3 hospital CEOs on why the pediatric mental health crisis needs more attention

The pandemic has led to an influx of children and families seeking help from hospital emergency rooms for mental and behavioral disorders. Three CEOs of children’s hospitals spoke to Becker’s in September and October about the mental health crisis facing children and health systems.

Marcy Doderer, CEO of Arkansas Children’s Hospital in Little Rock: The statistics across the country are quite startling. One in five children has a significant disability due to a mental illness, and the disease usually starts at the age of 13 or 14 years. Access to early assessment, intervention and treatment is challenging for children, especially those insured through the Medicaid program. These are not new signals. I think the industry has been seeing these signals since 2009 or 2010, where we’ve seen a massive increase in the number of emergency room visits for mental illness.

And I believe it has only been completely exacerbated by the pandemic. Virtual isolation in school and limited access to other forms of full involvement with peers or friends really leads to an aggressive response in children with mental disorders. We see a level of aggression and really uncontrolled behavior in some children who repeatedly ended up in our emergency room because the families are just looking for a respite.

Before the pandemic, mental disorders accounted for 1 percent of our emergency room visits. We are now moving towards 2.5 percent of those visits that are attributed to mental disorders, so a 150 percent increase over the past [18 months].

Arkansas Children’s is not directly active in psychiatric care. We do not have our own psychiatric hospital. We do not have an in-house psychiatric program, so we work with and refer patients to freestanding psychiatric hospitals in the state of Arkansas. One problem, not just for kids showing up to my ER, but ERs across the state, is that the inpatient facilities are full and they’re tight on space and staff, and the time it takes to get a child across. the clinical setting is now 50 to 75 percent longer than 18 months ago, and trying to understand how we as an industry and as a society can best address the mental, emotional and behavioral health needs of children is becoming a pressing topic for solutions.

Alicia Schulhof, CEO of Johns Hopkins All Children’s Hospital in St. Petersburg, Florida: We see, the rates are rising, but I’m concerned about the number of patients who haven’t even knocked on our door yet because we’re still in the middle of a pandemic. I think that’s why it’s so important from the point of view of masks and vaccinations, but then also, to get children into primary care, to keep up with the vaccinations and keep those screenings going, because that’s where we’re going to identify their mental health and behavioral health needs. And again, I think we’re just starting to scratch. I think this is an area that we will all have to work together on in the future, but I share it [Marcy Doderer’s] concern and her passion for saying we need to elevate this to an area of ​​national attention.

Madeline Bell, BSN, CEO of the Children’s Hospital of Philadelphia: This is probably one of our biggest challenges, the significant increase in children with emotional, mental and behavioral problems such as anxiety, depression and suicidal thoughts. It’s a big concern. In mid-September I had the opportunity to: [participate] in a small group discussion with President Biden, and I wanted to make sure I let him know that the pandemic has really exacerbated a problem we already had with children with behavioral problems. So there are a lot of things that I think can be done. As a country, I think we are hopelessly behind in preventing children from having such severe experiences of anxiety, depression and suicide that they end up in hospital. And so there’s a lot we need to do as a country.

One of the things we do [at CHOP] is embedding therapists into each of our primary care practices so that there is readily available support for families. We are building 46 psychiatric beds for children. I wish we didn’t have a crisis center. As I said, I feel there is so much we need to do to invest in prevention, but we’re not there yet as a country, so we’re left with seeing and responding to children who are the most having a crisis.

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