Whether your specialty is college, school, or therapeutic advising, I doubt there is a practitioner among us who has not encountered today’s youth mental health epidemic.
In February 2023, the Centers for Disease Control released shocking data that nearly 3 in 5 (57 percent) teen girls felt persistently sad or hopeless in 2021. Boys reported these symptoms at about half the rate, which is still an alarming figure.

Despite a shortage of pediatric behavioral health providers, and what seems like endless demand, we have seen multiple wilderness and residential program closures in the last three years. While I cannot begin to make sense of all the forces at play, here are themes I am watching in the behavioral health ecosystem. While some may seem irrelevant to our work, I think it is important to understand how the landscape at large is shifting.

First, there is the money. Spending and investment in mental health has never been more robust. The federal government has allocated $1 billion to boost mental health support in schools  and $240 million for programs that increase awareness and access to mental health support  for school-aged youth. New data from the Employee Benefit Research Institute (EBRI) indicates employer and employee spending on mental health services, as a percent of overall spending, increased from 6.8 percent in 2013 to 8.2 percent in 2020, for an estimated total of almost $77 billion on mental health in 2020 (this includes all age brackets but is still a staggering figure).

Private industry has also arrived on the scene. While we don’t know the total value of mergers and acquisitions (M&A) activity in the pediatric behavioral health space, it won’t surprise the therapeutic consultant community that deal activity was up over 46 percent in 2022 as compared to 2021. Independent educational consultants (IECs) will be familiar with some of the players and moves: Consonance Capital Partners acquired Embark in December 2022 for an undisclosed amount, though experts estimate it to be around $400 million.  Newport Healthcare, another well-known entity, acquired PrairieCare in November 2022 for an also undisclosed amount.

Not wanting to miss out, insurer payers are also investing in behavioral health. See, for example, UnitedHealth’s investment in digital platforms such as Alma and AbleTo. Optum (a UnitedHealth subsidiary) acquired Refresh Mental Health for a reported $700 million from a private equity firm.  Meanwhile, Blue Shield of California is a stakeholder in online youth mental care platform, Brightline. 

On that note, I would be remiss not to mention specific investment in pediatric digital mental health providers. There’s Hopscotch, which recently raised $8 million  and aforementioned Brightline, which has raised $212 million. Charlie Health is an all-virtual pediatric intensive outpatient program. An all-virtual program is probably not what many IECs and clinicians are used to, but it’s important to be aware that clients may be accessing these options prior to coming to us or, for some clients, that these are the only affordable and accessible options.

Not everything is roses in the tech space. Brightline laid off 20 percent of its workforce in November 2022 and another 20 percent of the workforce in May 2023.  One recalcitrant challenge, even for virtual platforms, is insurance payer reimbursement rates, but it’s hard to imagine that tech-based care isn’t here to stay, as it could address critical issues in access (insurance and geographic).

While we are on the subject of technology, let’s turn to AI, arguably a future cornerstone of healthcare. AI offers the promise of improving screening, triage, assessment, integrating the latest research into treatment, and providing enhanced clinical data collection and progress monitoring. You may have seen the controversy surrounding the eating disorder AI chatbot that encouraged eating disorders,  but there are many other AI applications. Videra, a Salt Lake City-based start-up that has raised over $3 million, provides AI-assisted insights into mental health screening and clinical progress.  Videra is already being used in residential treatment programs well known to IECs, such Cascade Academy in Midway, Utah.

At this time, no one thinks AI will replace the work of skilled human clinician. But rather, AI holds the promise of freeing up bandwidth for clinicians, providing large-scale screening and triage support, so we can better triage. It can also enhance clinicians’ work through improved progress monitoring.

A final space I want to touch on is residential programming. It used to be that high-quality, insurance-based residential programming was hard to come by. But now we are seeing an expansion in insurance-based residential options and an increase in more specialized residential options, such as OCD treatment, all-gender/LGBTQ+ programming, primary mental health, and neurodiversity focused (just a few examples: Cascade’s new OCD program, Ascend Healthcare in Los Angeles, and Polaris in Tarzana, California). Meanwhile, we are also seeing a contraction as some programs struggle with new regulatory challenges, particularly around how to work with acutely aggressive clients.

At the risk of generalizing, there are more options now—residentially but also even outpatient/virtually—for young people with internalizing behaviors (e.g., anxiety, depression, withdrawal). And there seem to be fewer options for those struggling with externalizing behaviors (e.g., any kind of aggression, defiance, lying).

It’s hard to say what the future holds for behavioral health. I think we will continue to see robust need for mental health services in the pediatric population, at every level of care. While it may wax and wane, investment seems likely to continue to try to meet this need. Meanwhile, it is really a time of change and adaptation as we adjust to social changes, new technology and modalities, and regulatory challenges. In the midst of everything, I think it’s important for IECs and clinicians to stay current while also staying grounded. Even in these rough waters, we still offer clients the benefit of safe harbor through our professional and relationally oriented approach to advising.

By Michelle Grappo, MA, EdM, NCSP, IECA (CA)

Last updated on October 19, 2023