Combating the Growing Children’s Mental Health Crisis
Download a PDF of this articleAfter three years, many of the policies and procedures put in place to address the COVID-19 pandemic and expand access to healthcare are beginning to expire, yet the long-term effects are here to stay. The pandemic brought to light long-standing issues in healthcare, and the mental health crisis is no exception. Millions of people, including children and adolescents, experienced new stressors and heightened negative emotions as a result of the pandemic, so much so that the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) declared a National State of Emergency in Children’s Mental Health in 2021.[i]
While mental health challenges among children and adolescents were already a growing concern prior to COVID-19, the pandemic exacerbated symptoms of depression, anxiety, suicidal ideation, and more at unprecedented levels amid lockdowns, loss of loved ones, and isolation from school and peers. Not only that, but the pandemic disproportionately impacted the mental health of children of color and other at-risk groups including LGBTQ youth.[ii] Further, the mental health crisis is ongoing and has taken a toll on the healthcare system, including on children’s hospitals. To continue providing lifesaving care to children in need as the crisis worsens, children’s hospitals will need the support of policymakers to fund the resources and tools necessary to strengthen mental health services.
The State of the Mental Health Crisis
The mental health crisis is actively permeating all points of children’s lives including at home, where mental health tops the list of parents’ concerns,[iii] and at school, where administrators and teachers are reporting increased disruptive and sometimes violent behaviors, trouble focusing and sitting still, and increased apathy towards grades.[iv],[v] Schools have taken advantage of federal pandemic money to invest in mental health resources and hire mental health specialists, but still do not have the personnel that they need to help students due to labor shortages driven by increased demand for mental health services.[vi] When parents try to seek care for their children outside of schools, they find that many therapists and mental health providers are also struggling and have waitlists of up to six months.[vii] Even when appointments become available, many families struggle to afford care as most mental health providers do not accept insurance and the out-of-pocket costs per session are too high, leaving children without the treatment they need.[viii]
Children’s hospitals also are being overwhelmed and hit hard by the mental health crisis. Hospitals are experiencing an influx of children and adolescents needing inpatient and outpatient mental health services,[ix] and this has led to children’s hospitals’ emergency departments (EDs) to become the point of entry for many families even though they are not staffed to treat mental health emergencies.[x] As a result, mental health-related hospital visits and revisits are on the rise.
While much of pandemic-related research is still in the early stages, one study found that pediatric mental health-related ED visits increased at the start of the pandemic and continued to increase monthly during the study period.[xi] Moreover, research has indicated that long wait times at EDs are only getting worse. In fact, between 2020 and 2021, approximately 21 percent of children who visited an ED for a mental health condition experienced stays that lasted over 12 hours, surpassing a peak of 12.7 percent reported prior to the pandemic.[xii] Over seven percent of pediatric mental health visits exceeded more than 24 hours over the two-year period.[xiii] Visits lasting over 24 hours were also much higher for much of 2021 compared to 2020.[xiv] As children’s hospitals grapple with the circumstances of overwhelmed EDs, these challenges are coinciding with the nationwide shortage of child and adolescent psychiatrists,[xv] making matters worse.
Tackling the Mental Health Crisis
Children’s hospitals, health organizations, and advocates are calling on lawmakers at both the state and federal levels to push for greater funding and investments into addressing the mental health crisis, including expanding the mental health and pediatric workforce and training.[xvi],[xvii] These groups have also asked the Biden administration to do more to address the mental health needs of children by issuing a National Emergency Declaration, which would allow the administration to leverage and allocate funds to help children and families.[xviii] At the same time, they have launched and participated in nationwide campaigns to increase awareness of the need for federal funding for mental health services.[xix]
The pandemic has changed the stigma around mental health and policymakers have overall been more receptive to engaging in the conversation. Still, there are opportunities for continuing to bolster pediatric mental healthcare, raise awareness of the ongoing crisis, and invest in mental health research and services. This will be crucial as the mental health emergency grows and as nationwide efforts to improve access to mental health services accelerates. Absent quick actions, the long-lasting effects of children and adolescents struggling with untreated mental health issues will prove to be harmful and dangerous. In pursuing additional policy changes to address the children’s mental health crisis, it will be critical to efficiently communicate with and persuade the Biden administration and Congress to expand and further invest in children’s mental health.
Taking Action
This Mental Health Awareness month, children’s hospitals and provider groups can consider the following actions to engage policymakers on the issue of children’s mental health and influence the legislative process to increase related funding:
- Develop messaging to communicate that existing investment has had a positive impact on addressing the children’s mental health crisis and why more funding is needed.
- Establish a stakeholder engagement strategy to rally patients, providers and community groups to communicate the needs for additional funding and expanded mental health services.
- Disseminate patient, parent and pediatrician stories through targeted media outlets.
- Prepare direct lobbying and policymaker engagement strategies at both the state and local levels.
- Forge a working relationship and partner with the U.S. Surgeon General, who has been an outspoken advocate on children’s and adult mental health issues.[xx] This could include coordinating visits to children’s hospitals.
