Hidden in the new children's health insurance plan signed by President Obama is a gift to millions of low-income parents: increased insurance coverage for children with mental-health problems. Before, 60 percent of the states had more limited coverage for mental health. The new law for the State Children's Health Insurance Program not only expands health coverage to 4 million more children beyond the 6 million already covered but also brings mental-health parity to the state programs that provide insurance for children in low-income families, requiring that they get the same access to treatment for bipolar disorder, depression, anxiety, and other serious disorders as they do for physical ailments.
"Mental-health needs are nowhere near being met," says Jay E. Berkelhamer, past president of the American Academy of Pediatrics and chief academic officer at Children's Healthcare of Atlanta. "At least 20 percent of all visits to pediatricians' offices are related to mental-health problems."
Normally, though, overworked pediatricians may not ask if a child has a mental-health problem—and may not know where to refer him or her if they do. About 20 percent of children and teenagers have a mental-health problem at any given time, or about 8 million to 13 million people. Two thirds of them are not getting the help they need.
Low-income families face bigger problems than most in getting help, with their children more likely to experience mental-health problems and affordable care more elusive. The first step, even for parents who aren't sure they meet income limits: Check out the CHIP program in your state. Each state's program is different, and eligibility rules will change as the new law, which mandates $32.8 billion for expanded coverage over five years, goes into effect.
But even with insurance coverage, finding treatment for a child's mental-health problem can be difficult to impossible. David Palmiter, a clinical psychologist in Clarks Summit, Pa., who gives workshops around the country on access problems, offers these strategies to help find care:
1. Look for a doctoral program in psychology at a local university. Such programs offer training programs that provide pretty thorough care. Although the providers are trainees, they're very closely supervised.
2. See if there's a community mental-health center in your area. These federally funded programs offer reduced-fee or free care, and the wait isn't necessarily long.
3. Religious charities provide mental-health care regardless of your religious affiliation. Catholic Charities and Jewish Mental Health Services are two good examples.
4. If you've found a provider you like, ask him or her for a break on the fee. Palmiter advises that you go in for an evaluation first, before asking for the discount. "I think most clinicians, once they've gotten to know a kid or family, are very open to that." Choosing a clinical social worker (with an M.S.W.) is another way to save; they are trained and licensed but are less expensive than M.D.'s or Ph.D.'s.
5. Find local support groups for your child's disorder (like CHADD for attention deficit hyperactivity disorder, and ask other parents for advice on finding good doctors or therapists.
Last year, Congress passed a mental-health parity law that requires commercial insurers to cover mental and physical ailments equally. This new law ensures that the 10 million or so children who will now be eligible for CHIP will have the same level of access. "It's exactly the same principle," says Kirsten Baronio, senior director of government affairs for Mental Health America. "This will help tear down the barriers to get access to care, care that's really critical for the healthy development of a lot of kids."
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