House lawmakers, expand children’s outpatient mental healthcare access now

The children’s mental health crisis isn’t going anywhere. Suicide has emerged as the second leading cause of death among adolescents and young adults, and despite 80% of chronic mental health disorders beginning in childhood, only 20% of afflicted children receive care from specialized providers, with even fewer receiving follow-up care.

Vignesh Subramanian

On the flip side, Connecticut’s schools fail to meet both the American School Counselor Association’s recommended 250:1 student-to-counselor ratio and the School Social Work Association of America’s recommended 250:1 student-to-social worker ratio — a deficit of support in the de facto frontline of mental health services for youth that allows less than 25% of those diagnosed to receive any treatment there.

The incompatibility between our schools and mental healthcare systems is a pressing issue, particularly amid the ongoing COVID-19 pandemic that has shone a spotlight on preexisting systemic faults. Workload-related pressures compounded by lack of social interaction have exacerbated underlying stresses among students; quarantines have sharpened concern about unaddressed anxiety- and depression-associated psychiatric disorders; many children, unable to escape family and home for extended periods, have lost access to safeguards at school and in public.

That is why I worked with my State Sen. Will Haskell (D-26) this legislative session to incorporate a key provision that addresses such gaps in the care pathway into Senate Bill No. 2, a comprehensive proposal on children’s health and safety that was formally approved by the Senate on May 5. This particular provision (Section 10) would expand minors’ access to outpatient mental healthcare by removing the cap on the number of counseling sessions they may seek without parental consent, allowing children in difficult home situations to maintain their privacy while taking advantage of therapy services to address critical needs.

Access to outpatient mental healthcare is particularly crucial in cases where parents may obstruct outreach to practitioners or where informing parents may worsen contributing factors. Some parents may outright reject the notion of their child speaking to mental health professionals over concern about stigma or the effects of prescribed medication. Patterns of abuse and contention over sexual orientation in the household can also incentivize children to look beyond immediate caregivers for models of support and security.

As the state’s Department of Children & Families and the Connecticut Medicaid Outpatient Behavioral Health Clinic Services have previously found, vulnerable children utilizing therapy generally require more than six sessions – the current cap – to meet their goals, and the overwhelming majority of outpatient care authorizations for minors explicitly pertains to mental health. Allowing minors to seek an unlimited number of outpatient counseling sessions would align ease of access with these clinical realities while keeping parents conditionally informed of developments in diagnoses, recommendations, and treatment plans.

Children may, in many instances, feasibly take advantage of expanded access by seeking coverage under CHIP, Medicaid, school plans, or external sponsorship. Depending on their insurance, minors may also be guaranteed counseling for depression and screening for interpersonal violence under the Affordable Care Act at no additional cost. Digitally-connected children may access care via telehealth services and promptly contend with symptoms – a viable substitute for physical visitation at a time when reimbursement rates for behavioral office visits remain low and the costs of late-stage inpatient care surge. Despite the logistical hurdles that remain, providing minors with this last-resort discretion would further minimize the number of those left to fend for themselves.

To the youth who have exhausted all options with regard to reaching out for support, the gift of new means of access – of just one more option – can make all the difference. I urge House lawmakers to pass Senate Bill No. 2 and uphold our state’s commitment to being a standout model for the availability of its public health resources. Let’s save lives.

Vignesh Subramanian lives in Wilton.

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