A gut-wrenching story was just published in the California Sacramento Bee newspaper regarding the alarming trend in California showing an increase in hospitalizations of young people. In the article, reporters Jocelyn Wiener and Phillip Reese paint a picture of the mental health delivery system in California that is not pretty. Here is just some of what they have found:

• Mental health hospitalizations of California’s youngest residents – those 21 and under – increased 38 percent between 2007 and 2012, jumping from 34,000 to 47,000, higher than the national average. The trend affected the privately insured, as well as poor children with government insurance. 
• The number of people 21 and under showing up in emergency rooms for mental health crises increased by 50 percent between 2007 and 2012. Some of those youths went on to be hospitalized.
• One of the providers interviewed for the story, Dr. Jason Bynum, describes a crisis situation where the “majority of the youth he treats are suicidal or self harming–the rest are violent, homicidal or deeply delusional. ” What is sobering is that because services are stretched so thin he ends up discharging his young clients without the help he feels they need. “It’s a matter of time,” he said, “before something bad happens.”
• A key observation made in the article is that young people in California ”are not receiving adequate mental health services at two key junctures: before they spiral into crisis, and after they come home from the hospital. The shortage of options in the middle, ranging from home-based mentoring and family therapy to acute residential treatment where children spend weeks or months, is driving up hospitalizations, Gardner said.”
• And yet another heart-breaking quote comes from Matt Soulier, a juvenile forensic psychiatrist at UC Davis’ MIND Institute, who said he sometimes finds himself wishing his patients would break the law. “Once they’re in the juvenile justice system, they have much better access to mental health treatments. It’s almost a blessing when they commit a crime. We tell parents of patients every day, ‘As soon as your kid commits a crime, for sure call the police.’ ”
• Read the full story on the Sacramento Bee website.

So what does all of this have to do with Parity?
For the CMHNetwork, this speaks directly to the challenge we see across the nation, as parity becomes a reality. Advocates must be brazen in ensuring that “parity” includes a full spectrum of services – not just inpatient and outpatient. It’s not enough to get those “in the middle” services in place, we have to get them insurance codes and healthy reimbursement. Parity is important and to be celebrated but parity that does not include payment for services in-between the two extremes keeps us in the dark ages of mental health delivery. I often get accused of “raining on the parity parade” by bringing this issue up. Think so? Consider another quote in this excellent article from Patrick Gardner, a San Francisco Bay Area attorney who specializes in children’s mental health law and policy. He describes children’s mental health care in California as a “bipolar” system – with 50-minute therapy sessions and psychotropic medications available on one end, and hospitalization on the other. The shortage of options in the middle, ranging from home-based mentoring and family therapy to acute residential treatment where children spend weeks or months, is driving up hospitalizations, Gardner said. “Those children are going to have to go somewhere. And typically where they go is emergency rooms, juvenile halls or hospitals.”

Don’t for one minute think that this bipolarization of the mental health delivery system is not taking place all across the country. This is but one more example of why advocacy groups need to get directly involved in discussions with insurance companies and Medicaid officials about the array of mental health services covered and payment structures to help better ensure quality in the delivery of services. We are heading for a national travesty in children’s mental health if we stay passive on this.

Scott Bryant-Comstock
President & CEO
Children’s Mental Health Network