Conventional wisdom may hold that the COVID-19 pandemic brought about a mental health crisis among children and adolescents, but medical experts say a pediatric mental health crisis was already underway.
Even before the pandemic, "pediatric behavioral health spending has been escalating somewhere in the 12 percent to 18 percent range annually," said Dena Bravata, chief medical officer of Castlight, a health care navigation service, as reported in the firm's 2022 Workforce Health Index.
"Leading up to the pandemic, we already had a mismatch of supply and demand related to behavioral health services," said Sandhya Rao, chief medical officer of Blue Cross Blue Shield of Massachusetts. In 2021, BCBS began including within its coverage dedicated pediatric and adolescent mental health services from Palo Alto, Calif.-based Brightline, which offers virtual team-based care for children ages 3 to 17 and their families.
"Pediatric mental health issues have grown so much over the past two years that employers recognize they need to help everybody in the household get what they need," Rao said. "Employers are thinking more specifically about how they can serve these families."
Closing the Trust Gap
A 2022 report from On Our Sleeves, a national children's mental health advocacy group based in Columbus, Ohio, shows that:
- 54 percent of working parents reported seeking out professional help for their children's mental and emotional well-being.
- Only 23 percent of those parents felt comfortable talking to an HR representative about a child's mental health.
- Even fewer—20 percent—felt comfortable talking to their supervisor about it.
The findings, reported in The Great Collide: The Impact of Children's Mental Health on the Workforce, reflect responses from 5,406 working adults across the U.S., surveyed from February through September 2021.
Marti Bledsoe Post, On Our Sleeves executive director, was blunt in her assessment of where we are as a society in providing adequate workplace resources for children's mental health needs. "If we just look at our data, I'd put us at a 4 on a scale of 1 to 10," she said. "We have a lot of room to improve."
To help families get the care they need for their children, employers could start with basic educational outreach about what benefits are available, Post said. "That may provide light on something they may not know they have access to already, such as an employee assistance program," she noted. "That's a very simple way they can tackle the issue, since not all the parents in our survey were even sure they had access to that type of help."
Tina Thornton, associate vice president of well-being and safety at Nationwide Insurance, whose nonprofit Nationwide Foundation funded the On Our Sleeves report, said the insurer was committed to providing its own employees with access to children's emotional and mental health care.
The company has put in place a concerted education effort that includes webinars, mailers, intranet pages and "a willingness to break the stigma of talking about mental health care needs," Thornton said. "It's about talking about it, recognizing it and providing the resources so our associates know where to go to get help."
Post said empathy for parents whose children are in need of behavioral health care must be borne out by action.
"There may be a policy in place that says, 'family is supported, family comes first,' but how workers are treated when they take advantage of [these benefits] tells them if they can trust what they have been told," Post said. "Our survey results showed fears of not getting promoted, or even of being fired. That's where some of that trust [between employer and workers] breaks down."
[SHRM members-only resource hub page: Mental Health]
What Employers Can Do
Employers can help assure that they provide, and workers take advantage of, benefits that cover pediatric mental health services by taking these actions:
Educate. Make sure employees know what their benefits are, through regular outreach and timely reminders. For instance, Bravata advised employers to tell their workers about no-cost or low-cost options for getting help, such as through employee assistance programs, to alleviate concerns about deductibles and out-of-pocket costs.
On Our Sleeves offers Bloom, a no-cost online curriculum employers can provide to their employees and their families. Bloom's advice, based on vetted research, is a resource for parents "who don't have the time to read a psychology journal about what works," Post said.
Advocate. Families often find there are long wait times to get access to qualified mental health providers. As payment systems trend toward more value-based care, benefits managers should ask their carriers if they are integrating mental health into their primary care networks, Rao said. "They can ask that question, and their carrier should have an answer."
Innovate. One of the positive lessons from the COVID-19 pandemic was the suitability of telehealth for behavioral health services, Rao said. Virtual services such as Brightline, which uses a team-based approach to providing care, scale better than traditional one-to-one therapist relationships, so wait times are not so onerous for families who need care.
Navigate. One of the most fundamental benefits employers can provide is running interference for families. "You can't expect these [parents under stress] to call a dozen providers and figure out if they have an opening for their child, and if they do, if their services are appropriate for their child's condition," Bravata said. Navigation services are especially vital if a child needs hospitalization and parents are tasked with finding a facility with an open bed.
Nationwide provides nurse-staffed navigation assistance for its employees, "to make sure that they get the services they need," she said.
FMLA Leave to Care for an Adult Child with a Mental Health Condition
In May 2022, the U.S. Department of Labor (DOL) issued new guidance stating that eligible employees may take leave under the Family and Medical Leave Act (FMLA) to care for a family member with a mental health condition, including an adult child with a mental or physical impairment that substantially limits one or more of their major life activities.
In a companion set of new Q&As, the DOL addressed the hypothetical question, "My daughter, who is 24 years old, was recently released from several days of inpatient treatment for a mental health condition. May I use FMLA leave for her care? She is unable to work or go to school and needs help with cooking, cleaning, shopping, and other daily activities."
The DOL responded, "Yes. Assuming that you work for a covered employer and are eligible for FMLA leave, you may use FMLA leave to care for your child who is 18 years of age or older if the child is incapable of self-care. … Major depressive disorder, bipolar disorder, obsessive compulsive disorder, and schizophrenia are a few examples of mental health conditions that may substantially limit one or more of an individual's major life activities when active."
Greg Goth is a freelance health and technology writer based in Oakville, Conn.