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Mental Health Care for Youth: Who Gets It? How Much Does It Cost? Who Pays? Where Does the Money Go?

General warns that the nation is facing a public crisis in caring for children and adolescents with behavioral, psychological, and emotional problems. The report, released in January 2001, notes that 1 in 10 young people suffer from mental illness severe enough to cause some level of impairment. Yet fewer than 20 percent of these children receive needed treatment in any given year. Efforts to improve mental health care for children and adolescents are under way and include parity laws for private insurance and the reorganization of public services. (Parity laws mandate equal coverage for mental health and physical health care.) At the policy level, however, many of these efforts are hindered by the lack of an up-to-date, comprehensive national picture of which troubled children are getting care, how much it costs to provide it, who pays for that care, and how resources are being used. In fact, the most recent child-oriented studies, limited primarily to adolescents, report data that are 15 years old, predating the rapid growth of managed care. Moreover, since that time, a number of advances have been made in treating mental illness. A team of RAND researchers has assembled a current national picture of mental health costs and utilization for children ages 1–17. Among their key findings: • The current cost of treating children and adolescents is estimated at nearly $12 billion, significantly more than expected based on previous estimates. Despite these annual expenditures , nearly three-quarters of troubled youth do not get the care they need. • Hispanic and African American children are the most likely to go without needed care. • Most of the money is now spent on outpatient rather than inpatient care. Health care planners and policymakers can get up-to-date, comprehensive figures on what the United States spends on mental health services for people in general. But they run into a dead end when looking specifically for national data on young people. This knowledge gap is often blamed on the complexity of the system that delivers mental health care for children. Some data do exist for children and adolescents, but they are scattered throughout countless insurance databases, national survey results, and government statistics. The RAND team culled more than a dozen data sources to find information on utilization and expenditures. Their study focused on young people ages 1–17 as a whole, as well as subgroups: preschoolers