Improving Adolescent Mental Health Services: A Data-Driven Approach

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1 Enhancing Access to Mental Health Services for Adolescents: A Data-Driven Solution Student's Name Institutional Affiliation Course Name and Number Instructor's Name Assignment Due Date

2 Enhancing Access to Mental Health Services for Adolescents: A Data-Driven Solution Executive Summary Mental health is a crucial component of overall well-being and a worldwide concern. Adolescents are disproportionately affected by mental health problems. Ensuring there is timely access to mental services for adolescents has become a significant priority within the health and social care systems. In recent years, the prevailing mental health problems among teenagers have risen due to a complex landscape, such as pressures in academics, aspirations in careers, and the effect of digital technologies such as social media. Digital technology has increased while fostering connectivity among adolescents has led to issues such as cyberbullying and constant comparison with peers. The briefing paper is centered on a data-driven approach to improving access to mental health services for young people in the United States and the United Kingdom. The study shows the importance of comprehensive solutions that help bridge the gap between the demand for mental health services and the capacity of the health system to offer equitable care.

3 Introduction Background Mental health remains a crucial component of well-being. Over the years, mental health has been a major cause of concern. People are suffering from mental health issues in different regions and parts of the globe. As part of the population most affected by mental health problems are adolescents. Ensuring timely access to mental health services for adolescents has risen to the forefront as a priority within the health spectrum and social care systems (García-Carrión et al., 2019). Within recent years, there has been a surge in the prevalence of mental health issues among adolescents, with different factors exacerbating the challenges. The landscape within which adolescents navigate their teenage years has become complex and full of innumerable demands, academic pressures, desire to be admitted to reputable colleges, and career prospects (Schnyder et al., 2019). To add salt to the injury, the advent of digital technology and the presence of social media have further created challenges in the lives of teenagers (García-Carrión et al., 2019). The platforms allow for interconnectivity and interactions among young people. However, they have also become platforms for bullying through body shaming and constant social comparison, which have a significant effect on the lives of adolescents and, specifically, their mental health. Additionally, the onset of the COVID-19 pandemic further has a role in mental health issues experienced among young people today. During those times, adolescents' lives were disrupted. There was a change from traditional face-to-face learning to online learning. Besides, interactions were limited among teenagers. The health crises did not only lead to physical havoc but also contributed to a surge in mental health issues. As Stiles-Shields et al. (2023) argued, lockdown, social isolation, and fear of the virus left most young people dealing with loneliness,

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4 anxiety, and uncertainty. There were concerns about the future and the loss of social interactions (Ghoshal, 2022). In the briefing paper, the focus is to delve into a data-driven journey that aims at addressing the quantitative inquiry of improving access to mental health services for adolescents in the context of the healthcare system of the United States and the United Kingdom. The objective is to shed light on the need for comprehensive solutions that could help bridge the gap between the demand for mental health services among adolescents and the ability of the infrastructure to provide timely and equitable care. This resolve has far-reaching consequences for adolescents and the broad health and social care system. Unmet mental health needs can persist through an individual's lifetime and society at large. Through this inquiry, it is evident that there is a need to address the mental health needs of adolescents, and it is not only a moral or ethical imperative but a practical need as well. Neglecting the mental well-being of adolescents could have long-term effects that could affect their future, social interactions, and overall contributions to society. There is a need to obtain recommendations from research that would help in resolving the mental health needs of the given population. The advice from research could play a substantial role in influencing a change in policy, healthcare practices, and social norms that could foster a healthy and more resilient group of adolescents. Problem Statement The United States has a complex and intricate health and social care system. The environment is characterized by a blend of public and private health providers that amalgamate, leading to a healthcare system that is fragmented and diverse. Accordingly, the intricate web of health entities comprises policymakers at the federal and state levels who have grappled with the

