American adolescents are in the midst of a mental health crisis. Surging demand for treatment of anxiety, depression, substance use disorders, and suicidal thoughts is colliding with a shortage of specialists, especially for children and teens.
According to a 2017 Milbank study, “1 in 5 children and adolescents aged 9 to 17 years may have a diagnosable psychiatric disorder. Yet not a single state in the country has an adequate supply of child psychiatrists, and 43 states are considered to have a severe shortage.” Similar trends hold true for non-prescribing behavioral health practitioners.
And that was five years ago.
According to the American Psychological Association’s 2022 Trends Report, “less than 4% of the more than 100,000 U.S. clinical psychologists are child and adolescent clinicians.” Another 2021 JAMA Pediatrics meta-analysis of over 80,000 participants found that “youth mental health difficulties” during the pandemic have “likely doubled.” This increase in demand and shortage of qualified specialists explains why many kids and teens can wait up to six months for mental health services. The American Academy of Pediatrics even declared “child and adolescent mental health a “national emergency” in October of 2021.
The COVID-19 pandemic served as a boiling point for the adolescent mental health crisis, increasing anxiety and depression rates among adolescents to all-time highs. Inadequate resources, restrictive insurance and billing requirements, and a lack of access to timely, effective adolescent mental health treatment has been a problem in the U.S. for decades. But there is a solution that can lower costs, expand access, and improve outcomes for kids of all ages with clinically-proven mental and behavioral health treatments.
Here’s how the right blend of technology and integrated care can bridge the gaps in America’s adolescent mental health treatment crisis.
Benefits of Integrated Care in Adolescent Mental Health Treatment
Integrated behavioral health care combines an interdisciplinary care team with measurement-based assessments, evidence-based treatments, and real-time tracking tools. With these tools adolescents can receive a continuum of care between their primary care providers (PCPs) and behavioral health specialists. Critically, integrated care allows providers to identify behavioral health conditions sooner and prevent crises before they occur. While the research continues to develop for integrated care in adolescent populations, it overwhelmingly supports the benefits of integrating behavioral health treatment and physical medicine to improve outcomes, lower costs, improve patient experience, and improve physician satisfaction.
One Milliman analysis even suggests that adolescents would be “two-thirds more likely to have a better outcome after receiving integrated medical-behavioral treatment than if they’d received usual care.” And engagement with integrated care models is critical to improving long-term outcomes as well as identifying and treating high risk individuals, especially adolescents.
We’ve observed the connection between high engagement rates with personalized, evidence-based resources and clinically-validated improvements in health outcomes, regardless of age. Individuals using the NeuroFlow platform have seen significant improvement in depression symptoms, particularly when taking part in a collaborative care (CoCM) program—one of the most vetted and effective models of integrated care. For example, 60% of individuals enrolled in CoCM through NeuroFlow achieved a response (50% reduction in symptoms) within 4-8 months of their first clinical-level assessment.
When you combine the powerful tools of the integrated care model with the ease and convenience of digital mental health tools, adolescents can receive consistent treatment remotely between in-person visits, which can help fill the gap in adolescent mental health specialists.
“The health care system in the U.S. was designed for adults. And when it doesn’t work for young people, we call them noncompliant and hard to reach. But it’s actually the system that’s hard to reach.”
— Angela Diaz, M.D., Ph.D., M.P.H. Director of the Mount Sinai Adolescent Health Center
Technology can reduce the burden for providers by identifying at-risk individuals so that they can be treated before a crisis occurs, and monitor patients with intelligent assessments and consistent data-driven care. This level of granularity allows providers to adapt treatment to each individual.
Remote telehealth technology can be especially beneficial for adolescent mental health treatment, as younger people—or “digital natives”—have grown up with technology as part of their daily lives. But integrated care comes in a variety of degrees, each with their own cost, benefits, and demands.
How it Works: Integrated Care Models for Adolescent Primary Care
Behavioral health integration (BHI) isn’t the same for adolescents as it is for adults. Kids see primary care providers (PCP) more often than adults, and shortages in adolescent behavioral health specialists can create care gaps. This makes it even more important to adopt the right kind of integrated care model to help increase access to quality care in a way that scales.
Here are three of the most common ways to adopt adolescent integrated care.
Consultation models—like the Massachusetts Child Psychiatry Access Project (MCPAP)—are one of the easiest ways to address the shortage of adolescent psychiatrists and other mental health professionals.
PCPs can partner with behavioral health specialists for assistance with patients that have a behavioral health concern. This initial phone consultation with a child psychiatrist can then lead to anything from an in-person clinical assessment, short-term therapy, or other community resources. And the results of this single integration are substantial.
Providers who partnered with MCPAP reported an increase in their “confidence in meeting the needs of children with behavioral health problems” from 8% to 63%.
Having behavioral health specialists on-site in a pediatric primary care setting is obviously one of the best ways to increase access to care while improving outcomes. And while the success of this integrated care method relies on addressing shortages of behavioral health specialists, the increased coordination can drastically streamline billing and lower costs.
Collaborative care is a team-based model that links PCPs with psychiatric consults to provide care. In this model behavioral health care managers help address barriers to care and facilitate self-management for more efficient, effective care, working with both the PCP and psychiatric consult. When providers adapt this model to include specialists that meet their specific needs and scale, collaborative care delivers incredibly positive outcomes.
A 2014 randomized, controlled trial of collaborative care in pediatric primary care analyzed the impact of adding on-site care managers to address ADHD and anxiety. The trial found “numerous benefits of BHI over usual treatment.” Those included “higher rates of treatment initiation and completion and improvement in behavior problems, parental stress, treatment response, and consumer satisfaction.”
Improving Adolescent Mental Health Treatment
Whichever model you choose, integrated care is essential to addressing the adolescent mental health crisis in the United States. Integrating mental health treatment into primary care can lower costs, help networks scale to meet demand, and provide more adolescents with better access to mental health treatment than ever before.
Learn more about how NeuroFlow helps organizations deliver integrated care remotely.