A study by PNAS (Proceedings of the National Academy of Sciences), Treatment of mental illness in American adolescents varies widely within and across areas, shows that many children fail to receive follow-up care (within 3 months), or receive inadequate care that falls short of guidelines for the initial treatment of mental illness in children. 


The study focused on variations in the care that adolescent patients receive when treated for an initial mental illness episode. The study used a large national sample of children covered by private health insurance for at least one year between 2012 and 2018. The study used administrative insurance claims data from the Blue Cross Blue Shield (BCBS) Alliance for Health Research. According to the survey:


“The majority do not receive therapy, and many children receive drugs that raise a red flag, such as benzodiazepines, tricyclic antidepressants, and drugs that are not Food and Drug Administration-approved for use in children. Shortages of mental health professionals can explain very little of the variation in these outcomes. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes.” 


While this research does not deal with the pandemic, the research would seem to lend credence to the concern that (just as during the COVID-19 pandemic) geography is critical in how people are impacted by the disparate health care system.   


The authors found large variations in the probability that children receive drug treatments that raise a red flag when viewed through the lens of treatment guidelines: “Overall, in the first 3 months after their initial claim for mental illness, 44.85% of children who receive drug treatment receive benzodiazepines, tricyclic antidepressants, or a drug that is not Food and Drug Administration-approved for their age.”


While the study found that only 71% of the children received treatment in the three months that followed an initial insurance claim, the study found that that rate varied widely from one zip code to the next. In some circumstances, almost 90 percent of children received follow-up care within three months, but in other zip codes, only half of the children received follow up care.


Over the years, one of the concerns has been that children and youth do not receive mental health care services because there is a shortage of trained mental health professionals who can provide adolescent mental health care. The authors argue that the disparities they found suggest the shortages could not be explained by staffing shortages alone. According to the authors, while the supply of mental health professionals impacts treatment choices, it cannot explain all the variation in treatment. One part of the research suggests that factors, such as physician practice style, may play an important role in the treatment that children receive. The authors did find that in communities where there are more psychiatrists, drug-only treatment, and treatment with red flag drugs is more common, while in communities with more of a supply of therapists, therapy-only treatment is more prevalent.