Behavioral Health Education and Integration in Pediatrics: A New National Emergency on Children’s Mental Health in the United States from October 1 to February 29, 2020
The panel of medical experts recommend for the first time that primary care doctors screen children ages 8 to 18 for anxiety in order to address the mental health crisis among American youth.
All adolescents should be screened for depression regardless of their age, according to the position of the U.S. Preventive Services Task Force.
The Children’s Hospital Association, the American Academy of Physicians and the American Academy of Child and Adolescent Psychiatry have declared a national emergency on children’s mental health in 2021.
The director of Behavioral Health Education and Integration in pediatrics at Weill Cornell Medicine in New York City said, “The earlier you identify symptoms, the sooner you intervene, and that reduces the amount of time a child is suffering.”
There were over 200,000 patients seen at 38 Children’s Hospitals in the United States between October 1, 2015 and February 29, 2020. The data came from the Pediatric Health Information System, an administrative database of children’s hospitals.
Meanwhile, the AAP offers some resources on HealthyChildren.org on RSV, influenza and Covid, including videos of troubled breathing that can indicate a child in need of medical care for RSV.
The emergency department is trying to keep people safe. It’s always open, but there’s limited extent to the types of mental health services we can provide in that setting,” Hoffmann said. There is not sufficient access to services that these kids need.
Suicides and Crisis: Some Reassurance and Advice for Parents and Carers in the Sierra Leone Children’s Health Care System (Scenario Report)
I can give some reassurance and advice to parents. If you or your family haven’t been Vaccined for Influenza or Covid-19, now is a good time to do so. Regular hand washing, staying home if you are sick and covering your mouth and nose to reduce viral transmission from coughs and sneezes will all help.
Don’t hesitate to contact your child’s doctor if you are worried about symptoms, most illnesses can be treated at home. Try to be patient, as they are most likely fielding a high number of calls from other parents and caregivers.
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline by dialing 9-8-8, or the Crisis Text Line by texting HOME to 741741.
A study found that visits to the ER with suicidal thoughts increased in the past two years. There was a corresponding increase in cases in which suicidal ideation was the principal diagnosis, which rose from 34.6% to 44.3%.
Brewer thinks the actual numbers are probably much higher than what the study says, since not all children who struggle with suicidal thoughts go to the emergency room.
Dr. Nicholas Holmes, senior vice president and chief operating officer at Rady Children’s Hospital in San Diego, said the increase in the number of kids seeking help in his health care system has been “profound.”
In the last nine years we had seen anywhere from 1 to 2 patients a day with a behavioral health crisis, now we are seeing twenty-plus a day.
Children also are responding to trauma in their lives and social influences on their health like poverty, historical trauma and marginalization, trouble at school, online bullying and the pressures brought by social media, in addition to a lack of access to counseling and therapy.
When a child is thinking about suicide, adults can intervene. She suggests caregivers watch for problems at the school and among friends, as well as for a child who is isolating themselves and showing signs of more anxiety or aggression than usual.
“They may act out or have problems sleeping. Irritability and being more withdrawn and isolating themselves are a lot of things that we oftentimes will think about,” Brewer said.
Parents should be allowed to sit back and listen to their kids and talk to them. Brewer said to try to relate and understand what is going on with their friends.
“We really need to develop more of a strategy to help support all kinds in different ways and really focus on some of those traumas and social influences of health,” Brewer said. Ensuring there are safe places for children to grow and thrive is something we need to do.
The new study found that without a follow-up, more than a quarter of the children had to go back to the ER for additional mental health care within six months of their initial visit.
“We see more and more mental health patients than ever before in the ER,” says Chris, the president of the American College of Emergency Physicians “I’ve heard stories of not just weeks but months.”
“Given more-than-doubling in fentanyl overdose deaths in teens from 2019 to 2021 just published by the CDC, it concerns me that we may only get one opportunity to intervene and help this highly vulnerable population who we urgently need to keep,” pediatrician Dr. Scott Hadland, chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School, who was not involved in the new study, wrote in an email to CNN.
In a commentary published alongside the new study, the authors say their research shows that the US “is not meeting the behavioral health needs of our young people.”
There is a growing need for better access to mental health services for young people and better funding to keep the services at their current level.
Bringing her daughter home with her to the ER: One day at a time in the night to deal with a serious mental health crisis
“She don’t know the danger that she was taking out there,” says Carmen, her voice choked with tears. “Walking in the middle of the night, anything can happen.”
Carmen picked up Haley, unharmed. But in those early morning hours, she learned about more potentially dangerous behavior — provocative photos her daughter had sent and plans to meet up with an older boy. She remembers the time when Haley said she wanted to die because she was being bullied. Carmen asked NPR to withhold the family’s last name to protect Haley’s identity.
She had driven her daughter to the local hospital, which was the only place they knew to look for help in an emergency, and Haley ended up on a gurney in a hallway with other young people with an urgent mental health problem.
A report from the Massachusetts Health & Hospital Association (MHA) shows youth ER boarding numbers dropped as more hospitals started referring families to one of the home-based options. The MHA says the numbers are hopeful, as demand for mental health care varies by season.
On her second day in the ER, Haley was given a psychological evaluation to determine what was best for her.
