Long wait times and insufficient resources for youth mental health are tragically common. Recently, in our emergency room at NewYork-Presbyterian Morgan Stanley Children’s Hospital, children and teenagers could wait an average of three to four days for an inpatient bed. This improved to a still unacceptable two- to three-day wait thanks to an obvious solution: Six more beds were added at one of our inpatient units — which was no easy task.
There are currently logjams at every portal to mental health care for inpatient and outpatient care, in person and over Zoom. I often cannot find other clinicians to refer children to or to 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 for every 100,000 youths in the United States, but the national average is just 11 such doctors per 100,000.
The increased need for care has turned this shortage into a full-on crisis. Among emergency department visits by girls ages 12 to 17 in early 2021, there was a more than 50 percent increase in suspected suicide attempts compared with the same period in 2019. In the first six months of this year, children’s hospitals across the country reported a 45 percent increase in the number of self-injury and suicide cases in 5- to 17-year-olds compared with the same period in 2019.
Both the American Rescue Plan of 2021 and Build Back Better, which has yet to be passed, have substantial allocations for pediatric mental health. The Substance Abuse and Mental Health Services Administration is distributing $3 billion in funding for mental health and addiction, with 25 percent for children, youth and families, focusing mainly on crisis care. Build 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 crisis services and 72-hour emergency evaluation units, more inpatient beds, and intensive outpatient programs designed to keep children out of the hospital and for them to transition into following hospitalizations. Repeat suicide attempts by teenagers, for example, are most common in the month after discharge from a psychiatric hospital.
We also need to improve access to care and preventive services, especially to reach suicidal teenagers. Although there has been a large expansion of remote-based mental “telehealth,” we need more mental health “boots on the ground” in our schools and pediatricians’ offices. Fewer 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 enhance our arsenal for treating pediatric mental health. A colleague suggested developing an AmeriCorps-type program to train college graduates to provide school-based mental health services.