How Children’s Hospitals Are Treating Mental Health

Rise in serious mental health problems — and suicide — in children and adolescents already had experts plenty worried. And then the pandemic put more strain on kids’ emotional stability. Given the trends of the past 10 years or so, the situation today is “kind of a crisis on top of a crisis,” says Dr. C.J. Glawe, co-medical director of the psychiatric crisis department at Nationwide Children’s Hospital in Ohio.

The proportion of children ages 6 to 17 ever diagnosed with anxiety or depression increased from less than 5.5% in 2003 to nearly 8.5% in 2011-2012, according to the Centers for Disease Control and Prevention. One in six students had enough emotional or behavioral impairment to be diagnosed with a childhood mental health disorder in a separate CDC study conducted in four school districts from 2014 to 2018. In late 2019, the CDC reported that the suicide rate for teens ages 15 to 19 had risen 76% between 2007 and 2017 and nearly tripled for children 10 to 14.

The COVID-19 pandemic exacted a mental health toll of its own. For American kids ages 13 to 18, private mental health insurance claims roughly doubled as a proportion of all medical claims in March and April 2020 compared to the same period in the previous year, according to a recent report by the nonprofit FAIR Health. Claims for intentional self-harm rose by more than 90% in that age group, with similar increases in generalized anxiety and major depressive disorders. At the same time, the U.S. health system struggles with a dearth of pediatric mental health specialists. “Not a single state in the country has an adequate supply of child psychiatrists, and 43 states are considered to have a severe shortage,” noted a March 2017 Milbank Memorial Fund report. General medical facilities must fill the void for families with nowhere else to go. “Pediatric emergency departments face higher volumes of patients presenting with psychiatric concerns,” warned a February 2020 letter in JAMA Pediatrics. “Many patients who require psychiatric hospitalization board in the ED despite needing treatment that extends beyond the scope of most EDs.” According to the Milbank report, only an estimated 15% to 25% of children with psychiatric disorders receive specialty care.

In response, children’s hospitals are ramping up their commitment to providing that care. In early 2020, for example, Nationwide Children’s opened a new state-of-the-art pavilion devoted to kids’ mental and behavioral health that offers multiple dimensions of care. In addition to the psychiatric crisis department, services include a youth crisis stabilization unit, family-based intensive therapy, a critical assessment and treatment clinic, a mood and anxiety program, a general psychiatry program and the Center for Suicide Prevention and Research.

Kids in distress may be referred to the emergency service by schools or police departments, or brought in by family members. Sometimes, they come in on their own. The issue with kids referred from school is typically a mood or anxiety disorder expressed to a counselor, or indications of self-harm or suicidal thoughts, Glawe says. Sometimes, it’s a behavioral problem such as outbursts or aggression.

[See: Apps to Support Your Mental Health]

Added Adversity

Similarly, mood and anxiety disorders and disruptive behaviors and conflicts at home are frequent reasons families bring a child in for treatment. Bipolar disorder, psychosis — including first-episode psychosis — are among other diagnoses. “We see a good number of autism and development disorders,” Glawe says, along with “smatterings” of other issues such as substance abuse or catatonia. The pandemic added a new dimension of stress, as families faced adversity and kids lost their routines and ability to play and socialize freely. Changes in structure have been particularly difficult for kids with autism and intellectual disabilities who rely on school programs and other services for their treatment and education, he says.

Community outpatient clinics and resources, as well as in-hospital services, are striving to meet growing demand. “Right now, the need has become so great that even though we are opening a new program and working on staffing as fast as we can,” Glawe says, “the need is so outstripping the access.”

That reality, coupled with the shortage of specialists, has put pediatricians and family practitioners on the front line. “I had one pediatrician say to me that recently they’ve seen more kids with mental health concerns than with ear infections,” says Dr. Lee Beers, medical director of community health and advocacy at Children’s National Hospital in the District of Columbia and president of the American Academy of Pediatrics.

[READ: Mental Health Support Groups: Pros & Cons.]

Helping Pediatricians

Beers leads an innovative project called DC MAP (for Mental Health Access in Pediatrics) that aims to arm physicians citywide with the support they need to help suffering children. Launched in September 2015, DC MAP is staffed in a collaboration between Children’s National Hospital and MedStar Georgetown University Hospital. Psychiatrists, psychologists, social workers and case managers from both health systems comprise DC MAP teams. In the community, primary care pediatricians can consult with these specialists whenever they identify a young patient with a mental health concern — for instance, while doing a routine screening during a wellness visit.

DC MAP represents part of a larger nationwide movement. Established in 2011, the National Network of Child Psychiatry Access Programs supports child psychiatry consultation initiatives to help integrate pediatric mental health and primary care and make it easier for families to overcome barriers to getting treatment. “Many mental health providers don’t take insurance and require out-of-pocket payment,” putting care out of reach for many families, Beers says. Language and transportation can pose other challenges.

