Mental Health Providers Need Better Incentives to Accept Insurance, Lawmakers Told

WILMINGTON, Del. — Mental health providers need more incentives to stay inside the health insurance system rather than requiring patients to self-pay for treatment, a Delaware private health system official said here Monday.

“How do we incentivize providers to stay out of the self-pay space to work more closely in the organizations and partnerships that allow people with different insurances to engage?” Erin Booker, LPC, vice president for community health and engagement at ChristianaCare, said at a roundtable on youth mental health sponsored by Nemours Children’s Health. “We are unfortunately experiencing in Delaware, a lot of people go into private practice and they’re making the choice to not take insurance because that process is very complicated.”

Rep. Lisa Blunt Rochester (D-Del.), who also attended the roundtable, said that often people don’t even consider becoming therapists in the first place. “We’ve worked on legislation that has focused on everything from incentivizing that training, and giving money and supports … and also on the infrastructure piece, ensuring that organizations like children’s hospitals have the support that they need to be able to not just get the workforce, but build out even the beds and the spaces, because that’s also a necessary component of it.”

Amy Knight, president of the Children’s Hospital Association, noted that “we have 75 million children in this country; 20% of them require mental health support, but only 20% of [those] get it because we don’t have enough of those providers.”

The federal government “can invest in training programs, not only for psychiatrists and psychologists but also for those in many other [mental health] professions as well … And we not only need to train them, we need to pay them once they are trained, making sure that mental health parity is right there along with health parity,” Knight said.

Andrew Celio, a rising senior at Caesar Rodney High School in Camden, Delaware, and president of Delaware Educators Rising, discussed his own mental health struggles, explaining that even after his middle school counselors found out how he was coping with his difficulties, “they provided me with weekly scar checks, instead of providing me with the counseling that I needed, due to a lack of resources.” He was eventually able to get counseling and said that his counselor “is the reason I’m here today.”

“I urge you to address the mental health crisis and the crisis that providers are experiencing right now, and the shortage of mental health providers,” Celio said to the lawmakers at the roundtable. “I need you to address the barriers with insurance and to eliminate the stigma against mental health and mental health providers.”

Sen. Chris Coons (D-Del.) said that he has supported a bill that would allocate $375 million for graduate medical education training in children’s hospitals, and added that he and Sen. Joni Ernst (R-Iowa) “are working on a specific program for NIH pediatric investigations.”

“NIH has gotten more and more funding year after year, but the amount of money dedicated to pediatric medical research has actually gone down,” Coons said. “We need to change some of that direction because we both need the training that comes from significant clinical investigatory work, and we need the graduate medical education funding.”

Delaware state representative Valerie Longhurst (D-15th District), who is also the Delaware House Majority Leader, described her own family’s mental health issues: “When I was growing up, my mom attempted suicide twice,” she said. “And you can’t ask Andrew or somebody else to go to school and sit in a classroom and learn what the capital of Delaware is when you have your own issues going on in your life.”

Longhurst said that 7 years ago, she got a program put into all Delaware schools “that all the teachers and administrators would have to take a course in suicide prevention, and that was huge for me, because it wasn’t just teachers — it was everybody in the school would have to go through that so they can find those signs and get the help.”

However, in passing that piece of legislation, “I found out that 86% of the elementary schools did not have social workers in their schools. That blew my mind,” she said. “I don’t know how we expect to have children if we don’t provide the services for them.” So she sponsored a bill in the state legislature — signed by the governor last August — that established mental health units in the state’s public elementary schools at a ratio of 250 full-time equivalent students for a full-time school counselor or social worker, and a ratio of 700 full-time equivalent students for employment of a full-time school psychologist.

Those ratios, though “are still not good enough for me,” Longhurst said, adding that when she talks to school counselors and school psychologists, “they ask me, ‘Who do I serve first? Do I serve the child that has been sexually abused, or do I serve a child that their parent just tried to commit suicide? Who do you decide gets that service first?'”

She is now working on a similar staffing bill for middle schools and intends to introduce legislation for high schools too.

Investing in these mental health resources early in a child’s life pays off in the long run, said Delaware Lieutenant Governor Bethany Hall-Long. “This week, I’ll sit in a room for our Board of Pardons, and 89% of those who come before me … were juveniles who experienced ACEs [adverse childhood events] and trauma,” she said. “It’s invest now, or pay later.”

Health and Human Services Secretary Xavier Becerra, who also came to the event, said at a press conference afterward that his message to children was “we want you to grow up, enjoy your childhood, become great Americans … We want to be there, we want to catch you, we want to nurture you, and watch us because we’re learning how to do it better.”