5 task of addressing the mental health needs of adolescents. At the national level, the Affordable Care Act (ACA) was enacted and implemented in 2010 under the Obama administration. The ACA played a critical role in revolutionizing the healthcare system in America and had a profound impact on mental health services for adolescents. One of the notable provisions under the ACA is the expansion of medical coverage to ensure that a significant portion of the American population, including a large number of adolescents, has access to healthcare without the need for out-of-pocket expenses (Settipani et al., 2019). The expansion of coverage was critical in enabling the recognition of the importance of mental healthcare among adolescents. In addition, the ACA led to a change in introducing the concept of parity in access to mental health services. This meant that insurance providers were mandated to offer mental health services at the same coverage level as they provided for physical health services (Saade et al., 2019). Typically, the legislation aimed to eliminate the historical disparity concerning access to mental health services. Ensuring that insurance companies provide equitable coverage for mental health allowed ACA to reduce the stigma that had surrounded mainly the issue of mental health needs in the United States. Nonetheless, despite the steps taken to reduce insurance disparities, significant gaps in adolescent access to mental health services persist. The issue at hand encompasses several dimensions: availability, stigma, and affordability. Over the years, the affordability of mental health services remains a concern, even with the expanded insurance coverage (Iorfino et al., 2019). A person accessing mental health services could be subjected to high deductibles, copayments, and out-of-pocket expenses that could create financial barriers, especially for adolescents and families seeking mental health services that are from marginalized populations

6 (Radez et al., 2021). The costs can dissuade those seeking the care they need to improve their mental well-being (Brueck, 2014). As a consequence, this leaves most of the adolescents with unaddressed mental health needs. Availability of mental health services is another challenge, considering that most of those who are affected by the problem are from rural and low-income areas (Herman et al., 2021). In such regions, there is a conspicuous lack of access to mental health professionals and treatment facilities (Panchal et al., 2022). In this regard, this causes a situation where adolescents living in underserved areas have complex mental health needs that go unmet. Comparatively, mental health within the United Kingdom is a significant concern. A majority of young people have issues in trying to access mental health services in the United Kingdom, in almost the same way as the Americans. Issues of cost and disparities in access to health among the people of the United Kingdom are a significant concern. There is also the issue of stigma that continues to persist on mental health issues. Stigma plays a substantial role in casting a shadow over adolescent mental healthcare. The societal bias against mental health concerns can prevent adolescents from seeking the help they need. The adolescents could fear judgment, discrimination, or being ostracized from society based on mental health issues (Colizzi et al., 2020). Based on these challenges, it is clear that significant measures have been taken in trying to ensure there is a countrywide recognition of the importance of mental health among adolescents. Nonetheless, there is still a lot that should be done. There is a need for practical solutions that address the affordability of services, expand care availability in underserved areas, and implement comprehensive anti-stigma campaigns. Policymakers must adapt and refine the health system to ensure that adolescents have equal access to physical and mental health services ( Mental health of adolescents , 2021). Combing legislative action, innovative health practices and

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7 shifts in societal attitudes could bring the needed hope to bridge the existing gaps in adolescent mental health access and indeed provide the deserved care to the people. Aim and Purpose of the Study The study aims at determining the mental health disparities in the healthcare system of the United States. The objectives are: 1. To understand the prevalence of mental health disparities among adolescents in the United States and the United Kingdom? 2. To formulate policies that could be implemented to resolve the issue of mental health disparities in the United Kingdom and the United States. Research Questions The study aims to answer the following research questions: 1. What is the prevalence of mental health disparities among adolescents in the United States and the United Kingdom? 2. What are some of the policies that could be implemented to resolve the issue of mental health disparities in the United Kingdom and the United States? Data Methodology In addressing the inquiry of enhancing access to mental health services for adolescents, publicly available data was obtained from different sources. Quantitative data was obtained from different websites containing statistical information on access to mental healthcare by adolescents. The sampling strategy was done by reviewing publications with recent statistical data that dates back from 2020 to date. The strategy employed was evaluation of selected sources and determining if the statistics were recent at least from the last three years. Basically, quantitative data was obtained from secondary data, such as NSDUH websites, Centers for

8 Medicare and Medicaid (CMS), and Medicaid and CHIP Payment and Access Commission (MACPAC), which were selected as data sources since they contain recent research on the topic. One of the sources used was the National Survey on Drug Use and Health (NSDUH). The NSDUH is an invaluable resource in healthcare research and analysis. The survey serves as a rich repository of data and provides insights into the interplay between substance use and mental health at different levels. The survey spans from the national landscape to the state and local communities. In the context of improving access to mental health for adolescents within the healthcare system of the United States, NSUDH is a critical resource. Notably, the survey questions the aspects of mental health and substance use and makes it a crucial tool for research. For this data, we leveraged data from the NSDUH to focus on adolescent mental health and their access to care. The data subset allows for a profound understanding of mental health among adolescents. The study sheds light on their vulnerabilities, challenges, and nuances to well- understand the adolescent's experiences. The national, state and local granularity of the data provided by NSDUH empowers an analysis that transcends the broad nationwide perspective. This research allowed the researchers to delve into the regional variations and disparities within the United States and the accessibility and quality of mental health services that vary from one area to another. The regional lens is vital as it identifies underserved regions, including those needing urgent attention. Using data from the NSDUH benefits this research, considering that the information provided is rich and transcends simple statistics. There is a nuanced understanding of adolescent mental health and care access, which is needed to shape policy recommendations and interventions that could have a positive impact on adolescents across the nation. The data from the website serves as a cornerstone of the analysis, enriching our insights and enabling us to