During the pandemic, it’s been important to recognize that “kids who are likely hardest hit are also likely to have the least equitable access to mental health resources, Beers says. The DC MAP teams help families get the support they need.

Early access to mental health care gives developing children an immense advantage, experts say. Berinna Doggett’s young son, now 7 and a second-grader, first connected with Children’s National Hospital in 2018 through its clinic for celiac disease. The autoimmune condition primarily affects the digestive system but can cause complications including childhood behavioral issues and attention deficit hyperactivity disorder. Every year, he would undergo a comprehensive evaluation, meeting with a mental health specialist, gastroenterologist and other team members. “We had started seeing some behavioral issues and just some anxiety, focus and attention issues” during preschool, says Doggett, a clinical social worker in the District of Columbia.

For nearly a year, the child worked with a psychologist at Children’s National. “We saw a lot of improvement — he was doing really well,” Doggett says. As kindergarten approached, the parents and psychologist paused therapy.

Then, just a couple months into the pandemic, Doggett says, some of those behaviors returned. Some new ones appeared as well, such as biting or sucking on his arm, leaving marks. Temper tantrums were frequent.

Making a Difference in Mental Healh

The family decided to resume therapy virtually, and the child’s therapist gave him “the tools and language to help him share his feelings,” Doggett says. For example, he learned to name colors to indicate his emotions, like red for “angry.” During one-on-one time with his psychologist, she says, he would take his computer to his room, and “show her where he would go to be calm, and they could talk about it.” After “graduating” from therapy in March, “he’s doing excellent now,” his mother says. “It made a huge difference.”

Comprehensive mental health care takes place on a continuum, says Jason Williams, a child psychologist and director of operations for the Pediatric Mental Health Institute at Children’s Hospital Colorado in Aurora. Outpatient, partial hospitalization, inpatient and emergency services are available for kids depending on their needs at any given time.

“We can really care for a kid in acute crisis coming to our emergency department, help stabilize them in our inpatient unit, and actually work to get them — in a step-down way — back to their community and provide care ongoing at a lower level of need,” Williams says. “And the reverse is true.”

For kids whose psychiatric issues disrupt their ability to function, the partial hospitalization program allows them to receive intensive treatment five days a week and then go home at night. They’re able to practice their skills with their families as well as within the program’s classroom-like setting.

[See: Tips to Support Someone Having a Panic Attack.]

Suicide Scares

Right now, the emergency department is exceptionally busy, Williams says, and at times he’s finding that “the No. 1 reason” for seeking treatment is suicidal ideation. “I have never seen that before,” he says. A roughly 10% increase started in March 2020, and kids are coming in with more serious physical injuries from suicide attempts than in the past. Self-harm is also increasing. Kids as young as 11 are coming in after suicide attempts, and kids as young as 6 are coming in with suicidal ideation, he says.

“That tells me we’re not getting to them earlier on, when these symptoms start to show,” Williams says. In a typical school setting, a teacher or peer might pick up on red flags and alert parents or a school counselor, and distressed kids could be identified. But virtual learning has made it easier to miss the signs of trouble.

Bailey Shelden, 17, is a Denver high school student who advocates with peers from area schools to raise awareness of — and reduce the stigma of — mental illness, including by creating and appearing in a video for school faculty on reaching out to troubled kids. Bailey speaks from experience, as she has coped with several serious mental health issues herself, including anxiety and depression, an eating disorder and several suicide attempts.

Her speaking out started with a ninth-grade English class discussion in which a student made a “backwards” comment about a young character in “The Kite Runner” who attempted suicide. “What does a Gen Z’er do if faced with a situation like that?” Bailey says. “I took it to Twitter, and I just made a tweet about how I was amazed that this ignorance still exists.”

The tweet caught the eye of a Youth Action Board member for Children’s Hospital Colorado Pediatric Mental Health Institute, where Bailey has received care. The YAB advises hospital faculty and staff on better ways to treat kids and teens with mental health issues, and raises community awareness through projects to support change. “Basically, I and several other ambassadors help to advise the school on ways that we can better the community and kind of better teach mental health to students every day,” she says.

Bailey is also dealing with just being a teen. She pushes herself in school, taking tough classes in the international baccalaureate program. In therapy, what she finds most helpful is an emphasis on mental health education and skills to help her cope, such as a calming method called box breathing. “It’s kind of a technique to center me and force me out of what my therapist and I like to call ‘anxiety brain,’?” she says. “Or if I’m about to have a panic attack.”

Here’s what Bailey wants everyone to understand: “Young people and mentally ill people — we just want more support, through all the highs and the lows, and the productivity and the nonproductivity. Just through all of it, we really want your support.”

More from U.S. News

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