Protect Our Children’s Mental Health: Expand Access to Preventative Healthcare

Every statistic supports what we already know—our youth mental health crisis is worsening. These numbers will improve when we increase preventative care access.

Free Mental Health Well Visit Policy Proposal

Giving every child, ages 0-17, the option to get a free, annual mental health well visit with their parent’s consent, through their insurance provider is important.

  • North Carolina youth who have had at least one major depressive episode in the past year has doubled from 8% in 2015 to 17% in 2022
  • 22% of high school students—and 48% of LGBTQ students—have contemplated suicide in the last 12 months
  • In 2020, suicide was the leading cause of death for North Carolina children ages 10-14

When we catch problems early, we can prevent the crises that threaten our kids’ health and development and overburden our workforce. But, too often, preventative care isn’t provided because of patient cost barriers and mental health stigma. To remove the barriers to preventative care access and use, FHLI/COE is developing a policy to give children the option of receiving a free annual mental health wellness visit. All North Carolina insurers would cover the cost of this visit—just as they do today for a physical. Creating a policy to address our youth mental health crisis is our priority. It is important to work with our partners to address this policy’s implications—including cost and workforce.

Delivering Well Visits

This policy will help protect North Carolina’s healthcare workforce by focusing on prevention. It will help reduce the number of children experiencing mental health crises and the provider time needed to treat them.

  • Well visits will remain optional and based on service availability—creating a way for providers to bill for preventative care will help them better integrate it into their services.
  • Many different practitioners with mental health experience can conduct well visits.
  • Practitioners will be able to deliver well visits via telehealth to help cover areas with provider shortages.
  • By focusing on wellness, it will help reduce clinician burnout.

Outlining the Mental Health Well Visit Process

If delivering in a medical office, a child attends their well-child appointment and the child and caregiver are asked to complete age appropriate screening tools to highlight potential concerns, including socio-emotional/mental health—just like today.

If a child screens positive for a mental health concern, the process unfolds just like today.

  • If the clinic has an integrated mental health clinician, the primary care physician (PCP) makes a warm handoff to conduct a follow-up assessment and intervention (assuming
    caregiver consent).
  • If the clinic does not have an integrated mental health clinician, the child and caregiver get referred to an outpatient clinician.

This proposed policy changes what happens when a child screens negative. This is when a mental health well visit would be initiated.

  • The PCP has the option to offer and inform the child and caregiver about a prevention service with a mental health practitioner. If the clinic has a mental health professional on staff, and the caregiver consents, then the referral is made via a warm handoff to conduct a mental health component of the well-child visit.
  • The PCP introduction emphasizes the importance of whole-person care and the value of participating in a brief behavioral health appointment.
  • If the facility does not have a mental health clinician, a PCP, PA, or APRN in the office with behavioral health experience can conduct the well visit; or the PCP can refer the child and caregiver to an outpatient clinician.
  • This mental health well visit is a conversation of up to 60 minutes (via telehealth or in person) focusing on building age-appropriate coping skills and also introduces the family to a behavioral health clinician when times are "good" to help reduce the stigma of talkign to a person with this training. Topics discussed can include but not be limited to:
    • Learning resilience strategies
    • Building healthy relationships
    • Strengthening social connections
    • Reducing stress and being mindful
    • Getting quality sleep

Similar mental health well-visit policies passed in other states include:

For more information or to provide your feedback, contact
Lisa Tyndall, PhD, LMFT, Interim Director of the FHLI Center of Excellence for Integrated Care.