DeAnna Pedro looked at Haley’s report and considered if there was a need to send a patient to a mental health unit.
Pedro says she was doing a lot of high-risk things. There was a lot of thought given to the extreme nature of a psychiatric admission.
Pedro’s and Haley’s parents were concerned about this option. The only experience with mental health care the 12-year-old had was her school counselor. So instead Pedro contacted Youth Villages, one of the youth diversion agencies Massachusetts hired during the pandemic. Haley’s family met with a supervisor in the ER.
Laura Polizoti, the Youth Villages counselor assigned to Haley’s case says that they look under rugs and behind picture frames. Youth Villages also provided window and door alarms that Haley’s parents could activate at night.
Counseling for Haley and her parents started right away. The goal was to understand why Haley was taking pictures at night.
Thermometry as a tool for mental health intervention: A case study of pediatric boarding at a community-based ER
“Have you ever done an emotional thermometer before?” The picture of the thermometer on the table was laid out by Polizoti. There were blank lines for five different emotions.
Haley told the person that her palms get sweaty, she stops talking, and she makes a weird face. Haley scrunched up her nose and frowned to demonstrate. Polizoti laughed.
As the exercise unfolded, Polizoti asked Haley to think of ways to calm herself before irritation turns to anger. Haley suggested spending time alone, watching TV, playing with her siblings or jumping on the family’s trampoline.
The study found that the children that did not have mental health help before their visit to the ER had a hard time finding timely care afterwards.
“We would like to get these diversions with more families, so we can work more on them,” said Ms. Viano, Associate Director at the Parent Professional Advocacy League. Families have heard that this program is great to get children to go to the next place to heal faster.
And then there’s the cost: $8,522, on average, for the typical course of care. At Youth Villages, that’s three 45-60 minute counseling sessions a week, in a patient’s home or other community setting, for three months. The savings is significant. One study calculated the cost of pediatric boarding at $219 dollars an hour, or $5,256 for just one day. And that’s before the expense of a psychiatric hospital stay.
Outpatient Mental Health Visit Rates for Children in Medicaid are Not Equal to School Psychologists, or Does Your Child Have a Psychiatric Prescription?
Making these kinds of systemic changes may require “getting past some inertia as well as some reluctance to say ‘is this really what we need to do?'” says Kang.
Some families hesitate to try diversion if their child takes psychiatric medications or if they think the child needs to start them. Youth Villages does not have prescribers on staff. Children who need medication see a psychiatrist or primary care doctor outside the program.
Stone says many of the mental health challenges faced by these children are a result of factors in their natural environment: their school, their neighborhood and their peer system. “We think that it’s not possible to address those factors with a child in a placement.”
Family members are sometimes brought into the hospital to have mental health counseling in the psychiatric units. There’s no data yet to compare the outcomes, though.
“A lot of parents don’t know what the kids are going through because they don’t want to accept that your kids really need help,” she said. “Hopefully this can help another family.”
For their study, published Monday in the journal Pediatrics, Hoffmann and her co-authors looked at records for more than 28,000 children ages 6 to 17 who were enrolled in Medicaid and had at least one trip to the emergency department between January 2018 and June 2019. They found that less than a third of the children had the benefit of an outpatient mental health visit within seven days of being discharged from the ER. A little more than 55% had a follow-up within 30 days.
Research has shown that follow-up with a mental health care provider lowers a person’s suicide risk, raises the chances that they will take their prescription medicine and decreases the chances that they will make repeated trips to the ER.
Black children are more likely to live in areas that have a shortage of mental health professionals. There is not much diversity in the mental health work force. Studies show that a majority of psychologists, counselors and social workers are White. And Black children more often rely on school-based mental health services, studies show.
Although the number of school counselors has been increasing over the years, few schools meet the National Association of School Psychologists’ recommended ratio of one school psychologist to 500 students. The association found that the ratio was 1, 127 to 1 in the school year.
A Mental Health Concern for Children and Adolescents: The Need for More Follow-up Services at Children’s Hospital New Orleans, explains Dr. Gross
Dr. Gross is the chief of the Emergency Department at Children’s Hospital New Orleans. Her hospital’s beds for with mental health concerns are “always busy,” she said.
We need more providers for these services. We deal with it every day,” said Gross, who was not involved in the new research.
The lack of providers who can do follow-up is a real source of concern. It isn’t acceptable to hand a phone number to a parent hoping they can arrange care. It can take weeks or even months for a child and adolescent Psychiatrist to make their first appointment.
Gross said that it leaves a lot of people feeling like they wish they could do more. “When you always leave asking yourself at the end of the day, ‘did I really do what I set out to do, and that is to help people,’ it’s one of our biggest frustrations, and it may be one of the biggest reasons people in my group of physicians feel burnout.”
Commentary on “Recommendation for a Better Mental Health Support System in the Local and Regional Emergency Rooms” by R.J. Hoffmann
Hoffmann said that the amount of support varies by emergency department. Some areas don’t have the coverage of mental health workers who are able to give recommendations for appropriate care. For example, many rural emergency rooms don’t have pediatric mental health providers and may have few resources in the community, if any.
“EDs are the last stop when all else has failed, and they, too, lack the resources to support, or even discharge, these patients,” the commentary says.