Behavioral Health Needs Spike for Children and Young Adults. How Providers Can Help

A new analysis of private healthcare claim records finds behavioral health disorders spiking among young people. Find out what one health system is doing to intervene.

Children and young adults are bearing the brunt of increased utilization of behavioral health services, a recent white paper published by New York–based FAIR Health says.

Over the past two decades, there has been a nationwide increase in behavioral health disorders. Suicide rates increased steadily from 1999 to 2014, according to the Centers for Disease Control and Prevention. A large-scale study found that the prevalence of major depression rose from 2005 to 2015. And the number of hospital stays for mental health and substance use disorders rose 12.2% from 2005 to 2014.

FAIR Health President Robin Gelburd told HealthLeaders that the nonprofit organization's white paper sheds light on key behavioral health trends.

"To meet this growing demand for mental health services, we are seeing patients being treated in less traditional venues, such as in a telehealth setting. In some states, we also see behavioral health conditions represented among the top conditions presenting in hospital emergency rooms. By releasing the type of data we include in our recent study, stakeholders can better understand the prevalence of different types of mental health diagnoses and the demographic character of those statistics," she says.

Behavioral health by the numbers
 

The white paper features an analysis of data from 2007 to 2017 drawn from FAIR Health's database of 28 billion private healthcare claim records.

At the macro level, the FAIR Health data shows a 108% increase in behavioral health diagnoses, increasing from 1.3% to 2.7% of all medical claims. Generalized anxiety disorder claims spiked from 2007 to 2017, increasing from 12% to 22% of mental health claims.

The white paper includes behavioral health statistics for children and young adults that are particularly striking:

• For youth aged 11 to 18, claims for adjustment disorders increased 54%.
   
• The pediatric share of claims for major depressive disorder rose from 15% to 23%.
   
• Claims for generalized anxiety disorder (GAD) among high school- and college-aged people increased by greater percentages than any adult group. Claims for GAD rose 441% among college-aged people and 389% for high school-aged people.
   
• In 2017, people 18 and under accounted for 32% of cannabis abuse claims, which was higher than any other age group.

Causes of increased behavioral health disorders in young people
 

Gelburd says there are likely three primary causes of the increase in behavioral health disorders among young people:

1. Mental health parity law: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 required a health plan's coverage for behavioral health treatment to be at parity with its coverage for medical-surgical treatment.

2. ACA: In 2010, the Patient Protection and Affordable Care Act made behavioral health an essential health benefit and enabled young people to remain as dependents on their parents' private insurance until age 26.

3. Social factors: The increased prevalence of depression and anxiety in young people may be associated with several social factors such as growing academic pressures, greater use of smartphones and social media, and school shootings.

Texas children's medical center rising to the challenge
 

Last year, Dell Children's Medical Center of Central Texas opened a new mental health unit at the Austin-based facility. The Grace Grego Maxwell Mental Health Unit has treated nearly 1,000 children over the past year, says Roshni Koli, MD, medical director of Pediatric Mental Health Services at Dell Children's.

"Being part of a children's hospital allows us to more holistically care for both the physical and mental health needs of our children and adolescents. Every child admitted to our MHU has an evaluation from our pediatric hospitalist team, which remains involved to help with any physical needs or questions that may arise," Koli says.

The new mental health unit features a multidisciplinary approach to care, including a dedicated art and music therapist as well as expanded nursing and social work teams. The new building also has an enclosed courtyard with a healing garden, so patients can get fresh air and play games such as basketball on a daily basis.

There are unique challenges when treating mental health disorders in children and young adults, Koli says.

"Children and adolescents with mental health disorders are among the most vulnerable individuals in our community. Understanding a child's mental health disorder means understanding their unique story and working closely with their family to understand all the aspects of their environment that are impacting their mental health," she says.

In supporting the construction and staffing of the Grace Grego Maxwell Mental Health Unit, the Austin metropolitan area is rising to the challenge of treating the growing number of young people who need mental health services, Koli says.

"The need for mental health treatment for our children and adolescents is large, and we often run into difficulties with shortages of providers and resources. However, our community recognizes the importance of mental health in our children and adolescents. With the continued collaboration with pediatricians, hospitals, and community partners, we can continue to reduce the stigma of mental health," she says.

The Dell Children's leadership team has played an important role in the new mental health unit's success, Koli says.

"We have been fortunate at Dell Children's to have the support of our leaders to expand our mental health program to meet these growing needs. Our vision is to provide excellent clinical care to every child who comes to our hospital and clinic, and to do so in a timely manner, reducing the barriers to accessing mental health care," she says.