OUR MENTAL HEALTH CRISIS

For most of America, the results from the CDC Youth Behavior Risk Survey 2021 about the state of mental health for our youth was a shock. Within 30 days of the survey being administered, 29% of youth experienced “poor mental health.”  Within the past year, 57% of girls experience symptoms of depression. 22% of youth seriously considered attempting suicide, and 10 % of all high school teenagers made a suicide attempt in the past year. 

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But for those of us who treat America’s youth, in pediatric primary care, specialty care, and emergency care settings- We saw this coming.  

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It has always taken time for a child or adolescent to get in to see a child psychiatrist or therapist.  The shortage has been longstanding for decades.

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It has always taken time to get children admitted to a psychiatric hospital if needed.  There have always been a shortage of pediatric psychiatry hospitals and beds available.

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But over the past 5 years, it has taken even more time to obtain access to both outpatient and inpatient youth mental health care. There has been greater awareness of mental health concerns, and an even greater surge of youth experiencing mental health crisis, flooding our medical emergency rooms.

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So where do these youth go when there are no inpatient psychiatry beds or outpatient appointment slots for psychiatry? 

 

They end up filling beds in the medical ER for days to weeks on end. They end up being admitted to inpatient medicine while they wait for a psychiatric bed. They end up “ seeming better” during their wait and are discharged home. They end up discharged back at their primary care office, back in their pediatricians office, with more questions and fewer answers to help meet their need.

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Even if they are psychiatrically admitted, children are often discharged out of a psychiatric hospital, and do not have a psychiatrist to follow up with.  Though insurance often requires they  have an appointment within 7 days at a mental health clinic, this does not guarantee they see a psychiatrist on that day.  Or their parents may completely forget about the appointment and come see you- their friendly pediatrician- who they know and trust.    

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So medications are often referred back to the pediatrician, where the pediatrician is left with a patient on psychiatric medications that they do not often use, with unclear knowledge of when this patient may get into see the specialist they truly need.

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Every day, pediatricians are left in the uncomfortable and unsafe situation, to manage a patient with unstable, unmitigated psychiatric symptoms alone without the support of a psychiatrist or therapist. 

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As this mental health crisis continues to surge, we have more and more primary care providers in this position- with no clear solution in sight. Pediatricians are left scrambling to seal cracks in the dam with wads of chewing gum.

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Our Mental Health Crisis is that the current system of mental health care, the dam, has already broken open, and the sweeping surge of mental health care needs for our children is already drowning pediatricians in the undertow.

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How can we help our pediatricians survive this surge? 

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