Comment: The kids are not all right; improve mental health care

More teens and pre-teens are being admitted to acute care facilities at a time of shrinking resources.

By Lisa Jarvis / Bloomberg Opinion

It’s no secret that kids in the U.S. are struggling with mental health issues in increasing numbers. Now, a new study in the Journal of the American Medical Association emphasizes the severity of the situation: Pediatric mental health hospitalizations are rising, and many more kids are being hospitalized for attempting suicide.

The data couldn’t be clearer: We’re not identifying and supporting struggling kids before they hit a crisis.

JoAnna Leyenaar, lead author of the study, is a pediatric hospitalist and vice chair of research for the department of pediatrics at Dartmouth-Hitchcock Medical Center in New Hampshire. She noticed a growing proportion of the patients at her hospital were coming in because of mental health conditions. She decided to mine the country’s largest public database of pediatric inpatient care to try to understand if it was a nationwide trend. And clearly, it is. Between 2009 and 2019, pediatric mental health hospitalizations at acute care facilities rose by nearly 26 percent. By 2019, two-thirds of those children and adolescents were coming into the hospital after having attempted suicide or harmed themselves.

“This is reflecting a very real change in the patterns of disease that are being seen by acute care hospitals around the country,” Leyenaar says. She notes that diagnostic classifications were updated and hospitals changed their coding systems during the study period; for example, differences in hospital coding might have resulted in an increase in the number of kids receiving multiple diagnoses. But she says the changes can’t account for the huge increase in kids being admitted for mental health emergencies.

A few important things came out of the data Leyenaar and her colleagues analyzed. First, because they chose to look at the 10-year period starting in 2009, the study makes clear that this rise in more serious mental health conditions can’t be blamed on the pandemic; kids were already in crisis before that upheaval.

Second, the increase in mental health hospitalizations is happening across the board, regardless of a child’s race, socioeconomic status, or ZIP code. Certain groups are struggling more, though. Girls experienced a much sharper rise in hospitalizations than boys; which jibes with a recent report from the Centers for Disease Control and Prevention that found a spike in teen girls feeling depressed and considering suicide. And kids in early adolescence — that is those between the ages of 11 and 14 — experienced the biggest uptick in mental health crises.

Last, many more kids are being admitted after having attempted suicide or harmed themselves. In 2009, about 31 percent of mental health hospitalizations included a report of self-injury; by 2019, that figure was just over 64 percent. That number doesn’t surprise Colleen Cicchetti, executive director for the Center for Childhood Resilience at Lurie Children’s Hospital of Chicago, who says it reflects not only the dire state of kids’ mental health, but also that limited capacity has raised the bar for being admitted to the hospital. In other words, conditions that would have warranted hospitalization in 2009 were, by 2019, being treated with outpatient care.

For mental health workers, these new data confirm the scope of the problem. “This is going to be one we’re going to be quoting for a long time,” Cicchetti says. “This is a massive database across the whole country. It’s highlighting that we have a real need to do something about it.”

The question, of course, is what can be done.

The most obvious solution is to throw all of our resources into preventing these crises from happening. That means building the health care capacity to treat kids long before they’re at a point where a parent has nowhere else to turn but an ER or hospital.

That’s not going to happen overnight. To address the needs of children and adolescents, the U.S. would need five times as many pediatric mental health specialists. Building out a sufficient network will require not only increasing the number of psychiatrists and social workers, but doing a better job training the people who interact with kids most: pediatricians, teachers and community leaders.

In the meantime, staff at acute-care facilities need more support. That includes training on how to best care for a child experiencing a serious mental health disorder. Most physicians in an acute care setting “are not trained mental health professionals, or have very minimal mental health training through medical school and residence,” Leyenaar notes.

And the U.S. simply needs more dedicated, high-quality mental health facilities for minors. The JAMA article pointed out that more kids are being admitted to acute care facilities at a time of shrinking resources.

Creating that capacity isn’t cheap. A recent article by WBEZ public radio noted that outfitting a patient room in an adolescent psychiatric unit, an endeavor that involves special safety features, can run upward of $1 million. A single room.

Yet even if such rooms could be built for free, pediatric mental health would not be a profitable business. A child psychiatry unit housed within a general hospital typically isn’t financially sustainable, according to a 2022 report from the American Psychiatric Association, because care is expensive and reimbursement rates are low.

But we can’t let resources hold us back from helping struggling kids. They are in crisis; and they’re counting on adults to help.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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