Children with mental health problems are flooding America's hospitals.
A new study of 4.8 million pediatric hospitalizations between 2009 and 2019 found that the number of acute care hospitalizations for kids with mental health problems increased significantly. In 2019, most were due to attempted suicides, suicidal thoughts or self-injury, researchers said.
"What we're seeing are more and more hospital stays by children and adolescents due to mental health concerns in terms of absolute numbers, and a substantially larger fraction of these stays are related to suicide or self-injury," said study leader Mary Arakelyan, research project manager at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
"With hospitalizations for mental health concerns representing a larger proportion of all pediatric hospitalizations in 2019 than in 2009, it's imperative to consider how inpatient settings will meet the mental health needs of a growing population of young people," she added.
The study found that pediatric mental health hospitalizations rose 26% between 2009 and 2019.
And, over that same period, those owing to attempted suicide, suicidal thought or self-injury increased from 31% to 64%.
Senior researcher Dr. JoAnna Leyenaar, vice chair of research in the pediatric department at Dartmouth-Hitchcock, said kids with mental health issues go to hospitals because they have nowhere else to turn.
"Acute care hospitals provide access to care for youth and families when they're experiencing a mental health crisis and aren't sure where else to turn, when they need medical care for a suicide attempt or self-injury, and when they're concerned that they're not safe at home," she said.
The hospitalizations are a marker of the increasing prevalence and severity of mental health conditions in kids, Leyenaar said.
The surge likely owes to many factors, she said.
"We know that there's a national shortage of mental health professionals and geographic disparities in mental health professionals who care for children," Leyenaar said. "As a result, community-based treatment is often hard to access." In many places, patients must travel a great distance to access care.
Meanwhile, the prevalence of mental health conditions in youth has continued to grow during the COVID-19 pandemic, she said.
In addition, there are several risk factors for mental health crises, and many have been on the rise over the past decade. These include social media, poor sleep, and peer and family conflict, Leyenaar said.
A lack of community and school resources are also contributors, Arakelyan said.
"It's likely that while other causes of hospitalization in children are becoming less common due to improved outpatient management, outpatient and community and school-based resources for mental health have not kept pace with needs," she said.
Leyenaar said it's important for parents to know that asking their children about suicide and thoughts of self-harm does not increase suicide risk.
"It may be protective, allowing families to seek support before a crisis occurs. Reducing stigma in talking about mental health conditions is also important," she said. "Mental health symptoms are common in adolescents, and being open to talking about them and seeking treatment early may be really helpful for some youth."
The study was published March 28 in the Journal of the American Medical Association.
A New York mental health expert agreed that there is a shortage of providers and lack of outpatient services to help kids who have emotional problems.
Dr. Scott Krakower sees the result of that in his practice as an attending pediatric psychiatrist at Northwell Health in Glen Oaks, N.Y.
"We are swamped in our outpatient services," he said. "We try our best but there are no other mental health providers to tackle outpatient needs."
Moreover, there aren't enough mental health care providers to help children before or after a crisis, Krakower said. And most insurance doesn't cover the long-term care these young people need.
"Insurances have gotten tighter about what they will cover," Krakower said. "Given everything that's happening, and because nobody wants to see people struggling with this, insurance coverage has been a big barrier."
If earlier diagnosis and treatment were more readily available, many of these hospitalizations could be avoided, he said.
As it is, a young person may have to wait up to six months for an outpatient appointment because of a shortage of providers, Krakower said. The lack of outpatient care is often why children and teens aren't treated for depression, anxiety and suicidal thoughts until a crisis occurs, and going to an emergency room is the only option, he said.
For more on children and mental health, see the U.S. Centers for Disease Control and Prevention.
SOURCES: JoAnna Leyenaar, MD, PhD, vice chair, research, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, N.H.; Mary Arakelyan, MPH, research project manager, Dartmouth-Hitchcock Medical Center, Lebanon, N.H.; Scott Krakower, DO, attending pediatric psychiatrist, Northwell Health, Glen Oaks, N.Y.; Journal of the American Medical Association, March 28, 2023