Our current health care system does not meet the needs of children with mental health disorders. Although 1 in 5 children in the United States suffers from a diagnosable mental health disorder, only 21% of affected children actually receive needed treatment. Mental illness is like any other disease; the earlier it is identified and treated, the better the health outcomes. Across the United States, there are serious shortages of pediatric subspecialists and child mental health providers, both groups that provide essential services to children and adolescents with special mental and physical health care needs. These shortages lead to decreased utilization of needed treatment, long wait times, and long distances traveled to care.
The AAP has been advocating tfor Congress to promote children's mental health by adopting policies that will develop a robust workforce of child and adolescent mental health specialists, facilitate the ability of primary care pediatricians to provide early identification and treatment for children with mental health disorders, and improve school-based mental health services and supports. In anticipation of congressional consideration of mental health reform, the AAP helped co-found a DC-based coalition called the Child and Adolescent Mental Health Coalition. Members of the coalition include provider groups, patient advocacy organizations, and organizations representing state mental health directors and counties. The Coalition sent a letter to congressional leaders offering recommendations for comprehensive mental health legislation.
The AAP approaches mental health as a component of overall health, and has long-standing support for federal mental health parity, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). In April 2015, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule outlining the application of MHPAEA to Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children's Health Insurance Program (CHIP). AAP submitted comments on the proposed rule. In March of 2016 CMS finalized the MHPAEA rule; AAP is continually monitoring implementation of MHPAEA in the public and private insurance markets and will continue advocating to ensure that children have access to robust mental and behavioral health benefits.
The AAP Department of Federal Affairs has been working to promote care and payment models that better integrate behavioral health in the pediatric primary care setting. One such approach is through support for statewide child psychiatry access programs. These innovative programs such as the Massachusetts Child Psychiatry Access Project and the Behavioral Health Integration in Pediatric Primary Care in Maryland program, support pediatricians' efforts to assess and manage mental health needs of children from infancy through adolescence through phone consultation, continuing education and resource and referrals. Legislation introduced by Rep. Dave Loebsack (see Children's Access to mental Health Services Act below) would provide an enhanced Medicaid administrative funding match to support states who want to create or expand access to this model.
Mental Health Legislation: Where AAP Stands
The AAP has endorsed the following proposals this Congress:
- The Helping Families in Mental Health Crisis Act (H.R. 2646), as passed by the House of Representatives on July 6, 2016. (AAP statement)
- The Children's Access to Mental Health Services Act (H.R. 5462) introduced by Rep. Dave Loebsack (D-Iowa), which would enable states to create the necessary infrastructure to develop and implement organized behavioral health access programs for children and adolescents. (Support letter)
- The Bringing Postpartum Depression Out of the Shadows Act (H.R. 3235, S. 2311), introduced by Reps. Katherine Clark (D-Mass) and Ryan Costello (R-Pa) and and Sens. Dean Heller (R-Nev.) and Kirsten Gillibrand (D-N.Y.), which aims to expand awareness, screening, and treatment for postpartum depression. (Endorsement letter)
- The Ensuring Children's Access to Specialty Care Act of 2015 (H.R. 1859) introduced by Reps. Chris Collins (R-NY) and Joe Courtney (D-Conn.), which would amend the Public Health Service Act to include pediatric subspecialists in the National Health Service Corps (NHSC) loan replacement program. (Endorsement letter)
- The Children's Recovery from Trauma Act of 2015 (S. 1494, H.R. 2632), which would reauthorize the National Child Traumatic Stress Network (AAP & Mental Health Liaison Group support letter)
- The Mental Health in Schools Act of 2015, introduced in the Senate by Senator Al Franken (D-Minn.) and in the House by Representative Grace Napolitano (D-Calif.), which provides access to more comprehensive school-based mental health services and supports (AAP & Mental Health Liaison Group support letter)
- The Mental Health Awareness and Improvement Act of 2015 (S. 1893, introduced by Senator Patty Murray (D-Wash.) and Senator Lamar Alexander (R-Tenn.), which reauthorizes and improves programs related to awareness, prevention and early identification of mental health conditions and promotes linkages to appropriate services for children and youth. (AAP & Mental Health Liaison Group endorsement letter)
- The Family Stability and Kinship Care Act of 2015 (S. 1964) introduced by Senator Ron Wyden (D-Ore.) opens up new eligibility for services, including child and parental mental health services, as a way to prevent the need for foster care. (AAP statement)
- The Garrett Lee Smith Memorial Act Reauthorization of 2015 (H.R. 938, S. 1299) reauthorizes the Garrett Lee Smith Memorial Act, signed into law by President George W. Bush in 2004, and would continue commitment to important youth and college suicide prevention programs. (AAP & Mental Health Liaison Group endorsement letter)