As professionals who strive every day to help children and families struggling with mental health disorders, it is shocking that we must issue this reminder. When these young people don’t get help, they are at risk for continued mental health problems, antisocial behavior, school failure, jail, drug abuse and suicide. These children are not always well-served by the system we have in place — not by a long shot. But just walking away would be the worst possible outcome.
Late last year, Congress passed legislation that made us optimistic that the nation might finally address the simmering public health crisis of childhood mental health disorders. It expanded research and treatment and prevention programs. It was a bipartisan success. But it will be for nothing if we dismantle the safety net, make care harder to access and afford, and actively legislate against that progress.
Professionals who know firsthand how the healthcare system affects families are appalled. Hospital associations and membership organizations like the American Medical Association have raised a clarion call about the potentially disastrous effects of eliminating expanded Medicaid coverage. A statement from the insurance lobby reminds us that “Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment.”
The Energy and Commerce Committee’s executive summary of the bill optimistically describes repeal of Medicaid expansion and the requirement that states provide essential health benefits as “returning flexibility to the States.” But the language of the law and the funding it makes available mean that “states will be required to make hard choices on which benefits they want to continue and on enrollment numbers,” says the National Association of State Mental Health Program Directors.
The flexibility the bill’s authors applaud might well be the flexibility to maneuver between a rock and hard place — dropping the most vulnerable off the rolls and through the cracks to avoid bankrupting the system.
The House healthcare proposal is a step backward into the “good old days” before the Great Society, when Americans could close their eyes to the realities of mental health disorders. Back then, mental illness was a silent burden or a life sentence, and we saved money by not talking about it or warehousing people in asylums.
Today, we have evidence-based mental health treatments that change lives. Patients and families are pushing aside the stigma and advocating for themselves. More and more, people are being open and seeking care.
We know better now. We have looked into the faces of children who meet these problems with more courage than Congress can dream of. Let’s not let them down.