National emergency declaration for children's mental health

The pandemic has pushed the number of kids and teenagers struggling with their mental health to a crisis level, leading three organizations to declare a national emergency. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association are calling for multiple measures to ease the situation.

Christopher Pruitt, M.D., a fellow of the American Academy of Pediatrics and medical director of the MUSC Shawn Jenkins Children’s Hospital Emergency Department, sees the need firsthand. “These kids often come later in the evening when no other resources are available. If it's deemed that they would benefit from inpatient psychiatric care, those resources are incredibly constrained. Inpatient beds for children and adolescents are at a premium everywhere.”

That needs to change, he said. Children need better treatment, earlier, and their families need more options.

“There is a dearth of mental health providers for children and adolescents across the country. There is a lack of timely resources for kids who are struggling with depression. The way this manifests itself is if there's a crisis moment or a time when a parent or a teacher learns that a child is suicidal; there are very few avenues for these adults to make sure that these young people are safe.”

The Declaration of a National Emergency in Child and Adolescent Mental Health cites the need for:

• More money to pay for scientifically sound mental health care for kids.
• Less red tape.
• Better access to telehealth.
• More mental health care in schools, primary care doctors’ appointments and other community settings.
• Better ways to ease the strain on emergency departments.
• Full funding for programs that connect families with mental health help.
• More people in the field of mental health care, including people from communities that are underrepresented.
• New policies that make sure mental health parity laws are followed.

The organizations that issued the declaration noted that between March and October 2020, emergency department visits for mental health emergencies rose 24% for kids 5 to 11 and more than 30% for children 12 to 17. And in early 2021, suspected suicide attempts among girls age 12 to 17 jumped more than 50% compared with the same period in 2019.

That’s the national picture. Locally, this year, mental health visits to the Emergency Department at the MUSC Shawn Jenkins Children’s Hospital are up noticeably. “It is an unusual day when I come into the Emergency Department and we don't have at least a couple of young people who are waiting for a psychiatric bed to open up,” Pruitt said.

So what’s behind the mental health numbers? The emergency declaration cites not only stress brought on by the pandemic but also inequities related to structural racism and the fact that more than 140,000 kids in this country have lost a primary or secondary caregiver to COVID.

 

But Pruitt said it’s not just that kids worry directly about COVID or racism or loss. The other people in their lives may be feeling stress, too – and that can affect everyone.

“These issues are multifactorial. It doesn't take a physician to know that mental health issues for a child or adolescent might come down to science and brain chemistry, but oftentimes, it comes down to family dynamics. Your family setting and your support systems can be really hard to address – things that involve the infrastructure of our country, the family unit or the school.”

He encouraged parents and caregivers to figure out where to get help. “Every family should know what their immediate support system is. Most schools in our area have a very good mental health resource, a person that's been placed in the schools,” Pruitt said.

“Obviously, we also want parents to talk to their kids and keep communication open. If a concern arises and there could be imminent danger, if your child is expressing suicidality, for instance, you don't want to wait. You want to lean on those resources that you have and that you've made yourself aware of. You don't want to assume it will just go away or that it’s a phase, because the consequences could be dire.”

Pruitt hopes the emergency declaration will lead to fast action that will help children and their families, saving lives. “The goal is to galvanize both citizens and lawmakers to push for changes in our communities and to make provisions that ensure that every resource is available to help these children and families in crisis.”