Teen and adolescent mental health needs are at crisis levels in the wake of COVID-19, but more screening to prevent suicides won’t help without places to refer patients who seek help in emergency departments (EDs), experts told the American Medical Association (AMA) House of Delegates on Monday.
Pediatric emergency physician Samantha Rosman, MD, MPH, delegate for the American Academy of Pediatrics (AAP), said, “We are in the midst of a massive pediatric mental health crisis in this country.
“In my emergency department in Boston, we have about 60 beds. About half of those right now are full of mental health boarders, with another 50-plus upstairs in our hospital — inpatients boarding and waiting for mental health beds,” she said.
Rosman said the community hospital she covers has had to convert their educational conference room into a place for 15 adolescents to board while awaiting beds.
She proposed several AAP amendments to the Council on Science and Public Health Report 3, which recognizes youth and young adult suicide as a serious health concern in the United States.
They included calls for the AMA to advocate at the state and national level for policies to prioritize children’s mental, emotional, and behavioral health and to advocate for a comprehensive system of care that includes prevention, management, and crisis care to address mental and behavioral health needs from infancy through adolescence.
“While we agree screening is critical, we cannot prevent suicide if we do not have the resources to refer children in crisis to manage them when they are depressed and get them in to counselors,” she said.
Tripti Kataria, MD, MPH, delegate from the American Society of Anesthesiologists, said the situation in Chicago is similar to the one in Boston that Rosman described.
In Chicago, “there are children waiting as long as 2 and 3 weeks for a bed in their hospital,” she said. “It’s imperative that our AMA advocate on a state and national level to prioritize this.”
The House of Delegates adopted the amended report.
Carole E. Allen, MD, alternate delegate from Massachusetts, acknowledged COVID-19 as a major factor in the rise in mental health care demands.
“COVID has been a disaster for children and particularly in terms of their mental health,” she said. “To go upstream and address all these issues is how we will prevent rising suicide levels.”
Lee Beers, MD, AAP president and AMA alternate delegate for the academy, said the crisis comes in large part because children can’t access care.
“I’m hearing from pediatricians across the country that their offices are just filled, filled,” she said.
Suicide Attempts Among Girls Up 51%
Beers pointed to a report that the Centers for Disease Control and Prevention released last week that indicated that suicide attempts among young girls are up by 51%.
In May 2020, the report states, ED visits for suspected suicide attempts began to increase among children and adolescents aged 12–17 years, especially among girls. From February 21 to March 20, 2021, ED visits for suspected suicide attempts were 50.6% higher among girls aged 12–17 years compared with the same period in 2019; among boys aged 12–17 years, ED visits for suspected suicide attempts increased 3.7%.
Kenneth Certa, MD, speaking for the American Psychiatric Association, said COVID further exacerbated long-standing access problems because many of the residential programs that treat children had to reduce the number of their patients. Distancing requirements meant double rooms became singles.
“We in psychiatry fight for this every single day,” Certa said. “We would love to have the rest of medicine come with us to our state houses to get additional funding.”
Stephen Epstein, MD, delegate from the American College of Emergency Physicians, speaking on behalf of the section council, said the people boarding the longest in EDs are psychiatric patients and children and adolescents. He said, “We are hopeful this type of policy will stop the revolving door of patients coming in, staying days and weeks in our EDs, only to go back to the community where there are inadequate resources and then bounce back to our emergency department.”
The board report also urges research to better understand suicide risk and effective prevention efforts for youth and young adults, especially in Black, LGBTQ+, Hispanic/Latinx, and Indigenous/Native Alaskan youth and young adults and among youth and young adults with disabilities.
The report also says the AMA will support developing new technologies and therapeutics, along with improved use of existing medications, to address acute suicidality and risk factors in teens and young adults.
Rosman, Kataria, Certa, Allen, and Epstein reported no relevant financial relationships.
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.
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