February 15, 2022
The psychological toll of the COVID-19 pandemic has exacerbated mental health challenges among children, prompting leading pediatric groups to call on public officials to address the growing crisis.
Mental health experts estimate that 1 in 6 children ages 2-8 have a diagnosed mental, behavioral or developmental disorder. Additionally, mental health visits for children ages 5-18 increased exponentially in 2020, the first year of the pandemic.
This crisis brought Dr. Tami Benton, psychiatrist-in-chief at Children's Hospital of Philadelphia, to Capitol Hill on Tuesday. She detailed the mental health challenges facing America's youth during a U.S. Senate Finance Committee hearing.
"I wish there were no need for me to appear before you today, but young children and adolescents in the U.S. are experiencing mental health stress at higher rates and with more dire consequences than ever before," Benton said in her opening remarks. "Fifty-three percent of adults with children in their household are concerned about their children's mental well-being, and they are not wrong to have these concerns.
"In the first half of 2021 alone, children's hospitals reported cases of self-injury and suicide in ages 5-17 at a 45% higher rate than during the same timeframe in 2019 and, for children under 13, the suicide rate is twice that for black children than for white children."
The COVID-19 pandemic has only worsened the mental health crisis among the nation's youth, leading to the American Academy of Pediatrics and others to declare a national emergency. More than 50 national groups and 70 children's hospitals have joined forces to kickstart the awareness campaign Sound the Alarm for Kids.
"We have not one, but two, urgent tasks before us: Addressing the immediate and undeniable crisis facing kids today and reframing our pediatric mental health system to provide the right care, at the right place, and at the right time," said Benton, who is also president-elect of the American Academy of Child and Adolescent Psychiatry.
Delayed care leads to poor outcomes and higher financial costs, Benton testified. It also puts a strain on child care and education systems, and pediatric health care systems, where medical hospital beds are often needed for children in mental health crises.
She added that these delays can lead to the wrongful placement of children in the juvenile justice system.
"The current state of care is unacceptable, and we must pivot to proven models of prevention to reduce the number of our children entering a period of crisis," Benton told the committee.
A lack of staff and resources to meet this growing need is one of the biggest challenges of the mental health crisis, Benton said.
She said "many children show up at emergency departments, brought there by distraught caregivers, sent there by overwhelmed schools, or taken there by police who see plainly in a particular case, that care, not confinement, is what is needed."
But emergency departments are not the ideal setting for children without medical conditions.
"Emergency departments can be stressful environments and starting a mental health journey that way often results in delayed care when children are 'boarded' either in the emergency department itself or admitted to a medical patient bed," Benton said. "Neither option satisfies the 'right care, right place, right time' mantra, and both can be detrimental."
CHOP has up to 50 patients waiting for mental health beds on any given day, she said. And because CHOP typically operates at – or over – capacity, there are less beds for children with more complex medical needs.
While these children in mental health crises are kept physically safe, they must wait for an appropriate treatment slot to open before their needs can be fully addressed.
"Sometimes this wait is only a few hours, but weeks of waiting is far too common, months is not unheard of, and there are even instances of a child or adolescent missing more than a year of their life, removed from school and family, while waiting for the services they need to safely return to home and school," she said.
Benton shared several stories underscoring the mental health crisis. A 5-year-old planned to run into traffic due to anxiety stemming from a parent's job loss and the other's depression. A 6-year-old witnessed a shooting, but was afraid to speak up, fearing retribution. A 16-year-old who was depressed over a breakup attempted suicided while waiting six weeks for treatment.
An estimated 15 million children need care from mental health professionals, according to the American Psychiatric Association. But there are just 8,000 to 9,000 psychiatrists treating youth in the United States.
One short-term solution would provide more tools to help parents, teachers, caregivers and pediatricians identify early symptoms and provide proven interventions, Benton said. This would include supplemental training, access to phone consultations and referrals, and an expansion of telehealth services.
She also called for more pediatric mobile behavioral health crisis units, which could help reduce psychiatric emergency department visits and provide well-staffed 24-hour crisis hotlines.
In the long-term, more emphasis should be placed on intensive outpatient programs, partial hospitalization programs, day programs, step-down services and preventive services, Benton said. Right now, these services are in short supply.
Benton urged the committee to consider the environmental factors that affect the well-being of children, including foster care, juvenile justice, child care, education and food programs, when drafting legislation.
The best way to improve integrated care and preventive services is to reach youth where they are likely to be – at a pediatrician's office, school or community-based center, she said.
When patients are referred from primary care to a mental health clinic, only 25 to 50% attend an appointment, Benton said. But treatment initiation dramatically improves when behavioral health providers are on site as part of a primary care team.
Certified community behavioral health clinics are another important access point to mental health care for children, particularly those in underserved communities, she said. In a recent survey, 79% of these health clinics reported coordinating with hospitals to improve access to care. And many of them have child and adolescent psychiatrists as part of their care teams.
CHOP partners with health clinics to fill in the gaps of care, she said.
"Providing these clinics with additional resources could be another way to have more appropriate care available closer to home for kids in need," she said.
Other important issues that need to be addressed include the higher suicide rate among children of color and the need for better access to care no matter a family's socioeconomic situation.
Telehealth services for mental health must also continue as an adjunct intervention, she said. Telehealth services have increased sharply since the beginning of the pandemic as health care providers sought safer ways to deliver care.