Access to Adolescent Mental Health Care

As symptoms of mental health disorders emerge and develop, they have strong influences on an adolescent’s behavior and can become more difficult to treat. Although effective therapies exist for many mental health disorders, not all adolescents who need treatment receive it.¹ The following disparities may partially explain why use of mental health services differs by gender, age, race/ethnicity, income, and other characteristics:

• Twenty-one percent of youth ages 6 to 17 who live in poverty have mental health disorders.²
• Half of all youth in the child welfare system, and nearly 70 percent of youth in the juvenile justice system, have a diagnosable mental health disorder.³
• Children who are living in foster care have a substantially greater risk of experiencing mental health disorders, especially those connected with traumatic stress, such as abuse and neglect.³
• Lesbian, gay, bisexual, and transgender (LGBT) youth have higher rates of mental health disorder challenges than other youth.⁴
• High school students who identify as lesbian, gay, or bisexual are much more likely to think about suicide than those who identify as heterosexual.⁵
• Female adolescents are more likely than male adolescents to receive mental health services.²
• Asian adolescents are less likely than adolescents of most other races/ethnicities to receive mental health services.²
• White youth are more likely to receive mental health services compared to youth of color.³
• A higher proportion of Hispanic youth have unmet mental health needs, compared to black and white youth.³

Advances in Mental Health and Health Care Related Legislation

The Mental Health Parity and Addiction Equity Act of 2008, the Affordable Care Act of 2010, and the recent Medicaid expansion in many states have helped improve access to mental health services for Americans of all ages:⁶

• The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that insurers cover and reimburse services for mental health and substance use disorders as they would other physical health services. However, MHPAEA does not require health insurance plans to include mental health/substance use disorders benefits; its requirements apply only to insurers that include mental health/substance use disorders in their existing benefit packages.
• The Affordable Care Act (ACA) requires that most individual and small-employer health insurance plans—including all plans offered through the Health Insurance Marketplace—cover mental health and substance use disorders services. Additionally, under the ACA, most health plans must now cover preventive services (e.g., depression screening for adults and behavioral assessments for children) at no additional cost.
• Medicaid expansion includes benefits for people with mental health and substance use disorders, and states that coverage must meet the same parity requirements required under MHPAEA for other health plans.
• The Children's Health Insurance Program also is required to comply with mental health and substance use disorder parity requirements.

Footnotes

¹ U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm ^{back to top}

² Lipari, R. N., Hedden, S., Blau, G., & Rubenstein, L. (2016). The CBHSQ report: Adolescent mental health service use and reasons for using services in specialty, educational, and general medical settings. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/adolescent-mental-health-service-use-and-reasons-using-services-specialty-educational-and ^{back to top}

³ Interagency Working Group on Youth Programs. (2018). Mental health: Prevalence. https://youth.gov/youth-topics/prevalence-mental-health-disorders-among-youth ^{back to top}

⁴ Interagency Working Group on Youth Programs. (2018). LGBT: Behavioral Health. https://youth.gov/youth-topics/lgbtq-youth/health-depression-and-suicide ^{back to top}

⁵ U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2020). Reduce suicidal thoughts in lesbian, gay, or bisexual high school students. https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt/reduce-suicidal-thoughts-lesbian-gay-or-bisexual-high-school-students-lgbt-06 ^{back to top}

⁶ Frank, R. G., Beronio, K, & Glied, S. A. (2014). Behavioral health parity and the Affordable Care Act. Journal of Social Work in Disability & Rehabilitation, 13(0), 31–43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334111/ ^{back to top}