Boston Medical Center Tackling the Childhood and Adolescent Mental Health Crisis

As the COVID-19 pandemic wanes with a tangible end in sight, assessing its aftermath is only beginning. In its wake is a plethora of pressing matters, many of which have been amplified by COVID-19. “A big, bright light is now shining on all these inequities that existed prior to COVID,” notes Michelle Durham, MD, MPH, child and adult psychiatrist at Boston Medical Center. One issue in particular holds youth and adolescents in its grip: a longstanding mental health crisis worsened by the pandemic.

The crisis before COVID-19

The Centers for Disease Control and Prevention report suicide to be the second leading cause of death among children and adolescents younger than 18. The pervasive issue is underscored by several factors that have contributed to mental health struggles: delayed reporting, barriers to access and racism and discrimination. “In general, most kids will say they were 12 or 13 when they first noted something was not right,” explains Durham. “There’s a gap between kids knowing that something’s not right and when they actually get help. That gap is about 10 years, which is pretty substantial.” Other possible factors that play a role in delaying care include the stigmatization of a mental illness, downplaying one’s own symptoms or not understanding mental health issues.

Mental health conditions are more prevalent for children raised in poverty and exposed to adverse circumstances. Among these, Black and Latinx children are disproportionately affected. Magnifying this inequity are challenges surrounding access to mental health care—due to low reimbursement rates and added administrative burden, many private practices do not accept state- and government-issued health insurance like MassHealth. “As a society, we have never invested in equitable reimbursement for mental health the way we do for physical health so it’s unfortunately no surprise we are in the place we are now,” says Durham.

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