Schools Poised to Anchor Youth Mental Health Services — Reimbursement, Privacy Concerns Pose Barrier

American K-12 schools could be the epicenter of an accelerating effort to address the youth mental health crisis.

Lawmakers, advocates and entrepreneurs see schools as the best place to center addressing the youth mental crisis because that’s where kids are for major portions of any given day for most of the year.

The American compulsory education system makes school a natural anchor for several aspects of a community, Suzanne Button, senior clinical director of high school program for the Jed Foundation, told Behavioral Health Business.

“It is a very logical place to address mental health needs from that perspective,” Button said.

Basing the renewed approach to addressing the youth mental health crisis also makes the most of existing infrastructure within communities. Schools and school districts already have organizations dedicated to deploying resources for the benefit of kids. And since they are tapped into the everyday life of their students, Button said that they would be able to identify and direct the right solutions for their unique community needs.

However, the onset of the coronavirus pandemic has deepened the youth mental health crisis — which was worsening before the pandemic.

In February, American Psychological Association Chief Science Officer Mitch Prinstein said that the U.S. was at a historic turning point that’s similar to the era following World War II when the federal government created the Veterans Administration and the National Institute of Mental Health.

Prinstein called on the Senate to invest $1 billion in new money into youth mental health research and called it “a very small proportion of the allocation currently offered to study conditions that afflict far fewer youth than those currently suffering from psychological disorders” during a February 1 meeting of the U.S. Senate Committee on Health, Education, Labor, and Pensions.

The first few months of the year have seen several movements around federal initiatives around mental health, especially youth mental health.

President Joe Biden revealed a “unity agenda” that included addressing mental health reforms in his State of the Union address at the beginning of March.

The House Subcommittee on Health of the Committee on Energy and Commerce held a nearly day-long meeting on April 5 to address 19 bills related to mental health reforms and program renewals — among them the KIDS CARES Act which would help schools get reimbursed for medical and behavioral health screenings for youth discharged from juvenile detention.

On April 21, the Biden administration released the “National Drug Control Strategy,” an overarching strategy document that laid out principles and objectives for the executive branch to follow in addressing addiction and illicit drug trafficking. K-12 schools would have an increased role, with support from the federal government, to increase prevention initiatives based on assessments of drug-use risk and adding more screening methods to identify potential use.

The U.S. Senate Finance Committee discussed and heard testimony on February 15 from experts on making schools the rallying point for youth mental health reforms.

The committee is leading several of the Senate’s efforts to draft legislation that addresses the worsening mental health crisis in the U.S. that was driven to new lows by the fallout of the coronavirus pandemic.

While no specific legislation or formal measures were discussed at the February 15 meeting, Chairman Sen. Ron Wyden, a Democrat from Oregon, said that he hoped that the testimony of experts, advocates and young people themselves would mobilize the Congress to act on mental health reforms.

Much of the conversation and movement in Congress followed a rare advisory issued by the Office of the Surgeon General in December about the importance of addressing the mental health crisis.

“The message of so many young people getting lost in the system is another extraordinary takeaway from today’s hearing,” Wyden said during the committee meeting.

Speaking to youth mental health advocate Trace Terrell of La Pine, Oregon, who testified at the meeting, he added. “I want you to know right at the heart of our work is our judgment — Democrats and Republicans — that our country is better than this. … You are going to have a seat at the table.”

Other experts discussed the many barriers to children receiving mental health treatment.

Many highlighted the 11-year gap that persists between when a mental health issue manifests and initial treatment, which some contend could be reduced with more resources and greater cultural acceptance of getting help for mental health issues in schools.

Barriers to schools addressing youth mental health crisis

They also contrasted that with many existing issues facing the typical American school district — chronic underfunding, poverty, staff shortages and a lack of mental health literacy by staff, students and parents alike.

The existing issues that schools face also run up against two federal privacy measures — the Health Insurance Portability and Accountability Act, which protects patient data, and the Family Educational Rights and Privacy Act, which allows parents access to and the protection of student records. These laws can leave schools feeling hesitant to get involved too deeply in the mental health of their students, the experts said.

Dr. Tami Benton, Psychiatrist-in-chief and executive director of the department of child and adolescent psychiatry and behavioral sciences at Children’s Hospital of Philadelphia, said that these laws complicate bringing telehealth into schools to solve access issues. Telehealth in schools was discussed at length as a means to overcome regional staffing issues and barriers like internet access.

“Some schools may have one or two school counselors, but not necessarily access to a provider team of psychiatrists that can partner with the schools,” Benton said, adding that schools may consider establishing community clinics or urgent care in or near schools.

Even when screenings or what services that do exist in schools reach students, Benton and others said the collective mental health system often fails to connect youth with services outside of schools.

“The other area that I would say is critical is really expanding data systems that allow for the seamless sharing of data between health and education sectors, and that has been done well in several districts and state,” Sharon Hoover, a professor of child and adolescent psychiatry and co-director of the National Center For School Mental Health at University of Maryland School of Medicine, said. “It’s just not widespread enough.”

But other big-picture issues may limit access to mental health services for students in the greatest need.

Many behavioral health providers don’t accept the comparatively low reimbursement rates for behavioral health services from the federal-state safety-net health plan Medicaid and its companion program for children — the Children’s Health Insurance Program (CHIP). This requires patients to pay for services out-of-pocket or rely on some other means of covering the cost of care.

The latest federal data show that 6.97 million children were insured through CHIP as of January 2022. Medicaid and related safety-net plans are the largest payers for mental health services in the U.S. including for youth. However, all the experts told the committee that access issues tied to low reimbursement extend into commercial plans as well.

Wyden tied lower reimbursement rates in the U.S. at large to lax enforcement and lower compliance with existing laws that require health plans to reimburse mental health services at a commensurate rate as physical health services. Parity is proving to be a flashpoint as advocates for mental health reform and those aligned with insurers’ interests strive to have their input on the legislative process.

“Without a realistic reimbursement structure, based on their current cost of living, there [are providers] who can no longer afford to work in mental health settings,” Jodie Lubarsky, vice president of clinical operations and youth and family services for Seacoast Mental Health Center, said. “While we can discuss an ideal service array, evidence-based practices and ideal care settings, none of this can be provided without a robust, well-trained, adequately compensated and sustainable mental health workforce from all professional disciplines and degree levels.”

Businesses seek to be an added resource to schools

Certain entrepreneurs are seeing opportunities to build businesses dedicated to serving youth in need within the structure of the K-12 school system.

For example, the San Francisco-based mental health startup Daybreak Health launched on the premise that it could use telehealth and other virtual tools to meet the mental health needs of youth in California.

Founded in early 2020, the company has established partnerships with 100 California schools and pediatricians who refer families to Daybreak health when an issue is identified. The company’s website says over 200,000 students have access to Daybreak Health’s services.

The company has landed a $10 million funding round at Series A. Menlo Park, California-based Lightspeed Venture Partners led the round with participation from Palo Alto, California-based Maven Ventures. Axios reports that individual investors included BetterUp’s Alexi Robichaux, Remind’s Brian Grey and GSV’s Deborah Quazzo.

Similarly, San Francisco-based physical and mental health telehealth provider Hazel Health aims to enhance efforts that are ongoing in schools and help schools better coordinate support for students. Founded in 2015, Hazel Health works with school districts to provide equipment to facilitate on-demand and scheduled physical and mental health services in collaboration with existing counselors’ or nurses’ offices. The company supplies tablets, headphones and a cart of over-the-counter medications that Hazel keeps current.