Original article written by Shannon Firth for MedPage Today
Improving mental health care means educating youth, investing in the workforce and the science, and eliminating barriers to treatment, witnesses told senators during a Senate Committee on Health, Education, Labor and Pensions (HELP) hearing earlier this month. Concerns over suicide has trickled down to 10-, 11-, and 12-year-olds, said Sen. Lisa Murkowski (R-Alaska) in opening remarks she delivered while briefly filling in for Richard Burr (R-N.C.), the committee's ranking member.
According to mental health advocate and recent Alaskan high school graduate Claire Rhyneer, young people are scared to speak up about their mental health. Sometimes they don't think they need the help, or they diminish their problems, she added. "They're afraid they'll be seen as weak, or crazy, or attention-seeking ... wacko, broken, a lost cause, any of those things." Rhyneer, who took a "gap year" to work for the National Alliance on Mental Illness, is working with other mental health advocates to try to pass a bill to bring mental health education to K-12 schools. Health classes already cover things like nutrition, dental health, and cancer prevention, she said, "and mental health deserves to be a topic in one of those classes. It's just as important.”
In addition to schools, hospitals have been battling a surge of mental health cases, and emergency departments are overcrowded due to a shortage of psychiatric beds. Dr. Mitch Prinstein, chief science officer for the American Psychological Association, noted that children's hospitals saw a 42% increase in injury and suicide cases in 2021. Asked what Congress can do to reduce delays in psychiatric care, Prinstein said that while adding more hospital beds might seem like the answer, the real solution is further upstream: increasing the number of outpatient providers. The science is there, and the treatments work; what's needed is more people to deliver the treatments and prevent kids from getting to a crisis stage, he urged.
The U.S. invests $15 billion annually to make sure the country has enough clinicians to provide physical health care in the appropriate specialties, but only 1% of that funding is directed towards the mental health workforce, Prinstein noted. As for immediate actions that Congress could take, over 5,000 psychology trainees could help shore up the mental health workforce if Medicare reimbursed them during residency, the same way medical residents are reimbursed, he said. He called for expanding graduate psychology education and minority fellowship programs, and increasing loan repayment for mental health professionals.
Another witness, Michelle Durham, MD, MPH, a pediatric and adult psychiatrist at Boston Medical Center, described barriers to delivering evidence-based mental health care, noting the prior authorization requirements that providers must contend with when transferring a patient to an inpatient psychiatric facility. "You would never do that with someone who comes in with a heart attack to the emergency room," but social workers, case managers, and sometimes physicians often spend hours trying to secure authorization for a bed, she said. Similarly, Durham has fought to keep children on medications after insurers changed their formularies. This can take hours, leaving her with less time for patient care.
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