Background
- a. Importance of Behavioral Health Services for Children and Pregnant Women
Mental health is key to overall health and plays a critical role in the well-being of children and pregnant women. There are unique vulnerabilities and developmental implications when it comes to mental health and substance use disorder conditions in children and pregnant women. Mental health disorders usually first arise in childhood, adolescence or early adulthood. As many as one in six U.S. children between the ages of 6 and 17 has a treatable mental health disorder.[1] In 2018, an estimated 21.2 million people aged 12 or older needed substance use treatment. About 1 in 26 adolescents aged 12 to 17 (3.8 percent), and about 1 in 7 young adults aged 18 to 25 (15.3 percent) needed treatment.[2] Several common mental health conditions impact Medicaid and CHIP children at higher rates than the general child population including conduct disorder, anxiety disorder, depression, autism spectrum disorder, and attention deficit disorder.[3]
With respect to pregnant women, approximately 40 percent experience psychological difficulties during or after pregnancy with 10 to 15 percent being diagnosed with a mental illness.[4] Low income women are more likely to develop some form of depression compared to other mothers, ranging from 40 to 60 percent suffering depressive symptoms.[5] Pregnant women also face challenges with substance use. A history of trauma has been associated with risk of substance use in women. During 1999 through 2014, the national prevalence of opioid use disorders increased 333 percent from 1.5 cases per 1,000 delivery hospitalizations to 6.5, an average annual increase of 0.4 per delivery hospitalizations per year[6]. In 2018, 9.9 percent of pregnant women drank alcohol, 11.6 used tobacco, and 5.4 percent used an illicit substance.[7]
SUPPORT Act Requirements
As noted above, section 5022 of the SUPPORT Act requires that child health and pregnancy related assistance “include coverage of mental health services (including behavioral health) necessary to prevent, diagnose, and treat a broad range of mental health symptoms and disorders, including substance use disorders.” This section describes the requirements for all states with separate CHIPs to cover specific behavioral health related screening and preventive services,
- ↑ Whitney, D.G., Peterson, M.D., JAMA Pediatrics. (2019). US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children.
- ↑ Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.
- ↑ MACPAC. (2016) Medicaid Access in Brief: Children’s Use of Behavioral Health Services. Accessed at https://www.macpac.gov/wp-content/uploads/2016/06/Childrens-access-to-behavioral-health-services.pdf.
- ↑ Gilbert, H., Gurvich, C. and Kulkarni. (2015). Journal of Nursing Care. Special Issues for Pregnant Women with Mental Illness.
- ↑ Centers for Medicare and Medicaid Services. (2016). Maternal Depression Screening and Treatment: A Critical Role for Medicaid in the Care of Mothers and Children. Accessed at https://www.medicaid.gov/federal-policyguidance/downloads/cib051116.pdf.
- ↑ Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014. MMWR Morb Mortal Wkly Rep 2018;67:845–849
- ↑ 7 Substance Abuse and Mental Health Services Administration. (2018). The National Survey on Drug Use and Health: 2018. Accessed at https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables. This may be an underrepresentation of the actual prevalence of substance use during pregnancy because it is often under-diagnosed.
