3 hospital CEOs on why the pediatric mental health crisis needs more attention

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The pandemic has created an influx of children and families seeking help from hospital emergency departments for mental and behavioral health disorders. Three children's hospital CEOs spoke with Becker's in September and October about the mental health crisis facing children and health systems.

Editor's note: These interview responses were lightly edited for length and clarity.

Marcy Doderer, CEO of Arkansas Children's Hospital in Little Rock: The stats across the country are pretty startling. One in five children is living significantly impaired with mental illness, and most of the time that onset of illness occurs by the age of 13 or 14 years old. Access to early assessment, intervention and treatment is challenging for kids, particularly those insured through the Medicaid program. These are not new signals. I think that the industry has been seeing these signals since 2009 or 2010, where we've seen huge increases in the number of emergency department visits for mental health illnesses. 

And I believe that it's just been fully exacerbated by the pandemic. Virtual school isolation and limited access to other kinds of full engagement with peers or friends is really sparking an aggressive response in children with mental disorders. We're seeing a level of aggression and really uncontrolled behaviors in some children who ended up landing in our emergency room repeatedly because the families are simply looking for respite.

Before the pandemic, mental health disorders accounted for 1 percent of our emergency department visits. We're now heading towards 2.5 percent of those visits being attributed to mental health disorders, so a 150 percent increase in just the last [18 months].

Arkansas Children's is not directly in the business of psychiatric care. We don't own our own psychiatric hospital. We do not have an inpatient psychiatric program, so we partner with and refer patients to freestanding psychiatric hospitals in the state of Arkansas. A problem, not just for kids who show up in my ED, but EDs across the state, is that inpatient facilities are full and they're strapped for space and staff, and the length of time it takes to transfer a child to the appropriate inpatient setting is 50 to 75 percent longer now than it was 18 months ago, and trying to understand how as an industry and as a society we can best address the mental, emotional and behavioral health needs of kids is becoming an urgent topic for solutions.

Alicia Schulhof, CEO of Johns Hopkins All Children's Hospital in St. Petersburg, Fla.: We're seeing it, the rates are increasing, but I am concerned by the number of patients that haven't even knocked on our doors yet because we're still in the midst of a pandemic. I think that's why it's so important from a mask and vaccination standpoint, but then also on top of that, to get kids into their primary care, to keep up on vaccinations and keep those well-checks going, because that's where we're going to begin to identify their mental health and behavioral health needs. And again, I think we're just beginning to scratch the surface. I think this is an area that we're all going to have to partner on into the future, but I share [Marcy Doderer's] concern and her passion for saying we've got to elevate this as an area of national attention.

Madeline Bell, BSN, CEO of Children's Hospital of Philadelphia: This is probably one of our largest challenges, the significant increase in children who have emotional, mental and behavioral problems like anxiety, depression and suicidal ideation. It's a grave concern. In the middle of September, I had the opportunity to [participate] in a small group discussion with President Biden, and I wanted to make sure I let him know that the pandemic has really exacerbated a problem that we already had with children who have behavioral health issues. So there are a lot of things I think that can be done. We are, I think, woefully behind as a country in being able to prevent children from having such severe experiences with anxiety, depression and suicide that they end up being in a hospital. And so there's a lot that we need to do as a country.

One of the things we're doing [at CHOP] is embedding therapists into each one of our primary care practices, so that there's readily available support for families. We're in the process of building 46 pediatric psychiatric beds. I wish that we didn't have to have a crisis center. As I said, I feel like there's so much we need to be doing to invest in prevention, but we're not there yet as a country, and so we're left with seeing and responding to children who have the most severe crisis. 

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