Recently, I encountered a stark reminder of the challenges facing our mental health care system. A 16-year-old Black boy came to us at Boston Community Pediatrics (BCP) in a state of crisis, expressing suicidal thoughts and a deep sense of fear. As part of our integrated behavioral health model, my mental health colleague and I immediately recognized the urgency of his situation. We arranged for an Uber to transport him and his mother to the hospital, understanding that in a moment of distress, the last thing they needed was the added burden of finding a ride.
However, once they arrived at the emergency room, they faced an entirely different challenge: nine hours of waiting with no care in sight. At 4 a.m., exhausted and still unseen by a provider, his mother requested a cab voucher to get home. The response? They didn’t qualify since they hadn’t yet been seen. So, they walked two miles home in the dark, an all-too-familiar narrative for families navigating the mental health crisis in our current system.
This young man’s story highlights the systemic inequities and barriers that countless families encounter in accessing mental health care. When I followed up with them the next day, I learned that while the Boston Emergency Services Team (BEST) was able to conduct a Zoom evaluation, the most appropriate care options were available miles away—yet transportation remained an insurmountable barrier.
When I offered to cover the cost of an Uber for the young man to attend a therapeutic program for two weeks, the BEST clinician was taken aback. She had never encountered another organization willing to provide such support. It is baffling that our health care system can justify spending hundreds of dollars per day on care but balks at covering a modest fare to ensure that a patient can access that care.
We are in the midst of a mental health crisis, and we must reimagine how children access not only mental health services but also routine medical care. The current system is failing to meet the needs of our most vulnerable populations, and we must do better.
At BCP, we are pioneering an integrated approach that prioritizes mental health alongside physical health. Our model allows providers and mental health clinicians to spend adequate time with patients, fostering a more thorough evaluation and care coordination beyond the exam room. We are committed to doing whatever it takes to ensure our patients receive the care they need, which includes supporting families in overcoming logistical hurdles.
The solutions to this crisis exist; they simply require a willingness to think outside the box. Other health care systems must adopt innovative, patient-centered approaches like ours that address not just the medical needs of children but also the barriers that prevent families from accessing care.
This is not just about health care; it is about health. Being healthy is so much more than having access to equitable health care—it is about having access to mental health services and access to support around the social determinants of health. Every child, regardless of their background or socioeconomic status, deserves access to comprehensive mental health care that is both affordable and accessible. The stories of families struggling to navigate this system are not just statistics—they are real lives impacted by a system that prioritizes cost over care.
Let us advocate for a health care system that embraces equity and accessibility, ensuring that no child is left behind. Together, we can reshape the landscape of pediatric mental health care and create a future where every child has the opportunity to thrive. The time for change is now, and it is up to all of us to push for a system that meets the needs of every child and family in our community.
Robyn Riseberg is a pediatrician.