9 work towards comprehensive and tailored solutions that address the pressing mental health needs of adolescents in the United States. Further, another research data source is the Medicaid and CHIP Payment and Access Commission (MACPAC). MACPAC publishes data related to Medicaid, a source showing insurance coverage for people and their families ( April 2023 Advising Congress on Medicaid and CHIP Policy , 2023). The data examined Medicaid's role in providing health services to adolescents. Another data source is the Centers for Medicare and Medicaid Services (CMS), which provides data to aid in understanding reimbursement rates and how mental health services are utilized in the United States health system. The sources will help to understand adolescents' use of mental health services. From the given data sources, analyses were made through the use of bar graphs and percentages as primary statistical measures. Data Fit for Inquiry The selected data sources align with the inquiry of improving adolescents' access to mental health services. They provide a comprehensive view of the existing state of mental health services, their use, and the financial aspects linked to Medicaid and insurance coverage. One of the data extraction and analysis techniques is data manipulation. The extracted and merged data from the sources were comprehensively analyzed. Information such as the number of adolescents seeking mental health services, insurance coverage, geographic variations, and demographic data was obtained from the data sources. The data was analyzed to understand the current state of access to mental health services for adolescents. The analyses include geospatial analysis, demographic analysis, and cost analysis. Geospatial analysis was done to map the availability of mental health services and determine the underserved areas. Demographic analysis was done to evaluate the disparities in access to healthcare among adolescents of different races, ethnicities,

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10 and socioeconomic groups. Cost analysis enabled the determination of the affordability of mental health services for people of varying income levels. Discussion In addressing the initial question of improving access to mental health services for adolescents within the healthcare system of the United States, a rigorous analysis revealed critical insights that underscore the complex nature of access to mental health services among adolescents. The senses are essential in fostering an understanding of the complexity of the issue. First, the analysis shed light on the geographic disparities in the availability of mental health services. From the NSDUH, the presence of substance use disorder is determined based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition (DSM-V), which is a recognized diagnostic manual for mental health and substance use disorders. Evaluation of the presence of substance use disorders was done in NSDUH when a series of questions related to alcohol or drugs they used in the 12 months before the survey. The list of drugs included marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, prescription stimulants, tranquilizers, sedatives, and pain relievers. The critical point is to note that the DSM-V substance use disorder criteria in 2021 were applied to people who misused prescription drugs and those who had used the medications as prescribed in the previous year. In essence, this accounts for the misuse and legitimate use of prescription drugs in evaluating substance use disorders. Figure 1. Substance Use Disorders Across Age Groups.

11 18-25 26 years above 12-17 years 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% Series 1 Series 1 The statistics above showed the prevalence of substance use disorders across people of different age groups in 2021. The highest number of people with a substance use disorder was young adults aged 18-25, with 25.6% of the group, which equates to about 8.6 million individuals, hence meeting the criteria for Substance Use Disorder ( 2021 National Survey of Drug Use and Health (NSDUH) releases , n.d.). Following the statistics, 16.1% of adults aged 26 and older had a substance use disorder. Adolescents aged 12-17 exhibited the lowest prevalence, with 8.5% meeting the substance use disorder criteria ( 2021 National Survey of Drug Use and Health (NSDUH) releases , n.d.). The statistics show the prevalence of substance use disorders, with young adults being vulnerable to the issues ( 2021 National Survey of Drug Use and Health (NSDUH) releases , n.d.). The information is needed for policymakers, health providers, and mental health professionals to develop targeted prevention and intervention strategies, hence ensuring that people across different age groups have the required support and resources to address substance use disorders and promote overall wellness.

