By Liat Jarkon, D.O.
The latest trend among adolescents is deadly.
The suicide rate for people ages 10-14 tripled between 2007 and 2017, according to a new report from the Centers for Disease Control. Suicide is now the second leading cause of death for Americans ages 10-24.
For years, doctors like me have stressed that similar to any physical illness, mental illness can lead to harmful consequences. Moreover, when left untreated, mental illness can potentiate physical disease resulting in expensive treatment needs.
But all this often goes unacknowledged—particularly by the insurance industry. Even in the midst of a youth suicide epidemic, most payers erect barriers to treatment for common mental illnesses just to cut costs.
This is more than irresponsible—it’s counterproductive. Mental illness can lead to serious and costly conditions. If insurers really wanted to keep costs down, they’d expand coverage for mental health services.
The spike in youth suicide is part of a broader public-health crisis. More than 17 million Americans had at least one major depressive episode in 2017. The nation’s suicide rate has jumped 33 percent since 1999, and the rate of death from drug overdose rose by nearly 10 percent between 2016 and 2017.
The rise in these and other “deaths of despair” have caused U.S. life expectancy to drop for three consecutive years—the longest decline in a century.
The insurance industry’s resistance to provide adequate mental health coverage has exacerbated this crisis. Many insurers don’t cover mental health services and those that do are legally required to make those benefits “comparable” to physical health coverage. But insurers have found ways to circumvent that requirement.
For instance, insurers often refuse to cover treatments ranging from therapy to antidepressants on the grounds that they aren’t “medically necessary.”
Consider the tale of a New Mexico woman who struggled with an eating disorder, as reported by NPR. She tried entering an inpatient treatment program, but even after losing 60 percent of her original body weight, Medicaid wouldn’t cover it unless she lost another 10 pounds or entered a psychiatric unit. She eventually enrolled in another plan but had to argue with them to cover care.
Insurers also make it hard for patients to find in-network mental health professionals. A survey by the National Alliance on Mental Health highlights this: more than one-third of respondents said they had difficulty finding a therapist who took their insurance. Meanwhile, just 9 percent had trouble finding an in-network primary care doctor.
This disparity exists because insurance companies pay mental health professionals less than they pay other providers. In 2017, primary care reimbursements were about 24 percent higher than behavioral reimbursements. And in 2014, private insurers paid mental health providers 13 to 14 percent less than what Medicare paid for the same services.
Consequently, many patients are forced to visit providers who don’t accept their insurance, which often means facing out-of-pocket costs. Patients with drug-use disorders pay over $1,200 more on average for out-of-network care annually than patients with diabetes.
Refusing to cover mental health care is absurd. It’s also not cost effective: In 2016 alone, it cost the U.S. $3.7 trillion. Insurers invested more on mental health care could slash spending on chronic diseases over time.
By expanding mental health coverage, insurers can save money—and more importantly, lives.
Liat Jarkon, D.O., M.P.H., is the director of the Center for Behavioral Health and assistant professor of Family Medicine at NYIT College of Osteopathic Medicine.