By Amy Kennedy, Education Director, The Kennedy Forum
In mid-April, the U.S. Preventive Services Task Force (USPSTF) released a draft recommendation stating all kids aged eight to 18 should be screened annually for generalized anxiety disorder (GAD) and all youth aged 12 to 18 should be screened annually for major depressive disorder (MDD).
These recommendations follow a thorough analysis of evidence, and declarations within the past year from the U.S. Surgeon General and leading youth health organizations warning of a youth mental health crisis.
By age 14, an average of 50% of children with mental health conditions exhibit symptoms, with an even lower median age onset for impulse-control and anxiety disorders. When we fail to detect these symptoms early, consequences like substance use, school drop-out, incarceration, homelessness, and even suicide, are more likely to follow. By implementing the USPSTF drafts into formal recommendations, we can cast a much larger safety net.
I was happy to see news of the USPSTF screening recommendations spread quickly—even popping up in a recent Saturday Night Live skit. People—and mainstream media and entertainment—are finally talking about something that for far too long has remained hidden in the shadows. Because the truth is, it wasn’t just the pandemic that spurred an increased need to address youth mental health. Parents, caregivers, and advocates have been calling for better access to care and better prevention efforts for decades, amid serious red flags.
But regardless of how we got here, the time has come for meaningful change. If the USPSTF recommendations are adopted, nearly all private and commercial insurance plans nationwide would have to cover assessment screenings without patient cost-sharing. Progress!
Other preventative “physical” care services are already required to be covered by most plans without cost-sharing, including well-child visits and cancer screenings. Consider that suicide accounted for nearly four times the number of deaths in teenagers aged 15 to 19 in 2019 compared to deaths from cancer. Yet only the latter is nationally covered in terms of prevention services.
As is the case for many mental health and substance use conditions, Medicaid is much farther ahead of private insurers in its coverage of preventive services and screenings. Congress enacted Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) in recognition of the unique needs of children’s development and the importance of the early identification and treatment of their needs. The EPSDT benefit provides Medicaid-eligible children and adolescents with a broad entitlement to mental health care. And, as the name suggests, it includes regular screenings for common mental health conditions.
While some states, like New Jersey, have enacted legislation that disallows cost-sharing for mental health screenings, nationwide coverage would make these essential prevention screenings available to allchildren. After all, it’s well-documented that cost-sharing discourages treatment for low-income communities, directly affecting families in urban and rural areas experiencing poverty.
Nevertheless, there is one major problem with USPSTF’s current recommendations that must be addressed: the exclusion of a suicide risk assessment. Though overall rates of suicide have trended downward in recent years, rates of suicide for adolescents aged 10 to 24 remain on the rise. For high schoolers, one out of every 53 students makes a suicide attempt serious enough to necessitate medical treatment. Rates are even higher rates within minority communities.
In fact, racial and ethnic minorities experience the highest rates of mental illness, but are at a lower likelihood to receive care. And with two-thirds of children who lost a parent or caregiver to COVID-19 belonging to racial and ethnic minority groups, we have to account for the disproportionate emotional weight on under-resourced populations.
Marginalized communities across the board already feel the effects of inadequate care. In the National Survey on LGBTQ Youth Mental Health 2021, released by The Trevor Project, it was found that an overwhelming 77% of LGBTQ youth experienced symptoms of GAD, closely followed by 70% experiencing symptoms of MDD.
Public comment and support of the USPSTF draft recommendations are the primary vehicle for propelling them into use. Please take a moment to comment here in support of USPSTF’s screening recommendation for major depressive disorder and here to request reconsideration for the screening recommendation for generalized anxiety disorder to include suicide risk assessment.
We are on the verge of a great awakening around mental health. Access to free screening tools for youth will save lives. Let’s ensure these good ideas see the light of day and start the transformation we so desperately need.