Minnesota legislators, address the mental health system. Don’t make kids wait.

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When you train as a hospital-based pediatrician, you anticipate and are prepared to care for children with a massive array of diagnoses from the utterly common to the ultra-rare. What you don’t expect are patients like Sarah, a child we have anonymized and combined from dozens of other patients.

Sarah is a healthy teenager with a grandparent who loves her and wants her at home. She does not need surgery or IV medications or help eating. Not a single nurse, doctor, social worker or therapist thinks she should be in the hospital. And Sarah doesn’t want to be here, either.

The problem is that Sarah has severe mental illness. She had a rough childhood, passed between caregivers who were unable to adequately care for her. Her grandmother recently got custody and is getting to know her bright, sarcastic, inquisitive grandchild. Sarah really wants to go back to school, her favorite class is math, “even though the teacher is a total nerd.”

But instead of school, Sarah is in the hospital. Her grandmother is very concerned for Sarah’s mental health. When they went to the pediatrician, they were referred to therapists and psychiatrists with monthslong waiting lists. In the meantime, Sarah is still suffering. When she is stressed, she harms herself. She bangs her head against the wall or cuts her wrists. Because of her untreated mental illness, she sometimes lashes out at her grandmother. They came to the ER because her grandmother didn’t feel safe keeping Sarah at home.

Sarah’s problems are not easily fixed in a short emergency stay in the hospital. It took years for her to develop to this point and it will take time and consistency for her to get better. She can’t access the outpatient or community resources she needs, and inpatient mental health units are meant to stabilize kids in acute crisis. We are frantically looking for a place where she can be safe and get appropriate mental health treatment.

But there is simply no place for her, so she waits. This young person is a victim of a society that is utterly failing her.

Imagine a world that was built for Sarah. A society that understands the unseen challenges of mental health are as important to address as physical health. In this world, Sarah’s grandmother could have immediately been connected to support. A therapist could come to their home regularly and work with Sarah to process her trauma. With the right access to the care the family needed early on, they may have been able to keep Sarah at home, rather than having nowhere to turn but the hospital.

Why are we so far from that world? Put simply, money. Medicaid only reimburses about 60%, on average, of the cost to deliver mental health services. Our current mental health providers are closing their doors or decreasing their services. Access to care is decreasing and wait lists are ever growing. And the staffing crisis is real. Current reimbursement levels make it impossible to recruit, retain, train and support staff.

The Minnesota Legislature has the power to change this, and to build the mental health system children and families need to live their best lives. Building that system begins with increasing Medicaid reimbursement rates for outpatient and inpatient mental health services.

As hospital pediatricians at Children’s Minnesota, we have met so many kids like Sarah. We trained for years to be able to care for hospitalized children, but none of us have the power to bring to the hospital the social supports Sarah needs now and has needed her whole life.

We are calling for the Legislature to take this on with the same urgency we feel as we care for these kids day in and day out. Increasing Medicaid reimbursement is a simple first step we can take. My colleagues and I are working tirelessly to support patients and families, and we need the Legislature to support us by making these investments now. These kids deserve so much better.