Tens of thousands of adolescents in Connecticut still do not have access to effective mental health care, despite the passage of a 2008 federal law requiring health insurers to provide equal benefits for mental health.

Poor access to care leads to undiagnosed or misdiagnosed mental illness in children and adolescents, an increase in use of emergency rooms for psychiatric issues, and is a risk factor for severe mental illness, substance abuse, failure in school, and entering the juvenile justice system.

National studies show that about 1 in 5 children and teens have mental illness, but only one quarter of them receive services. “That leaves about 125,000 children without mental health care in Connecticut,” said Susan Kelley, director of the Alliance for Children’s Mental Health.

Some say that estimate is low, partly because it doesn’t capture mental illness misdiagnosed as behavioral problems. “I think that’s a very optimistic figure,” said Eliot Brenner, PhD, president and CEO of the Child Guidance Center of Southern Connecticut. “It’s probably closer to 80 percent who need mental health treatment that aren’t getting it,” he said.

Advocates point to low reimbursements by health insurers, which discourage psychologists and other mental health providers from joining networks, and lead to high out-of-pocket costs for families. In Connecticut, poor access can also be traced to a lack of coordinated services for children and families in need.

Low insurance participation

Many qualified mental health providers do not participate in insurance networks in Connecticut.

In fact, state legislators are pushing for the passage of Senate Bill 384 that requires insurance companies to offer a larger network of mental health providers and require mental health screenings at all annual physical exams.

A study in JAMA Psychiatry found that a little over half of psychiatrists nationally take insurance, compared with close to 90 percent of physicians in other medical specialties. One reason is low reimbursement rates, according to a report by the National Alliance on Mental Illness (NAMI). “For the amount of time that’s needed to spend with a patient, the private insurers don’t pay enough for many clinicians to accept insurance,” Brenner said.

According to the NAMI survey, 34 percent of people with private insurance reported difficulty finding a mental health therapist in network. Of those who had received residential mental health care, 27 percent reported trouble finding an appropriate facility, either in or out of network, and 24 percent had to go out of network, racking up large out-of-pocket costs. “There are hard-working middle-class families who do pretty well, but they can’t afford certain mental health services, especially residential care,” Kelley said.

Evelyn Cope…

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