Missouri is facing a pediatric behavioral health crisis • Missouri Independent

Pediatric COVID statistics obscure the enormity of a shadow pandemic that is pulverizing our nation’s children: the deterioration of mental, emotional and behavioral health (photo courtesy of St. Louis Children’s Hospital).

Since the start of the COVID-19 pandemic, it has been widely accepted that the virus is not as dangerous for children. Of the more than 600,000 deaths in our country attributed to COVID-19, nearly 400 are in children aged 0 to 17. For anyone tempted to impartially view this impact as “minimal”, we can assure you it is not.

These pediatric COVID statistics obscure the enormity of a shadow pandemic that is pulverizing our country’s children: the deterioration of mental, emotional and behavioral health.

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Recently, the weekly senior leadership meeting at St. Louis Children’s Hospital was halted when one of the participants received a warning. “I must inform this group that we have a 16-year-old on campus who, according to our public security officers, is at risk of throwing himself off the top of our parking garage in an apparent suicide attempt.”

Fortunately, in this case, the child did not commit suicide.

A 14-year-old with no history of mental health problems arrived at the emergency room with acute suicidal thoughts, with a plan and the resources to carry it out. The plan was discovered after the teen shared a text message with a friend to say goodbye. Inpatient psychiatric care was needed, but beds in the hospital and throughout the St. Louis area were full. While health care providers searched for available beds for inpatients in Columbia, Mo., Springfield, Illinois, and beyond, the patient stayed in a small examination room in the emergency department, distraught parents next door. The patient’s stress and the parents’ despair increased by the hour. After 80 hours, a hospital bed became available in a regional adolescent psychiatric unit. The teen was transferred, but proper acute care was initially delayed — time lost to improve health and well-being.

These are just two examples. These kinds of anecdotes have become unnervingly commonplace in children’s hospitals in Missouri and across the country.

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Make no mistake, our current crisis in childhood mental health picked up steam long before COVID-19 took hold. Nationally, the suicide rate among children aged 10 to 24 has increased by 60% between 2007 and 2018. The number of admissions and emergency room visits for suicide attempts in children’s hospitals doubled from 2008 to 2015. Similarly, visits to children’s hospitals by children aged 6 to 12 also doubled the need for mental health care from 2016 to 2019.

In the past 15 months, children’s well-documented social isolation and increased family stress have only exacerbated troubling pre-pandemic trends in serious mental illnesses such as suicidal ideation, self-harm and substance abuse disorders. The Children’s Hospital Association (CHA) notes that from April to October 2020, the proportion of mental health emergency room visits increased significantly among children aged 5 to 11 (+24%) and 12 to 17 (+31%) versus the same period 2019.

This spring it is as if the floodgates are opening wide. The emergency rooms of children’s hospitals across the country have been overrun with families in need of immediate assistance. On average, some of Missouri’s most renowned pediatric health care providers — a group that includes St. Louis Children’s Hospital, Children’s Mercy Kansas City, SSM Health Cardinal Glennon Children’s Hospital, and Mercy Children’s Hospital St. Louis — saw significant increases in the number of patients presenting at our emergency departments with behavioral health needs vs. the same period in 2019.

The implications for the timely, appropriate and safe care of children with mental health needs are multifaceted.

1. At the moment, the demand for mental health care for children far exceeds the available supply. This applies to both human and physical resources. In the first case, there are simply not enough specially trained caregivers to care for this population of children. The CHA estimates that our country has a demonstrated need for 47 child psychiatrists per 100,000 children and teenagers. Currently there are 10 child psychiatrists per 100,000. With regard to the latter, hospitals lack the number of hospital beds and remote placement options to provide appropriate and safe care for patients with the most acute needs.

2. Children’s hospitals are not equipped to care for patients with mental health needs on a large scale. Because there is a shortage of specialist caregivers for these children, children’s hospitals bear the brunt of the volumes, as in some cases our emergency rooms are the only refuges for children or families. It is not therapeutic to keep children with mental health needs in our emergency rooms – often for 24 hours or more – while they wait for a hospital bed to become available. Stimulation from a busy and sometimes chaotic environment can increase their level of anxiety and excitement. It often results in a worsening of symptoms, a higher risk of injury for both patients and staff, and a greater chance of eviction – defined as patients being released from hospital when it poses an immediate threat to their safety.

3. “Safe care” is a two-sided coin. Children’s hospitals – and more specifically the people who work there – are there to care for the most vulnerable children of our communities in times of greatest need. But even those who thought they knew what they were signing for—the triumph, the heartbreak, the risk—couldn’t have imagined this. Our most acute patients can pose a threat to themselves, but also to our employees. Patients in crisis do not always know how to express themselves. Sometimes they lash out, and several have caused a lot of damage to many of our frontline team members. With the growing shortage of health professionals across the country, especially in the state of Missouri, we must do everything we can to protect our staff from harm, while also ensuring that our patients receive the highest level of care.

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As a group, Missouri Children’s Hospitals continue to emphasize the need for immediate federal, state and local support to help health care providers meet the demands of our children, our families and our communities. We believe that long-term solutions are needed to address decades of chronic underinvestment in pediatric mental health and infrastructure. We have begun to convene several behavioral health stakeholders to explore potential solutions and look forward to bringing health care providers, patient advocates and the state together to develop a best-in-class approach to addressing the behavioral health needs. address the health needs of our communities.

Our children, families and communities deserve better.

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