COVID-19 is also mental health epidemic for children

 The COVID-19 pandemic’s impact on our nation has been well documented, but a less publicized mental health epidemic is further stressing the capacity of our hospital systems, particularly children’s hospitals. Now, with the country beginning to open back up, policymakers and health leaders need to prioritize action to address the staggering crisis in children’s mental health.

Pandemic-related shutdowns of schools left a significant impact on kids who couldn’t socialize, participate in extracurricular activities or even family events. These shutdowns also left kids without access to the school-based resources and health services, often the first stop for children experiencing unusual stress. As a result, pediatric emergency department visits for severe mental health conditions are on the rise.

Between April and October of last year the Centers for Disease Control and Prevention reported U.S. hospitals saw a 24 percent increase in the proportion of mental health emergency department visits for kids ages 5 to 11. Emergency mental health visits for adolescents ages 12 to 17 grew by 31 percent. This dramatic spike is now overloading hospitals. 

Last month, Dr. Tami Benton, Psychiatrist-in-Chief at Children’s Hospital of Philadelphia testified to the U.S. Senate on the toll the mental health epidemic is taking on children, families, and their providers.

“Many of the children that we are seeing were managing well in their communities before the pandemic, receiving care in their local mental health agencies, schools and primary care offices but are now presenting for emergency care due to worsening symptoms,” said Benton. As a result, Children’s Hospital of Philadelphia, where 95 percent  of the behavioral health care is provided in outpatient settings, now has up to 50 patients per day on its waiting list for mental health beds.

Benton’s testimony is consistent with the experiences of children’s hospitals across the country, where capacity constraints are so severe that children and youth are sometimes forced to wait, in hospital emergency rooms and other beds unsuited for the special care they need, until beds open up in hospital psychiatric units, often in other states.

Most concerning is that children’s hospitals are typically the last resort for families seeking mental health care for their children. If they can’t get access to it there, there may literally be nowhere else for them to turn. It is worth noting that the pandemic has coincided with a dramatic increase in youth suicide rates. Last year, Cook Children’s Health System in Fort Worth, Texas reported a record number of suicide deaths marking the first time that suicide was the leading cause of trauma deaths at the hospital. 

While the pandemic has certainly exacerbated the youth mental health crisis, this problem was trending in the wrong direction years before the pandemic. Youth suicide rates have been rising for a decade, with suicide becoming the second leading cause of death for youth and young adults by 2018. It wasn’t until 2013 that we fully understood mental health conditions begin in childhood. 

Also, troubling is that symptoms of mental health issues are starting to appear at increasingly younger ages. Since 2016, the number of children ages 6 to 12 who visited children’s hospitals for suicidal thoughts or self-harm has more than doubled. The Children’s Hospital Association documented 5,485 emergency room or inpatient visits for suicidal thoughts or self-harm at nearly 50 children’s hospitals in 2019, up from 2,555 in 2016.

May is Mental Health Awareness Month, but this issue requires more than awareness. It requires action. Children’s hospitals should be the last line of defense in fighting the mental care crisis facing our youth. Much like physical ailments, hospitalization is the least desirable, most expensive option and in mental health frequently comes too late to address the underlying causes of illness. 

A good start would be investing more resources into preventative care. Policymakers need to provide greater funding for programs that will help educate and train more licensed mental health professionals, physicians and non-physicians. In addition, there needs to be greater support for state and local programs that emphasize mental and behavioral health care, school-based services, and outpatient programs. Finally, we need to help pediatric hospitals expand capacity now to help children in severe crisis access critical treatment and services. It is estimated that the United States needs roughly 12,600 child and adolescent psychiatrists to meet current demands. We currently have just 8,300.

As our country strives to return to “normal,” we must remember that the pandemic’s impact on children will be felt for years to come. By necessity, hospitals became the front lines in the battle against the coronavirus. We cannot afford for them to now carry the burden of our fight for children’s mental health. These kids deserve our full support.

Amy Knight is president of Children’s Hospital Association.