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Our View: Third? Great, but still plenty of work to be done

Far too many children in Minnesota and across the nation are struggling to stay mentally afloat.

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Our View
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Once each year, the Annie E. Casey Foundation releases the results of a comprehensive assessment of child well-being in the United States. The data covers topics that include economics, education, health, risky behaviors, family structures, housing, community environment and many more.

At first glance, Minnesota looks like a “winner” in this year's assessment. We ranked third nationwide in the overall measure of child well-being , trailing only Massachusetts and New Hampshire. Last year's study produced the same top-three rankings.

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But that's where the good news ends, at least pertaining to kids' mental health. Indeed, celebrating Minnesota's ranking would be the equivalent of saying “Hooray! Our lifeboat has fewer leaks than yours!”

Far too many children in Minnesota and across the nation are struggling to stay mentally afloat.

Even before COVID-19, children in Minnesota and across the nation were experiencing a mental health crisis. For example, in 2016, 12.2% of Minnesota children ages 3-17 had been diagnosed with anxiety and/or depression. By 2020, that number had grown to 14% – which is well above the national average of 11.8%.


It was a tough time to be a kid. A quarter of children 6-17 were being bullied. More than one-third of families with children reported worrying about the safety of their neighborhood. And, perhaps most distressingly, one-quarter of all parents reported that they had no one to turn to for emotional support as they raised their children.

This was all pre-COVID. The pandemic thoroughly disrupted data collection for the past two years, but the Casey Foundation predicts rather grim long-term consequences. Next year's study is likely to document a big uptick in childhood mental health problems and attempted suicides.

And sadly, even kids who aren't suicidal today are at risk of dying due to self-medicating with illicit drugs or prescription opioids. Nationally, overdose deaths soared 30 percent in 2020 compared to 2019, with 91,799 deaths – and kids played a big role in that increase. In 2019, 23 of every million kids between the ages of 14 and 18 died of an overdose, but that figure doubled to 46 out of a million in 2020, with another substantial increase expected for 2021 when the data is finalized.

It's a perfect storm. A growing number of kids feel isolated, depressed, anxious and/or hopeless, and many of these children lack access to high-quality, affordable mental health care – so they look for help in pills they get from their friends or order online from sketchy websites. Or they turn to hard and highly addictive drugs like heroin.

Regardless, it's a game of Russian roulette, especially with the ever-growing presence of Ffentanyl in street drugs. Last weekend in the Rochester area, law enforcement responded to five separate overdoses. Fortunately, none proved fatal, and the overdose-reversing drug Narcan was administered to four of the people involved.

While none of these overdose victims were teens, the statistical likelihood is that at least three of these people – four, in all likelihood – began using drugs during childhood. Furthermore, the odds are that some type of childhood mental health problem played a role in their drug use.

Is there a solution? Yes, but it will be both expensive and difficult.

Mental health conditions require early, fast intervention, but the Centers for Disease Control and Prevention reports that while roughly 20 in 100 children have a mental, emotional or behavioral disorder, only four of those 20 get care from a specialized mental health care provider – and those numbers get much lower in rural or low-income urban settings.


Nationally, there are roughly 8,000 practicing child psychiatrists, which is well below the 12,500 that are needed. And, of the nation's 100,000 clinical psychologists, just 4,000 specialize in child and adolescent psychology.

So, even if your family has a good income, quality insurance and lives in a densely populated area, your child might wait weeks – or even months – for a first visit with a mental health professional. During that time, kids in crisis too often turn to illegal drugs or alcohol, with disastrous results.

We need more mental health care providers. We need them in rural areas. We need them in inner cities. We need them in public hospitals.

To make that happen, our state and our nation must give future health care professionals a reason to enter this important field. Loan forgiveness programs for college debt can be a good start, but ultimately, we'd argue that insurance companies are the real problem.

We won't paint all insurers with the same brush, but for far too many Americans, the biggest barrier between their child and a mental health provider is an insurance company.

Many health plans lack in-network mental health providers, so families must go out-of-network, which dramatically increases the out-of-pocket cost. And, even if a provider is available, families often must wade through a mountain of pre-qualifying paperwork, just to satisfy the insurance company that such care is needed.

Finally, when the child actually meets with a therapist or psychiatrist, the insurance company too often pays a low-ball reimbursement rate that, over time, can push good therapists into a cash-only practice – thus leaving low-income patients with nowhere to go.

Why do insurance companies get away with such practices? We blame the persisting disparity in the perception of mental health conditions versus physical health conditions.


Parents of children with leukemia, bone cancer or a brain tumor tell their stories on Facebook or on CaringBridge pages. They buy T-shirts and bumper stickers that boast of their child's toughness.

Yet the world still tells us that a child's mental health struggles aren't to be talked about, and that we should take whatever the insurance company offers and be grateful for it.

Too many children and young adults are paying a steep price for that misperception.

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