Our children are in crisis; thus, our village is in crisis

As a society, we often refer to the proverb, it takes a village to raise a child. The village — families, friends, schools, clinical professionals, communities and elected officials — has never been more important as our children experience the pain and impacts caused by struggles with their mental health. Our children are in crisis; thus, our village is in crisis.   

The numbers are heartbreaking. The Centers for Disease Control and Prevention (CDC) found that mental health-related emergency department (ED) visits increased 24 percent for children ages 5 to 11 and 17 percent for adolescents ages 12 to 17 in 2020 compared to the same months of 2019. In 2021, the CDC found that 4 in 10 teens reported persistent feelings of sadness or hopelessness, while 1 in 5 reported contemplating suicide. Despite a growing awareness of the crisis through the COVID-19 pandemic, cases continued to climb. In 2021, children’s hospitals across the U.S. saw a 31 percent increase in mental health inpatient admissions for children and teens ages 3 to 18 and a 153 percent increase in emergency room visits for suicide attempts and self-injury for kids ages 5 to 18, compared to 2016.  

The severity and pervasiveness of this crisis in children led the American Academy of Pediatrics, Children’s Hospital Association, and the American Academy of Child & Adolescent Psychiatry to declare an emergency in child and adolescent mental health. The U.S. Surgeon General echoed our concerns and issued an advisory on the crisis late last year.  

At the Children’s Hospital Association, we are too familiar with these statistics and the children and families’ stories behind them. Children’s hospitals across the country are often the last resort for families. While emergency rooms can be critical access points in a health crisis —  physical or mental, the steady rise in visits over the past decades and the sharp rise over the past five years are symptoms of a pediatric mental health system that is overwhelmed and under resourced. With mental health programs over their capacities and too few behavioral health specialists to meet the demand for care, children and families are left in limbo and not receiving the timely care they need. While waiting to receive care, they board – meaning they are safely held – in the hospital’s emergency room or in an inpatient room, until they can be released to a treatment program or facility. During this time, they are separated from their families, schools, friends and communities, critical social supports that help children cope. 

The magnitude of this crisis requires renewed attention and action at the federal, state, and local levels. We must make purposeful investments in resources to support the social and emotional well-being of our children, thus preventing and reducing the severity of the mental health challenges our children face. The people, programs and professionals are needed where children live, learn, and play: their communities and schools. Investments are also needed in treating children who require more intensive therapies and care to ensure they recover and maintain their health. Current payment for therapy services, intensive outpatient programs and inpatient care are far below the actual cost of providing the care, worsening the shortages of behavioral health services for children. 

Shortages across key pediatric behavioral health professions, including psychology, child and adolescent psychiatry, family therapy, and school counseling are well-documented. Currently, there are only 10 psychiatrists per 100,000 children – nearly one-fifth of what is required. And only 20% of children with mental, emotional, and behavioral health disorders receive care from a specialist at all.  

The lack of adequate care for children now will have negative ramifications for their future and ours. Adult addiction, incarceration, homelessness, and violence can often be traced to unaddressed or undertreated issues in mental health in childhood and adolescence. We know that 50 percent of mental health conditions begin before the age of 14, and go unaddressed for on average, 11 or more years. Can we change these outcomes? 

We have reason to hope. We are encouraged by the bipartisan work in both the Senate and the House of Representatives that seeks to expand access to pediatric mental health services. The policies in these pieces of legislation are important steps towards investing in the pediatric mental health workforce, strengthening critical mental health infrastructures for children and expanding pediatric mental health care capacities across the continuum of care.  

This week, leaders and mental health experts from children’s hospitals across the country are in Washington, D.C., to work with members of Congress and the Biden administration on solutions that address the youth mental health emergency. Representing one part of the pediatric mental health system for children, we hope to shine a light on the full system of care needed. 

Children’s hospitals and health systems stand ready to confront the mental health crisis being experienced by children and youth head on in partnership with families, providers, schools, communities, and policymakers. We are all aware of the issues, let us now transform this awareness into action. We need smart, durable policy to support what is most important for the health and well-being of our children. 

Amy Wimpey Knight is the president of Children’s Hospital Association, representing over 220 hospital organizations and pediatric programs dedicated to improving child health through innovation in policy and care delivery.