So Mr. Surgeon General,
we are doing a story about child
mental health in the pandemic
and there are three major themes
that we identified by talking
to experts here on the ground.
One is that wait times are
continuing to increase.
That reimbursement rates are
not keeping up with inflation.
So private practice people are either
getting out of the business or now
requiring that they're not accepting
insurance or taking out of pocket.
And the third is that there simply are
not enough people to deal with the demand.
And pandemic has simply
exasperated the problem.
So of those three themes are you
hearing the same thing nationally,
and what as a nation do we need
to do to handle this quote UN
quote avalanche of children that
are in desperate need of help but
are being told on the other end
of the phone by their parents?
There's no one to help your child.
You're going to have to be on a
wait list for a year or six months.
Well Kevin, first of all,
this is a critical issue and I
appreciate you drawing attention to it.
You've mental health matters not
just because it's gotten tougher for
a lot of kids during the pandemic.
That is a really important reason,
and we know depression.
Anxiety have increased for many
children during this pandemic,
but the truth is that our kids were
struggling before the pandemic as well.
Rates of suicide had increased
by more than 50% in the decade
or so preceding the pandemic.
We'd also seen a 44% increase.
The percentage of high school
students who were saying that
they felt persistent feelings of
sadness and hopelessness in the
decade prior to the pandemic.
So our kids were struggling before the
pandemic has made it worse for some kids,
especially those 140,000 plus young
people who lost a caregiver to COVID-19.
And there are a couple of
challenges that we've got to meet
and meet as quickly as we can.
One of them is exactly what you mentioned.
The gap in treatment,
and the reason that people are having
difficulty accessing treatment
comes from several sources.
One. We don't have enough mental
health care providers.
We need more.
The second is,
despite in 2008,
passing the mental health parity
law and Addiction Equity Act,
which was supposed to bring
reimbursement for mental health care
services into parity with other
traditional health services that
is not being adequately enforced
in many parts of the country.
And so you're finding that
reimbursements are still too low.
But we're also Kevin not using
technology well enough to bring mental
health services to rural areas.
Even to urban areas which may
not have the number of providers
that they actually need,
technology can be a boon if we
actually saw that during the pandemic.
But we've got to make sure that we
close the gaps in broadband access
and bring these services to people
where they are, so there's a.
I feel a great sense of urgency around this.
I'm a dad first and foremost.
I've got two small kids who are
four and five.
Thankfully they are well now,
but I want to know as a father and
as a doctor as a surgeon general,
that if any child in our country needs help,
we have the help available.
For them,
and that is just not true everywhere
right now.
What do we do? What do we need to do
as a nation to greater incentivize
people to get into this field?
Because the people that we're talking to
say you can spend all the money you want,
but there are not enough
people to help these children.
The waitlists just continue to grow. Well,
I think we have to think creatively
and broadly about the workforce.
So we when we think about mental health care,
we tend to think about psychiatrists
who are an important part of the
mental health care workforce.
But they are one component of the workforce
and we recognize it takes years to train
somebody to be a psychiatrist and we
we need more psychiatrists for sure.
But we also need more therapists
and more psychologists.
We need more counselors in schools where the
ratio of school counselors to children is.
Is imbalanced and we need to correct that.
We also need to think about peers.
We know that peer support groups can be
extraordinarily helpful in helping provide
some additional support to children,
especially when they're struggling.
It doesn't mean peer support is
a substitute for medical help,
but to really get kids to support
that they need.
Broadly speaking,
you need a spectrum of support
and peer support groups can be a
critical part of that, and finally,
community members, family members,
and other community members,
including.
Teachers can be important resources
here as well.
Some communities have taken
it upon themselves to train
individuals in mental health,
first aid to be able to to serve,
to serve as a frontline if you will,
for getting people help and then connecting
them to resources in their community.
These are all the different ways
in which we can think about
building a mental health force.
If you will.
Of individuals across the spectrum who
can help people who might be struggling
and finally just keep in mind that
technology piece matters here too,
because we know that one of the
challenges is making sure that.
Somebody has access to provider
but they may not be private
provider in their community,
but they can use technology to have a session
or consultation with somebody who might
be hundreds of thousands of miles away,
but can be present,
can provide them with the
care that they need.
Virtually that can be a huge value add.
We do that in some parts of
the country very successfully.
We just need to expand that
kind of technology outreach.
I mean, if a child has to wait six months
to a year to get help, is that acceptable?
No, it's not. It's not acceptable.
You know our children should be able
to get help much sooner than that.
