With mental health challenges on the rise among youths, Delaware officials said school-based services have become essential in addressing issues.

A new checklist from the mental health advocacy group Inseparable guides parents and educators to ensure their children receive the mental health care they need. The checklist outlines key areas of focus, including staff training, availability of mental health professionals and regular wellness checks.

Caitlin Hochul, vice president of public policy for Inseparable, said the checklist helps identify what services may be needed.

"When you identify a mental health condition early, you have a better chance for better outcomes," Hochul pointed out. "We help make sure that kids are receiving the care that they need before they experience potentially a mental health emergency or life-threatening crisis. So it really helps ensure better outcomes and can help save lives."

Delaware lawmakers recently approved a measure ensuring at least one mental health professional is available for every 700 elementary and middle school students and for every 250 high schoolers. The state also distributed a $2.5 million Medicare/Medicaid grant to expand school-based mental health services.

Hochul noted the checklist covers training for teachers and staff in mental health, substance use and suicide prevention; maintaining appropriate ratios of on-site mental health professionals to students; regular wellness check-ins; teaching relationship and life skills; and promoting mental health literacy.

"The checklist can help signal to parents a school's ability to provide the support that helps students succeed academically and in life," Hochul explained. "We encourage parents to review this checklist, and if they're seeing that their school is not providing these services, get in touch with your community members, get in touch with your local lawmakers."

The Centers for Disease Control and Prevention estimated 20% of children have a mental, emotional or behavioral disorder and of those, only one-in-five have access to specialized mental health care. Hochul said school-based professionals can help bridge the coverage gap.

"That's really why school-based mental health services are so important," Hochul asserted. "They help improve access to care and are really one of the most effective tools we have to help improve children's mental health."

More than 1 million Coloradans are living with a diagnosed mental health condition but insurance companies are denying coverage for care their policies promise to pay for.

Jake Williams, CEO of the advocacy group Healthier Colorado, said insurers reject many claims as not medically necessary, even when a doctor has prescribed the treatment.

"Seventy-five percent of Coloradans with commercial insurance, who have a diagnosed mental health condition, have not received the care that they need over this past year," Williams reported. "There are real consequences to this."

In 2008, Congress passed a law requiring insurers to offer the same access to mental health care as to physical care. But a loophole in the law allows insurers to determine what care is "necessary or appropriate."

An investigation by ProPublica found UnitedHealth Group was using algorithms to deny claims, a practice later deemed illegal in three states. United defended its claims program, arguing it ensures patients get safe, effective and affordable treatment.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said insurance companies should not be denying care using standards inconsistent with accepted clinical standards. He believes there are roles for both state and federal lawmakers to address the problem.

"We're encouraging policymakers across the board to take some common sense steps to ensure that health plans are ultimately covering the services that they promised to cover when you have health insurance," Lloyd emphasized.

Williams pointed to a bill recently introduced in the Colorado General Assembly as one path forward. The measure would require insurers to cover treatment using criteria developed by the American Academy of Child and Adolescent Psychiatry, or the American Association for Community Psychiatry.

"What we'd like to do is make it uniform," Williams stressed. "So that just like physical health there's a standard definition of medical necessity, so insurers and patients and doctors are all on the same page, and patients are more likely to get these critical services covered."

As young people struggle with mental health issues, schools often provide the best avenue for getting them help. However, Washington state has fallen behind in providing services to students.

Eric Bruns, professor of psychiatry at the University of Washington School of Medicine, said school is the most common venue for young people to receive mental health supports and so, from a public health standpoint, there is no better place to invest in resources.

"That's because kids spend the majority of their non-sleeping hours that aren't at home in schools, and we have professionals there," Bruns explained. "We have adults who care about young people who can, systemically or just informally, observe when kids are struggling."

One concern is mental health professionals are not spread evenly across Washington schools. A 2022 report from the mental health advocacy group Inseparable found the ratio of students to mental health professionals is high. For instance, in some schools, there is only one psychologist for more than 1,400 students.

Youth mental health experts said state lawmakers can help in this session by providing more resources.

Anna Nepomuceno, director of public policy for the National Alliance on Mental Illness-Washington, said legislators could also ensure Medicaid coverage of services in schools. She noted students tell her mental health support at schools is a top priority.

"There's a lot of students whose health insurance might not cover adequate mental health care, so they don't have access to it. Or they're unable to find therapists, especially if you're on Medicaid," Nepomuceno observed. "Sometimes the waitlist to see a therapist is really long, especially when you're talking about youth mental health."

The Superintendent of Public Instruction has proposed almost $6 million for grants to support school districts with the least access to behavioral health services.

Nepomuceno added school mental health resources were important in her life.

"I went to a high school that was a bit more affluent. We had a school psychologist, we had a therapist, and I actually saw both of them," Nepomuceno recounted. "I personally don't know if I'd be alive if I didn't have access to those services when I was young."


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Mental health groups are stepping up to help victims of the Los Angeles area wildfires deal with the extreme stress brought on by the disaster.

The California Parent and Youth Helpline is beginning to work at evacuation centers and is looking to partner with community or government entities to provide victims with emotional support.

Lisa Pion-Berlin, president and CEO of Parents Anonymous, which runs the helpline, said people can call, text or live chat with a trained counselor.

"That emotional support really needs to be handled by an experienced professional, who's trained to listen and to help people deal with the immediate angst and depression," Pion-Berlin asserted. "Because they don't know where to turn."

The helpline is open 12 hours a day at 877-427-2736 to guide people through the chaos, desperation and fear. And the group's website caparentyouthhelpline.org will also connect people to ongoing online support groups.

Pion-Berlin pointed out Parents Anonymous would like to expand if fire relief funding becomes available. However, the service may be in jeopardy, because Gov. Gavin Newsom left the helpline out of his January budget proposal.

Now, with entire neighborhoods wiped out, she said the need for mental health assistance is greater than ever.

"Because they no longer have their community. They never don't have their school, they don't have the safe place they lived in," Pion-Berlin outlined. "They're displaced, and the impact is devastating."

Parents Anonymous is asking lawmakers to continue to support the helpline as they negotiate the final budget this spring. The California Parent and Youth Helpline received a two-year appropriation of $4.7 million in the 2023 budget. If it is not renewed, the funding will run out this summer.