Long wait times and insufficient resources for youth mental health are tragically common. Recently, in our emergency room at New York-Presbyterian Morgan Stanley Children’s Hospital, children and teens could wait an average of three to four days for an inpatient bed. This turned to a still unacceptable wait of two to three days thanks to an obvious solution: six more beds were added in one of our inpatient units, which was not an easy task.
There are currently blocks on every mental health care portal for inpatient and outpatient care, in person and through Zoom. Often times, I can’t find other clinicians to refer children to or treat alongside me using other types of therapy because everyone is already too busy.
This shortage predates the pandemic. A 2019 study found that nearly half of the 7.7 million pediatric patients in the United States with a mental health disorder were not receiving treatment. The American Academy of Child and Adolescent Psychiatry estimates that there should be 47 child and adolescent psychiatrists per 100,000 youth in the United States, but the national average is only 11 physicians per 100,000.
The increased need for care has turned this shortage into a real crisis. Among emergency department visits by girls aged 12 to 17 at the start of 2021, there was a more than 50 percent increase in suspected suicide attempts compared to the same period in 2019. During In the first six months of this year, children’s hospitals across the country reported a 45% increase in the number of self-harm and suicide cases among 5- to 17-year-olds compared to the same period in 2019.
The 2021 US bailout and Build Back Better, which has yet to be passed, both have substantial allocations for pediatric mental health. The Substance Abuse and Mental Health Services Administration distributes $ 3 billion in funding for mental health and addiction, 25 percent of which goes to children, youth and families, focusing primarily on crisis care. Building back better would provide $ 165 million.
The open question is how to allocate this money. We need more clinicians in schools, more child psychiatrists, better screening, more emergency departments and 72-hour emergency assessment units, more inpatient beds and intensive outpatient programs designed to keep children out of hospital and so they can transition to subsequent hospitalizations. Repeated suicide attempts among adolescents, for example, are more common in the month following discharge from a psychiatric hospital.
We also need to improve access to preventive care and services, especially to reach suicidal adolescents. While there has been a large expansion of remote “tele-mental health”, we need more “field boots” of mental health in our schools and pediatrician offices. Less than 40 percent of schools in our country had full-time nurses in 2017. Psychologists are responsible for an average of 1,211 students. We need to recruit and train more clinicians and improve our arsenal for the treatment of pediatric mental health. A colleague suggested developing an AmeriCorps-like program to train college graduates to provide school-based mental health services.