Recent CDC research paints a sobering picture of youth mental health in the US. The agency’s data show that 1 of every 7 children have received a diagnosis of anxiety, depression or another behavioral health disorder in the US. However, many still lack access to necessary care for reasons including geographic location, provider shortages and stigma about mental health challenges.
A recent American Hospital Association webinar, From Infancy to Adolescence: Supporting Youth Mental Health, offered insights on what hospitals can do to strike a healthier balance between patient need and available care. Psychiatrist John Walkup of Lurie Children’s Hospital of Chicago and Thomas Saggio, director of behavioral health operations for St. Louis Children’s Hospital, shed some light on what health facilities can do to drive change.
A wide-ranging issue
Walkup said the foundation for good mental health is laid during childhood and adolescence, so it’s important to address potential problems early. “About three-quarters of adults with mental health issues start experiencing them before the age of 18 years, and about 1 in 5 young people will have a mental health issue before they graduate high school. Most will get either limited care or none at all,” Walkup noted.
“The vast majority of places in the country have really limited resources, and they don’t get to all the kids who actually have a need,” said Walker, who shared map data that showed nearly every US state is a “severe shortage area” for practicing child and adolescent psychiatrists.
Walkup broke down the different types of mental health issues people face, including disorders (“what someone has”), constitutional differences (“who someone is”), problem behaviors (“what someone does”), and problematic narratives (“how someone experiences their environment”). Walker also examined different ways of viewing a clinical population with regard to those factors.
“For most kids, underlying psychological disorders and the behaviors that manifest are the main issues,” Walker said. “We have good treatments, but they can be difficult to disseminate. And we’ll probably never have a workforce that is big enough.”
However, Walkup said there are ways to mitigate the issue, and partnering with other types of clinicians is paramount. Walker recommended that obstetrics and gynecology practitioners understand family risk factors and parenting capacity at the start of a pregnancy. Having pediatricians take a detailed family history early in a child’s life is also important — as early as the first well baby visit — to identify potential issues ahead of time.
“Doing it in later childhood is not as effective,” Walkup said.
Next, child screening should be performed, and social determinants of health should be considered, as they influence parenting capacity. Primary care physicians, pediatric specialists and emergency and inpatient clinicians all can play key roles, Walker said.
“We need to build this into health and social policy,” Walkup noted. “Mental and physical health really are not separate.”
Practical solutions
Saggio shared some of the practical ways St. Louis Children’s Hospital is improving mental health patient flow and ensuring safe, effective delivery of services. Saggio noted that the hospital’s mental health patient volume has hit record highs in recent months.
“Ten years ago, we would have about 765 [young behavioral health patients] show up for services in our emergency department, and in 2023 we had a high of 2,176,” Saggio noted. “We are continuing to see the sustained higher volume.”
The increasing need caused the facility to establish an acute behavioral health unit, Saggio said. A number of new positions have been created to manage the demand.
“We added two psychiatry attendings, six behavioral health advanced practice nurses with seven-day-a-week coverage, a director-level position, an additional manager and a behavioral health educator,” Saggio noted. “Our emergency department APNs are just so invaluable. They provide in-person reassessment, medication adjustments and initiation very quickly. They are very involved in coordination of care and discharge planning.”
The hospital also created a behavioral assessment and response treatment, or BART, team to respond to escalating patient situations. The results of all these efforts have been notable, including improvements in discharge and medical admission statistics for this population, Saggio said.
Saggio also described the hospital’s recent physical and protocol improvements to provide a secure environment for young patients with mental health issues and their clinicians. Private patient rooms, a calm atmosphere, safe furniture and fixtures, modern evaluation tools, mental health technicians and other additions all make it easier to identify and address patient needs. There are also plans to build a new acute pediatric inpatient facility and renovate the existing emergency department, all to address patient needs at a stage when the best results can be achieved.
“When you talk to adults with mental health problems, they will often identify that their onset occurred much earlier, and most have limited access [to care],” Walkup said. “So we have had to figure out a better way.”
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