In many industrialized countries, all adolescents showing signs of mental illness receive early, comprehensive psychological care. The outcome is that these young adults often overcome or learn to manage their conditions.
But in the United States, young people with emotional problems are left to fail in school, develop substance-use problems, exhibit angry and suicidal behaviors and often wind up in the criminal justice system with their families struggling to cope.
A key reason for the disparity is the lack of comprehensive coverage for mental health services offered by U.S. health insurance providers.
It is well known that most serious mental disorders emerge during adolescence and that the best outcomes are achieved through comprehensive care delivered when the earliest signs of mental illness emerge.
Early mental health care and treatment for our youths would be transformative – for education, health care, the criminal justice system, the economy and our entire society.
Most importantly, it would give young people access to our new and ample arsenal of early treatment approaches to combat mental illness.
California is leading the way in the prevention and early intervention for youth mental health care, through the state Mental Health Services Act.
In Sacramento, the county Department of Behavioral Health Services’ Early Diagnosis and Preventive Treatment Program, with UC Davis, has used resources from the Mental Health Services Act to change how we treat youths with mental illness.
The county’s program provides personalized, comprehensive assessment and care for people 12 to 25 with emerging signs of serious mental illness, such as schizophrenia or bipolar disorder. It receives hundreds of referrals each year from schools, families and the community.
Mental Health Services Act funds support all elements of the psychosis specialty care model, including coordinated community outreach, education and stigma reduction, comprehensive assessment and individualized treatment planning, psychiatric care and counseling and, critically, recovery programming.
This means all young people experiencing the onset of a serious mental disorder who have Medi-Cal or are uninsured can receive state-of-the-art, comprehensive psychosis care.
But young people with private health insurance do not have access to many elements of this treatment model, such as interdisciplinary care coordination, case management and recovery services, including supportive education and employment, which are critical to successful prevention and early intervention.
In a parallel Early Diagnosis and Preventive Treatment Program at UC Davis that treats youths with health insurance, families who can do so pay for some of these services. Some have been supported by the state or by philanthropy. But for many young people, they remain unavailable.
A young person in Sacramento experiencing the onset of serious mental illness has better access to comprehensive care if they are uninsured.
Clearly it is time to revisit how we reimburse for mental health services.
Our understanding of how evidence-based practices can change the course of serious mental illness has grown immeasurably. How we deliver those services to youths has evolved.
With better outcomes and more young people remaining insured by their parents until age 26, health plans should consider bundled-care approaches that include care coordination and recovery services that yield better outcomes and reduce expensive hospitalizations.
Reimbursement for the range of evidence-based approaches that affect the onset of serious mental illness would address the gap in psychiatric care for California youths and serve the interests of insurers.
The Mental Health Services Act is driving innovation through the public mental health system. It’s time more political leaders in California fully support comprehensive mental health care services for all our precious youths.
And it’s time that health plans recognize it’s in their financial interest to cover them.
Cameron Carter is a professor of psychiatry and director of the Behavioral Health Center of Excellence at UC Davis. Frederick J. Meyers is vice dean of the UC Davis School of Medicine. Darrell Steinberg is the director of policy and advocacy at the Behavioral Health Center of Excellence and the founder of the Steinberg Institute.