The number of emergency department visits to Children’s Healthcare of Atlanta has more than doubled since 2015, and COVID-19 has only exacerbated the need for care.
Behavioral health care, which includes mental health care, is particularly needed, said the first chief of children’s behavioral and mental health, Dr. John Constantino.
The mental health crisis has intensified since the start of the pandemic, with 46% of American adolescents treated for major depressive episodes in 2020, according to the National Institute of Mental Health.
These are only the people who have been able to access care.
In 2021, more than 100,000 Georgian students reported feeling depressed, sad or withdrawn, Children’s said in a news release.
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Thanks to a gift from David and Helen Zalik and the Zalik Foundation, the Children’s Healthcare of Atlanta Zalik Behavioral and Mental Health Center will be established on a 10-acre site near the Children’s North Druid Hills campus.
When that center opens next year, the hospital will use a $566 million endowment created by Children’s board, donors and stakeholders to help fill the void, Constantino said.
The interest from the endowment, which Constantino estimates at $30 million per year, becomes a revolving source to subsidize the provision of much greater capacity for child mental health care throughout the child care system.
“It’s an endowment in perpetuity,” he said, noting that the interest allows Children to fill that void so the hospital can break even instead of losing money treating patients. patients.
Historically, the true cost of providing effective mental health services to children has simply not been covered, Constantino said.
“What Medicaid reimburses for providing mental health care is not the true cost of care,” Constantino said.
Quality care is prohibitively expensive, which has led to a lack of providers who don’t want to waste money, he said.
“And so what’s happened over the years is that the capacity and the people engaged in providing mental health care to this population has eroded and eroded and eroded,” Constantino said. “And access to care is impossible. I mean, it’s pretty hard even for well-off kids, but for kids on Medicaid, it’s impossible.”
Peter Nunn, board member of the Georgia Chapter of the American Foundation for Suicide Prevention, said inadequate provider networks are a major problem.
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Insurers’ provider networks are the crucial intermediate step between insurance coverage and access to medical care, Nunn said, but many insurers point to an overall shortage in the number of behavioral health care providers to try to excuse their inadequate networks.
“This action, however, is nothing more than verbal sleight of hand used by insurers to distract from insurers’ seemingly deliberate breaches of network adequacy obligations,” Nunn said, citing a study by an actuarial firm, which found that children in Georgia are forced out of the system for behavioral health care more than 10 times more frequently than they are for general medical care.
Constantino said children with mental health issues need intervention from multiple sources, which is why his plan involves working with community partners and leveraging community resources in ways that bring them together into an integrated ecosystem.
The new Children’s Behavioral Health Center will not include a residential program.
“Residential treatment settings are usually not part of health systems per se, but rather very specialized situations where longer-term support and care for children is needed,” Constantino said.
One of the great enemies of the effectiveness and impact of mental health care is its fragmentation, he said.
Constantino said the biological aspects, social psychological aspects and social determinants of behavioral conditions must be addressed in an integrated plan.
“This situation of desperation with funding has generated a situation, nationwide, where every entity that provides an important service has to somehow fend for itself to keep that service alive,” Constantino said. “And they’re completely disintegrated with each other and fragmented in terms of how they’re delivered.”
(READ MORE: Children’s mental health crisis is a national emergency, experts say. Here’s where to get help in Chattanooga.)
While the center and its funding for care are subsidized by donors, Constantino wants to demonstrate how working within a health system has high impact, saves money, and represents a distinctive improvement in health. children’s health and mental health.
One perspective for the future, given the recently passed Mental Health Parity Act, he said, involves extrapolating this model of care to other branches of the state and system.
“If we use this resource wisely and demonstrate what the true cost of great care is and show what the impact is, then we can advocate for what mental health parity looks like and that is what needs to be done. to be subsidized in the future as a matter of entitlement, as a matter of the whole landscape of how mental health care is funded for children,” Constantino said.
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