Children’s Hospital Association CEO talks about mental health crisis

Nearly a year ago, Matthew Cook began a new role as president and CEO of the Children’s Hospital Association.

The organization represents more than 200 children’s hospitals nationwide. Before joining the association, he served as president of UCSF Benioff Children's Hospitals and senior vice president of Children’s Services at UCSF Health. Previously, Cook served as president of Riley Children’s Health and chief strategy officer for Indiana University Health.

“I get to work at a different level,” Cook says. “You know, when you're a hospital leader, you're working really just in your local community, and as CEO of CHA, I get to have this impact across the country. So it's been a little bit of an intellectual transition, but it's been a great year for me.”

In an interview with Chief Healthcare Executive®, Cook spoke at length about one of the most pressing challenges for children’s hospitals: the growing mental health needs of kids and teens.

In his work at UCSF Health and in Indiana, Cook says he saw firsthand the rising number of pediatric patients with mental health emergencies. As leader of the Children’s Hospital Association, he’s getting a broader look at a national crisis that’s getting worse. (Watch part of our conversation in this video. The story continues below.)

‘Behind the eight ball’

More children and teens are showing up in pediatric hospitals with mental health emergencies.

“Once a kid shows up in the ED with a mental health crisis or issue, it's already too late,” Cook says. “We've already lost ground with that child. It really means that something was not identified, diagnosed and treated at the appropriate time earlier for that child, and so by the time they get to the hospital emergency department, we're really behind the eight ball with that kid.”

In 2023, more than 30% of the visits to the emergency departments of pediatric hospitals are related to mental health issues and, significantly, to suicidal ideation.

“The emergency departments are not places for children with a mental health crisis,” Cook says. “We have a hard time placing them in the appropriate facility. So what you see are our kids staying in an ED for multiple days, which is highly inappropriate, and not good for the child. And so it's really been a challenge.”

Researchers have found that more kids are spending greater amounts of time in emergency departments. More girls are seeking help for mental health needs as well.

The number of children and teens showing up in pediatric hospitals for mental health reasons has dropped since the height of the COVID-19 pandemic, Cook says. But he adds, “the visits are still way above pre-pandemic levels.”

Cook also stresses that the mental health crisis in children has been building for years.

“We talk about Covid as the pandemic, but in children's health care, we actually talk about the mental health crisis as the first pandemic, and covid as the second pandemic,” he says. “Because again, the mental health crisis in kids started long before the pandemic. It's just the pandemic aggravated it considerably.”

"The amount of children we're treating is far above the pre-pandemic levels, which were already way too high as it was," he adds.

Cook describes the pediatric mental health crisis as “multi-factorial.”

“You have the increase in substance abuse, you have just depression, you have suicide ideation, and so you have all of these different factors going on, and they coalesce to create this perfect storm of a mental health crisis, and we're, we're having a hard time addressing it. And we're really not in front of it.”

• Read more: Surgeon general’s social media warning resonates with mental health leaders

Engaging earlier

To help address the mental health challenges in kids, some pediatric health systems are partnering with schools. Children’s Hospital New Orleans has expanded its outreach efforts with schools to reach kids who may need assistance with their mental health, before problems escalate to an emergency.

“A lot of children's hospitals have programs connected to schools and have clinics that they run inside of schools, and those are really good places to screen and identify kids that have mental health needs,” Cook says.

Cook also sees opportunities for primary care physicians to help kids who may be struggling with their mental health.

“We have this artificial sort of separation in our minds from physical to mental health, and we think of them as two distinct sorts of paths or areas, and they're really not, they're very much integrated,” he says.

However, Cook also recognizes that many primary care doctors have a high volume of patients and limited time with each visit.

“They see a lot of patients every day, and they're not necessarily trained to be mental health providers,” Cook says. “And so the question is, how do we support them behind the scenes, in order for them to feel like they have access to resources, or to embed mental health resources into their practice?”

He says children’s hospitals can play a role in offering more support to primary care practices.

“In the absence of expanding the workforce, we need to think more creatively about how we provide support and advice to primary care physicians when they have somebody in their practice who has a need,” Cook says.

• Read more: Rady Children’s finds success in reducing mental health visits to emergency department