Tag cost

Ignoring Kids’ Mental Health Needs is Expensive

With most of the Affordable Care act being upheld this week by the Supreme Court, it seems like an apt time to review an example of how costs rise when kids’ mental health needs are not sufficiently addressed.

A few months ago The American Journal of Child and Adolescent Psychiatry published a national study regarding the cost of pediatric (age ≤ 18) usage of emergency room visits in the U.S. from 2001 to 2008. (As many know, ER and hospital care is usually much more expensive than outpatient care. Moreover, mental health problems are more likely to be treated in this more expensive setting when a youth’s outpatient needs for care have not been adequately attended to.) The abstract can be found here. Some high points:

• Of the 73,105 visits, 1,476 were for mental health issues. When appropriate statistical adjustments were made, it was estimated that there are 480,700 emergency department visits for mental health issues in the US each year.

• 21.8% of the mental health contacts arrived by ambulance compared to 6.3% of other kinds of contacts; they also stayed longer  (median 169 minutes vs. 108 minutes) and had a higher rate of admission into the hospital (16.4% vs. 7.6%).

• The rate of usage was not significantly different across gender and between Caucasian and African-American kids; however, the usage rates for Hispanics was lower than non-Hispanics.

• Quoting the authors: “Depressive disorders were the most common principal diagnoses, followed by anxiety and disruptive behavioral disorders or ADHD.”

• Following appropriate statistical adjustments, the researchers determined that 1/3rd of the mental health related visits to hospitals result in a hospitalization.

• Additional collateral costs (e.g., the need to have security personnel monitor the youth, the fact that many arrived with escorts that had a professional role in the child’s life) were also noted.

• Quoting the authors: “Probability of extended stays for mental health visits rose over the period that we studied. By 2008, the odds of an extended stay (> 4 hours) was almost twice that in 2001, and we did not observe comparable growth in the duration of non-mental health visits.”

The authors also acknowledge that their rates may represent underestimates of usage as they used stricter criteria for defining a mental health visit than have other investigators that have examined this area.

For me this study place another brick in the wall that demonstrates the tremendous costs–financial only being one of them–that accrue when we neglect the mental health needs of our children and teenagers. If you’d like to read more about this, please see Chapter 10 of my book Working Parents, Thriving Families, or any of the blog entries below:

Signs That a Kid Needs Mental Health Services

Seven Common Myths About Counseling

Affording Mental Health Care

Affording Mental Health Care

This entry reviews the cost issues affiliated with mental health care.  While paying a provider for counseling can be expensive, it need not be. Some thoughts to help:

• Many health insurance policies cover some portion of the cost. Often a client is left with only a small copay. Moreover, with the signing into law of the Mental Health Parity and Addiction Equity Act, many policies have expanded their coverage of mental health services.

• Monies spent on counseling are usually considered a medical expense and so may be deductible from your taxes..

• If you have a university in your region with a graduate program in the mental health professions (e.g., clinical psychology, psychiatry, etc.), they may have an outpatient training clinic that offers services at a very low cost. In these clinics those working towards advanced degrees often provide the care under the supervision of experienced faculty. For instance, I direct such a clinic and our most common fee is $10/visit.

• Most people do not live far from a community mental health center. These centers receive public funding to support their charter. Therefore, many of them will offer services on a sliding scale or otherwise arrange for flexible payment plans. If you’re unsure where the one by you is, call up any psychologist in the yellow pages and ask.

• There are a number of charitable organizations that sponsor mental health services on a sliding or a reduced fee scale (e.g., Catholic Charities, Jewish Social Services, etc.). In all of the instances that I know of, one need not belong to the sponsoring religious group in order to get care.

• If you or a loved one suffer from a chronic medical or psychiatric problem you may qualify for support from social security. To find out more be in touch with an attorney that specializes in disability applications, your local community mental health center or your state’s mental health or disability offices.  Other programs may also be available if you cannot afford health insurance.

• Many providers may be willing to reduce their fee if you can show cause. I would not ask for this up front. But, after the evaluation is concluded, and the provider has come to know you and your circumstances, it never hurts to ask. The large majority of the thousands of mental health professionals I’ve met over the years are a mission-driven lot who care deeply about what they do. To find such a person near you, click here.

In factoring cost issues please also consider what it would be worth to be free of the problems that are having you consider getting care. What would it be worth to be free of depression, to have your child stop acting defiantly or be free of anxiety, to have your marriage healed, etc.? Imagine life with troubling mental health burdens either eliminated or controlled; then ask yourself what that would be worth?

For my post about common myths about counseling click here.

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