K-5UUY].
40 The Mental Health Parity and Addiction Equity Act 10th Anniversary, ParityTrack, https://www.paritytrack.org/mhpaea-10th-anniversary [https://perma.cc/2L8X-S38X] (last visited Feb. 20, 2024).
41 Id.
42 Id.
43 National Emergency Declaration, supra note 16.
44 Peter S. Jensen et al., Overlooked and Underserved: “Action Signs” for Identifying Children with Unmet Mental Health Needs, 128 Pediatrics 970, 971 (2011).
45 Id.; see also Surgeon General’s 1999 Report, supra note 11.
46 Jensen et al., supra note 44; see Owens et al., supra note 11.
47 Bernice A. Pescosolido, Public Knowledge and Assessment of Child Mental Health Problems: Findings from the National Stigma Study-Children, 47 J. Am. Acad. Child & Adolescent Psychiatry 339 (2008).
48 Id.
49 Id.
50 See, e.g., Bhat, supra note 6 (sharing the story of a 15-year-old girl who was hospitalized after a suicide attempt – when the young girl confided in her parents that she was feeling depressed, her parents ignored her because they “thought it was a phase that would go away” and “didn’t take it as seriously as they should have.”).
51 Id.
52 Lori Saldago, “Tell Me When ‘Normal’ Stops”: How Parents Recognized Their Child’s Mental Illness, 11 Walden Univ. J. Soc. Change 1 (2019).
53 Parent Views on Addressing Mental Health Concerns in Adolescents, Mott Poll Report, Mar. 21, 2022, https://mottpoll.org/reports/parent-views-addressing-mental-health-concerns-adolescents [https://perma.cc/7L6S-Q3KV].
54 Mental Illness in Children: Know the Signs, Mayo Clinic, https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/mental-illness-in-children/art-20046577 [https://perma.cc/48SL-57G6] (last visited Feb. 26, 2024).
55 Loni Crumb et al., “Get Over It and Move On”: The Impact of Mental Illness Stigma in Rural, Low-Income United States Populations, 13 Mental Health & Prevention 143 (2019).
56 See Mental Illness Stigma, healthdirect, https://www.healthdirect.gov.au/mental-illness-stigma [https://perma.cc/N25T-BZXS] (last visited Feb. 26, 2024).
57 Ahmed A. Ahad et al., Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review, Cureus, May 26, 2023, at 1.
58 See Mental Illness Stigma, supra note 56.
59 Ahad et al., supra note 57.
60 Id.
61 Id.
62 Mental Illness Stigma, supra note 56.
63 Id.
64 Id.
65 Id.
66 See Ahad et al., supra note 57.
67 Id.
68 Norman Sartorius, Stigma and Mental Health, 370 The Lancet 810 (2007).
69 See id.
70 See Ahad et al., supra note 57.
71 Id.
72 See Satcher, supra note 15; see also National Emergency Declaration, supra note 16.
73 Ahad et al., supra note 57; H. Stuart, Reducing the Stigma of Mental Illness, 3 Global Mental Health, Mar. 2016, at 2.
74 Stuart, supra note 73, at 2.
75 Id.
76 Id.
77 5 Ways to End Mental Health Stigma, Children’s Health, https://www.childrens.com/health-wellness/5-ways-to-end-mental-health-stigma [https://perma.cc/693Y-E8ZQ] (last visited Mar. 8, 2024).
78 Id.
79 Id. (quoting clinical psychologist Nicholas J. Westers).
80 Stigma, Prejudice and Discrimination Against People with Mental Illness, Am. Psychiatric Ass’n, https://www.psychiatry.org/patients-families/stigma-and-discrimination [https://perma.cc/4VFL-WRCG] (last visited Mar. 8, 2024).
81 Rebecca L. Collins et al., Interventions to Reduce Mental Health Stigma and Discrimination 11 (2012), https://www.rand.org/content/dam/rand/pubs/technical_reports/2012/RAND_TR1318.pdf [https://perma.cc/8WGF-JNJD].
82 Id.
83 Id.
84 Stuart, supra note 73, at 9.
85 Id.
86 See World Mental Health Day, World Health Org., https://www.who.int/campaigns/world-mental-health-day [https://perma.cc/4HWC-M6SA] (last visited Mar. 8, 2024).
87 Stuart, supra note 73, at 9.
88 Nami’s Federal Advocacy, https://www.nami.org/Advocacy/Advocate-for-Change/NAMI-s-Federal-Advocacy [https://perma.cc/W6MQ-NU2P] (last visited Mar. 8, 2024).
89 Id.
90 Behavioral Health Integration, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/childrensmentalhealth/documents/access-infographic.html [https://perma.cc/3ZVG-NCM2] (last visited Mar. 13, 2024).
91 Id.
92 Behavioral Health Integration in Physician Practices, Am. Medical Ass’n (Feb. 6, 2024), https://www.ama-assn.org/delivering-care/public-health/behavioral-health-integration-physician-practices [https://perma.cc/79B8-4FD7].
93 Behavioral Health Integration, supra note 90.
94 Behavioral Health Integration Fact Sheet, Am. Pscyh. Ass’n (June 2022), https://www.apa.org/health/behavioral-integration-fact-sheet [https://perma.cc/4RN5-RQ27].
95 Id.
96 Id.
97 Id.
98 Id.
99 Toure et al., supra note 29.
100 Ashley Abramson, Children’s Mental Health Is in Crisis, Am. Psych. Ass’n, Jan. 1, 2022, https://www.apa.org/monitor/2022/01/special-childrens-mental-health [https://perma.cc/X5TT-CC5J].
101 Supporting the Needs of All Students with American Rescue Plan Funds, Off. Elementary & Secondary Educ., https://oese.ed.gov/files/2022/04/Mental-Health-Fact-Sheet.pdf [https://perma.cc/4VER-KX69] (last visited Mar.13, 2024).
102 Fact Sheet: President Biden to Announce Strategy to Address Our National Mental Health Crisis, as Part of Unity Agenda in His First State of the Union, White House, Mar. 1, 2022, https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union [https://perma.cc/W39G-5L3V].
103 Id.
104 Id.
105 Supporting the Needs of All Students with American Rescue Plan Funds, supra note 101.
106 Id.
107 Id.
108 Id.
109 See National Emergency Declaration, supra note 16.
110 See Policy Statement on Behavioral Healthcare Workforce Shortage, supra note 17.
111 Id.
112 Mental Illness Stigma, supra note 56.
113 See Sartorius, supra note 68.
114 See National Emergency Declaration, supra note 16.
115 Id.
