A NEW NATIONAL report ranked Massachusetts best in the country for child welfare, but buried in the report is one significant danger sign: Massachusetts is one of the worst in the country when it comes to rates of depression and anxiety among children and teenagers.
According to the Annie E Casey Foundation’s 2022 Kids Count data book, based on an analysis of the US government’s national survey on children’s health, 18.4 percent of Massachusetts children ages three to 17 have experienced anxiety or depression as of 2020, an increase of 50.8 percent from 2016, when 12.2 percent of children had anxiety or depression. The national average in 2020 was 11.8 percent.
The figures are estimates based on surveys asking if the child has ever been diagnosed with anxiety or depression by a health care provider.
Only Vermont had a higher rate of pediatric anxiety and depression, 19.2 percent, and New Hampshire was tied with Massachusetts for the second-highest rate in the country. Massachusetts had the seventh-highest rate of increase in anxiety and depression between 2016 and 2020, behind South Dakota, California, Arkansas, Washington, DC, South Carolina, and Alaska.
Of course, anxiety and depression are not the only metrics of child welfare. Massachusetts ranked first among all states overall, a ranking that includes metrics related to health, economic well-being, education, and family and community. It fared much better than the national average in the number of children without health insurance, teen births, children living in poverty, and child and teen deaths. Out of 16 indicators, the only one where Massachusetts fared worse than the national average related to children living in households with a high housing cost burden.
But the high rates of mental health issues among children and teens present a major problem that state officials and mental health providers say they are already grappling with.
“We hear from family members and youth themselves that the impact of the pandemic, the shutting down of schools, not being able to see friends, to socialize, left them feeling lonely, isolated, they lacked that social connection,” said Mary McGeown, executive director of the Massachusetts Society for the Prevention of Cruelty to Children and a leader in the Children’s Mental Health Campaign.
One caveat is advocates say the high ranking may not be all bad – it may mean Massachusetts is better than other states at identifying and treating children with mental health needs.
Danna Mauch, president and CEO of the Massachusetts Association for Mental Health, said Massachusetts has the highest rate of insurance for kids, with near-universal coverage. (The Annie E Casey data found that only 1 percent of Massachusetts children lacked health insurance between 2016 and 2020, compared to 5 percent nationally.)
As a result of a sweeping 2006 court decision, MassHealth requires primary care physicians at well-child visits to include a standardized behavioral health screening and refer children to treatment if necessary. Mauch said MassHealth data show that more than 85 percent of children who qualify for Medicaid are having annual mental health screenings. Private insurers have also focused more in recent years on integrating behavioral health care into primary care, including screening for behavioral health problems.
“There’s more opportunity to access services and places where your mental health and wellbeing will be observed,” Mauch said.
Mauch said there remain problems with timely access to mental health care. But screenings and insurance coverage mean problems are getting identified, leading to higher reporting rates. “There is significant under-reporting of what actual levels are in other jurisdictions where kids don’t have benefits and don’t have access to services and therefore aren’t getting screened,” Mauch said.
Regardless of the interstate comparisons, advocates say the high rates of reported anxiety and depression track with what they are seeing among providers and families.
“Even pre-pandemic, children’s mental health was a crisis in Massachusetts,” McGeown said, citing high anxiety rates and suicide attempts. The pandemic, she said, exacerbated those trends.
Particularly in 2020, she said, many children were worried about the impact of COVID and the possibility of their parents getting sick. Some older students were trying to manage remote learning while babysitting for younger siblings. Social isolation compounded the problems. Children lost access to mental health services that would typically be offered in school.
While many mental health clinicians switched to telehealth, that is not always the best way to reach a child. “It’s challenging to provide behavioral health services to a six-year-old remotely,” McGeown said. “It’s more challenging after they spend the entire day on Zoom for school.”
“All of this contributed to young people feeling more anxious and more depressed at a time when being able to access these services was strained and challenging,” McGeown said.
State officials are working to address the problem. The Executive Office of Health and Human Services has launched several public awareness campaigns to destigmatize conversations around mental health. The administration launched a Roadmap for Behavioral Health Reform, which creates a multi-year framework for improving mental health services. The framework makes ioutpatient evaluation and treatment more available, including in primary care settings; creates more community-based urgent care centers for people with mental health crises; and expands inpatient psychiatric bed capacity.
A behavioral health helpline is on track to launch in January 2023, which would offer 24-hour access for people to be assessed by a clinician and referred to outpatient treatment at community behavioral health centers or seen by a mobile crisis team. The administration recently announced the selection of 25 community behavioral health centers that will offer expanded access to routine, urgent, and crisis care beginning in January, including same-day visits, evening and weekend hours, and mobile crisis teams. A behavioral health urgent care program also started earlier this year, which now has providers in 40 locations offering evening and weekend hours and same or next day appointments.
Separately, the House and Senate recently passed a mental health bill, which is awaiting action by Gov. Charlie Baker. Many provisions would help children and adults, like ensuring parity in insurance coverage for physical and mental health care and guaranteeing coverage for annual mental health wellness exams. The bill addresses long waits in the emergency room for inpatient psychiatric beds, a problem that has been particularly acute for young people, by creating an online portal where hospital providers can find open beds. The bill also enhances the availability of school-based mental health supports, limits the use of suspensions and expulsions for children in preschool, and requires behavioral health evaluations and referrals for all children entering foster care.