Who Gets To Get Help?

On Sunday, the New York Times posted a front page article on the plight of families with a troubled teenager, and whether help was available to truly aid in treating such a young person.


I appreciated Benedict Carey’s article.  But by focusing on potentially violent males, it missed the fact that many adolescents of both sexes are grappling with debilitating psychiatric problems including depression, anxiety, self-harming behaviors and substance abuse.  These youngsters are as likely to be imploding – collapsing within – as exploding in actions towards others.

Carey is also incorrect, however, to state that help does not exist.  There is a realm of residential programs variously known as residential treatment centers, emotional growth schools or therapeutic boarding schools where adolescents receive individual, family and group therapy; continue on with their education; engage in activities from sports to arts that feed their talents; have their medications adjusted (downwards as they make strides in managing their lives); and live in a safe supportive environment with caring, skilled therapists and teachers.  Students typically stay in a school nine to twelve months because that’s the length of time it takes to break old patterns of thinking, addictions and behaviors, and to build a more positive identity and approach to life.  Most of the best programs belong to NATSAP, The National Association of Therapeutic Schools and Programs.

Carey also failed to mention the source of support to families that Independent Educational Consultants provide. We work hard with individual families to discern whether their child needs residential treatment, and which programs are going to best suit his or her needs.  Ed Consultants serve as case managers, gathering information from families and the local professionals with whom a child has worked, and present it to programs whose particular treatment niche, extracurricular activities, educational support, and peer group seems most appropriate for the teenager. Then the consultant remains a support for the family throughout the application and matriculation processes.  Because we spend significant portions of our professional time visiting programs, and because we are ethically precluded from having any fiduciary relationship with the programs or schools, we are uniquely qualified to provide expert guidance and moral support to families.

But here’s the rub!  Therapeutic programs are expensive.  The good therapeutic programs now cost $7,500 – $11,000 a month – less than Carey’s stated price, but more than most families can pay.  Insurance companies have been resistant to helping families get the treatment that will truly heal their youngsters.  Instead they will pay for very short hospital stays to temporarily stabilize suicidal teenagers while providing no long-term benefit.   The situation is analogous to pretending that an occasional police visit for domestic violence will solve a family’s dysfunction.  To truly heal and develop more positive coping skills, a troubled teenager requires months of treatment.  With the ACA now covering psychiatric care, the insurance companies should come to a realization that true treatment for adolescent mental health issues is a long-term proposition.  By financing only short term, dispiriting, and ultimately worthless crisis intervention, insurance companies harm the child, the family, and the fabric of society.