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The pandemic has pushed children’s mental health and access to care to a ‘crisis point’

By Jen Christensen, CNN

Throughout the Covid-19 pandemic, Bailey Lynn and her friends often talked about the toll the virus has taken. Still, the high school senior was surprised recently by the results of a survey she created to assess her classmates’ mental health during the pandemic: Only a quarter who said they thought they needed a therapist had access to one.

“I didn’t know it was so bad,” said Lynn, a member of the Children’s Hospital Colorado Youth Action Board. “And I know the situation isn’t much better at other schools.”

Many adults report that the pandemic has been hard on their mental health. For kids, some experts say, it has become a crisis.

Children’s hospitals around the country say they have seen a meteoric rise in the number of children who need mental health help. Access to care, which was a problem before the pandemic, particularly for kids of color, has gotten much worse.

Several children’s hospitals said the supply of inpatient psychiatric beds has been so short, they’ve had to board kids in their emergency departments — sometimes for weeks.

“We really have never seen anything like this rapid growth in kids presenting with mental health problems and the severity of those problems. I’ve never seen this in my entire career,” said Jenna Glover, the director of psychology training at Children’s Hospital Colorado.

It got so bad, Children’s Hospital Colorado declared a “state of emergency” in May. Glover said the number of kids they treated for anxiety doubled — and depression numbers tripled — compared to pre-pandemic levels. Substance and eating disorders increased, too.

In January through April of this year, behavioral health emergency department visits were up 72% over the same time period two years ago, the hospital said. The numbers have been tapering off this month and last, but there is concern there will be another spike when school starts back in August and September.

Other hospitals saw even bigger increases. In January, Wolfson Children’s Hospital in Jacksonville, Florida, for example, said it saw a 300% increase in the number of behavioral health emergency admissions since April 2020.

“Kids’ mental health, truly, has been under assault for over a year,” Glover said. “It’s probably actually worse than people think it is.”

Nationally, the US Centers for Disease Control and Prevention found emergency department visits for suspected suicide attempts during February and March of 2021 were more than 50% higher for teen girls, compared to 2019. It was up more than 4% for boys. From April to October 2020, hospitals around the country saw a 31% increase in 12- to 17-year-old kids seeking help for their mental health, and a 24% increase for kids ages 5 to 11.

In March of this year, Seattle Children’s reported seeing one or two patients every night for attempted suicide. With so few inpatient psychiatric beds in the area, the hospital had to board kids in the emergency department. Some waited two weeks before a bed became available.

With so few pediatric psychiatric beds available In Massachusetts, 39% of pediatric patient who came to the ER for a mental health issue in 2020 wound up staying there, according to a state report.

During the pandemic, Ann & Robert H. Lurie Children’s Hospital of Chicago has reached what Dr. Jennifer Hoffmann called a “crisis point.” There were so many mental health-related emergency room visits that it activated a response usually reserved for disaster management. “It allows for coordination at the highest level of leadership in order to address the mental health crisis among children,” said Hoffmann, an attending physician in emergency medicine.

Hoffmann’s hospital also had to board kids in the emergency department or admitted them to medical beds, where they sometimes wait for days until a psychiatric inpatient bed opened up. Colleague Dr. John Walkup, chair of the Pritzker Department of Psychiatry and Behavioral Health at the hospital, said the pandemic exacerbated access problems that have been around for awhile.

“We’ve never had an adequate mental health system in the United States for kids — never — and so you take an inadequate system to begin with, and then all of a sudden, you put kids who are at elevated risk … in a very difficult living and life situation. And you now have a crisis of access,” Walkup said.

Many of the kids his hospital treats in the emergency department had a mental health problem that was never diagnosed, or was inadequately treated before the pandemic. Now, when they seek help, they can’t get a regular appointment with a therapist. Even before the pandemic, studies have shown it can sometimes take months to get a first appointment.

“Those kids, when you take away school, family support, income support, food support, housing support, or they lose a relative, those kids really become symptomatic in a big way,” Walkup said.

Children who can get treatment, Walkup says, are doing OK during the pandemic. It’s the ones who can’t access help that the world should worry about.

“The world doesn’t work if we don’t have good behavioral health for kids,” Walkup said.

In Colorado, the mismatch of supply and demand for additional inpatient psychiatric beds is unmatched in pre-pandemic times, said Zach Zaslow, the senior director of government affairs at Children’s Hospital Colorado.

“We end up boarding kids in our emergency department or in our inpatient unit, not because that’s what’s best for them but because there’s literally nowhere else for them to go,” Zaslow said. “Sometimes they get transferred to out-of-state residential facilities to get the care that they need, which splits families up,” he said. “And that can be traumatizing for kids as well.”

If there is a silver lining in the pandemic, the experts say, people have started to recognize that the system has to change.

“The pandemic has become the great equalizer and there seems to be a wider recognition that this is something we have to address more broadly,” said Colleen Cicchetti, a pediatric psychologist with Lurie Children’s Hospital.

Zaslow said after Children’s Hospital in Colorado declared a state of emergency, there was bipartisan recognition about issues of access. The state set aside about $500 million of the money Colorado got from the federal American Recovery Act plan for behavioral health for adults and kids. Colorado also increased its funding for residential treatment facilities.

And if kids are able to get support, there are highly effective treatments.

Bailey Lynn knows exactly how important it can be. In addition to being on the youth board for Children’s Hospital Colorado, the hospital has helped her with her own mental health long before the pandemic. She was bullied for much of her life, and in seventh grade, she felt so isolated that she couldn’t see a way through.

“That of course led to my first suicide attempt and I’ve had a few more throughout the years,” Lynn said.

Therapy, and being able to advocate for help, kept her alive. But the pandemic has not left her unscathed.

“I just remember days that I would just turn off my computer when school was over and I would just lay in my bed and I wouldn’t have the motivation to do anything, and then I would simultaneously be anxious from not doing anything,” Lynn said.

Lynn said it helps to know she’s not alone.

Talking with her peers on the board she learned “everyone was just burnt out” from the pandemic. Together, they are now “just counting down the days until this quarantine and Covid is over.”

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