The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the U.S. Surgeon General, and the National Children’s Hospital Association have declared a pediatric mental health crisis. I see this up close in the broad mental health system that I monitor every day. Anxiety, depression, eating disorders, and suicidal behavior have increased. Young people sit for days or weeks in emergency rooms or general pediatric beds, waiting to be admitted to a hospital psychiatric unit.
For children who are lucky enough to find a psychiatric bed, clinics tell us that when we try to discharge them, they cannot give the young person a relatively high level of outpatient care. In addition, waiting lists of up to six months are common for routine outpatient psychiatric care.
Why has mental health become such a huge issue among our youth? There are many reasons. Over the last 15 years, young people’s depression and suicidal behaviors have steadily increased. The CDC’s Youth Risk Behavior Survey shows a 10% increase in depressive symptoms and a 5% increase in suicidal thoughts and plans from 2009 to 2019. Access to care has not kept pace with the growth of need, especially for children who need more. intensive services. Tragically, suicide is currently the leading cause of death among people between the ages of 10 and 24, and will end the lives of more young people than any other health condition.
On top of the basic trends, COVID has put tremendous stress on children and families, doubling the need for youth mental health services. Our children’s mental health service system is falling apart due to the weight of demand. The divestment of public and commercial payers and the reduction of payments have left us completely unprepared for decades for the rising needs.
Despite many challenges, we have learned a great deal about children’s mental illness over the last 20 years and have developed many effective treatments that have been shown to work throughout their developmental life. We know that reaching children as early as possible on the path to illness is linked to better health and well-being. Why wait until the children are really sick? What do we need to do to deliver these effective services to children and their families on time?
First of all, we have to deal with the drivers who are rooted in our inadequate care system, and these drivers are largely financial. Over the last two decades, the steady decline in hospital psychiatric treatment and hospital beds for children and adolescents has been directly linked to a reduction in hospital and residential care return rates. Outpatient mental health services, which should be the focus of our care system, suffer from the same deficiency. Medicaid and commercial insurance refunds do not cover the cost of quality or evidence-based mental health care.
Specifically, on the commercial side, insurance companies pay at such low rates that mental health care providers are unable to pay to care for these patients. Finding a network provider can be a daunting task for families, especially if young people need to see a child and adolescent psychiatrist, as the supply is particularly poor. Families are forced to go online to find providers, where their commercial insurance will cover only a small percentage of the actual cost of care if they also find a mental health provider.
For low-income families, Medicaid often provides better access, but the lack of a sufficient rate of return is reflected in low wages and high workloads, often provided by clinicians with the least experience. Here, we have underpaid and demoralized staff who are leaving the public service as soon as possible. They can easily earn more in the private sector, in private practice or in a completely different field.
The promise of community-based intensive services – one of the justifications for the reduction in psychiatric hospitalization and residential treatment capacity – that can keep children safe at home and in their communities has not been fulfilled. This causes tremendous stress and pain for families trying to care for sick children at home. These services will not be available until you know how to pay for them permanently.
We spent billions and millions of dollars to keep people alive at the beginning of COVID’s response. ICU beds were set up in every hospital in the city in just a few days. The fans were sent across the country as the rise changed. The National Guard was mobilized to help. So I ask: where is the emergency response to our mental health to the tremendous suffering that children and families are experiencing? How can we fix our mental health system to prevent such a breakdown from happening again? Why don’t we have a realistic rescue plan?
Havens is Professor Arnold Simon and head of the Department of Child and Adolescent Psychiatry at NYU Grossman School of Medicine.