If you look at the data.
Also, you recognize that kids often
have to wait eleven years on average
from the onset of their symptoms.
They ultimately getting a diagnosis and then
being on the way to get the help they need.
It's 11 long, painful years during
which a child suffers and by extension,
their families worry about them
in the family. Suffer too.
No parent should ever have
to go through that.
No child should ever have to
suffer for that amount of time.
That's why I issued a surgeon general
advisory and youth mental health in
December of last year because we
can't wait for the pandemic to end to
start thinking about how to address
youth mental health issues or kids
have been struggling for too long,
we've got to step up and do everything
we can inside and outside government to
make sure they have the help they need.
There was
a white paper here that was
written that basically said.
The work behavioral health
workforce is at a breaking point.
Is it a national emergency
or is it at a breaking point?
How would you describe it? I
do think that the behavioral health
workforce is strained and under
great duress across the country,
and some of that is because of.
Pre pandemic issues but we
didn't have enough providers.
We had insufficient reimbursement.
We had systems which weren't,
which did not integrate primary care and
traditional care with behavioral health care,
which made it harder for
providers and for patients.
But the pandemic has made this
even more challenging for many
providers and for their patients.
And you know,
we're seeing that as people struggle and
burnout in the health care workforce,
not just in the paper health community,
but the broader health care workforce
that people are starting to drop out.
Of the workforce due to depression,
anxiety and a sense of PTSD.
Honestly,
after everything they our
health care workers have gone
through during the pandemic.
What I worry,
people don't may not fully
understand is the implications
for us even after the pandemic.
If people leave an already thin workforce,
then we're not going to be able
to get the help that we need
for ourselves for our families.
For our kids,
most importantly,
and that it will compound an
already very difficult situation.
I'm sure you've had many discussions
with the President about this, is there?
Anything in the horizon that
the President can do to greater
incentivize people to get into the
profession to do loan forgiveness,
to pay for training, to pay for internships?
To help states, you know, sort of,
prop them up to give them some help.
Yeah, so this is an issue that's
very important to the President.
He and I have talked about it in the
past and I can certainly tell you
that he is not wasted time certainly,
and making sure that we're taking
steps to better fund youth mental
health services across the board.
You know that includes the billions
of dollars that actually went
in to the American rescue plan.
We we asked schools to actually
use those that those funds to
support mental health services,
including hiring counselors in
many school districts have in
fact used the funds to do that.
But we also have seen millions of
dollars put into expanding behavioral
health programs for both mental
illness and substance use disorders.
We've seen more funding on the
administration to support the integration
of primary care and mental health services.
So busy primary care provider who recognizes
their patient has a mental health need,
can quickly and easily bring
in the help they need,
as opposed to trying to look for
an outside referral that may
be inaccessible to a patient.
So this is all in addition to
this substantial.
Increase in funding that the President
has asked for in his 2022 budget,
which will further expand the treatment
options that are available to our kids.
So this is a very important issue to the
President and you know he's a parent.
He's a grandparent,
and it's on that level that we've talked
about the importance of making sure
that our kids have the help they need,
but this should be an issue that
unites people across America across
party geography across age groups,
because first and foremost,
we've got to take care of our kids there.
Telling us very clearly that
they need more help,
the data is telling that the stories are
telling that and we've got to step up and
not just expand Kevin the treatment side,
but something we don't talk
about often enough.
He's a prevention side as well.
We have programs that we know work
when implemented in school and
community based settings to reduce the
likelihood kids will struggle with
mental health issues down the line.
We're not implementing enough of
those and that's why in my advisory
I asked for a strong investment
in prevention and treatment,
as well as an emphasis on eradicating this
terrible stigma that still surrounds.
Mental illness it makes young people
feel like something is wrong with them
that they are broken in some way.
If they're struggling with their
mental health
and we just need more people,
that seems to be more people,
not necessarily more money,
but more people as well.
We didn't have more people as well,
but I do think that the the the
funding is an important piece of it,
so you know if if people don't
have the funding to support them.
Being counselors in schools and
they don't have the funding to
to address medical debt in,
which is a profound challenge right now for
many health care workers in our country.
It just makes it harder for them
not to stand in the profession.
So yes, we've got to pull every lever
we can to strengthen our mental
health workforce and to make sure.
Ultimately we get services to
people who need
them right. All right, Mr Surgeon general.
Thank you so much for your time. I appreciate
it. Thanks so much Karen.
Really good to be with you today.
Nice to talk with you. Take care.