The Trend of Mental Health Visits and Visits Revisited: How Many Children Are Seeking Help in their Health Care? Dr. Nicholas Holmes at Rady Children’s Hospital
Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.
Hadland said that the trend of increased mental health emergency department visits and revisits matches what health care providers see on the front lines.
Brewer thinks the true numbers are probably much higher than what the study found, because not all children who struggle with thoughts of suicide go to the emergency room.
Dr. Nicholas Holmes, senior vice president and chief operating officer at Rady Children’s Hospital in San Diego, said the increase in the number of kids seeking help in his health care system has been “profound.”
“Over the last nine years, where we would see about anywhere from one to two patients a day that were having a behavioral health crisis, now we’re seeing 20-plus a day,” said Holmes, who was not involved in the new research.
A report from the Massachusetts Health & Hospital Association (MHA) shows youth ER boarding numbers dropped as more hospitals started referring families to one of the home-based options. The MHA says the numbers of patients seeking mental health care are hopeful.
Children also are responding to trauma in their lives and social influences on their health like poverty, historical trauma and marginalization, trouble at school, online bullying and the pressures brought by social media, in addition to a lack of access to counseling and therapy.
Brewer said adults can intervene when a child is thinking about suicide. She advises caregivers to be on the lookout for problems at school or among friends and to watch for a child who is isolating themselves or showing signs of more anxiety or aggression than usual.
They might act out or have problems sleeping. Irritability and being more withdrawn and isolating themselves are a lot of things that we oftentimes will think about,” Brewer said.
Parents need to feel confident to listen to their kids and talk to them. Really try to relate and understand what is going on with them and help promote positive relationships,” Brewer said.
We need to develop more of a strategy to help support all kinds in different ways and focus on some of the traumas and social influences of health. We need to make sure that there are places where kids can grow up.
Mental health revisits increased by 6.3% annually, but in general, the percentage of mental health visits that had a subsequent revisit remained stable, “which may reflect that the factors associated with revisit did not change substantially during the study period, even as the pediatric mental health crisis worsened,” wrote the researchers, from Children’s Hospital Los Angeles, the University of Southern California and Boston Children’s Hospital.
The new study included data on more than 200,000 patients seen at 38 children’s hospitals across the United States between October 1, 2015 and February 29, 2020. The data was from a database of children’s hospitals.
“We see more and more mental health patients, unfortunately, languishing in emergency departments,” says Dr. Chris Kang, president of the American College of Emergency Physicians. “I’ve heard stories of not just weeks but months.”
“Given more-than-doubling in fentanyl overdose deaths in teens from 2019 to 2021 just published by the CDC, it concerns me that we may only get one opportunity to intervene and help this highly vulnerable population who we urgently need to keep,” pediatrician Dr. Scott Hadland, chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School, who was not involved in the new study, wrote in an email to CNN.
“We are absolutely seeing this rise. I run our primary care clinic for teens in Boston, and on a typical day in clinic, more than four out of every five teens I see are struggling with mental health concerns,” he said. We know that Covid kept young people from school and other activities important to their healthy development because they were socially isolated. As a result, rates of the same mental health problems are probably even higher now.”
Hadland added that there is a growing need for improved access to mental health services for youth and better funding to keep these services sustained.
Diagnosis of a Mental Health Crisis in the Early Stage of the Pandemic: The Case of Haley and Pedro at the Massachusetts Youth Villages
Carmen says that she doesn’t know what danger she is taking out there. “Wherever you are at night, anything can happen.”
Carmen picked up Haley. She discovered that her daughter was sending suggestive photos and that she was going to meet up with an older boy. She remembered a time when Haley said she wanted to die and was being bullied. Carmen asked NPR to withhold the family’s last name to protect Haley’s identity.
She drove her daughter to a local hospital – the only place they knew to look for help in an emergency – where Haley ended up on a gurney, in a hallway, with other young people who’d also come with an urgent mental health problem.
There is a growing number of mental health organizations that can offer urgent care outside of hospitals, but it’s not easy to start a diversion program.
To determine what’s best for a child, hospitals in Massachusetts start with a psychological evaluation like Haley had on her second day in the ER.
DeAnna Pedro, the liaison between pediatrics and psychiatry at UMass Memorial Medical Center, reviewed Haley’s report and considered recommending time in a psychiatric unit.
“She was doing a lot of high-risk things,” Pedro says. There was a lot of thought given to, would we need to go to extreme lengths in order to get help?
But both Pedro and Haley’s parents worried about this option. It would be a dramatic change for a 12-year-old whose only experience with mental health care was her school counselor. Pedro contacted Youth Villages, a Massachusetts youth diversion agency that was hired during the Pandemic. The family of Haley met with the supervisor in the ER.
“We look under rugs, we look behind picture frames, we look in the dirt of plants,” says Laura Polizoti, the counselor from Youth Villages assigned to Haley’s case. Youth Villages also provided window and door alarms that Haley’s parents could activate at night.
Counseling for Haley and her parents started right away. A key goal was to understand why Haley was sneaking out at night and taking sexually inappropriate pictures.
Source: https://www.npr.org/sections/health-shots/2023/02/09/1154953475/one-state-looks-to-get-kids-in-crisis-out-of-the-er-and-back-home
Getting Kids in Crisis Out Of The Er And Back Home: Two State Looks to Get Kids In Thermometer Before They Get Out Of Their Own And That’s What They Need
“Have you ever done an emotional thermometer before?” Polizoti asked, laying an oversized picture of a thermometer on the table. The lines were blank for all five emotions.
Haley said that her palms are sweaty and that she makes a weird face. She frowned to demonstrate, as she put her nose up. Polizoti laughed.
As the exercise unfolded, Haley was told to think of ways to calm herself before she became angry. Haley suggested spending time alone, watching TV, playing with her siblings or jumping on the family’s trampoline.
The main complaint they hear from parents of children with mental health issues is that hospitals don’t present at home care quickly enough and that when they do, there is often a wait.
“We would love to have more opportunities to get these diversions with more families,” said Meri Viano, associate director at the Parent Professional Advocacy League (in Massachusetts). “We’ve seen in the data and heard from families that this has been a great program to get children in that next place to heal faster.”
On average, the cost is $8,522 for a course of care. At Youth Villages, that’s three 45-60 minute counseling sessions a week, in a patient’s home or other community setting, for three months. The savings are significant. One study calculated the cost of pediatric boarding at $219 dollars an hour, or $5,256 for just one day. And that’s before the expense of a psychiatric hospital stay.
Hospitals need to find new ways to pay for home-based services if state and local governments don’t take the lead. Hospitals are overwhelmed by staffing shortages.
Making these kinds of systemic changes may require “getting past some inertia as well as some reluctance to say ‘is this really what we need to do?’” says Kang.
Source: https://www.npr.org/sections/health-shots/2023/02/09/1154953475/one-state-looks-to-get-kids-in-crisis-out-of-the-er-and-back-home
Diversion: How many children are in a psychiatric unit, or how many are going to see a pediatrician?
Some families hesitate to try diversion if their child takes psychiatric medications or if they think the child needs to start them. Youth Villages does not have prescribers on staff. Children who need medication can see a Psychiatrist or primary care doctor outside the program.
According to Stone, the mental health challenges that these children are facing are driven by factors in their natural environment. We don’t think there’s any way to address those factors with a child in a placement.
Clinicians in psychiatric units do work on family and social issues, sometimes bringing family members into the hospital for sessions. There’s no data yet to compare the outcomes, though.
A lot of parents don’t know what their kids are going through because they don’t want to accept that their kids need help. I hope this can help another family.