What You Don’t Know About the Children’s Mental Health Crisis
Or What Insurance Needs to Know about Hurting Families
I’m a children’s mental health counselor. I’m in the trenches. I sit across from families desperate for solutions I feel unqualified to provide. I spend countless unpaid hours on the phone and online trying to find help for people in a world where that help just doesn’t exist.
I knew before starting that working with kids would be complicated. I knew helping set up interventions at schools would take time and effort. That dealing with parental divorce meant twice the paperwork and 2–3 lawyers (Mom’s, Dad’s, and the court-appointed Guardian ad Litem who speaks for the child. Supposedly.)
I spent extra money on training that wasn’t required. (Did you know you can treat kids without any specialized training in treating kids?) I shopped for toys and books to help with communicating with the youngest clients. I poured my wallet into the work in a way that many providers can’t afford.
But I was prepared for that.
I wasn’t prepared for everything.
I was surprised to learn that the agencies tasked with protecting children turn down cases of suspected abuse without investigating every single day because they literally don’t have the manpower to intervene and are just trying to keep the worst cases of torture and sexual abuse from resulting in tragic ends. I have seen a parent smack a kid around in my office, and there was nothing I could do to stop it.
I cried myself to sleep watching families falling apart under the strain of alcohol and drug dependency, financial disaster, food insecurity, and parental mental disorders who fall through the cracks due to a lack of options for intervention. I’ve spent hours on the phone contacting community agencies, only to be told that the family lives too far away or doesn’t qualify because of a million pointless excuses.
I was surprised by my waiting list. Right now, if you call to schedule an appointment with me, you might have to wait 6–9 months. That’s unconscionable. And there is nothing I can do about it because there aren’t enough providers.
When a child is suicidal, emergency departments often must turn them away because of lack of space and providers, implementing safety plans and trusting parents to do the difficult work of supervision, and leaning on outpatient counselors to oversee treatment without ever meeting them.
But I press on. For the sake of the children. The next movers and shapers of this nation. If we want to fix the mental health crisis, it starts with helping the children.
Our idealism won’t last. But the reason isn’t what you think.
When I treat an adult, I can bill for a 60-minute session with almost no time spent outside of the session. When I treat a child, they usually only have the attention span to handle a 45-minute session (a price disparity of 150% under some insurance plans) Additionally, that same child will mean 15 minutes of time setting up the toys, cleaning up the toys, and taking notes on the session. Minimum. If that child also means talking to parents, schools, and lawyers, the unpaid time just goes up from there. Sometimes as much as an hour of unpaid time per session.
So, for an adult client, I take home an average of $30 per hour. For kids, it’s closer to $20 per hour once you factor in the unpaid time. And that doesn’t include the extra training and the extra supplies, which is an ongoing expense for things like craft supplies and take-home projects. Dropping the average to closer to $14 per hour. And did I mention that maintaining a license requires paying for classes every year and paying a fee every two years?
Financially speaking, providing kids quality care is a stupid decision when you have $70,000+ in school debts just for the Master’s degree required to get the license. If one does see kids, it makes more sense to not be trained, not buy equipment and supplies, and not bother updating parents or reaching out to schools and community agencies.
And now, insurance has pulled another “money-saving” change to billing coding that shoots pediatric mental health providers in the foot. They removed play therapy from qualifying for “interactive complexity.” Apparently, crawling around on the floor with an autistic child trying to help him understand emotions using puppets doesn’t qualify as a communication barrier anymore.
As my boss so kindly pointed out, “It’s only $2 per appointment less.” Look at the math. $12 an hour. I could make twice that driving buses.
I posit that the children’s mental health crisis is partially because big insurance companies don’t pay those of us in the trenches what we need to provide quality care. And it needs to change.
We need to be provided appropriate training for working with kids. It should be part of that $70,000 degree. We need funding and grants for the play equipment we use in session. And we need paid for the dichotomy in work between adult and pediatric clients.
Or we won’t keep seeing kids.
That is the real crisis.