12 The reality of geographic disparities lies in the availability of mental health. Different variations exist across many nations, particularly in rural areas and low-income urban communities, hence grappling with the issue of scarcity or adequate mental health services (Verhulst et al., 2022). The services in underserved regions leave adolescents with limited options and exacerbate the burden of people traveling long distances to access care (Verhulst et al., 2022). The geographic divide underscores the need for innovative solutions that would help bridge the gap in service availability, especially in areas where access to care is of significant concern. Additionally, there are pronounced demographic disparities in access to mental health services among adolescents. Precisely, adolescents from marginalized communities, including those from low-income households and communities of color, face barriers when attempting to access mental health services (Verhulst et al., 2022). The disparities are ingrained in socioeconomic inequality, cultural stigmas, and limited awareness of the existing resources. Addressing the inequities is needed to ensure that each adolescent, irrespective of their background, has access to the mental health services they deserve (Aguirre et al., 2020). Policy solutions must be attentive to the unique challenges faced by marginalized groups. Further, there are affordability issues in access to healthcare. It is clear that despite there being universal coverage, most adolescents and their families deal with financial burdens linked to mental health services. The high deductibles and copayments can accumulate and render care unaffordable for a significant population ( Improving Access to Children's Mental Health Care , 2023). The financial barrier deters adolescents from seeking the care they need, to places an undue strain on their families. Enhancing access to mental health services requires policies to address the persistent economic hurdles, ensuring that the cost of care is not a formidable barrier.

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13 Data-Driven Solution Suggestion In pursuit of enhancing access to mental health services for adolescents within the healthcare system of the United States, specific evidence-based solutions could be implemented to tackle the issues identified. The keys are designed to create an equitable and accessible mental health landscape for adolescents, ensuring they obtain the needed care. First, expanding telehealth services emerges as a pivotal solution (Bantjes, 2022). Telehealth has demonstrated its potential to bridge geographical disparities in access to mental health services. Leveraging technology can bring mental health professionals to adolescents in remote and underserved areas, overcoming barriers posed by distance and availability of health services. The approach enhances accessibility and addresses convenience, improves accessibility to healthcare, and addresses the convenience factor, thus allowing young people to access healthcare from the comfort of their homes. As a result, this helps in lowering the stigma linked to in-person mental health treatment. Further, cultural competence in mental healthcare is needed. Notably, culture plays a significant role in the solution set regarding access to mental health. Reduction of demographic disparities in access is essential to invest in treating and incentivizing mental health professionals to provide culturally competent care. Such an understanding is needed to understand adolescent patients' unique needs, values, and cultural backgrounds, hence fostering trust and improving the efficacy of treatment (Moroz et al., 2022). Acknowledgment and respect for diversity among adolescents is crucial. Besides, tailoring care helps ensure that mental health services are practical and inclusive, irrespective of a patient's cultural, racial, and ethnic background. Further, affordability is a crucial component of the given solutions. The burden of copayments and high deductibles can deter adolescents and their families from obtaining mental health services even when they have insurance coverage. Implementing policies could help cap

14 out-of-pocket costs for mental health services, which is crucial in making the services financially accessible. Reducing financial barriers can ensure that mental health is within the reach of all, irrespective of their economic status, and minimize the financial strain placed on families. Lastly, there is advocacy for developing and funding community-based mental health programs that specifically target at-risk populations, including schools and community centers (Moroz et al., 2022). The programs can create an approach that would help in addressing mental health issues among adolescents. They provide a supportive, accessible, stigma-free environment where young people can receive mental health education, early intervention, and continued support (Moroz et al., 2022). Embedding mental health services within the community makes access easy and promotes a culture of openness and proactive wellness. Conclusion Improving access to mental health services for adolescents is a sophisticated issue within the healthcare system of the United States. There are issues in terms of equal access to healthcare. There are disparities in access to mental healthcare based on ethnicity, race, and culture. Also, the issue of stigma remains prime in the United States. In this regard, data-driven solutions include expanding telehealth medication, cultural competence training, affordability measures, and community-based programs. The answers are integral in addressing the challenge effectively. Leveraging the insights gained from the data analysis is crucial for policymakers and stakeholders to work towards achieving an inclusive and accessible solution to mental health solutions, thus promoting overall well-being. These evidence-based solutions are needed to create an accessible and responsive healthcare system. The holistic approach ensures that all people., irrespective of their location, background, or financial situation, they can access high-

15 quality mental healthcare, fostering their well-being and providing them with the resources needed to navigate the challenges of adolescence and beyond.