- Develop communications materials in anticipation of mental health-related funds expiring or not being renewed.
- Be ready to communicate to beneficiaries that services might be cut off.
- Collaborate with community groups and pediatricians to redirect patients to outside programming or to provide resources for children and adolescents in need.
[i] “AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health,” American Academy of Pediatrics (last updated October 19, 2021), https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/.
[ii] “Protecting Youth Mental Health,” The U.S. Surgeon General’s Advisory (2021), https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf.
[iii] Rachel Minkin and Juliana Menasce Horowitz, “Parenting in America Today,” Pew Research Center (January 24, 2023), https://www.pewresearch.org/social-trends/2023/01/24/parenting-in-america-today/.
[iv] Christine Vestal, “COVID Harmed Kids’ Mental Health—And Schools Are Feeling It,” Stateline (November 8, 2021), https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/11/08/covid-harmed-kids-mental-health-and-schools-are-feeling-it.
[v] Jocelyn Gecker, “With students in turmoil, US teachers train in mental health,” AP News (April 4, 2022), https://apnews.com/article/health-california-education-mental-health-distance-learning-7d6c8b93794d2522e5807ca9fe2fb0cf.
[vi] Associated Press, “Youth Mental Health Is in Crisis. Are Schools Doing Enough?,” U.S. News & World Report (August 17, 2022), https://www.usnews.com/news/us/articles/2022-08-17/youth-mental-health-is-in-crisis-are-schools-doing-enough.
[vii] Brenda Goodman, “Long waiting lists, long drives and costly care hinder many kids’ access to mental health care,” CNN Health (Updated October 6, 2022), https://www.cnn.com/2022/10/06/health/youth-parents-mental-health-kff-poll-wellness/index.html.
[viii] Id.
[ix] “Pandemic Has U.S. Hospitals Overwhelmed With Teens in Mental Crisis,” UC San Diego Health Library (May 24, 2022), https://myhealth.ucsd.edu/RelatedItems/6,1657345683.
[x] Rebecca T. Leeb, PhD; Rebecca H. Bitsko, PhD; Lakshmi Radhakrishnan, MPH; Pedro Martinez, MPH; Rashid Njai, PhD; and Kristin M. Holland, PhD, “Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020,” Centers for Disease Control and Prevention (November 13, 2020), https://www.cdc.gov/mmwr/volumes/69/wr/mm6945a3.htm.
[xi] Lavanya G. Shankar, MD, MS; Michele Habich, DNP, APRN/CNS, CPN; Marc Rosenman, MD; Jennifer Arzu, MPH; George Lales, MS; and Jennifer A. Hoffmann, MD, “Mental Health Emergency Department Visits by Children Before and During the COVID-19 Pandemic,” National Library of Medicine (June 3, 2022), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164513/.
[xii] Alexander T. Janke, MD, MHS; Katherine A. Nash, MD; Pawan Goyal, MD; Marc Auerbach, MD, MSc; and Arjun K. Venkatesh, MD, MBA, “Pediatric mental health visits with prolonged length of stay in community emergency departments during COVID-19,” Wiley Online Library (December 20, 2022), https://onlinelibrary.wiley.com/doi/10.1002/emp2.12869.
[xiii] Id.
[xiv] Id.
[xv] “Severe Shortage of Child and Adolescent Psychiatrists Illustrated in AACAP Workforce Maps,” American Academy of Child and Adolescent Psychiatry (May 4, 2022), https://www.aacap.org/aacap/zLatest_News/Severe_Shortage_Child_Adolescent_Psychiatrists_Illustrated_AACAP_Workforce_Maps.aspx.
[xvi] Letter to Congress, Children’s Hospital Association (November 2, 2022), https://www.childrenshospitals.org/-/media/files/public-policy/mental_health/letters/2022/110222_end_of_year_priorities_congress_letter.pdf.
[xvii] Boram Kim, “Texas children’s hospitals ask lawmakers to prioritize youth behavioral health in 2023,” State of Reform (December 15, 2022), https://stateofreform.com/featured/2022/12/texas-childrens-hospitals-ask-lawmakers-to-prioritize-youth-behavioral-health-in-2023/.
[xviii] American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association, “Health Organizations Urge the Biden Administration to Declare a Federal National Emergency in Children’s Mental Health,” American Academy of Pediatrics (last accessed May 4, 2023), https://www.aap.org/en/news-room/news-releases/aap/2022/health-organizations-urge-the-biden-administration-to-declare-a-federal-national-emergency-in-childrens-mental-health/.
[xix] “Wolfson Children’s joins national call for legislation, funding for children’s mental health resources,” Wilson Children’s (January 6, 2022), https://www.wolfsonchildrens.com/about/news/news-release/wolfson-children-s-joins-national-call-for-legislation-funding-for-children-s-mental-health-resources.
[xx] “Protecting Youth Mental Health,” The U.S. Surgeon General’s Advisory (2021), https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf.
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