Are We Ready to Honor the Promise of “Free” Depression Screenings for Teens?
December 23, 2016 | By: Andy Carter
One in ten Pennsylvania teenagers has suffered from a major depressive episode during the past year—and many more go undiagnosed. Without early detection and treatment, depression can cause problems at home and school––and can follow teens into their adult lives.
According to the Substance Abuse and Mental Health Services Administration’s most recent National Survey on Drug Use and Health, the percentage of youth aged 12–17 with depression increased from 8.2 percent during 2011 to 11.4 percent during 2014. Pennsylvania tracks closely with this trend.
According to the Centers for Disease Control and Prevention, 16 percent of high school students reported considering suicide during the previous 12 months, and about half made an attempt.
Depression screening for adolescents is a covered preventive health service
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 required health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care.
The Affordable Care Act (ACA) expanded MHPAEA’s requirements by ensuring that qualified plans offered on the Health Insurance Marketplace cover many behavioral health treatments and services. Depression screening for adolescents is a preventive health service that is to be provided at no cost by most health insurers.
These critical preventive health services must be maintained in any plans to replace the ACA.
Fulfilling the promise in practice
Family doctors, pediatricians, and emergency departments are the de facto health system for families. By default, this also makes them the de facto mental health system, trusted by their patients to recommend care.
Primary care providers are charged with detecting and preventing physical health illness through routine medical checkups. It only makes sense that we would incorporate preventive health services for mental illness in primary care settings to help overcome the obstacles—fear, stigma, and uncertainty—that often keep patients from seeking out mental health services. Regardless of whether an adolescent shows signs of depression, primary care physicians should provide adolescent patients with a universal depression screening.
Hospitals are proactive
The Children’s Hospital of Philadelphia (CHOP) knows this, and has been working to improve mental health care for its pediatric patients.
CHOP has implemented routine depression screening in its emergency department and most of its primary care practices, many of which now feature collaborative care models that co-locate medical and mental health services.
The CHOP Division of Psychiatry also implemented the Behavioral Health Integrated Program, which provides comprehensive inpatient and outpatient psychiatric assessment of children with chronic illnesses.
Through routine depression screening for teens, providers have the opportunity to intervene early and connect their patients with the treatment and resources they need.
To implement mental health care in their practices, primary care providers will need the training and resources to facilitate preventative screenings.
Hospitals and health systems play a crucial role in facilitating appropriate treatment for depression. There are many ways that facilities can support their physicians:
- Enhance mental health training for clinicians
- Develop education tools for staff and patients and their families
- Provide support to integrate depression screening into the clinical workflow
- Ensure efficient communication between medical and mental health providers when transferring patients for care
Taking action: How policy-makers can help
HAP and other patient and provider stakeholders are working to reduce some of the regulatory barriers to providing teen depression screenings and early intervention in primary care settings.
Until recently, physical health and mental health providers faced barriers to providing co-located, coordinated patient care, due to rules that hindered multiple providers from enrolling in the state’s Medical Assistance program under the same address.
HAP recently worked with the state Department of Human Services to establish an attestation process to streamline the enrollment process, and make it easier for physical providers and mental health providers to practice side-by-side.
Recognizing the severe shortage of pediatric mental health providers, HAP is working to remove barriers to the use of telehealth services that can help bridge the workforce gap in vulnerable communities. Providers can and should increase the use of telehealth services to provide access to mental health screenings, assessment, diagnosis, counseling, and treatment programs. Insurers should reimburse providers for those services.
HAP has worked with the Department of Health to secure much needed flexibility within the state’s licensure environment to support the use of telehealth. In addition, HAP has been working to secure passage of legislation that defines the key components of telemedicine, and, for the first time, requires health insurers to provide reimbursement for telemedicine services if they pay for the same service in person.
We are making progress, but the data tells us we must do more. The resources are available to identify problems earlier and get teens the support they need. Lawmakers, state and federal leaders, and health care advocates must continue work to remove outdated regulatory barriers and give providers the flexibility and reimbursement needed to better coordinate care and increase access to services.
One young person at risk is one too many.