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16 References 2021 National Survey of Drug Use and Health (NSDUH) releases . (n.d.). SAMHSA - Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh- releases#:~:text=Conducted%20annually%2C%20the%20National%20Survey Aguirre, A., Silva, I., Billings, J., Jimenez, M., & Rowe, S. (2020). What are the barriers, facilitators, and interventions targeting help-seeking behaviors for common mental health problems in adolescents? A systematic review. BMC Psychiatry . https://doi.org/10.21203/rs.2.15552/v3 April 2023 Advising Congress on Medicaid and CHIP Policy . (n.d.). https://www.macpac.gov/wp-content/uploads/2023/04/Access-in-Brief-Health-Care- Experiences-and-Satisfaction-by-Race-and-Ethnicity.pdf Bantjes, J. (2022). Digital solutions to promote adolescent mental health: Opportunities and challenges for research and practice. PLOS Medicine, 19 (5), e1004008. https://doi.org/10.1371/journal.pmed.1004008 Brueck, M. (2014). Promoting access to school-based services for children's mental health. AMA Journal of Ethics, 18 (12), 1218–1224. https://doi.org/10.1001/journalofethics.2016.18.12.pfor1-1612 . Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in youth mental health: Is it time for a multidisciplinary and trans-diagnostic model for care? International Journal of Mental Health Systems, 14 (1). https://doi.org/10.1186/s13033- 020-00356-9

17 García-Carrión, R., Villarejo-Carballido, B., & Villardón-Gallego, L. (2019). Children and adolescents mental health: A systematic review of interaction-based interventions in schools and communities. Frontiers in Psychology, 10 (918). https://doi.org/10.3389/fpsyg.2019.00918 Ghoshal, M. (2022, June 6). Barriers and challenges impacting adolescent mental health treatment . psycom.net. https://pro.psycom.net/special_reports/adolescent-behavioral- health-and-institutional-care-in-the-us/barriers-to-treatment Herman, K. C., Reinke, W. M., Thompson, A. M., M. Hawley, K., Wallis, K., Stormont, M., & Peters, C. (2021). A public health approach to reducing the societal prevalence and burden of youth mental health problems: introduction to the special issue. School Psychology Review, 50 (1), 8–16. https://doi.org/10.1080/2372966x.2020.1827682 Iorfino, F., Cross, S. P., Davenport, T., Carpenter, J. S., Scott, E., Shiran, S., & Hickie, I. B. (2019). A digital platform designed for youth mental health services to deliver personalized and measurement-based care. Frontiers in Psychiatry, 10 . https://doi.org/10.3389/fpsyt.2019.00595 Improving access to children's mental health care . (2023, March 8). Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/access.html Mental health of adolescents . (2021, November 17). World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health Moroz, N., Moroz, I., & Slovinec D’Angelo, M. (2020). Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthcare Management Forum, 33 (6), 282–287. https://doi.org/10.1177/0840470420933911

18 Panchal, N., Cox, C., & Rudowitz, R. (2022, September 6). The landscape of school-based mental health services . KFF. https://www.kff.org/mental-health/issue-brief/the-landscape- of-school-based-mental-health-services/ Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry, 30 (2), 183–211. https://doi.org/10.1007/s00787-019- 01469-4 Saade, S., Lamarche, A. P., Khalaf, T., Makke, S., & Legg, A. (2023). What barriers could impede access to mental health services for children and adolescents in Africa? A scoping review. BMC Health Services Research, 23 (1). https://doi.org/10.1186/s12913-023- 09294-x Schnyder, N., Lawrence, D., Panczak, R., Sawyer, M. G., Whiteford, H. A., Burgess, P. M., & Harris, M. G. (2019). Perceived need and barriers to adolescent mental health care: Agreement between adolescents and their parents. Epidemiology and Psychiatric Sciences, 29 . https://doi.org/10.1017/s2045796019000568 Settipani, C. A., Hawke, L. D., Cleverley, K., Chaim, G., Cheung, A., Mehra, K., Rice, M., Szatmari, P., & Henderson, J. (2019). Key attributes of integrated community-based youth service hubs for mental health: a scoping review. International Journal of Mental Health Systems, 13 (1). https://doi.org/10.1186/s13033-019-0306-7 Stiles-Shields, C., Ramos, G., Ortega, A., & Psihogios, A. M. (2023). Increasing digital mental health reach and uptake via youth partnerships. PubMed Central, 2 (1). https://doi.org/10.1038/s44184-023-00030-1

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19 Verhulst, S., Vidal Bustamante, C. M., Carvajal, L., Cece, F., Requejo, J. H., Shaw, A., Winowatan, M., Young, A., & Zahuranec, A. J. (2022). Toward a demand-driven, collaborative data agenda for adolescent mental health. Journal of Adolescent Health . https://doi.org/10.1016/j.jadohealth.2022.05.027

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