Children’s mental health crisis is ‘at risk of overwhelming the system’

More kids and teens have struggled with their mental health, and often, they are showing up in hospitals.

Lawrence Moss, president and CEO of Nemours Children's Health, says that the mental health crisis in children is a serious problem. (Photo: Nemours)

Lawrence Moss, president and CEO of Nemours Children’s Health, says the system has seen an increase in adolescents needing treatment at the system’s children's hospitals for mental health issues. He said more children have needed treatment since the emergence of the COVID-19 pandemic, but the problem was escalating in previous years.

“People often say, ‘COVID caused the child mental health crisis.’ Not true,” Moss tells Chief Healthcare Executive®. “There was a child health mental health crisis before COVID. We just weren't talking about it enough and realizing it, and COVID shined a bright light on it and made it worse.”

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The Centers for Disease Control and Prevention has estimated that as many as one in five children experience some type of mental health disorder annually, which Moss calls a “shocking number.” Suicide is the second leading cause of death for those between the ages of 10 and 14, according to CDC data.

Moss says the rise in mental health needs among children and teens is a major problem.

“It is at risk of overwhelming the system,” Moss said. “And yes, we need to as a society, take it seriously and come up with answers.”

The number of mental health hospitalizations more than doubled from 2016 to 2022, according to a report released in May by Clarify Health. Mental health hospitalizations among kids and young adults rose 124% during those years, the report states.

Pediatric mental health encounters in outpatient facilities and emergency departments have dipped from pandemic highs, but remain higher than pre-pandemic levels, according to an analysis by Epic Research. Mental health hospital admissions among pediatric patients appears to be increasing, rising from 5.0% in November 2022 to 5.9% in May 2023, Epic found.

Girls are more likely than boys to be treated for mental health issues in hospitals and outpatient facilities, according to the Epic analysis.

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Lack of clinicians

Dozens of healthcare organizations have described the pediatric mental health crisis as a national emergency. Groups like American Alliance of Family Physicians, the American Psychiatric Association and the National Alliance on Mental Illness have pressed the Biden administration for more attention to the issue.

Like Nemours, other hospitals and health systems say they’re treating far more young people with mental health emergencies.

This week, Northwell Health announced a $500 million initiative to expand pediatric behavioral health services. The planned Child and Adolescent Mental Health Pavilion will be built next to Cohen Children’s Medical Center and Zucker Hillside Hospital, an adult mental health facility, in Queens, N.Y.

Rady Children’s Hospital-San Diego has seen dramatic increases in pediatric mental health visits in the emergency department. In a December 2022 interview with Chief Healthcare Executive, Ben Maxwell, chief of child and adolescent psychiatry at Rady Children’s, said, “It’s beyond unprecedented for us at this point.”

Intermountain Healthcare is expanding its capabilities to treat kids with mental health needs as part of a broader campaign to extend pediatric care.

Experts say that the crisis is being compounded by a lack of mental health providers. More than half of all U.S. counties lack a practicing psychiatrist, according to the University of Michigan. And there’s an even shorter supply of mental health clinicians trained in working with kids.

“We just simply do not have enough pediatric psychologists and psychiatrists to treat kids,” Moss says. “And there are large, large communities in this country that don't have a single pediatric psychiatrist.”

“Why? Because reimbursement is poor. Salaries are poor. It's hard to attract students with large, large debts to pay back into these fields where they can't pay off their debts,” he adds.

Providers also struggle with a lack of reimbursements, Moss says.

“Pediatric mental healthcare is paid at a markedly lower rate to a commensurate amount of physical healthcare,” he says.

“Everything Nemours does, and we do a lot in pediatric mental health, we essentially do at a loss,” Moss says. “And, you know, you can only do so much of that and stay alive. And so that's a big, big issue.”

Many children with complex health conditions also have behavioral health needs, Moss says.

“We take care of tons of kids with complex multi system disease or specialty disease,” Moss says. “Those kids have significant mental health problems as well and we need to meet that need, which is also increasing.”

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Using telehealth

With more kids needing mental health services, Moss says telehealth has been a critical tool in extending services to kids and teens.

“That has been somewhat of a game changer in the treatment of patients with mental health disease,” Moss says.

Nemours invested heavily in telehealth, which “has been a huge step forward and a huge resource for us,” Moss says.

He pointed to a program Nemours has launched in Jacksonville, Fla. to expand mental health services to young people via telehealth. Supported by donors, the Pediatric Acute Telemental Health (PATH) Program offers kids between the ages of 2-17 access to mental health counselors or social workers. The program also offers referrals for additional services if needed.

Nemours recently launched the program and expects to serve about 150 patients per month as it ramps up. Moss says it’s about “early intervention” and making it easier for families to get help.

“It's been a huge step forward there, and we found that we can avert a lot of these crises by getting involved early,” Moss says. “So we're really excited about that program. We think it's actually going to have a demonstrable impact on the overall population of kids in the regions that we serve.”

More patients are seeking virtual options for mental health needs. Nearly two-thirds (62.8%) of telehealth visits in the fourth quarter of 2022 were for behavioral health appointments, according to a report by Trilliant Health.

Moss sees telehealth as a tool to effectively utilize limited resources, and make it easier for families and kids to get help.

“Let's put the patients and the providers together and we can use technology to do that,” Moss says.

Getting help

988 Suicide & Crisis Lifeline: Dial or text 988 to connect with someone. Help is available 24/7.