As the pandemic continues, mounting what may be another wave of infections, it’s time to stop and reflect on the mental health crisis we’re facing today, especially among our children. I’m the volunteer state coordinator for the Selective Mutism Association, a parent and a former school nurse, and I’m seeing the urgent need to make mental health services more accessible for children and their families.
In 2013, my son Ram spontaneously developed a condition called selective mutism, a childhood anxiety disorder. Children with this disorder lose the ability to speak in certain social situations. In my son’s case, he stopped speaking to anyone outside of our home at age 3. I didn’t realize there was a problem until the preschool teacher told me he no longer talked at school. As a mom and a children’s advocate, I diligently researched treatment options and found out that he needed Cognitive Behavior Therapy. After three months of searching for a therapist taking new patients, I finally found an experienced psychologist familiar with child development and who understood selective mutism. My husband and I felt so relieved— until we found out she doesn’t take insurance.
It turns out, this scenario is common. Health insurance — whether private or through California’s Medi-Cal program — doesn’t pay what many psychologists request for their services. Ram’s psychologist charges $200 an hour. Yet a typical insurance reimbursement rate for psychotherapy in California is around $85 a session. Many therapists decline insurance because rates like these do not cover the cost of providing care. That leaves many families unable to afford mental health care for their children, even if they have insurance.
In the case of my family, we paid for Ram’s therapy out of pocket and then filed a claim with our insurance company to try to get reimbursed. Much to our frustration, our insurance did not reimburse any of the cost. We had a high deductible plan that required us to spend $12,000 before any care would be reimbursed.
While this was manageable for my family, I shudder to think what this situation would mean for lower-income families or one-parent households. Even so, it was a difficult journey for our family. I put my career on hold so I could provide full-time support to Ram and teach staff at his school how to support him as well.
Thankfully Ram is now fully recovered and a confident speaker. He even spoke on a panel with me about selective mutism in 2019, which made me so proud.
Unfortunately, many families that have a child with selective mutism cannot access the resources that were vital for us. Not only do many California families have to cope with the stress and worry of caring for a child with a mental health disorder, but they must also pay a hefty price to get their child treatment. Many do not have the resources to pay out of pocket, let alone try to navigate the system, and they don’t have the ability to take time off work. Those who speak a language other than English or lack health insurance can face even more barriers.
Not being able to pay for mental health services can impact whether a child overcomes selective mutism, anxiety or other mental health struggles. In my work at the state level, I hear from many parents struggling to find psychotherapy for their children that is covered by health insurance. It’s also a common topic of discussion on Facebook support groups, where parents go to find advice on how to navigate the complicated insurance system. We need policy changes that improve coverage of mental health treatments so that our children can regain their mental health and thrive.
Mental health programs in schools are one way to help provide care for children with anxiety and other disorders. As a former school nurse, I’ve seen many students deal with social and separation anxiety as a result of online learning and the pandemic. Transitioning back to in-person learning at the beginning of the 2021-22 school year was very difficult for children at the schools I worked at. My office was constantly busy with students complaining of nausea, tummy aches and headaches — symptoms frequently associated with anxiety. I assessed each child, noted when children made recurrent visits for the same symptoms, and called their parents to give them guidance on how to ease their child’s anxiety about going back to school.
Thankfully, children are unbelievably resilient, and by October, the number of health visits related to anxiety had decreased at my assigned schools. It was a team approach; parents, teachers, fellow nurses, administrators and staff members all worked toward the common goal of helping transition students to a regular school routine. However, I know some of the students I worked with would have benefited from additional therapeutic support. Yet many families did not have the means or the insurance coverage to pay for therapy outside of school.
The need for better, more affordable access to pediatric mental health care is urgent. A recent study by the U.S Department of Health and Human Services found that, between 2016 and 2020, the number of children ages 3 to 17 with anxiety and depression increased by 29 percent and 27 percent respectively. These rates have likely increased even further since then, given the well-documented youth mental health crisis in the wake of the pandemic. The study highlights the critical need to support mental and emotional well-being of parents and caregivers.
The Health Resources and Services Administration, which conducted this study, offers recommendations for expanding access to children’s mental health services. These include training child psychiatrists and psychologists to modify treatment plans according to a child’s developmental stage and investing in growing the mental health workforce. These recommendations, if implemented, could make a huge difference in improving children’s mental wellbeing. However, they do not address the problem of insurance coverage and reimbursement, an issue I believe must be central to efforts to improve our mental health system.
While we await changes at the policy level, I encourage parents to continue advocating for their children and learning how to support their mental health. Platforms such as the Selective Mutism Association and Child Mind Institute, for example, offer free, educational webinars and resources. The Selective Mutism Association also has a directory of mental health professionals searchable by geographic area. No matter the challenge, a parent’s love, support and advocacy can go a long way toward helping a child heal.
Lola Ravid is a registered nurse and freelance writer who is passionate about child advocacy, child mental health and parent education.