Accessibility to Mental Health Services for Children: How Can We Improve?

Jonathan Polakoff January 31, 2022

Mental health disorders can be detrimental to many aspects of life, including relationships, employment, long-term health effects, etc. According to the American Disability Act, mental impairment that substantially limits at least one significant life activity is considered a disability. More often than not, a mental health disability can lead to a financial burden to patients, families, and society (Drake et al., 2012). A report on mental health disability from an international perspective found that the rate of mental health disability is growing dramatically in free-market countries like the US. Furthermore, the prevalence of mental health disorders in children is as high as 13.4% (Polanczyk et al., 2015), which will be the focus of this blog.

Unless treated, mental health problems in children can persist from childhood through adulthood (Anderson et al., 2017). While mental health disorders are common among children, there are barriers to mental health services, which prevent them from receiving the help they need. As we know, COVID-19 was declared a pandemic over a year ago. Reports in late 2020 show evidence of declined mental health in children due to social isolation and loneliness from lockdown (Loades et al., 2020). Moreover, the pandemic increases children’s vulnerability to depression, stress, anxiety, avoidance behavior, and PTSD (Thakur et al., 2020). With the pandemic passing over us, we need to address the barriers to mental health services now more than ever.

Mental health services should be accessible to everyone as it has proven to be an essential component of overall health. Service-level barriers for access and engagement have been highlighted by different groups of users (Anderson et al., 2017). These barriers include lack of knowledge about available services, difficulty access and stress associated with the help-seeking process, extensive wait time, and financial restrictions. In addition, vulnerable populations like children and families living in poverty experience the barriers to a greater extent (Hodgkinson et al., 2017). Removing these barriers will help address rising rates of mental health disability (Drake et al., 2012).

In current literature, several methods had been proposed to tackle the barriers to mental health services, with policy change as the primary target. A on international trends suggests shifting to the prepayment system from out-of-pocket payment systems widely used in many countries (Drake et al., 2012). One benefit highlighted by the article is that the prepayment system allows individuals with low socioeconomic status to receive the equivalent healthcare as the wealthier people. Additionally, a different study recommends that we address a set of complementary policies, rather than focusing on just one lever, such as insurance-based policy lever, to manage multiple outcomes at the same time to see a population-level impact (So et al., 2019). Outside of the policy realm, one study suggests increased training of pediatric primary care physicians (PCP) as vulnerable children and families are more likely to use a pediatric PCP as a resource of mental health services (Hodgkinson et al., 2017). Overall, there are many ways to address the barriers to mental health services, but past studies suggest that policy changes will create the most impactful results.

References

Anderson, J. K., Howarth, E., Vainre, M., Jones, P. B., & Humphrey, A. (2017). A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people. Children and Youth Services Review, 77, 164–176. https://doi.org/10.1016/j.chil...

Drake, R. E., Bond, G. R., Thornicroft, G., Knapp, M., & Goldman, H. H. (2012). Mental health disability: An international perspective. Journal of Disability Policy Studies, 23(2), 110–120. https://doi.org/10.1177/104420...

Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving mental health access for low-income children and families in the primary care setting. Pediatrics, 139(1), e20151175. https://doi.org/10.1542/peds.2...

Loades, M., Chatburn, E., Higson-Sweeney , N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M., Borwick, C., & Crawley, E. (2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59(11), 1218–1239. https://doi.org/10.1016/j.jaac...

Polanczyk, G.V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. , Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. . Journal of Child Psychology and Psychiatry, 2015. 56(3): p. 345-365

So, M., McCord, R. F., & Kaminski, J. W. (2019). Policy levers to promote access to and utilization of children’s mental health services: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 46(3), 334–351. https://doi.org/10.1007/s10488...

Thakur, K., Kumar, N., & Sharma, N. (2020). Effect of the pandemic and lockdown on mental health of children. The Indian Journal of Pediatrics, 87(7), 552–552. https://doi.org/10.1007/s12098...